Role of schools of public health on maternal and child health programmes in the Asia-Pacific region.

PubMed

Zulkifli, S N; Yun-Low, W; Yusof, K

1998-01-01

This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.

Current status of master of public health programmes in India: a scoping review.

PubMed

Tiwari, Ritika; Negandhi, Himanshu; Zodpey, Sanjay

2018-04-01

There is a recognized need to improve training in public health in India. Currently, several Indian institutions and universities offer the Master of Public Health (MPH) programme. However, in the absence of any formal body or council for regulating public health education in the country, there is limited information available on these programmes. This scoping review was therefore undertaken to review the current status of MPH programmes in India. Information on MPH programmes was obtained using a two-step process. First, a list of all institutions offering MPH programmes in India was compiled by use of an internet and literature search. Second, detailed information on each programme was collected via an internet and literature search and through direct contact with the institutions and recognized experts in public health education. Between 1997 and 2016-2017, the number of institutions offering MPH programmes increased from 2 to 44. The eligibility criteria for the MPH programmes are variable. All programmes include some field experience. The ratio of faculty number to students enrolled ranged from 1:0.1 to 1:42. In the 2016-2017 academic year, 1190 places were being offered on MPH programmes but only 704 students were enrolled. MPH programmes being offered in India have witnessed a rapid expansion in the past two decades. This growth in supply of public health graduates is not yet matched by an increased demand. Despite the recognized need to strengthen the public health workforce in India, there is no clearly defined career pathway for MPH graduates in the national public health infrastructure. Institutions and public health bodies must collaborate to design and deliver MPH programmes to overcome the shortage of public health professionals, such that the development goals for India might be met.

Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012-2016).

PubMed

Schneider, Helen; Maleka, Nelisiwe

2018-01-01

Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012-2016. A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries-India, South Africa and Brazil, in particular-leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message-that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs.

Exploring the Changing Face of School Inspections

ERIC Educational Resources Information Center

Brown, Martin; McNamara, Gerry; O'Hara, Joe; O'Brien, Shivaun

2016-01-01

Background: A number of countries have had school inspection for many years. The origins of these systems date back to the nineteenth century when mass public schooling was introduced, and education and other emerging public services were required to comply with centrally mandated rules and programmes. In contrast, many countries across the world…

Salt fluoridation--an alternative in automatic prevention of dental caries.

PubMed

Marthaler, T M; Petersen, P E

2005-12-01

Despite great improvements in terms of reduced prevalence and amount of dental caries in populations worldwide, problems still persist particularly among the underprivileged groups of both developed and developing countries. Research and practical experience gained in several countries have demonstrated however, that dental caries can be prevented effectively through establishment of fluoride programmes. Water fluoridation, salt fluoridation, milk fluoridation and use of affordable fluoridated toothpastes play the major roles in public health. The present paper outlines the relevance and some practical aspects in relation to implementation of salt fluoridation programmes. The World Health Organisation Oral Health Programme provides technical assistance to countries in the process of planning, implementing and evaluating salt fluoridation projects.

Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012–2016)

PubMed Central

Maleka, Nelisiwe

2018-01-01

Introduction Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012–2016. Methods A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. Results The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries—India, South Africa and Brazil, in particular—leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. Conclusion The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message—that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs. PMID:29765777

Assessing Quranic Reading Proficiency in the j-QAF Programme

ERIC Educational Resources Information Center

Zarif, Muhammad Mustaqim Mohd; Mohamad, Nurfadilah; Bakar, Bhasah Abu

2014-01-01

In its effort to provide solid religious foundation for Muslim students, the Ministry of Education Malaysia has launched a national religious literacy initiative known as the j-QAF Programme in 2004. This programme has since been implemented in public primary schools throughout the country and incorporated as a part of the curriculum of studies.…

Neurology expertise and postgraduate training programmes in the Arab world: a survey.

PubMed

Benamer, Hani T S

2010-01-01

Neurological disorders are increasingly recognised as a major public health problem, especially in the developing world. Having adequate neurology expertise to tackle this issue is essential. A 17-item survey was conducted to gather information about the number, training and location of neurologists and supportive facilities available to them in the 16 middle- and high-income Arab countries. Data about the availability of postgraduate training programmes was collected. Surveys were returned from all targeted countries. The population per neurologist ranges from 35,000 to just over two million, and the most neurologists are based in large cities. Most of the practising neurologists had received extensive training in neurology and/or passed specialty exams. The majority had all or part of their training abroad. Neuro-radiological and neuro-physiological investigations are generally available in most surveyed countries but neuro-genetics and neuro-immunology services are lacking. Neurology training programmes are available in ten Arab countries with a total of 504-524 trainees. The availability of neurologists, supportive services and training programmes varies between Arab countries. Further development of neurology expertise and local training programmes are needed. Copyright 2010 S. Karger AG, Basel.

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

PubMed

Sankaranarayanan, R; Budukh, A M; Rajkumar, R

2001-01-01

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

PubMed Central

Sankaranarayanan, R.; Budukh, A. M.; Rajkumar, R.

2001-01-01

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives. PMID:11693978

Evaluation of a multinational, multilingual vaccine debate on Twitter.

PubMed

Becker, Benedikt F H; Larson, Heidi J; Bonhoeffer, Jan; van Mulligen, Erik M; Kors, Jan A; Sturkenboom, Miriam C J M

2016-12-07

Public confidence in an immunization programme is a pivotal determinant of the programme's success. The mining of social media is increasingly employed to provide insight into the public's sentiment. This research further explores the value of monitoring social media to understand public sentiment about an international vaccination programme. To gain insight into international public discussion on the paediatric pentavalent vaccine (DTP-HepB-Hib) programme by analysing Twitter messages. Using a multilingual search, we retrospectively collected all public Twitter messages mentioning the DTP-HepB-Hib vaccine from July 2006 until May 2015. We analysed message characteristics by frequency of referencing other websites, type of websites, and geographic focus of the discussion. In addition, a sample of messages was manually annotated for positive or negative message tone. We retrieved 5771 messages. Only 3.1% of the messages were reactions to other messages, and 86.6% referred to websites, mostly news sites (70.7%), other social media (9.8%), and health-information sites (9.5%). Country mentions were identified in 70.4% of the messages, of which India (35.4%), Indonesia (18.3%), and Vietnam (13.9%) were the most prevalent. In the annotated sample, 63% of the messages showed a positive or neutral sentiment about DTP-HepB-Hib. Peaks in negative and positive messages could be related to country-specific programme events. Public messages about DTP-HepB-Hib were characterized by little interaction between tweeters, and by frequent referencing of websites and other information links. Twitter messages can indirectly reflect the public's opinion about major events in the debates about the DTP-HepB-Hib vaccine. Copyright © 2016 Elsevier Ltd. All rights reserved.

Progress towards early detection services for infants with hearing loss in developing countries

PubMed Central

Olusanya, Bolajoko O; Swanepoel, De Wet; Chapchap, Mônica J; Castillo, Salvador; Habib, Hamed; Mukari, Siti Z; Martinez, Norberto V; Lin, Hung-Ching; McPherson, Bradley

2007-01-01

Background Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. Methods A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. Results Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. Conclusion Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery. PMID:17266763

Social inequality in health: dichotomy or gradient? A comparative study of problematizations in national public health programmes.

PubMed

Vallgårda, Signild

2008-01-01

Recent public health programmes from four countries: Denmark, England, Norway, and Sweden, are studied to analyse how social inequality in health is described, explained and suggested to be tackled, i.e., the problematization or the discursive process whereby the issue is framed and made accessible to political action. Social inequality in health is defined in these programmes both as a disadvantaged minority with major health problems, in contrast to the rest of the population, i.e., as a dichotomy; and as a gradient in which health problems are seen as increasing with lower social class or educational level. The causes of health inequality are identified as behaviour, social relations and underlying social structures. Policies aimed at reducing health inequality can be characterized as either in accordance with a residual welfare state model, targeting the disadvantaged, or a universal model, addressing the whole population. All countries have policies that are mixtures of these problematizations, but with some systematic differences between the countries. In this field England resembles the Scandinavian countries, as much as they resemble each other dispelling the idea of a Nordic or Scandinavian welfare state model.

Cervical cancer screening in Europe: Quality assurance and organisation of programmes.

PubMed

Elfström, K Miriam; Arnheim-Dahlström, Lisen; von Karsa, Lawrence; Dillner, Joakim

2015-05-01

Cervical screening programmes have reduced cervical cancer incidence and mortality but the level of success is highly variable between countries. Organisation of programmes is essential for equity and cost-effectiveness. However, there are differences in effectiveness, also among organised programmes. In order to identify the key organisational components that determine effectiveness, we performed a Europe-wide survey on the current status of organisation and organised quality assurance (QA) measures in cervical cancer prevention programmes, as well as organisation-associated costs. A comprehensive questionnaire was developed through systematic review of literature and existing guidelines. The survey was sent to programme organisers, Ministries of Health and experts in 34 European Union (EU) and European Free Trade Agreement (EFTA) countries. Detailed aspects of programme organisation, quality assurance, monitoring, evaluation and corresponding line-item costs were recorded. Documentation of programme guidelines, protocols and publications was requested. Twenty-nine of 34 countries responded. The results showed that organised efforts for QA, monitoring and evaluation were carried out to a differing extent and were not standardised, making it difficult to compare the cost-effectiveness of organisation and QA strategies. Most countries found it hard to estimate the costs associated with launching and operating the organised programme. To our knowledge, this is the first questionnaire to request detailed information on the actual organisation and QA of programmes. The results of this survey can be used as a basis for further development of standardised guidelines on organisation and QA of cervical cancer screening programmes in Europe. Copyright © 2015 Elsevier Ltd. All rights reserved.

Private health insurance: implications for developing countries.

PubMed Central

Sekhri, Neelam; Savedoff, William

2005-01-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

Private health insurance: implications for developing countries.

PubMed

Sekhri, Neelam; Savedoff, William

2005-02-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Global cost of child survival: estimates from country-level validation

PubMed Central

van Ekdom, Liselore; Scherpbier, Robert W; Niessen, Louis W

2011-01-01

Abstract Objective To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. Methods After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). Findings Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010–2015. Conclusion Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope. PMID:21479091

Exploring the Effectiveness of Mandatory Premarital Screening and Genetic Counselling Programmes for β-Thalassaemia in the Middle East: A Scoping Review.

PubMed

Saffi, Marwa; Howard, Natasha

2015-01-01

β-Thalassaemia is a common genetic blood disorder in the Middle Eastern region. Mandatory premarital screening and genetic counselling (PMSGC) programmes are implemented in 8 Middle East countries to reduce at-risk marriages and thus disease prevalence. A scoping review was conducted to explore the effectiveness of these programmes. The 6-stage scoping framework of Arksey and O'Malley [Int J Soc Res Methodol 2005;8:19-32] was used. Reported outcomes were analysed per country, with success defined as achieving a 65% reduction in at-risk marriages and/or thalassaemia-affected births. Emergent enablers and barriers were analysed thematically. Twenty-one sources were included from the 1,348 identified, discussing 7 country programmes, with 95% (20/21) published during 2003-2013. Five publications each were included for Iran and Saudi Arabia, 3 for Turkey, 2 each for Bahrain and Iraq (Kurdistan), and 1 for the United Arab Emirates, plus 2 multi-country evaluations. No programme achieved a 65% at-risk marriage cancellation rate. Though data on thalassaemia-affected birth reductions were minimal, programmes in Iran, Turkey and Iraq reported at least 65% reductions. A thematic analysis found that screening timing, access to prenatal detection and abortion, socio-religious issues, awareness and counselling affected decisions. This review found that PMSGC programmes were unsuccessful in discouraging at-risk marriages but successful in reducing the prevalence of affected births in countries providing prenatal detection and therapeutic abortion. A life cycle approach to prevention, incorporation of school screening, awareness campaigns, reconsideration of therapeutic abortion, and screening and counselling of couples married prior to programme inception are likely to improve the effectiveness of such programmes in the Middle Eastern region. © 2015 S. Karger AG, Basel.

Breast Cancer Screening Programmes across the WHO European Region: Differences among Countries Based on National Income Level.

PubMed

Altobelli, Emma; Rapacchietta, Leonardo; Angeletti, Paolo Matteo; Barbante, Luca; Profeta, Filippo Valerio; Fagnano, Roberto

2017-04-23

Breast cancer (BC) is the most frequent tumour affecting women all over the world. In low- and middle-income countries, where its incidence is expected to rise further, BC seems set to become a public health emergency. The aim of the present study is to provide a systematic review of current BC screening programmes in WHO European Region to identify possible patterns. Multiple correspondence analysis was performed to evaluate the association among: measures of occurrence; GNI level; type of BC screening programme; organization of public information and awareness campaigns regarding primary prevention of modifiable risk factors; type of BC screening services; year of screening institution; screening coverage and data quality. A key difference between High Income (HI) and Low and Middle Income (LMI) States, emerging from the present data, is that in the former screening programmes are well organized, with approved screening centres, the presence of mobile units to increase coverage, the offer of screening tests free of charge; the fairly high quality of occurrence data based on high-quality sources, and the adoption of accurate methods to estimate incidence and mortality. In conclusion, the governments of LMI countries should allocate sufficient resources to increase screening participation and they should improve the accuracy of incidence and mortality rates.

Postgraduate education in nutrition in south Asia: a huge mismatch between investments and needs

PubMed Central

2014-01-01

Background Despite decades of nutrition advocacy and programming, the nutrition situation in South Asian countries is alarming. We assume that modern training in nutrition at the post graduate level is an important contributor to building the capacity of individuals to think and act effectively when combating undernutrition. In this context, this paper presents a regional situation analysis of master’s level academic initiatives in nutrition with a special focus on the type of programme we think is most likely to be helpful in addressing undernutrition at the population level: Public Health Nutrition (PHN). Methods This situational analysis of Masters in nutrition across South Asian countries viz. India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Maldives, Nepal, Bhutan was conducted using an intensive and systematic Internet search. Further, detailed information was extracted from the individual institute websites and library visits. Results Of the131 master’s degree programmes we identified one that was in PHN while another 15 had modules in PHN. Most of these universities and institutions were found in India with a few in Bangladesh and Sri Lanka. In the rest of the countries, neither nutrition nor PHN emerged as an academic discipline at the master’s level. In terms of eligibility Indian and Sri Lankan programmes were most inclusive, with the remaining countries restricting eligibility to those with health qualifications. On modules, no country had any on nutrition policy or on nutrition’s interactions with agriculture, social protection, water and sanitation or women’s empowerment. Conclusion If a strong focus on public health nutrition is key to reducing undernutrition, then the poor availability of such courses in the region is cause for concern. Nutrition master’s courses in general focus too little on the kinds of strategies highlighted in the recent Lancet series on nutrition. Governments seeking to accelerate declines in undernutrition should incentivize the delivery of postgraduate programmes in nutrition and Public Health Nutrition (PHN) that reflect the modern consensus on priority actions. In the absence of PHN type programmes, the competence to scale up nutrition capacity is likely to be impaired and the human potential of millions of infants will continue to be squandered. PMID:24397258

Postgraduate education in nutrition in south Asia: a huge mismatch between investments and needs.

PubMed

Khandelwal, Shweta; Paul, Tanusree; Haddad, Lawrence; Bhalla, Surbhi; Gillespie, Stuart; Laxminarayan, Ramanan

2014-01-07

Despite decades of nutrition advocacy and programming, the nutrition situation in South Asian countries is alarming. We assume that modern training in nutrition at the post graduate level is an important contributor to building the capacity of individuals to think and act effectively when combating undernutrition. In this context, this paper presents a regional situation analysis of master's level academic initiatives in nutrition with a special focus on the type of programme we think is most likely to be helpful in addressing undernutrition at the population level: Public Health Nutrition (PHN). This situational analysis of Masters in nutrition across South Asian countries viz. India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Maldives, Nepal, Bhutan was conducted using an intensive and systematic Internet search. Further, detailed information was extracted from the individual institute websites and library visits. Of the 131 master's degree programmes we identified one that was in PHN while another 15 had modules in PHN. Most of these universities and institutions were found in India with a few in Bangladesh and Sri Lanka. In the rest of the countries, neither nutrition nor PHN emerged as an academic discipline at the master's level. In terms of eligibility Indian and Sri Lankan programmes were most inclusive, with the remaining countries restricting eligibility to those with health qualifications. On modules, no country had any on nutrition policy or on nutrition's interactions with agriculture, social protection, water and sanitation or women's empowerment. If a strong focus on public health nutrition is key to reducing undernutrition, then the poor availability of such courses in the region is cause for concern. Nutrition master's courses in general focus too little on the kinds of strategies highlighted in the recent Lancet series on nutrition. Governments seeking to accelerate declines in undernutrition should incentivize the delivery of postgraduate programmes in nutrition and Public Health Nutrition (PHN) that reflect the modern consensus on priority actions. In the absence of PHN type programmes, the competence to scale up nutrition capacity is likely to be impaired and the human potential of millions of infants will continue to be squandered.

Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

PubMed

Kakoma, Jean Baptiste

2016-01-01

The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.

Nature and impact of European anti-stigma depression programmes.

PubMed

Quinn, Neil; Knifton, Lee; Goldie, Isabella; van Bortel, Tine; Dowds, Julie; Lasalvia, Antonio; Scheerder, Gert; Boumans, Jenny; Svab, Vesna; Lanfredi, Mariangela; Wahlbeck, Kristian; Thornicroft, Graham

2014-09-01

Stigma associated with depression is a major public health issue in the EU, with over 20 million people experiencing depression and its associated personal distress each year. While most programmes against stigma related to mental health problems are of a general nature, the knowledge about programmes tackling stigma against people with depression is limited. This study therefore aims to assess the nature and impact of depression-specific programmes in EU countries. Using a web-based tool, 26 programmes were identified across the 18 EU countries taking part in the study. Most were universal and targeted the whole population, while many also targeted specific population groups or settings, such as young people or health professionals. The most common programme aim was improving literacy, although reducing stigmatizing attitudes and discriminatory behaviour and promoting help-seeking were also common. Most programmes originated from professional bodies, or as grassroots initiatives from service user groups/NGOs, rather than as part of national and local policy. The approaches used were primarily different forms of education/information, with some, but very limited, use of positive personal contact. Overall, the quality and extent of impact of the programmes was limited, with few leading to peer-reviewed publications. Specific programmes were identified with evidence of positive impact, and we drew on these examples to develop a framework to be used for future programmes against stigma and discrimination associated with depression. These findings are provided in full in the Anti-Stigma Partnership European Network Toolkit available at www.antistigma.eu. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Transfer of radiation technology to developing countries

NASA Astrophysics Data System (ADS)

Markovic, Vitomir; Ridwan, Mohammad

1993-10-01

Transfer of technology is a complex process with many facets, options and constraints. While the concept is an important step in bringing industrialization process to agricultural based countries, it is clear, however, that a country will only benefit from a new technology if it addresses a real need, and if it can be absorbed and adapted to suit the existing cultural and technological base. International Atomic Energy Agency, as UN body, has a mandate to promote nuclear applicationsand assist Member States in transfer of technology for peaceful applications. This mandate has been pursued by many different mechanisms developed in the past years: technical assistance, coordinated research programmes, scientific and technical meetings, publications, etc. In all these activities the Agency is the organizer and initiator, but main contributions come from expert services from developed countries and, increasingly, from developing countries themselves. The technical cooperation among developing coutries more and more becomes part of different programmes. In particular, regional cooperation has been demonstrated as an effective instrument for transfer of technology from developed and among developing countries. Some examples of actual programmes are given.

Competitive funding and structures for public health research in European countries.

PubMed

McCarthy, Mark; Conceição, Claudia; Grimaud, Olivier; Katreniakova, Zuzana; Saliba, Amanda; Sammut, Marvic; Narkauskaité, Laura

2013-11-01

The European Union is giving increasing emphasis to research as a driver for innovation and economic development. The European collaborative study PHIRE (Public Health Innovation and Research in Europe) investigated the funding and structures of public health research at national level in European countries. Background materials were prepared for national public health associations of European countries to hold workshops or discussions with research and policy stakeholders on their public health research systems. The reports, supplemented from internet sources for 23 EU countries (four did not contribute), provided information for framework analysis. All countries have public funding and administrative structures for research, but structures for public health research are more varied. In most countries, competitive health research funding is controlled by the Ministry of Science, with little input from the Ministry of Health. In four countries, Ministries of Health provide competitive funding alongside Ministries of Science, and in two countries there is a single health research council. There is no comparative reporting of public health research funding, and little connection with European public health research programmes. Europe needs a comprehensive picture of national and regional systems of public health research, in order to critically assess them and better adapt to changes and challenges, and to achieve a European Research Area for public health.

Policy Support and Resources Mobilization for the National Schistosomiasis Control Programme in The People's Republic of China.

PubMed

Zhu, H; Yap, P; Utzinger, J; Jia, T-W; Li, S-Z; Huang, X-B; Cai, S-X

2016-01-01

Schistosomiasis remains a public health problem in many developing countries around the world. After the founding of The People's Republic of China, from 1949 till date, all levels of government, from central to local, have been attaching great importance to schistosomiasis control in The People's Republic of China. With considerable policy support and resources mobilization, the national schistosomiasis control programmes have been implemented during the past 65years. Here, we summarize the successful experience of schistosomiasis control during the process. Recommendations for the future management of the Chinese national schistosomiasis elimination programme are put forward after considering the remaining challenges, shortcomings and lessons learnt from 65years of schistosomiasis control drives in The People's Republic of China. They will help to sustain past achievements, foster the attainment of the ultimate goal of schistosomiasis elimination for the country and provide reference for schistosomiasis control programme in other countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Training the public health workforce at the National School of Public Health: meeting Africa's needs.

PubMed

Mokwena, Kebogile; Mokgatle-Nthabu, Mathilda; Madiba, Sphiwe; Lewis, Helen; Ntuli-Ngcobo, Busi

2008-01-01

The inadequate number of trained public health personnel in Africa remains a challenge. In sub-Saharan Africa, the estimated workforce of public health practitioners is 1.3% of the world's health workforce addressing 25% of the world's burden of disease. To address this gap, the National School of Public Health at the then Medical University of Southern Africa created an innovative approach using distance learning components to deliver its public health programmes. Compulsory classroom teaching is limited to four two-week blocks. Combining mainly online components with traditional classroom curricula reduced limitations caused by geographical distances. At the same time, the curriculum was structured to contextualize continental health issues in both course work and research specific to students' needs. The approach used by the National School of Public Health allows for a steady increase in the number of public health personnel in Africa. Because of the flexible e-learning components and African-specific research projects, graduates from 16 African countries could benefit from this programme. An evaluation showed that such programmes need to constantly motivate participants to reduce student dropout rates and computer literacy needs to be a pre-requisite for entry into the programme. Short certificate courses in relevant public health areas would be beneficial in the African context. This programme could be replicated in other regions of the continent.

Training of public health workforce at the National School of Public Health: meeting Africa's needs.

PubMed

Mokwena, Kebogile; Mokgatle-Nthabu, Mathilda; Madiba, Sphiwe; Lewis, Helen; Ntuli-Ngcobo, Busi

2007-12-01

The inadequate number of trained public health personnel in Africa remains a challenge. In sub-Saharan Africa, the estimated workforce of public health practitioners is 1.3% of the world's health workforce addressing 25% of the world's burden of disease. To address this gap, the National School of Public Health at the then Medical University of Southern Africa created an innovative approach using distance learning components to deliver its public health programmes. Compulsory classroom teaching is limited to four two-week blocks. RELEVABT CHANGES: Combining mainly online components with traditional classroom curricula reduced limitations caused by geographical distances. At the same time, the curriculum was structured to contextualize continental health issues in both course work and research specific to students' needs. The approach used by the National School of Public Health allows for a steady increase in the number of public health personnel in Africa. Because of the flexible e-learning components and African-specific research projects, graduates from 16 African countries could avail of this programme. An evaluation showed that such programmes need to constantly motivate participants to reduce student dropout rates and computer literacy needs to be a pre-requisite for entry into the programme. Short certificate courses in relevant public health areas would be beneficial in the African context. This programme could be replicated in other regions of the continent.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

PubMed

Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes

PubMed Central

Yahaya, Ali A.; Gumede-Moeletsi, Hieronyma N.

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance. PMID:28879135

Main competences and skills to perform Essential Public Health Operations, offered by Schools of Public Health in four European countries: a short pilot report.

PubMed

Otok, Robert; Foldspang, Anders

2016-07-01

To consider the stage of implementation of main competences and EPHO skills in selected schools of public health in four European countries-France, Poland, Portugal, and the UK. By use of visual analogue scales (VAS) ranging 1-5, the leads of three schools of public health (SPH) in each of the four countries, France, Poland, Portugal and the UK, reported the strength of intellectual and practical competences as well as skills to perform essential public health operations (EPHOs), offered by their education and training programmes. The self-reports indicated substantial coverage of the multidimensional public health discipline. Each country representation had its overall characteristic profile, and there was found noteworthy within-country as well as between-country variation. The schools should meet the challenge of establishing collaborative networks, which will be important for public health strategy making and implementation, for shaping a coherent public health profession, and thus ultimately for population health. This pilot report should be followed up by more systematically penetrating and comprehensive analyses to identify met and unmet needs in public health education and training.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

WHO at country level.

PubMed

Lucas, A

1998-03-07

WHO's activities at country level have earned the organisation both criticism and praise. The organisation's technical publications are esteemed as authoritative guidelines for disease control. Successful disease-control programmes and contributions to health research have heightened WHO's reputation. The organisation has also provided the focus for evolution of important ideas, such as primary health care and the relevance of equity and other ethical issues. But WHO has been criticised for not adapting rapidly and logically to changes in the health field. With increasing national capacity in the more advanced developing countries, and with the involvement of new participants in the health sphere, the organisation needs to reassess its role at country level. My recommendation is that WHO improves its analytical capacity so that its programmes take into consideration the health needs of the country, its national capacity, and the contributions from other external agencies.

European otorhinolaryngology training programs: results of a European survey about training satisfaction, work environment and conditions in six countries.

PubMed

Oker, N; Alotaibi, Naif H; Reichelt, A C; Herman, P; Bernal-Sprekelsen, M; Albers, Andreas E

2017-11-01

ORL-students and residents have an ongoing debate about the "best" programme in Europe. Aim of this study was to comparatively assess differences among programmes in training, satisfaction, quality of life (QoL) of residents and recent otorhinolaryngologist (ORL) specialists in France, Germany, Spain, Italy, Austria, and Belgium. A self-administered anonymous questionnaire, structured in ten sections including general information, provided guidance, working environment, training structure, teaching of medical students, publication work, QoL, and satisfaction with training, were emailed to residents and recent ORL specialists. 476 returned questionnaires from 6 countries revealed that daily work hours were the highest in France and Belgium with 11 and 10.4 h on average, respectively. QoL, work conditions, and salary were best in Germany followed by Austria in terms of possibility of part-time contracts, better respect for post-duty day off, and compensation for overtime. Satisfaction with training including support and guidance of seniors was lowest in Italy, but, on the other hand, the publication work and support had a more important place than in other countries. In Belgium, there was some gap between the quality of teaching and feedback from seniors as well as apprenticeship. The highest satisfaction with training was in France and Spain followed by Austria. The study results provide guidance before choosing an ORL training programme in Europe. Country-specific strengths could be included into future harmonization efforts to improve all programmes, facilitate professional exchange and, finally, establish standards-of-care carried out by well-trained doctors also looking after a satisfying work-life balance.

Screening for Infectious Diseases among Newly Arrived Migrants: Experiences and Practices in Non-EU Countries of the Mediterranean Basin and Black Sea.

PubMed

Napoli, Christian; Dente, Maria Grazia; Kärki, Tommi; Riccardo, Flavia; Rossi, Pasqualino; Declich, Silvia

2015-12-08

Changing migration dynamics in the Mediterranean Sea and differences in infectious diseases (ID) burden between the countries of origin have raised questions whether public health actions are needed to avoid the transmission of ID. Screening newly arrived migrants for ID is one health monitoring option, offering opportunities for prevention, early detection and treatment. The authors conducted a survey among country experts in non-European Union countries of the Mediterranean and Black Sea, in order to explore current ID screening practices and policies for newly arrived migrants. The association between the existence of guidelines and the proportion of refugees in the population was also estimated. Eighteen country experts responded (90%) out of the 20 invited. Eleven countries (61%) implemented screening programmes and six (38%) had national guidelines. Screening was performed most often for tuberculosis at the holding level. A higher proportion of refugees in the population was associated with the existence of guidelines for screening (p = 0.05). Fourteen experts (88%) considered screening among migrants useful. The results show that screening for ID in newly arrived migrants is relevant for non-EU countries of the Mediterranean and Black Sea. Common guidelines could be promoted focusing on both individual and public health benefits of screening programmes.

Financing the response to HIV among gay men and other men who have sex with men: Case studies from eight diverse countries.

PubMed

Grosso, Ashley; Ryan, Owen; Tram, Khai Hoan; Baral, Stefan

2015-01-01

Despite reductions in the number of new HIV infections globally, the HIV epidemic among men who have sex with men (MSM) is expanding. This study characterises financing of HIV programmes for MSM and the impact of criminalisation on levels of funding, using data from five countries that criminalise same-sex sexual practices (Ethiopia, Mozambique, Guyana, India and Nigeria) and three that do not (China, Ukraine and Vietnam). For each country, all publicly available documents from the Global Fund to Fight AIDS, Tuberculosis and Malaria for approved HIV/AIDS grants in Rounds 5-9 and Country Operational Plans detailing investments made through the President's Emergency Plan for AIDS Relief (PEPFAR) from US fiscal year (FY) 2007-2009 were examined. Eleven of 20 HIV proposals to the Global Fund contained programmes for MSM totalling approximately $40 million or 6% of proposed budgets. In six countries providing activity-level data on MSM programming, PEPFAR funding that served this population and others ranged from $23.3 million in FY2007 to $35.4 million in FY2009, representing 0.5-25.9% of overall, non-treatment funding over this period. Countries that criminalise same-sex sexual practices spend fewer resources on HIV programmes serving MSM. However, they also show consistent underfunding of programmes serving MSM regardless of context or geography.

Initial assessment of strategic plans for improving the performance of veterinary services in developing countries: a review of OIE PVS gap analysis reports.

PubMed

Weaver, J; Leon, E; Edan, M; D'Alessio, F

2012-08-01

The World Organisation for Animal Health (OIE) carries out Gap Analysis missions (if a country so wishes) as part of its programme to assess and improve the Performance of Veterinary Services (the 'PVS Pathway') in Member Countries. These Gap Analysis missions have found that many national Veterinary Services comply to only a limited extent with the international standards established by the OIE and that their competence is compromised by poor governance. This failure threatens animal and public health not only nationally but also internationally. The OIE PVS Gap Analysis reports reviewed found that all the Veterinary Services have a strong vision and commitmentto improvement but are held back by a weak chain of command, inadequate and outdated legislation, insufficient funding, weak technical competencies, compromised technical independence, poor communications and limited joint programmes. There are weaknesses across all the core technical areas of trade, animal health, veterinary public health and veterinary laboratories and also in the overall management of the Veterinary Services. The OIE PVS Gap Analysis missions recommend significant increases in budget in all countries.

Controlling hepatitis C in Rwanda: a framework for a national response.

PubMed

Mbituyumuremyi, Aimable; Van Nuil, Jennifer Ilo; Umuhire, Jeanne; Mugabo, Jules; Mwumvaneza, Mutagoma; Makuza, Jean Damascene; Umutesi, Justine; Nsanzimana, Sabin; Gupta, Neil

2018-01-01

With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken in Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case-finding. Increased public and private financing is essential to support care and treatment services.

1974 is World Population Year.

ERIC Educational Resources Information Center

Asian Population Programme News, 1974

1974-01-01

This publication is a special issue of the Asian Population Programme News. This particular publication is concerned with population year 1974. Highlights from the thirtieth session of the Economic Commission for Asia and the Far East (ECAFE) are presented. World, regional, and country population news are included in separate sections. A listing…

Reflecting the Context of MPA Education in the Time of Economic Crisis in Public Sectors in Britain and the Netherlands

ERIC Educational Resources Information Center

Oldfield, Chrissie; Berg, Mireille van den

2013-01-01

The reality of the economic crisis and subsequent cuts in public sector funding in some European countries means that the context for public management education is significantly changing. In a period of economic constraint there is the obvious questioning of the cost of public management education programmes and even more of their relevance and…

Veterinary public health activities at FAO: echinococcosis/hydatid disease.

PubMed

Eddi, C; de Balogh, K; Lubroth, J; Amanfu, W; Speedy, A; Battaglia, D

2004-12-01

Cystic hydatidosis is a zoonotic disease that remain as a significant cause of human morbidity and mortality in many parts of the world. The disease has veterinary public health implications. FAO is involved with some activities in the control of echinococcosis/hydatid disease: within the Animal Production and Health Division the Veterinary Public Health (VHP) Programme is constituted by members of the different Services (Animal Health, Animal Production, and Livestock Policy) within the Division. FAO regular programme has also established a global network of professionals directly involved in VPH. Furthermore FAO's Technical Cooperation Projects (TCP) is a tool to assist member countries in responding to urgent and unforeseen demands.

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

PubMed Central

De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Flores-Ayala, Rafael; del Socorro Jefferds, Maria Elena

2015-01-01

Objective Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health. PMID:23507463

Debt relief and public health spending in heavily indebted poor countries.

PubMed Central

Gupta, Sanjeev; Clements, Benedict; Guin-Siu, Maria Teresa; Leruth, Luc

2002-01-01

The Heavily Indebted Poor Countries (HIPC) Initiative, which was launched in 1996, is the first comprehensive effort by the international community to reduce the external debt of the world's poorest countries. The Initiative will generate substantial savings relative to current and past public spending on health and education in these countries. Although there is ample scope for raising public health spending in heavily indebted poor countries, it may not be advisable to spend all the savings resulting from HIPC resources for this purpose. Any comprehensive strategy for tackling poverty should also focus on improving the efficiency of public health outlays and on reallocating funds to programmes that are most beneficial to the poor. In order to ensure that debt relief increases poverty-reducing spending and benefits the poor, all such spending, not just that financed by HIPC resources, should be tracked. This requires that countries improve all aspects of their public expenditure management. In the short run, heavily indebted poor countries can take some pragmatic tracking measures based on existing public expenditure management systems, but in the longer run they should adopt a more comprehensive approach so as to strengthen their budget formulation, execution, and reporting systems. PMID:11953794

Building capacity without disrupting health services: public health education for Africa through distance learning.

PubMed

Alexander, Lucy; Igumbor, Ehi Uche; Sanders, David

2009-04-01

The human resources crisis in Africa is especially acute in the public health field. Through distance education, the School of Public Health of the University of the Western Cape, South Africa, has provided access to master's level public health education for health professionals from more than 20 African countries while they remain in post. Since 2000, interest has increased overwhelmingly to a point where four times more applications are received than can be accommodated. This home-grown programme remains sensitive to the needs of the target learners while engaging them in high-quality learning applied in their own work contexts. This brief paper describes the innovative aspects of the programme, offering some evaluative indications of its impact, and reviews how the delivery of text-led distance learning has facilitated the realization of the objectives of public health training. Strategies are proposed for scaling up such a programme to meet the growing need in this essential area of health human resource capacity development in Africa.

Building capacity without disrupting health services: public health education for Africa through distance learning

PubMed Central

Alexander, Lucy; Igumbor, Ehi Uche; Sanders, David

2009-01-01

The human resources crisis in Africa is especially acute in the public health field. Through distance education, the School of Public Health of the University of the Western Cape, South Africa, has provided access to master's level public health education for health professionals from more than 20 African countries while they remain in post. Since 2000, interest has increased overwhelmingly to a point where four times more applications are received than can be accommodated. This home-grown programme remains sensitive to the needs of the target learners while engaging them in high-quality learning applied in their own work contexts. This brief paper describes the innovative aspects of the programme, offering some evaluative indications of its impact, and reviews how the delivery of text-led distance learning has facilitated the realization of the objectives of public health training. Strategies are proposed for scaling up such a programme to meet the growing need in this essential area of health human resource capacity development in Africa. PMID:19338669

'The Anglo-Saxon disease': a pilot study of the barriers to and facilitators of the use of randomised controlled trials of social programmes in an international context.

PubMed

Roberts, Helen; Petticrew, Mark; Liabo, Kristin; Macintyre, Sally

2012-11-01

There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value.

Public health nutrition workforce development in seven European countries: constraining and enabling factors.

PubMed

Kugelberg, Susanna; Jonsdottir, Svandis; Faxelid, Elisabeth; Jönsson, Kristina; Fox, Ann; Thorsdottir, Inga; Yngve, Agneta

2012-11-01

Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries. A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data. The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK. Sixty key informants participated in the study. There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents. There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes.

What Do We Really Learn from PISA? The Sociology of Its Reception in Three European Countries (2001-2008)

ERIC Educational Resources Information Center

Pons, Xavier

2011-01-01

This article synthesises some findings of an international research project called "Know&Pol" to question the effects of the OECD's Programme for International Student Assessment (PISA) on the public debate in three European countries (France, Portugal and Scotland). Using a political science approach, it shows that Pisa did not…

Veterinary vaccines and their use in developing countries.

PubMed

Lubroth, J; Rweyemamu, M M; Viljoen, G; Diallo, A; Dungu, B; Amanfu, W

2007-04-01

The burden of infectious diseases in livestock and other animals continues to be a major constraint to sustained agricultural development, food security, and participation of developing and in-transition countries in the economic benefits of international trade in livestock commodities. Targeted measures must be instituted in those countries to reduce the occurrence of infectious diseases. Quality veterinary vaccines used strategically can and should be part of government sanctioned-programmes. Vaccination campaigns must be part of comprehensive disease control programmes, which, in the case of transboundary animal diseases, require a regional approach if they are to be successful. This paper focuses on the salient transboundary animal diseases and examines current vaccine use, promising vaccine research, innovative technologies that can be applied in countries in some important developing regions of the world, and the role of public/private partnerships.

A public health e-learning master's programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience.

PubMed

Chastonay, Philippe; Zesiger, Véronique; Moretti, Roberto; Cremaschini, Marco; Bailey, Rebecca; Wheeler, Erika; Mattig, Thomas; Avocksouma, Djona Atchenemou; Mpinga, Emmanuel Kabengele

2015-08-13

Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices. A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored. The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects. Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

Commissioning the University of Excellence: Swedish Research Policy and New Public Research Funding Programmes

ERIC Educational Resources Information Center

Hallonsten, Olof; Silander, Charlotte

2012-01-01

In many countries, current research policy is dominated by managerialism and excellence, manifesting the aim of making universities into national strategic assets in the globally competitive knowledge economy. This article discusses these policy trends and their mirror in recent developments in public funding for academic research, with special…

Differences in Scholastic Achievement of Public, Private Government-Dependent, and Private Independent Schools: A Cross-National Analysis

ERIC Educational Resources Information Center

Dronkers, Jaap; Robert, Peter

2008-01-01

The gross differences in scholastic achievement among public, private government-dependent, and private independent schools in 22 countries are analyzed with Programme for International Student Assessment 2000 data. In a multilevel approach, the authors estimate these sector effects, controlling for sociological characteristics of students and…

Epidemiology and statistics at the Nordic School of Public Health: Teaching and research 1979-2014.

PubMed

Eriksson, Bo

2015-08-01

The Nordic School of Public Health (NHV) was jointly founded in 1953 by the Nordic countries. Until 1979, the school provided ad hoc courses on public health topics, using external teachers drawn mainly from the Nordic countries. At the time, the permanent staff of the school was small. In 1979, it began a Master's degree programme and a few academic positions were established and filled, to support these courses. The programme included four main areas: Epidemiology, Social Medicine, Environmental Health and Health Services Administration. Epidemiology was compulsory in all Master of Public Health (MPH) exams, but there were a handful of optional courses that could be substituted for the other subjects.This paper tells the story of Epidemiology at NHV from about 1980, up until closure of the school in 2014. The original MPH model ran until 1995. Nursing Science entered NHV from about 1985 and worked mainly with qualitative research that often focused on individual patients. The new methods attracted nurses, midwives, psychologists and other groups that previously had been less represented in NHV. Being quantitative and population oriented, Epidemiology lost its unique position as a mandatory subject for the MPH examination. In addition the 'New Public Health' proposed by the World Health Organisation (WHO) that advocated health promotion and the philosophy of salutogenesis became a challenge for the programme in epidemiology: pathogenesis no longer was of primary interest. From 1995, the MPH format changed repeatedly and a DrPH programme was begun. For the last 8 years of its existence, NHV offered a reasonably comprehensive, basic course in Epidemiology.Throughout the years, epidemiology training and research at NHV were very traditional. In being a relatively free institution in terms of academic choices, NHV should have contributed to the development and innovation of epidemiology in public health. For several reasons, this did not happen. © 2015 the Nordic Societies of Public Health.

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed Central

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-01-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific. PMID:21729919

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-07-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function.

PubMed

Wilson, Philip; Wood, Rachael; Lykke, Kirsten; Hauskov Graungaard, Anette; Ertmann, Ruth Kirk; Andersen, Merethe Kirstine; Haavet, Ole Rikard; Lagerløv, Per; Abildsnes, Eirik; Dahli, Mina P; Mäkelä, Marjukka; Varinen, Aleksi; Hietanen, Merja

2018-05-01

Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.

Revolution then evolution: the advance of health economic evaluation in Australia.

PubMed

Lopert, Ruth; Viney, Rosalie

2014-01-01

All governments face immense challenges in providing affordable healthcare for their citizens, and the diffusion of novel health technologies is a key driver of growth in expenditure for many. Although important methodological and process variations exist around the world, health economic evaluation is increasingly seen as an important tool to support decision-making around the introduction of new health technologies, interventions and programmes in countries of varying stages of economic development. In Australia, the assessment of the comparative cost-effectiveness of new medicines proposed for subsidy under the country's national drug subsidy programme, the Pharmaceutical Benefits Scheme, was introduced in the late 1980s and became mandatory in 1993, making Australia the first country to introduce such a requirement nationally. Since then the use of health economic evaluation has expanded and been applied to support decision-making across a broader range of health technologies, as well as to programmes in public health. Copyright © 2014. Published by Elsevier GmbH.

Addressing poverty through disease control programmes: examples from Tuberculosis control in India

PubMed Central

2012-01-01

Introduction Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. Methodology A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Conclusion Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country. PMID:22449205

Global policy for improvement of oral health in the 21st century--implications to oral health research of World Health Assembly 2007, World Health Organization.

PubMed

Petersen, Poul Erik

2009-02-01

The World Health Organization (WHO) Global Oral Health Programme has worked hard over the past 5 years to increase the awareness of oral health worldwide as oral health is important component of general health and quality of life. Meanwhile, oral disease is still a major public health problem in high income countries and the burden of oral disease is growing in many low- and middle income countries. In the World Oral Health Report 2003, the WHO Global Oral Health Programme formulated the policies and necessary actions to the continuous improvement of oral health. The strategy is that oral disease prevention and the promotion of oral health needs to be integrated with chronic disease prevention and general health promotion as the risks to health are linked. The World Health Assembly (WHA) and the Executive Board (EB) are supreme governance bodies of WHO and for the first time in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120 and WHA60, the Member States agreed on an action plan for oral health and integrated disease prevention, thereby confirming the approach of the Oral Health Programme. The policy forms the basis for future development or adjustment of oral health programmes at national level. Clinical and public health research has shown that a number of individual, professional and community preventive measures are effective in preventing most oral diseases. However, advances in oral health science have not yet benefited the poor and disadvantaged populations worldwide. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The WHO Global Oral Health Programme invites the international oral health research community to engage further in research capacity building in developing countries, and in strengthening the work so that research is recognized as the foundation of oral heath policy at global level.

Public communication of science in Mexico: past, present and future of a profession.

PubMed

Sánchez-Mora, Carmen; Reynoso-Haynes, Elaine; Sánchez Mora, Ana María; Tagüeña Parga, Julia

2015-01-01

In this article, we offer an analysis of the evolution of the professional field of public communication of science in Mexico, particularly at the National Autonomous University of Mexico, the influences it has received from other countries, the impact it has on Mexican society and some of its relationships with other Latin American countries. We present examples of successful programmes in different mass media and an analysis of the evolution and diversification of science communicators over the last four decades. © The Author(s) 2014.

Museums and art galleries as partners for public health interventions.

PubMed

Camic, Paul M; Chatterjee, Helen J

2013-01-01

The majority of public health programmes are based in schools, places of employment and in community settings. Likewise, nearly all health-care interventions occur in clinics and hospitals. An underdeveloped area for public health-related planning that carries international implications is the cultural heritage sector, and specifically museums and art galleries. This paper presents a rationale for the use of museums and art galleries as sites for public health interventions and health promotion programmes through discussing the social role of these organisations in the health and well-being of the communities they serve. Recent research from several countries is reviewed and integrated into a proposed framework for future collaboration between cultural heritage, health-care and university sectors to further advance research, policy development and evidence-based practice.

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

PubMed Central

Lalla-Edward, Samanta Tresha; Fobosi, Siyabulela Christopher; Hankins, Catherine; Case, Kelsey; Venter, W. D. Francois; Gomez, Gabriela

2016-01-01

Background Truck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population’s health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes. Methods We searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects). Results Thirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed positive changes in risk behaviours, knowledge, and attitudes. Our conclusions were robust in sensitivity analyses. Conclusion Diverse healthcare programmes tailored to the needs of truck drivers implemented in 30 sub-Saharan African countries have shown potential benefits. However, information gaps about availability of services and their effects impede further planning and implementation of effective healthcare programmes for truck drivers. PMID:27333301

Setting priorities for safe motherhood programme evaluation: a participatory process in three developing countries.

PubMed

Madi, Banyana Cecilia; Hussein, Julia; Hounton, Sennen; D'Ambruoso, Lucia; Achadi, Endang; Arhinful, Daniel Kojo

2007-09-01

A participatory approach to priority setting in programme evaluation may help improve the allocation and more efficient use of scarce resources especially in low-income countries. Research agendas that are the result of collaboration between researchers, programme managers, policy makers and other stakeholders have the potential to ensure rigorous studies are conducted on matters of local priority, based on local, expert knowledge. This paper describes a process involving key stakeholders to elicit and prioritise evaluation needs for safe motherhood in three developing countries. A series of reiterative consultations with safe motherhood stakeholders from each country was conducted over a period of 36 months. In each country, the consultation process consisted of a series of participatory workshops; firstly, stakeholder's views on evaluation were elicited with parallel descriptive work on the contexts. Secondly, priorities for evaluation were identified from stakeholders; thirdly, the evaluation-priorities were refined; and finally, the evaluation research questions, reflecting the identified priorities, were agreed and finalised. Three evaluation-questions were identified in each country, and one selected, on which a full scale evaluation was undertaken. While there is a great deal written about the importance of transparent and participatory priority setting in evaluation; few examples of how such processes could be implemented exist, particularly for maternal health programmes. Our experience demonstrates that the investment in a participatory priority-setting effort is high but the process undertaken resulted in both globally and contextually-relevant priorities for evaluation. This experience provides useful lessons for public health practitioners committed to bridging the research-policy interface.

The contribution of the polio eradication initiative to narrowing the gaps in the health workforce in the African Region.

PubMed

Kamso, Jean; Mvika, Eddy S; Ota, M O C; Okeibunor, Joseph; Mkanda, Pascal; Mihigo, Richard

2016-10-10

The Global Polio Eradication Initiative (GPEI) massively invested to overcome the crippling disease in countries of the WHO African Region. In the context of economic crisis, almost all countries in the Region lack an adequate health workforce. Large amounts were invested by GPEI in human resources. This paper shows how the human resources funded by polio contributed to narrowing the gaps in health workforce and helped strengthening and supporting other priority health programmes in Angola, Chad, DRC, Nigeria, Tanzania, and Togo. The health workforce strengthening methods used in the five different countries included the following: policy development and strategic planning, microplanning, capacity building of public health and community workers, implementation and services, monitoring and evaluation, advocacy and social mobilization, and programme review. Staff funded by polio helped with achieving good coverage in vitamin A and insecticide-treated mosquito nets (Angola, Chad); improvement of EPI and integrated disease surveillance indicators, improved quality of data (all five countries), administrative support, smooth introduction of new vaccines, increased case detection, and early isolation of patients suffering from the Guinea worm (Chad); reduction of cholera, extension of directly observed TB short course treatment (Democratic Republic of Congo); significant staff performance improvement (Nigeria). GPEI investment achieved far beyond its primary goal, and contributed to narrowing the gaps in the health workforce in countries of the African Region, as demonstrated by the best practice documentation exercise. We recommend that expertise and experience of polio funded staff should be leveraged to strengthen, expand and support other public health programmes. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

A pinch of salt goes a long way in communicating astronomy

NASA Astrophysics Data System (ADS)

Manxoyi, S.

2008-06-01

The building of the Southern African Large Telescope not only revolutionised the methods of data collection in astronomy as a science in South Africa, but also changed the face, approach and impact of astronomy communication in our country. This presentation examines the various ways in which SALT has been supporting and continues to drive astronomy communication with the public. These include the following strands: learner activities, educator programmes, special events and national events as well general public programmes. The learner activities include SALT tours, space camps, stargazing, astronomy quiz, workshops, science clubs and job shadowing. The educators' strand includes workshops, projects, mini conferences, tours, team and co teaching. The public is catered for through special events, national events, exhibitions, star parties and festivals.

Economic comparison of the monitoring programmes for bluetongue vectors in Austria and Switzerland.

PubMed

Pinior, B; Brugger, K; Köfer, J; Schwermer, H; Stockreiter, S; Loitsch, A; Rubel, F

2015-05-02

With the bluetongue virus serotype 8 (BTV-8) outbreak in 2006, vector monitoring programmes (according to EU regulation 1266/2007) were implemented by European countries to obtain information on the spatial distribution of vectors and the vector-free period. This study investigates the vector monitoring programmes in Austria and Switzerland by performing a retrospective cost analysis for the period 2006-2010. Two types of costs were distinguished: costs financed directly via the national bluetongue programmes and costs contributed in-kind by the responsible institutions and agricultural holdings. The total net costs of the monitoring programme in Austria amounted to €1,415,000, whereby in Switzerland the costs were valued at €94,000. Both countries followed the legislation complying with requirements, but differed in regard to sampling frequency, number of trap sites and sampling strategy. Furthermore, the surface area of Austria is twice the area of Switzerland although the number of ruminants is almost the same in both countries. Thus, for comparison, the costs were normalised with regard to the sampling frequency and the number of trap sites. Resulting costs per trap sample comprised €164 for Austria and €48 for Switzerland. In both countries, around 50 per cent of the total costs can be attributed to payments in-kind. The benefit of this study is twofold: first, veterinary authorities may use the results to improve the economic efficiency of future vector monitoring programmes. Second, the analysis of the payment in-kind contribution is of great importance to public authorities as it makes the available resources visible and demonstrates how they have been used. British Veterinary Association.

Economic comparison of the monitoring programmes for bluetongue vectors in Austria and Switzerland

PubMed Central

Pinior, B.; Brugger, K.; Köfer, J.; Schwermer, H.; Stockreiter, S.; Loitsch, A.; Rubel, F.

2015-01-01

With the bluetongue virus serotype 8 (BTV-8) outbreak in 2006, vector monitoring programmes (according to EU regulation 1266/2007) were implemented by European countries to obtain information on the spatial distribution of vectors and the vector-free period. This study investigates the vector monitoring programmes in Austria and Switzerland by performing a retrospective cost analysis for the period 2006–2010. Two types of costs were distinguished: costs financed directly via the national bluetongue programmes and costs contributed in-kind by the responsible institutions and agricultural holdings. The total net costs of the monitoring programme in Austria amounted to €1,415,000, whereby in Switzerland the costs were valued at €94,000. Both countries followed the legislation complying with requirements, but differed in regard to sampling frequency, number of trap sites and sampling strategy. Furthermore, the surface area of Austria is twice the area of Switzerland although the number of ruminants is almost the same in both countries. Thus, for comparison, the costs were normalised with regard to the sampling frequency and the number of trap sites. Resulting costs per trap sample comprised €164 for Austria and €48 for Switzerland. In both countries, around 50 per cent of the total costs can be attributed to payments in-kind. The benefit of this study is twofold: first, veterinary authorities may use the results to improve the economic efficiency of future vector monitoring programmes. Second, the analysis of the payment in-kind contribution is of great importance to public authorities as it makes the available resources visible and demonstrates how they have been used. PMID:25841165

Status of pesticide management in the practice of vector control: a global survey in countries at risk of malaria or other major vector-borne diseases.

PubMed

van den Berg, Henk; Hii, Jeffrey; Soares, Agnes; Mnzava, Abraham; Ameneshewa, Birkinesh; Dash, Aditya P; Ejov, Mikhail; Tan, Soo Hian; Matthews, Graham; Yadav, Rajpal S; Zaim, Morteza

2011-05-14

It is critical that vector control pesticides are used for their acceptable purpose without causing adverse effects on health and the environment. This paper provides a global overview of the current status of pesticides management in the practice of vector control. A questionnaire was distributed to WHO member states and completed either by the director of the vector-borne disease control programme or by the national manager for vector control. In all, 113 countries responded to the questionnaire (80% response rate), representing 94% of the total population of the countries targeted. Major gaps were evident in countries in pesticide procurement practices, training on vector control decision making, certification and quality control of pesticide application, monitoring of worker safety, public awareness programmes, and safe disposal of pesticide-related waste. Nevertheless, basic conditions of policy and coordination have been established in many countries through which the management of vector control pesticides could potentially be improved. Most countries responded that they have adopted relevant recommendations by the WHO. Given the deficiencies identified in this first global survey on public health pesticide management and the recent rise in pesticide use for malaria control, the effectiveness and safety of pesticide use are being compromised. This highlights the urgent need for countries to strengthen their capacity on pesticide management and evidence-based decision making within the context of an integrated vector management approach.

Status of pesticide management in the practice of vector control: a global survey in countries at risk of malaria or other major vector-borne diseases

PubMed Central

2011-01-01

Background It is critical that vector control pesticides are used for their acceptable purpose without causing adverse effects on health and the environment. This paper provides a global overview of the current status of pesticides management in the practice of vector control. Methods A questionnaire was distributed to WHO member states and completed either by the director of the vector-borne disease control programme or by the national manager for vector control. In all, 113 countries responded to the questionnaire (80% response rate), representing 94% of the total population of the countries targeted. Results Major gaps were evident in countries in pesticide procurement practices, training on vector control decision making, certification and quality control of pesticide application, monitoring of worker safety, public awareness programmes, and safe disposal of pesticide-related waste. Nevertheless, basic conditions of policy and coordination have been established in many countries through which the management of vector control pesticides could potentially be improved. Most countries responded that they have adopted relevant recommendations by the WHO. Conclusions Given the deficiencies identified in this first global survey on public health pesticide management and the recent rise in pesticide use for malaria control, the effectiveness and safety of pesticide use are being compromised. This highlights the urgent need for countries to strengthen their capacity on pesticide management and evidence-based decision making within the context of an integrated vector management approach. PMID:21569601

Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis.

PubMed

Bruni, Laia; Diaz, Mireia; Barrionuevo-Rosas, Leslie; Herrero, Rolando; Bray, Freddie; Bosch, F Xavier; de Sanjosé, Silvia; Castellsagué, Xavier

2016-07-01

Since 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths. Between Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level. From June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39-55 million) received the full course of vaccine, representing a total population coverage of 1·4% (95% CI 1·1-1·6), and 59 million women (48-71 million) had received at least one dose, representing a total population coverage of 1·7% (1·4-2·1). In more developed regions, 33·6% (95% CI 25·9-41·7) of females aged 10-20 years received the full course of vaccine, compared with only 2·7% (1·8-3·6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178 192 averted cases by age 75 years) than in high-income countries (165 033 averted cases), despite the lower number of vaccinated women (13·3 million vs 32·2 million). Many women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention. PATH, Instituto de Salud Carlos III, and Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR). Copyright © 2016 Bruni et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

WHO programme for the prevention of rheumatic fever/rheumatic heart disease in 16 developing countries: report from Phase I (1986-90). WHO Cardiovascular Diseases Unit and principal investigators.

PubMed

1992-01-01

The programme was initiated in 1984 by WHO in close collaboration with the International Society and Federation of Cardiology (ISFC). Sixteen countries in five WHO Regions participated: Mali, Zambia and Zimbabwe (in Africa); Bolivia, El Salvador and Jamaica (in the Americas); Egypt, Iraq, Pakistan and Sudan (in the Eastern Mediterranean); India, Sri Lanka and Thailand (in South-East Asia); and China, the Philippines and Tonga (in the Western Pacific). The programme was planned for implementation in three phases: pilot study and control programme in a selected area, control programmes in all the selected communities, and their extension to the whole country. In Phase I, a total of 1,433,710 schoolchildren were screened and 3135 cases of rheumatic fever/rheumatic heart disease (RF/RHD) were found, giving a prevalence of 2.2 per 1000 (higher in the African and Eastern Mediterranean regions); 33,651 recently identified or already known cases were registered; completion of secondary prophylaxis was irregular but averaged 63.2% coverage; percentages of adverse reactions (0.3%) and recurrence of acute RF (0.4%) were very small; 24,398 health personnel and teachers were trained. Health education activities were organized for patients, their relatives, and the general public in hundreds of health education sessions. Thousands of pamphlets, brochures and posters were distributed, and health education programmes were broadcast on radio and television. The quality of care for RF/RHD patients improved under the programme, which has been expanded to other areas.

Preferences for the normative basis of health care priority setting: some evidence from two countries.

PubMed

Olsen, Jan Abel; Richardson, Jeff

2013-04-01

The present paper concerns the criteria people would prefer for prioritising health programmes. It differs from most empirical studies as subjects were not asked about their personal preferences for programmes per se. Rather, they were asked about the principles that should guide the choice of programmes. Four different principles were framed as arguments for alternative programmes. The results from population surveys in Australia and Norway suggest that people are least supportive of the principle that decision makers should follow the stated preferences of the public. Rather, respondents expressed more support for decisions based upon health maximisation, equality and urgency. Copyright © 2012 John Wiley & Sons, Ltd.

Cross-section analyses of attitudes towards science and nature from the International Social Survey Programme 1993, 2000, and 2010 surveys.

PubMed

Reyes, Joseph Anthony L

2015-04-01

This paper explores public attitudes towards science and nature in twelve countries using data from the International Social Survey Programme environment modules of 1993, 2000, and 2010. Analysis of attitude items indicates technocentric and pessimistic dimensions broadly related to the Dominant Social Paradigm and New Environmental Paradigm. A bi-axial dimension scale is utilized to classify respondents among four environmental knowledge orientations. Discernible and significant patterns are found among countries and their populations. Relationships with other substantial variables in the surveys are discussed and findings show that the majority of industrialized countries are clustered in the rational ecologist categorization with respondents possessing stronger ecological consciousness and optimism towards the role of modern institutions, science, and technology in solving environmental problems. © The Author(s) 2013.

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

PubMed

Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

2014-05-01

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

Public engagement in Malawi through a health-talk radio programme ' Umoyo nkukambirana': A mixed-methods evaluation.

PubMed

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O'byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2018-02-01

Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ' Umoyo nkukambirana' was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings.

Public engagement in Malawi through a health-talk radio programme ‘Umoyo nkukambirana’: A mixed-methods evaluation

PubMed Central

Nyirenda, Deborah; Makawa, Tamara Chipasula; Chapita, Greyson; Mdalla, Chisomo; Nkolokosa, Mzati; O’byrne, Thomasena; Heyderman, Robert; Desmond, Nicola

2016-01-01

Radio is an effective source of health information in many resource poor countries. In Malawi, 53% of households own radios however few radio programmes in Malawi focus on health issues in the context of medical research. An interactive health-talk radio programme ‘Umoyo nkukambirana’ was introduced by Malawi-Liverpool-Wellcome Trust Clinical Research Programme on a national radio station. The aim was to increase awareness of health and medical research, and improve engagement between researchers, healthcare workers and the public. The content and presentation were developed through participatory community consultations. Focus Group Discussions were conducted with established Radio Listening Clubs whilst quantitative data was collected using toll free FrontlineSMS to explore national response. A total of 277 to 695 SMS (Median: 477) were received per theme. The majority of SMS were received from men (64%) and mainly from rural areas (54%). The programme improved knowledge of medical research, health and dispelled misconceptions. This study suggests that the radio may be an effective means of increasing the exposure of men to health information in resource poor settings. PMID:27365364

India mental health country profile.

PubMed

Khandelwal, Sudhir K; Jhingan, Harsh P; Ramesh, S; Gupta, Rajesh K; Srivastava, Vinay K

2004-01-01

India, the second most populated country of the world with a population of 1.027 billion, is a country of contrasts. It is characterized as one of the world's largest industrial nations, yet most of the negative characteristics of poor and developing countries define India too. The population is predominantly rural, and 36% of people still live below poverty line. There is a continuous migration of rural people into urban slums creating major health and economic problems. India is one of the pioneer countries in health services planning with a focus on primary health care. Improvement in the health status of the population has been one of the major thrust areas for social development programmes in the country. However, only a small percentage of the total annual budget is spent on health. Mental health is part of the general health services, and carries no separate budget. The National Mental Health Programme serves practically as the mental health policy. Recently, there was an eight-fold increase in budget allocation for the National Mental Health Programme for the Tenth Five-Year Plan (2002-2007). India is a multicultural traditional society where people visit religious and traditional healers for general and mental health related problems. However, wherever modern health services are available, people do come forward. India has a number of public policy and judicial enactments, which may impact on mental health. These have tried to address the issues of stigma attached to the mental illnesses and the rights of mentally ill people in society. A large number of epidemiological surveys done in India on mental disorders have demonstrated the prevalence of mental morbidity in rural and urban areas of the country; these rates are comparable to global rates. Although India is well placed as far as trained manpower in general health services is concerned, the mental health trained personnel are quite limited, and these are mostly based in urban areas. Considering this, development of mental health services has been linked with general health services and primary health care. Training opportunities for various kinds of mental health personnel are gradually increasing in various academic institutions in the country and recently, there has been a major initiative in the growth of private psychiatric services to fill a vacuum that the public mental health services have been slow to address. A number of non-governmental organizations have also initiated activities related to rehabilitation programmes, human rights of mentally ill people, and school mental health programmes. Despite all these efforts and progress, a lot has still to be done towards all aspects of mental health care in India in respect of training, research, and provision of clinical services to promote mental health in all sections of society.

Global survey of malaria rapid diagnostic test (RDT) sales, procurement and lot verification practices: assessing the use of the WHO-FIND Malaria RDT Evaluation Programme (2011-2014).

PubMed

Incardona, Sandra; Serra-Casas, Elisa; Champouillon, Nora; Nsanzabana, Christian; Cunningham, Jane; González, Iveth J

2017-05-15

Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, and assurance of quality is a key factor to promote good adherence to test results. Since 2007, the World Health Organization (WHO) and the Foundation for Innovative New Diagnostics (FIND) have coordinated a Malaria RDT Evaluation Programme, comprising a pre-purchase performance evaluation (product testing, PT) and a pre-distribution quality control of lots (lot testing, LT), the former being the basis of WHO recommendations for RDT procurement. Comprehensive information on malaria RDTs sold worldwide based on manufacturers' data and linked to independent performance data is currently not available, and detailed knowledge of procurement practices remains limited. The use of the PT/LT Programme results as well as procurement and lot verification practices were assessed through a large-scale survey, gathering product-specific RDT sales and procurement data (2011-14 period) from a total of 32 manufacturers, 12 procurers and 68 National Malaria Control Programmes (NMCPs). Manufacturers' reports showed that RDT sales had more than doubled over the four years, and confirmed a trend towards increased compliance with the WHO procurement criteria (from 83% in 2011 to 93% in 2014). Country-level reports indicated that 74% of NMCPs procured only 'WHO-compliant' RDT products, although procurers' transactions datasets revealed a surprisingly frequent overlap of different products and even product types (e.g., Plasmodium falciparum-only and Plasmodium-pan) in the same year and country (60 and 46% of countries, respectively). Importantly, the proportion of 'non-complying' (i.e., PT low scored or not evaluated) products was found to be higher in the private health care sector than in the public sector (32% vs 5%), and increasing over time (from 22% of private sector sales in 2011 to 39% in 2014). An estimated 70% of the RDT market was covered by the LT programme. The opinion about the PT/LT Programmes was positive overall, and quality of RDTs as per the PT Programme was rated as the number one procurement criteria. This survey provided in-depth information on RDT sales and procurement dynamics, including the largely unstudied private sector, and demonstrated how the WHO-FIND Programme has positively influenced procurement practices in the public sector.

Putting two and two together? Early childhood education, mothers’ employment and care service expansion in Chile and Mexico.

PubMed

Staab, Silke; Gerhard, Roberto

2011-01-01

In recent years, several middle-income countries, including Chile, Mexico and Uruguay, have increased the availability of early childhood education and care (ECEC) services. These developments have received little scholarly attention so far, resulting in the (surely unintended) impression that Latin American social policy is tied to a familialist track, when in reality national and regional trends are more varied and complex. This article looks at recent efforts to expand ECEC services in Chile and Mexico. In spite of similar concerns over low female labour force participation and child welfare, the approaches of the two countries to service expansion have differed significantly. While the Mexican programme aims to kick-start and subsidize home- and community-based care provision, with a training component for childminders, the Chilean programme emphasizes the expansion of professional ECEC services provided in public institutions. By comparing the two programmes, this article shows that differences in policy design have important implications in terms of the opportunities the programmes are able to create for women and children from low-income families, and in terms of the programmes’ impacts on gender and class inequalities. It also ventures some hypotheses about why the two countries may have chosen such different routes.

Research Capacity Strengthening in Low and Middle Income Countries - An Evaluation of the WHO/TDR Career Development Fellowship Programme.

PubMed

Käser, Michael; Maure, Christine; Halpaap, Beatrice M M; Vahedi, Mahnaz; Yamaka, Sara; Launois, Pascal; Casamitjana, Núria

2016-05-01

Between August 2012 and April 2013 the Career Development Fellowship programme of the Special Programme for Research and Training in Tropical Diseases (World Health Organization) underwent an external evaluation to assess its past performance and determine recommendations for future programme development and continuous performance improvement. The programme provides a year-long training experience for qualified researchers from low and middle income countries at pharmaceutical companies or product development partnerships. Independent evaluators from the Swiss Tropical and Public Health Institute and the Barcelona Institute for Global Health used a results-based methodology to review the programme. Data were gathered through document review, surveys, and interviews with a range of programme participants. The final evaluation report found the Career Development Fellowship to be relevant to organizers' and programme objectives, efficient in its operations, and effective in its training scheme, which was found to address needs and gaps for both fellows and their home institutions. Evaluators found that the programme has the potential for impact and sustainability beyond the programme period, especially with the successful reintegration of fellows into their home institutions, through which newly-developed skills can be shared at the institutional level. Recommendations included the development of a scheme to support the re-integration of fellows into their home institutions post-fellowship and to seek partnerships to facilitate the scaling-up of the programme. The impact of the Professional Membership Scheme, an online professional development tool launched through the programme, beyond the scope of the Career Development Fellowship programme itself to other applications, has been identified as a positive unintended outcome. The results of this evaluation may be of interest for other efforts in the field of research capacity strengthening in LMICs or, generally, to other professional development schemes of a similar structure.

A new theme within public health science for increased life quality.

PubMed

Björk, Evastina

2015-08-01

In 2006 the Nordic Council of Ministers concluded that there was need for education and training in how to plan and design society to enable people to live active, independent, and full lives without adding supplementary, segregating adjustments or expensive specialised solutions, especially for the elderly or persons with disabilities. The universal design (UD) concept became a public health issue for all Nordic countries. The first academic educational-training initiative in universal design was initiated at the Nordic School of Public Health (NHV) in 2006. Thereafter, a number of UD courses were held for professionals mainly from the Nordic countries who worked with development and creation of the public arena. In 2011 the first diploma programme in universal design was established at NHV. A new field in public health research was also established and a number of publications in scientific journals, presentations at Nordic and international conferences, together with seminars and workshops have established a solid ground for further development of the field in the Nordic countries. © 2015 the Nordic Societies of Public Health.

Economic and health efficiency of education funding policy.

PubMed

Curtin, T R; Nelson, E A

1999-06-01

Public spending programmes to reduce poverty, expand primary education and improve the economic status of women are recommended priorities of aid agencies and are now gradually being reflected in third world governments' policies, in response to aid conditions imposed by the World Bank and OECD countries. However outcomes fall short of aspiration. This paper shows that donors' lending policies, especially those restricting public spending on education to the primary level, (1) perpetuate poverty, (2) minimise socio-economic impact of public health programmes and (3) prevent significant improvement in the economic status of women. These effects are the result of fundamental flaws in donors' education policy model. Evidence is presented to show that health status in developing countries will be significantly enhanced by increasing the proportion of the population which has at least post-primary education. Heads of households with just primary education have much the same probability of experiencing poverty and high mortality of their children as those with no education at all. Aid donors' policies, which require governments of developing countries to limit public funding of education to the primary level, have their roots in what is contended here to be an erroneous interpretation of human capital theory. This interpretation focuses only on the declining marginal internal rates of return on public investments in successive levels of schooling and ignores the opposite message of the increasing marginal net present values of those investments. Cars do not travel fastest in their lowest gear despite its fastest acceleration, life's long journey is not most comfortable for those with only primary schooling.

Distance learning--an educational tool for developing countries.

PubMed

Dobson, M B

2000-01-01

Many anaesthetists in small hospitals and developing countries have poor access to educational materials. The use of electronic means of publication and distribution, combined with the concepts of distance learning, can lead to better levels of knowledge and clinical practice. A project based on these principles has been set up in Zimbabwe, and is proving helpful to both trainers and trainees. All District Hospitals have been visited, and trainees in them identified. A survey has been completed to identify the subject areas in which training is most necessary. Trainees have been provided with reference materials on CD-ROM which they can access by computer (each hospital has a computer). Specialist anaesthesiologists in the country are producing interactive tutorials which can be sent out by e-mail to every hospital, and these are backed up by a programme of regular visits, seminars and clinical teaching. The programme is proving helpful to both trainees and tutors, and has the potential to be used in the future in other developing countries.

Rural Development and Labour-Intensive Schemes. Impact Studies of Some Pilot Programmes.

ERIC Educational Resources Information Center

Gaude, J.; And Others

1987-01-01

Examines case studies of special public works programs in five countries (Burkina Faso, Burundi, Rwanda, Nepal, and United Republic of Tanzania) that included afforestation projects, anti-erosion works, and the building of reservoirs. Discusses program design, implementation, and impact. (CH)

Comrades' Power: Student Representation and Activism in Universities in Kenya

ERIC Educational Resources Information Center

Macharia, Mwangi J.

2015-01-01

In the last decade, student politics and governance of universities in Kenya and in other African countries have undergone a tremendous transformation. The unprecedented expansion and massification of public universities, the introduction of "Module 2" programmes, the admission of private, "parallel" and…

A comprehensive review of the SLMTA literature part 2: Measuring success.

PubMed

Luman, Elizabeth T; Yao, Katy; Nkengasong, John N

2014-01-01

Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% - 95% reductions in turn-around times, 69% - 93% reductions in specimen rejection rates, 76% - 81% increases in clinician satisfaction rates, 67% - 85% improvements in external quality assessment results, 50% - 66% decreases in nonconformities and 67% increases in staff punctuality. The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion.

Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean.

PubMed

Kelly, J A; Somlai, A M; Benotsch, E G; Amirkhanian, Y A; Fernandez, M I; Stevenson, L Y; Sitzler, C A; McAuliffe, T L; Brown, K D; Opgenorth, K M

2006-01-01

This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention.

Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean

PubMed Central

KELLY, J. A.; SOMLAI, A. M.; BENOTSCH, E. G.; AMIRKHANIAN, Y. A.; FERNANDEZ, M. I.; STEVENSON, L. Y.; SITZLER, C. A.; MCAULIFFE, T. L.; BROWN, K. D.; OPGENORTH, K. M.

2008-01-01

This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention. PMID:16282071

Impact of innovations in national public health markets in Europe.

PubMed

McCarthy, Mark; Alexanderson, Kristina; Voss, Margaretha; Conceição, Claudia; Grimaud, Olivier; Narkauskaité, Laura; Katreniakova, Zuzana; Saliba, Amanda; Sammut, Marvic

2013-11-01

Social innovations can contribute to health and wellbeing. PHIRE (Public Health Innovation and Research in Europe) investigated the impacts at national level of innovation projects funded by the European Union Public Health Programme. Through the European Public Health Association, experts assessed the uptake of the eight public health projects, for 30 European countries. Their reports were assembled by country and, thereafter, national public health associations reviewed the reports. Following stakeholder workshops, or internal and external consultations, 11 national reports were produced which included discussion on the impacts of the public health innovations in national product markets. In 11 countries, there were reports on the eight innovations for 45 (51%) of the possible public health markets. The innovations contributed positively to policy, practice and research, across different levels and in different ways, in 35 (39%) market, while competing innovation activities were recorded in 10 (11%) markets. The workshops also discussed contributing factors and limitations in dissemination and timing for policy cycles. The impacts of European Union social innovations in public health markets can be identified through national discussions. Further attention should be given to understanding drivers and incentives for successful public health innovations.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

PubMed

Ngidi, Wilbroda H; Naidoo, Joanne R; Ncama, Busisiwe P; Luvuno, Zamasomi P B; Mashamba-Thompson, Tivani P

2017-05-29

Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

Food and waterborne infections associated with package holidays.

PubMed

Cartwright, R Y

2003-01-01

The surveillance and prevention of food and waterborne infections in package holiday tourists relies more on common sense and experience rather than evidence based scientific facts. In spite of the major economic value to both sending and receiving countries it is a problem that is largely ignored by health departments at both local and national levels. Package holiday tourism is a growing industry with over 20 million holidays sold every year in the UK. Destinations are in every continent including countries with poorly developed, as well as those with an advanced, public health infrastructure. The incidence of gastrointestinal infection is not reflected in official surveillance programmes as they largely fail to capture information on travel associated infections. Outbreaks of food and waterborne infections in these resorts are largely not investigated. Major British tour operators have responded by developing a crude but effective continuous surveillance system for subjective travellers' diarrhoea. The importance of food and water hygiene is, however, not ignored and proactive preventative programmes are being developed and implemented in some resort as well as by the tourist industry and international agencies. There is a need for further cooperation and partnership between workers in different countries, different disciplines and between the public and private sectors.

Ends versus means: the role of markets in expanding access to contraceptives.

PubMed

Hanson, K; Kumaranayake, L; Thomas, I

2001-06-01

Achieving and sustaining universal access to contraceptives are key policy goals of interventions supplying contraceptive commodities. Donor support for contraceptive supplies is substantial and many public and national programmes rely on donated and subsidized supplies of contraceptives. Sustainability of programme benefits is a concern to both national governments and donor agencies. At the same time, market-based provision of contraceptives has become a major source of contraceptives for individuals in a number of countries. While the goals or 'ends' of policy are to increase and sustain universal access to contraceptives, there is debate about the role of markets and their negative impacts on equity and universality. There is also concern that while public programmes supplying free contraceptives may, in the medium-term, achieve high coverage, they may hamper the achievement of long-term sustainability and the development of commercial markets. This paper focuses on the tension between the public health and market paradigms, and uses economic analysis as a framework in order to examine the relative roles or 'means' for subsidized public and commercial private sector supply of contraceptives. The review of the theory and evidence focuses on the trade-offs between public sector and market provision of contraceptives, examining the role for the public sector given the potential for market failures, the impact of public provision on the development of markets, and the role of price in demand. However, because of the potential conflict between these policy objectives, we argue that strategies to deliver contraceptives should be based on the specific characteristics of the context. In particular four variables (contraceptive prevalence rates, HIV prevalence, income level of country, size and geographic spread of private sector development) are important in characterizing this context, and these are highlighted in a matrix of programme priorities. Public choices need to take into account the ways in which they will affect the potential for development of sustainable private sources of supply. Undertaking a 'market assessment' should be a key stage in the analysis of policy options. Such an assessment should address demand factors, health priorities, actual and potential sources of supply and the relationships between public and private supply. Clearly the development of markets for contraceptives is not an end in itself, but may prove an important means of improving the health of women and men.

Public preferences for vaccination programmes during pandemics caused by pathogens transmitted through respiratory droplets - a discrete choice experiment in four European countries, 2013.

PubMed

Determann, Domino; Korfage, Ida J; Fagerlin, Angela; Steyerberg, Ewout W; Bliemer, Michiel C; Voeten, Helene A; Richardus, Jan Hendrik; Lambooij, Mattijs S; de Bekker-Grob, Esther W

2016-06-02

This study aims to quantify and compare preferences of citizens from different European countries for vaccination programme characteristics during pandemics, caused by pathogens which are transmitted through respiratory droplets. Internet panel members, nationally representative based on age, sex, educational level and region, of four European Union Member States (Netherlands, Poland, Spain, and Sweden, n = 2,068) completed an online discrete choice experiment. These countries, from different geographical areas of Europe, were chosen because of the availability of high-quality Internet panels and because of the cooperation between members of the project entitled Effective Communication in Outbreak Management: development of an evidence-based tool for Europe (ECOM). Data were analysed using panel latent class regression models. In the case of a severe pandemic scenario, vaccine effectiveness was the most important characteristic determining vaccination preference in all countries, followed by the body that advises on vaccination. In Sweden, the advice of family and/or friends and the advice of physicians strongly affected vaccine preferences, in contrast to Poland and Spain, where the advice of (international) health authorities was more decisive. Irrespective of pandemic scenario or vaccination programme characteristics, the predicted vaccination uptakes were lowest in Sweden, and highest in Poland. To increase vaccination uptake during future pandemics, the responsible authorities should align with other important stakeholders in the country and communicate in a coordinated manner.

Are TB control programmes in South Asia ignoring children with disease? A situational analysis.

PubMed

Shakoor, Sadia; Qamar, Farah Naz; Mir, Fatima; Zaidi, Anita; Hasan, Rumina

2015-02-01

Paediatric tuberculosis (TB) has long been an evasive entity for public health practitioners striving to control the disease. Owing to difficulty in diagnosis of paediatric TB, incidence estimates based on current case detection fall short of actual rates. The four high-burden countries in South Asia (SA-HBC)-Afghanistan, Pakistan, India and Bangladesh-alone account for >75% of missed TB cases worldwide. It follows that these countries are also responsible for a large although unmeasured proportion of missed paediatric cases. In view of current Millennium Development Goals recommending a scale-up of paediatric TB detection and management globally, there is a dire need to improve paediatric TB programmes in these high-burden countries. Inherent problems with diagnosis of paediatric TB are compounded by programmatic and social barriers in SA-HBC. We have reviewed the current situation of TB control programmes in SA-HBC countries based on published statistics and performed a strengths, weaknesses, opportunities and threats situational analysis with a view towards identifying critical issues operant in the region posing barriers to improving paediatric TB control. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Civil society engagement in innovation and research through the European Public Health Association.

PubMed

Zeegers Paget, Dineke; Barnhoorn, Floris; McCarthy, Mark; Alexanderson, Kristina; Conceição, Claudia; Devillé, Walter; Grimaud, Olivier; Katreniakova, Zuzana; Narkauskaité, Laura; Saliba, Amanda; Sammut, Marvic; Voss, Margaretha

2013-11-01

The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHA's participative structures. In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances could be made if the European Commission worked more directly with EUPHA's expert members and with the national public health associations.

PROGRAMMES IN PRINT 1966.

ERIC Educational Resources Information Center

CAVANAGH, PETER, COMP., ED.; JONES, CLIVE, COMP., ED.

APPROXIMATELY 1200 PROGRAMS ARE LISTED WITH TITLE, AUTHOR, DATE OF PUBLICATION, PUBLISHER, PRICE, COUNTRY OF ORIGIN, DATE OF LATEST EDITION IF REVISED, MONTHLY RENTAL PRICE, TYPE OF PROGRAM, NUMBER OF FRAMES, NUMBER OF PAGES IF A BOOK PROGRAM, TARGET POPULATION, STUDY TIME, AVAILABILITY FOR MACHINE USE, AND SUPPLEMENTARY MATERIALS WITH THEIR…

Combating Terrorism via the Womb: Empowering Iraqi Women

DTIC Science & Technology

2009-04-01

households that originated in developing countries where it successfully enables women have been forced to be the breadwinners of the extremely...support should not be just financial but should include training programmes [sic] to help women find jobs in the public and private sectors.”23 She

A systematic review of outcome and impact of Master’s in health and health care

PubMed Central

2013-01-01

Background The ‘human resources for health’ crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master’s degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is increasing, but questions have been raised regarding their relevance, outcome and impact. We conducted a systematic review to evaluate the outcomes and impact of health-related master’s degree programmes. Methods We searched the databases Scopus, Pubmed, Embase, CINAHL, ERIC, Psychinfo and Cochrane (1999 - November 2011) and selected websites. All papers describing outcomes and impact of health-related Master programmes were included. Three reviewers, two for each article, extracted data independently. The articles were categorised by type of programme, country, defined outcomes and impact, study methods used and level of evidence, and classified according to outcomes: competencies used in practice, graduates’ career progression and impact on graduates’ workplaces and sector/society. Results Of the 33 articles included in the review, most originated from the US and the UK, and only one from a low-income country. The programmes studied were in public health (8), nursing (8), physiotherapy (5), family practice (4) and other topics (8). Outcomes were defined in less than one third of the articles, and impact was not defined at all. Outcomes and impact were measured by self-reported alumni surveys and qualitative methods. Most articles reported that competencies learned during the programme were applied in the workplace and alumni reported career progression or specific job changes. Some articles reported difficulties in using newly gained competencies in the workplace. There was limited evidence of impact on the workplace. Only two articles reported impact on the sector. Most studies described learning approaches, but very few described a mechanism to ensure outcome and impact of the programme. Conclusions Evidence suggests that graduates apply newly learned competencies in the field and that they progress in their career. There is a paucity of well-designed studies assessing the outcomes and impact of health-related master’s degree programmes in low- and middle-income countries. Studies of such programmes should consider the context and define outcomes and impact. PMID:23388181

The COSPAR Capacity Building Initiative - past, present, future, and highlights

NASA Astrophysics Data System (ADS)

Gabriel, Carlos; Mendez, Mariano; D'Amicis, Raffaella; Santolik, Ondrej; Mathieu, Pierre-Philippe; Smith, Randall

At the time of the COSPAR General Assembly in Moscow, the 21st workshop of the Programme for Capacity Building will have taken place. We have started in 2001 with the aim of: i) increasing the knowledge and use of public archives of space data in developing countries, ii) providing highly-practical instruction in the use of these archives and the associated publicly-available software, and iii) fostering personal links between participants and the experienced scientists who lecture during the workshops and supervise the projects carried on by the students. Workshops in many space disciplines have been successfully held so far (X-ray, Gamma-ray and Space Optical and UV Astronomy, Magnetospheric Physics, Space Oceanography, Remote Sensing and Planetary Science) in thirteen countries (Argentina, Brazil, China, Egypt, India, Indonesia, Malaysia, Morocco, Romania, Russia, South Africa, Thailand and Uruguay). An associated Fellowship Programme is helping former participants of these workshops to build on skills gained at them. We will summarize the past and discuss the present and future of the Programme, including highlights like the most recent one: the identification of a transient magnetar (the 9th object of this class so far discovered) in the vicinity of a supernova by one of our students, during the CB workshop on high-energy Astrophysics in Xuyi, China, in September 2013.

Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries.

PubMed

Hanvoravongchai, Piya; Adisasmito, Wiku; Chau, Pham Ngoc; Conseil, Alexandra; de Sa, Joia; Krumkamp, Ralf; Mounier-Jack, Sandra; Phommasack, Bounlay; Putthasri, Weerasak; Shih, Chin-Shui; Touch, Sok; Coker, Richard

2010-06-08

Since 2003, Asia-Pacific, particularly Southeast Asia, has received substantial attention because of the anticipation that it could be the epicentre of the next pandemic. There has been active investment but earlier review of pandemic preparedness plans in the region reveals that the translation of these strategic plans into operational plans is still lacking in some countries particularly those with low resources. The objective of this study is to understand the pandemic preparedness programmes, the health systems context, and challenges and constraints specific to the six Asian countries namely Cambodia, Indonesia, Lao PDR, Taiwan, Thailand, and Viet Nam in the prepandemic phase before the start of H1N1/2009. The study relied on the Systemic Rapid Assessment (SYSRA) toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response. The study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI) response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored. Health system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints.

Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries

PubMed Central

2010-01-01

Background Since 2003, Asia-Pacific, particularly Southeast Asia, has received substantial attention because of the anticipation that it could be the epicentre of the next pandemic. There has been active investment but earlier review of pandemic preparedness plans in the region reveals that the translation of these strategic plans into operational plans is still lacking in some countries particularly those with low resources. The objective of this study is to understand the pandemic preparedness programmes, the health systems context, and challenges and constraints specific to the six Asian countries namely Cambodia, Indonesia, Lao PDR, Taiwan, Thailand, and Viet Nam in the prepandemic phase before the start of H1N1/2009. Methods The study relied on the Systemic Rapid Assessment (SYSRA) toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response. Results The study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI) response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored. Conclusion Health system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints. PMID:20529345

Health economic decision making in Europe--a new priority for breast cancer advocacy.

PubMed

Knox, Susan

2009-04-01

The lay public, patients and advocates are not usually aware of how decisions are made by health systems, insurers, or governments concerning the availability of medicines provided through national health systems. Today a variety of health economic analyses are undertaken to determine if a particular therapy is cost effective and meets specific criteria to be covered under the national health service programmes. This decision making process is complicated, and in some countries the methodology used is not transparent; these decisions are not adopted in the same way in all countries and often there is no communication or approval required by the public or patient representatives. This is not acceptable from the patient's perspective as effectiveness must remain the criteria and these decisions must be understood and shared in such a way that all stakeholders agree on guidelines for the approval and delivery of new medicines. Other solutions that impact cost need to be explored--new methods of raising funds for research, public health prevention programmes to reduce the burden in future years and increasing health budgets by taxing items that contribute to the cancer burden such as tobacco and alcohol.

Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State

PubMed Central

Salve, Solomon; Sheikh, Kabir; Porter, John DH

2016-01-01

Background: Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. Methods: The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. Results: PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector’s dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as ‘partners with the TB programme.’ Conclusion: Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported. PMID:27801358

Public Trust in Physicians—Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries

PubMed Central

Huang, Ellery Chih-Han; Pu, Christy; Chou, Yiing-Jenq; Huang, Nicole

2018-01-01

Trust in physicians has declined, and surveys of public opinion show a poor level of public trust in physicians. Commodification of health care has been speculated as a plausible driving force. We used cross-national data of 23 countries from the International Social Survey Programme 2011 to quantify health care commodification and study its role in the trust that patients generally place in physicians. A modified health care index was used to quantify health care commodification. There were 34 968 respondents. A question about the level of general trust in physicians and a 4-item “general trust in physicians” scale were used as our major and minor outcomes. The results were that compared with those in the reference countries, the respondents in the health care–commodified countries were approximately half as likely to trust physicians (odds ratio: 0.47, 95% confidence interval [CI]: 0.31-0.72) and scored 1.13 (95% CI: 1.89-0.37) less on the general trust scale. However, trust in physicians in the health care–decommodified countries did not differ from that in the reference countries. In conclusion, health care commodification may play a meaningful role in the deterioration of public trust in physicians. PMID:29502479

Equity, social determinants and public health programmes--the case of oral health.

PubMed

Petersen, Poul Erik; Kwan, Stella

2011-12-01

The WHO Commission on Social Determinants of Health issued the 2008 report 'Closing the gap within a generation - health equity through action on the social determinants of health' in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on 'Equity, Social Determinants and Public Health Programmes', with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined. © 2011 John Wiley & Sons A/S.

Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia

PubMed Central

Mahendradhata, Yodi; Probandari, Ari; Widjanarko, Bagoes; Riono, Pandu; Mustikawati, Dyah; Tiemersma, Edine W.; Alisjahbana, Bachti

2014-01-01

There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme. PMID:25361728

Art Education: An International Survey.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

This study was made within the art education programme adopted by the Unesco General Conference at its fifteenth session. Its purpose is to provide educational administrators, students, teachers and the general public with information showing what countries are thinking and doing about art education. Twelve member nations were selected to reflect…

What Influences Spending on Education? Education Indicators in Focus. No. 46

ERIC Educational Resources Information Center

OECD Publishing, 2016

2016-01-01

The challenge of providing more and better education with tightening public budgets has made governments increasingly interested in the efficient allocation of education resources. Results from the OECD Programme for International Student Assessment (PISA) show that, among countries with a comparatively high gross domestic product (GDP) per…

Engaging Employers in Apprenticeship Opportunities: Making It Happen Locally

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

This joint OECD-ILO publication provides guidance on how local and regional governments can foster business-education partnerships in apprenticeship programmes and other types of work-based learning, drawing on case studies across nine countries. There has been increasing interest in apprenticeships which combine on the job training with…

Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana.

PubMed

Bussmann, Hermann; Wester, C William; Ndwapi, Ndwapi; Vanderwarker, Chris; Gaolathe, Tendani; Tirelo, Geoffrey; Avalos, Ava; Moffat, Howard; Marlink, Richard G

2006-02-01

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care.

Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana.

PubMed Central

Bussmann, Hermann; Wester, C. William; Ndwapi, Ndwapi; Vanderwarker, Chris; Gaolathe, Tendani; Tirelo, Geoffrey; Avalos, Ava; Moffat, Howard; Marlink, Richard G.

2006-01-01

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care. PMID:16501730

How do public health policies tackle alcohol-related harm: a review of 12 developed countries.

PubMed

Crombie, Iain K; Irvine, Linda; Elliott, Lawrence; Wallace, Hilary

2007-01-01

To identify how current public health policies of 12 developed countries assess alcohol-related problems, the goals and targets that are set and the strategic directives proposed. Policy documents on alcohol and on general public heath were obtained through repeated searches of government websites. Documents were reviewed by two independent observers. All the countries studied state that alcohol causes substantial harm to individual health and family well-being, increases crime and social disruption, and results in economic loss through lost productivity. All are concerned about consumption of alcohol by young adults and by heavy and problem drinkers. Few aim to reduce total consumption. Only five of the countries set specific targets for changes in drinking behaviour. Countries vary in their commitment to intervene, particularly on taxation, drink-driving, the drinking environment and for high-risk groups. Australia and New Zealand stand out as having coordinated intervention programmes in most areas. Policies differ markedly in their organization, the goals and targets that are set, the strategic approaches proposed and areas identified for intervention. Most countries could improve their policies by following the recommendations in the World Heath Organization's European Alcohol Action Plan.

A comprehensive review of the SLMTA literature part 2: Measuring success

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. Objective We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. Methods We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Results Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% – 95% reductions in turn-around times, 69% – 93% reductions in specimen rejection rates, 76% – 81% increases in clinician satisfaction rates, 67% – 85% improvements in external quality assessment results, 50% – 66% decreases in nonconformities and 67% increases in staff punctuality. Conclusions The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion. PMID:29043201

Health surveillance for former asbestos exposed worker: a specific programme developed in an Italian region

PubMed Central

Battisti, Francesca; Cristaudo, Alfonso; Sartorelli, Pietro; Calà, Piergiuseppe

2018-01-01

Asbestos-related diseases usually have a long latency since first exposure and this legitimates a health surveillance programme addressed to asbestos workers after the cessation of their occupational exposure. After a brief history of health surveillance initiatives performed in Italy as well as in other countries, we describe a regional programme for former asbestos-exposed workers, focusing on organizational features. A regional group of experts defined its operational and economical aspects. The Regional Council supported the whole programme, making it free of charge for all subjects who fulfil the predefined enrolment criteria (being resident in the region, being younger than 80 years old with cessation of occupational asbestos exposure within the last 30 years). The programme activities are classified in two levels: a first level for a basic health evaluation and a second level for in-depth analyses. In order to guarantee an homogeneous delivery in the whole region, the programme has to be performed by public health services with a quality control of activities. The involvement of specific public health services and the cooperation of social stakeholders are expected to play a major role in overcoming still open critical issues, such as the lack of programme existence awareness and adhesion, the correct stratification of subjects for the follow-up, and the real homogeneous delivery of the health surveillance in whole region. PMID:29507808

A Scientometric Evaluation of the Chagas Disease Implementation Research Programme of the PAHO and TDR

PubMed Central

Carbajal-de-la-Fuente, Ana Laura; Yadón, Zaida E.

2013-01-01

The Special Programme for Research and Training in Tropical Diseases (TDR) is an independent global programme of scientific collaboration cosponsored by the United Nations Children's Fund, the United Nations Development Program, the World Bank, and the World Health Organization. TDR's strategy is based on stewardship for research on infectious diseases of poverty, empowerment of endemic countries, research on neglected priority needs, and the promotion of scientific collaboration influencing global efforts to combat major tropical diseases. In 2001, in view of the achievements obtained in the reduction of transmission of Chagas disease through the Southern Cone Initiative and the improvement in Chagas disease control activities in some countries of the Andean and the Central American Initiatives, TDR transferred the Chagas Disease Implementation Research Programme (CIRP) to the Communicable Diseases Unit of the Pan American Health Organization (CD/PAHO). This paper presents a scientometric evaluation of the 73 projects from 18 Latin American and European countries that were granted by CIRP/PAHO/TDR between 1997 and 2007. We analyzed all final reports of the funded projects and scientific publications, technical reports, and human resource training activities derived from them. Results about the number of projects funded, countries and institutions involved, gender analysis, number of published papers in indexed scientific journals, main topics funded, patents inscribed, and triatomine species studied are presented and discussed. The results indicate that CIRP/PAHO/TDR initiative has contributed significantly, over the 1997–2007 period, to Chagas disease knowledge as well as to the individual and institutional-building capacity. PMID:24244761

Heart failure management programmes in Europe.

PubMed

Jaarsma, T; Strömberg, A; De Geest, S; Fridlund, B; Heikkila, J; Mårtensson, J; Moons, P; Scholte op Reimer, W; Smith, K; Stewart, S; Thompson, D R

2006-09-01

The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

AED in Europe. Report on a survey.

PubMed

Bahr, Jan; Bossaert, Leo; Handley, Anthony; Koster, Ruud; Vissers, Bart; Monsieurs, Koen

2010-02-01

Based on the strategies for community defibrillation defined by a joint policy conference of ESC and ERC, we have conducted a survey to identify the current status of AED programmes in Europe. All registered visitors to the website of the ERC were contacted by e-mail and invited to participate in a web-based survey. Of the 983 usable responses, 899 came from 36 European countries, representing a total of 748 million inhabitants. In 11 countries AED use by non-physicians has been implemented partially. All but 3 countries reported that first-tier ambulances are equipped with defibrillators. In 13 countries everybody is allowed to use an AED and in 11 countries anybody who has been trained. In 14 countries there are a few community responder programmes, in 14 countries there are hardly any, and in 7 countries there are none. Thirteen countries have implemented a few on-site responder programmes; in 16 countries there are hardly any such programmes, and in 7 countries none. Programmes for home responders can hardly be found in 19 countries; in-hospital programmes exist in 7 countries nearly everywhere. Only 1 country reported that epidemiologic and/or economic evaluations are carried out nearly everywhere when planning AED programmes. Nationwide registries to collect data from resuscitation attempts have been set up in 4 countries. In 27 countries inventories for AEDs can be found here and there. Much has been achieved concerning the provision and use of AEDs in Europe, but there is still a long way to go. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

The challenges of starting a cochlear implant programme in a developing country.

PubMed

Krishnamoorthy, Kumaresh; Samy, Ravi N; Shoman, Nael

2014-10-01

Deafness is indeed a silent disability in many parts of the world, and the majority of people who have hearing impairment live in developing countries. With rising economy and developing nations becoming hub of industrialization, hearing loss may increase in these countries. In this review, the authors have elected to focus the discussion on India to frame the challenges of cochlear implants in a developing country. This article reviews the common causes of hearing loss, the challenges faced by those with hearing impairment and why the penetration of these devices is low and also reviews some reasons for the inability of the government to support the implant programme in India. Early identification of hearing is crucial towards ensuring appropriate hearing rehabilitation; it is, however, challenged by various factors, including public awareness, absence of a national new born screening programme, accessibility to diagnostic centres, availability of trained personnel and equipment and patient affordability. Cochlear implants are a proven auditory rehabilitative option for individuals with severe to profound sensorineural hearing loss, who otherwise do not benefiting from hearing aids. Nevertheless, only a small percentage of these individuals receive cochlear implants, and cost remains a leading prohibitive factor, particularly in developing countries. For example, in India, the personal average annual income is well below US $2000, whereas these devices cost between $12,000 and $25,000, exclusive of hospital and staff fees. Hence, the technology is virtually unavailable to the masses. To overcome the cost limitation of those who would benefit from cochlear implants countries such as India and China have started to develop their own indigenous implants.

Immunisation Information Systems – useful tools for monitoring vaccination programmes in EU/EEA countries, 2016

PubMed Central

Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

2017-01-01

Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. PMID:28488999

Immunisation Information Systems - useful tools for monitoring vaccination programmes in EU/EEA countries, 2016.

PubMed

Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

2017-04-27

Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. This article is copyright of The Authors, 2017.

Outreach Programmes for Education and Training: Contributions from the International Cartographic Association

NASA Astrophysics Data System (ADS)

Cartwright, W. E.; Fairbairn, D.

2012-07-01

Organisations like the International Cartographic Association champion programmes that develop and deliver education and training to cartographers and geospatial scientists, globally. This can be in the form of traditional university and training college programmes, short courses for professional and technical members of mapping agencies and as outreach initiatives to transfer knowledge about the discipline and its contemporary practices. Through its international community, the ICA undertakes the transfer of knowledge about cartography and GI Science by publishing books and special editions of journals and running workshops. Colleagues from the ICA community conduct these workshops on a volunteer basis, generally with the support of the national member organisation of ICA or the national mapping body. For example, the ICA promotes the generation of extensive publications, generally through its Commissions and Working Groups. The publications include books, journals and the ICA Newsletter. Outreach activities are especially pertinent to up skill colleagues from developing countries. Specialist programmes can be offered for professional and 'everyday' map users (from adults to children). The ICA can assist with its current programmes, designed to embrace professional and non-professional cartographers alike. This paper will address how education and outreach programmes can be supported by international associations, by offering programmes independently, or in partnership with sister associations and national and regional organisations and societies. As well, the paper will address the need to deliver education and outreach programmes not to just the professional international community, but also to map users and citizen map publishers.

Maxillofacial prostheses challenges in resource constrained regions.

PubMed

Tetteh, Sophia; Bibb, Richard J; Martin, Simon J

2017-10-24

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations. A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries. Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach. In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

International Directory of Music Education Institutions.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

This directory is designed for students, teachers, and members of the general public throughout the world who plan to visit or study in other countries, and who desire information concerning available educational programmes and events in the field of music. A world-wide survey was made in which information was collected from seventy-one countries…

School Buildings in Today's Crisis

ERIC Educational Resources Information Center

Blyth, Alastair

2009-01-01

To get a picture of the impact of the current economic and financial crisis on educational building programmes so far, the OECD Centre for Effective Learning Environments (CELE) has been conducting a survey of member countries and regions. The survey focuses on three main issues: the impact of the crisis on publicly funded projects, the impact on…

A situational analysis of pharmacovigilance plans in the Global Fund Malaria and U.S. President's Malaria Initiative proposals.

PubMed

Stergachis, Andy; Bartlein, Rebecca J K; Dodoo, Alexander; Nwokike, Jude; Kachur, S Patrick

2010-05-30

Pharmacovigilance programmes can monitor and help ensure the safe use of medicines that are critical to the success of global public health programmes. The widespread deployment of artemisinin-based combination therapy (ACT) by national malaria control programmes as part of the overall Global Malaria Action Plan for malaria control to elimination and eradication makes ACT an excellent candidate for pharmacovigilance activities. In 2008, The Roll Back Malaria partnership issued guidelines for inclusion of pharmacovigilance in Global Fund and other related proposals. In light of this recommendation and the rapid scale-up of ACT worldwide, an analysis of Global Fund Round 8 proposals and the President's Malaria Initiative (PMI) 2009 Malaria Operational Plans was conducted to assess if and how pharmacovigilance has been incorporated into countries' national malaria plans and donor budget requests. The Global Fund-Malaria Round 8 proposals for the 26 countries and the PMI Malaria Operational Plans (MOPs) for fiscal year 2009 for the 15 countries that were approved and received funding from either the Global Fund-Malaria Round 8 or PMI were accessed through the programme websites. The analysis consisted of conducting word counts and key word in context analyses of each proposal and plan. Twelve out of 26 (46%) of the Global Fund proposals mentioned that established pharmacovigilance systems were present in their countries. Four of the fifteen PMI MOPs (27%) mentioned that established pharmacovigilance systems were present in their countries. Only seven of the 26 (27%) Global Fund proposals included a request for funding for new or current pharmacovigilance activities. Seven of 15 (47%) MOPs included a request for funding for pharmacovigilance activities. There were relatively few requests for funding for pharmacovigilance activities, demonstrating a lack of emphasis placed on pharmacovigilance systems in recipient countries. The findings stress the need for more active direction to strengthen active surveillance and passive adverse event reporting systems to augment the issuance of guidance documents.

Gastrointestinal helminthiasis presenting with acute diarrhoea and constipation: report of two cases with a second pathology.

PubMed

Sobani, Z A; Shakoor, S; Malik, F N; Malik, E Z; Beg, M A

2010-08-01

Gastrointestinal helminthiasis in developing countries contributes to malnutrition and anemia. Diagnosis and treatment of helminthiasis, especially with low worm load is an unmet public health need in such settings. The infection may sometimes become manifest when a second pathology leads to purgation of the gastrointestinal tract. Two cases of helminthiasis are presented in which the infections only became amenable to diagnosis due to acute diarrhoea caused by giardiasis and lactulose administration. In the first case, acute giardiasis revealed Ascaris lumbricoides infestation, and in the second case primary helminthiasis (strongyloidiasis) was revealed by lactulose, and also led to Vibrio cholera bacteremia. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes.

Echinococcosis/hydatidosis: a severe threat in Mediterranean countries.

PubMed

Dakkak, A

2010-11-24

Echinococcosis/hydatidosis is one of the most important parasitic zoonotic diseases in the world. Both cystic hydatidosis (CE) caused by Echinococcus granulosus and alveolar echinococcosis (AE) caused by E. multilocularis have been reported in several countries of the Mediterranean region (MR). E. granulosus has always been present in the MR and is the most common species. This parasite depends on the dog-sheep cycle and is actively transmitted in all pastoral regions where sheep, cattle and camelids predominate. E. multilocularis occurs only sporadically in limited areas of France, Serbia and Montenegro, Turkey, Tunisia and Morocco. However recent evidence indicates that it is spreading into other regions of the Mediterranean. Due to the lack of well-documented data, and to the fact that CE is not a notifiable disease in the majority of M countries, the precise incidence and prevalence of CE in humans and animals are not known. Published data suggests that prevalence is rather high in North Africa, Turkey, Greece, and in several regions of Italy and Spain. CE is an increasing public health and socio-economic concern due to the considerable morbidity rates that give rise to high economic losses both in the public health sector and in the livestock industry. Hospitalisation for human CE lasts from 2 weeks to more than 1 month in case of surgery. A number of factors contribute to the increase of prevalence and to the spreading of CE in the MR. These include the diversity of livestock production systems (predominantly extensive, traditional animal husbandry), small, ill-equipped and unsupervised slaughter-houses, illegal and family slaughtering, low public awareness of hydatid diseases, and the high population of stray dogs. Cyprus is the only country where an eradication programme has been successfully implemented. There have been, however, important developments in the last decade in CE epidemiology, in the diagnosis of canine infection, in strain characterisation and in immune strategies against CE in animals. This scientific progress, together with effective health education programmes, will likely improve control programmes and reduce the time required to achieve significant decreases in prevalence or eradication. Copyright © 2010 Elsevier B.V. All rights reserved.

A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control

PubMed Central

2011-01-01

Introduction The STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives. Methods We undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives. Results Twelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were the dominant category. The literature review yielded information on 22 projects in which 'private-for-profit qualified clinical providers' were again the dominant category. The contributions made by 'private-for-profit qualified clinical providers' and 'Non Governmental Organisation qualified clinical providers', were assessed against the four global PPM objectives. Reporting on tuberculosis case detection and treatment outcomes was generally good and demonstrated important PPM contributions in these areas. Reporting on equity, access and reduced patient costs was often lacking or inconclusive. Conclusions PPM has improved case detection and treatment outcomes among patients seeking care with private providers. Evidence on reducing patient costs is inconclusive, and there is scope for increasing equity in access to care by systematically engaging those providers who are the primary agents for poor people seeking health care. Guidelines outlining which types of providers best contribute to achieving the four global objectives, along with the resources required by National Tuberculosis Programs for such engagement is needed. PMID:22074377

Screening for Infectious Diseases among Newly Arrived Migrants in EU/EEA Countries—Varying Practices but Consensus on the Utility of Screening

PubMed Central

Kärki, Tommi; Napoli, Christian; Riccardo, Flavia; Fabiani, Massimo; Dente, Maria Grazia; Carballo, Manuel; Noori, Teymur; Declich, Silvia

2014-01-01

Screening is one possible tool for monitoring infectious diseases among migrants. However, there is limited information on screening programmes targeted for newly arrived migrants in EU/EEA countries. Our aim was to investigate the implementation, practices and usefulness of these programmes. We conducted a survey among country experts from EU/EEA countries and Switzerland, asking whether their countries had implemented screening programmes. We also estimated the association between the implementation of these programmes and the rate of asylum-seekers in the population. Of the countries, 16 (59%) had implemented screening programmes and 15 (56%) had national guidelines. The rate of asylum-seekers was associated with implementation of screening programmes (p = 0.014). Screening was performed most often for tuberculosis; most commonly on holding level, and was targeted to specific migrant groups in over half of the countries performing screening. Twenty-five of all the country experts (96%) considered screening among migrants useful, and 24 (92%) would welcome EU level guidelines for screening. The implementation of screening programmes varied, and the practices were different among countries. Our survey suggests, that establishing EU level guidelines for screening would be useful, although they would have to take into account differences between individual countries. PMID:25337945

The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

PubMed

Howard, N; Mounier-Jack, S; Gallagher, K E; Kabakama, S; Griffiths, U K; Feletto, M; LaMontagne, D S; Burchett, H E D; Watson-Jones, D

2016-09-01

Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.

Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view.

PubMed

Solomons, Noel W

2005-07-01

Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of "evidence-based" policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes.

Intergenerational influences on child growth and undernutrition.

PubMed

Martorell, Reynaldo; Zongrone, Amanda

2012-07-01

Intergenerational effects on linear growth are well documented. Several generations are necessary in animal models to 'wash out' effects of undernutrition, consistent with the unfolding of the secular trend in height in Europe and North America. Birthweight is correlated across generations and short maternal stature, which reflects intrauterine and infant growth failure, is associated with low birthweight, child stunting, delivery complications and increased child mortality, even after adjusting for socio-economic status. A nutrition intervention in Guatemala reduced childhood stunting; it also improved growth of the next generation, but only in the offspring of girls. Possible mechanisms explaining intergenerational effects on linear growth are not mutually exclusive and include, among others, shared genetic characteristics, epigenetic effects, programming of metabolic changes, and the mechanics of a reduced space for the fetus to grow. There are also socio-cultural factors at play that are important such as the intergenerational transmission of poverty and the fear of birthing a large baby, which leads to 'eating down' during pregnancy. It is not clear whether there is an upper limit for impact on intrauterine and infant linear growth that programmes in developing countries could achieve that is set by early childhood malnutrition in the mother. Substantial improvements in linear growth can be achieved through adoption and migration, and in a few selected countries, following rapid economic and social development. It would seem, despite clear documentation of intergenerational effects, that nearly normal lengths can be achieved in children born to mothers who were malnourished in childhood when profound improvements in health, nutrition and the environment take place before conception. To achieve similar levels of impact through public health programmes alone in poor countries is highly unlikely. The reality in poor countries limits the scope, quality and coverage of programmes that can be implemented and modest impact should be expected instead. The Lancet series on Maternal and Child Undernutrition estimated that implementation to scale of proven interventions in high burden countries would reduce stunting by one-third; this is perhaps a realistic upper bound for impact for high quality programmes, unless accompanied by sweeping improvements in social services and marked reductions in poverty. Finally, because so much can be achieved in a single generation, intergenerational influences are unlikely to be an important explanation for lack of programme impact aimed at the window of the first 1000 days. Failure to prevent linear growth failure in developing countries has serious consequences for short- and long-term health as well as for the formation of human capital. The nutrition transition has created a double burden by adding obesity and related chronic diseases to the public health agenda of countries still struggling with the 'old' problems of maternal and child undernutrition. The challenge ahead is to increase efforts to prevent linear growth failure while keeping child overweight at bay. © 2012 Blackwell Publishing Ltd.

Obesity and poverty paradox in developed countries.

PubMed

Żukiewicz-Sobczak, Wioletta; Wróblewska, Paula; Zwoliński, Jacek; Chmielewska-Badora, Jolanta; Adamczuk, Piotr; Krasowska, Ewelina; Zagórski, Jerzy; Oniszczuk, Anna; Piątek, Jacek; Silny, Wojciech

2014-01-01

Obesity is a civilization disease and the proportion of people suffering from it continues to grow, especially in the developed countries. Number of obese people in Europe has increased threefold over the last 20 years. The paradox of obesity and poverty relationship is observed especially in the developed and developing countries. In developing countries, along with economic development and income growth, the number of people with overweight and obesity is increasing. This paradox has a relationship with both the easy availability and low cost of highly processed foods containing 'empty calories' and no nutritional value. To date, this paradox has been described in the United States and the United Kingdom, although many European countries are also experiencing high percentages of obese people. Among the reasons for the growing obesity in the population of poor people are: higher unemployment, lower education level, and irregular meals. Another cause of obesity is low physical activity, which among the poor is associated with a lack of money for sports equipment. Due to the large rate of deaths caused by diseases directly linked to obesity, the governments of many countries implement prevention programmes of overweight and obesity. These programmes are based primarily on educating the public about a healthy lifestyle based on healthy eating, daily physical activity and avoiding alcohol and cigarettes.

Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: the case of Mexico.

PubMed

Grogger, Jeffrey; Arnold, Tamara; León, Ana Sofía; Ome, Alejandro

2015-06-01

Low- and middle-income countries increasingly provide broad-based public health coverage to their residents. One of the goals of such programmes is to reduce the extent to which beneficiaries incur catastrophic out-of-pocket expenditures on health care. A recent field experiment showed that on average Mexico's new public insurance programme reduced such expenditures in rural areas. Our reanalysis of that data, augmented with administrative data on health infrastructure, shows that this effect depends strongly on the type of health facility to which the beneficiary has access. A second analysis, based on data from Mexico's National Household Income and Expenditure Surveys (abbreviated ENIGH for its name in Spanish), substantiates those findings. It shows that catastrophic expenditures have fallen sharply for rural households with access to well-staffed facilities, but that they have fallen little if at all for rural households with access to poorly staffed facilities. Our analysis of the ENIGH also shows that Mexico's public health insurance programme has sharply reduced catastrophic spending among urban households. Considering that most Mexicans live either in urban areas or in rural areas with access to well-staffed facilities, our results show that the public health insurance programme has been largely successful in achieving one of its key goals. At the same time, our results show how difficult it can be to provide effective protection against catastrophic health expenditures for residents of remote rural areas. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Communicating astronomy with the public in Cuba

NASA Astrophysics Data System (ADS)

Alvarez, O.

2008-06-01

Communicating astronomy with the public to produce attractive materials for a broad audience on TV is a difficult job in a third world country. One way of developing effective communication in fields like astronomy, astrophysics, and cosmology whilst connecting the professional astronomer with a majority of the people is to combine the knowledge of the scientist with the most spectacular TV production methods of first world countries: integrating, through commentary and analysis, astronomy and science into the public debate of lay citizens. Here I present my ten years of experience of presenting a TV programme devoted to general science outreach. I also comment on the progress of the construction of the new planetarium, a cultural centre for science and technology, to be opened as part of the commemoration activities for the 2009 International Year of Astronomy. It is hoped to guide the interest of the people of Cuba towards basic science and astronomy in the most populated and frequented area of the country.

Meeting the requirements of importing countries: practice and policy for on-farm approaches to food safety.

PubMed

Dagg, P J; Butler, R J; Murray, J G; Biddle, R R

2006-08-01

In light of the increasing consumer demand for safe, high-quality food and recent public health concerns about food-borne illness, governments and agricultural industries are under pressure to provide comprehensive food safety policies and programmes consistent with international best practice. Countries that export food commodities derived from livestock must meet both the requirements of the importing country and domestic standards. It is internationally accepted that end-product quality control, and similar methods aimed at ensuring food safety, cannot adequately ensure the safety of the final product. To achieve an acceptable level of food safety, governments and the agricultural industry must work collaboratively to provide quality assurance systems, based on sound risk management principles, throughout the food supply chain. Quality assurance systems on livestock farms, as in other parts of the food supply chain, should address food safety using hazard analysis critical control point principles. These systems should target areas including biosecurity, disease monitoring and reporting, feedstuff safety, the safe use of agricultural and veterinary chemicals, the control of potential food-borne pathogens and traceability. They should also be supported by accredited training programmes, which award certification on completion, and auditing programmes to ensure that both local and internationally recognised guidelines and standards continue to be met. This paper discusses the development of policies for on-farm food safety measures and their practical implementation in the context of quality assurance programmes, using the Australian beef industry as a case study.

A new method for developing compassionate communities and cities movement-"Todos Contigo" Programme (We are All With You): experience in Spain and Latin America countries.

PubMed

Librada Flores, Silvia

2018-01-01

Todos Contigo (We are All With You) is a programme for social awareness, training, and implementation of care networks for citizens to support, accompany and care for those who face advanced chronic disease and end of life situations. From New Health Foundation this programme collaborates with the Public Health and Palliative Care International Charter of Compassionate Communities. It seeks to promote a new integrated palliative care model in the daily lives of individuals, to make families and health/social professionals the main promoters of compassionate communities and compassionate cities movement. This workshop aims to: (I) describe the methodology of the programme: required tools and steps for building and developing a compassionate city or community; (II) identify stakeholders and organizations to join the compassionate community as networking agents; (III) sharing experiences from the implementation of this project in various contexts while providing specific examples and lessons learned from the perspective of various roles; (IV) explain the process of becoming a part of the project and of getting the official recognition for being a compassionate city. This workshop aims to share a new methodology "Todos Contigo" (We are all with you) Programme for the development of compassionate communities and cities movement. We describe our experiences in Spain and Latin American countries. The method is based on creating community networks, carrying out social awareness and training programmes related to end of life care.

Unemployment insurance and deteriorating self-rated health in 23 European countries.

PubMed

Ferrarini, Tommy; Nelson, Kenneth; Sjöberg, Ola

2014-07-01

The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe. Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009. Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment. Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The role and utilisation of public health evaluations in Europe: a case study of national hand hygiene campaigns

PubMed Central

2014-01-01

Background Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention. Methods A cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States. Results Thirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation. Conclusion The study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health. PMID:24507086

Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines.

PubMed

Larson, Heidi J; Smith, David M D; Paterson, Pauline; Cumming, Melissa; Eckersberger, Elisabeth; Freifeld, Clark C; Ghinai, Isaac; Jarrett, Caitlin; Paushter, Louisa; Brownstein, John S; Madoff, Lawrence C

2013-07-01

The intensity, spread, and effects of public opinion about vaccines are growing as new modes of communication speed up information sharing, contributing to vaccine hesitancy, refusals, and disease outbreaks. We aimed to develop a new application of existing surveillance systems to detect and characterise early signs of vaccine issues. We also aimed to develop a typology of concerns and a way to assess the priority of each concern. Following preliminary research by The Vaccine Confidence Project, media reports (eg, online articles, blogs, government reports) were obtained using the HealthMap automated data collection system, adapted to monitor online reports about vaccines, vaccination programmes, and vaccine-preventable diseases. Any reports that did not meet the inclusion criteria--any reference to a human vaccine or vaccination campaign or programme that was accessible online--were removed from analysis. Reports were manually analysed for content and categorised by concerns, vaccine, disease, location, and source of report, and overall positive or negative sentiment towards vaccines. They were then given a priority level depending on the seriousness of the reported event and time of event occurrence. We used descriptive statistics to analyse the data collected during a period of 1 year, after refinements to the search terms and processes had been made. We analysed data from 10,380 reports (from 144 countries) obtained between May 1, 2011, and April 30, 2012. 7171 (69%) contained positive or neutral content and 3209 (31%) contained negative content. Of the negative reports, 1977 (24%) were associated with impacts on vaccine programmes and disease outbreaks; 1726 (21%) with beliefs, awareness, and perceptions; 1371 (16%) with vaccine safety; and 1336 (16%) with vaccine delivery programmes. We were able to disaggregate the data by country and vaccine type, and monitor evolution of events over time and location in specific regions where vaccine concerns were high. Real-time monitoring and analysis of vaccine concerns over time and location could help immunisation programmes to tailor more effective and timely strategies to address specific public concerns. Bill & Melinda Gates Foundation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Review: interventions to increase influenza vaccination among healthcare workers in hospitals

PubMed Central

Hollmeyer, Helge; Hayden, Frederick; Mounts, Anthony; Buchholz, Udo

2012-01-01

Please cite this paper as: Hollmeyer et al. (2012) Review: interventions to increase influenza vaccination among healthcare workers in hospitals. Influenza and Other Respiratory Viruses 7(4), 604–621. Annual influenza vaccination rates among hospital healthcare workers (HCW) are almost universally low despite recommendations from WHO and public health authorities in many countries. To assist in the development of successful vaccination programmes, we reviewed studies where interventions aimed to increase the uptake of influenza vaccination among hospital HCW. We searched PUBMED from 1990 up to December 2011 for publications with predetermined search strategies and of pre‐defined criteria for inclusion or exclusion. We evaluated a large number of ‘intervention programmes’ each employing one or more ‘intervention components’ or strategies, such as easy access to vaccine or educational activities, with the goal to raise influenza vaccine uptake rates in hospital HCW during one influenza season. Included studies reported results of intervention programmes and compared the uptake with the season prior to the intervention (historical control) or to another intervention programme within the same season that started from the same set of baseline activities. Twenty‐five studies performed in eight countries met our selection criteria and described 45 distinct intervention programmes. Most studies used their own facility as historical control and evaluated only one season. The following elements were used in intervention programmes that increased vaccine uptake: provision of free vaccine, easy access to the vaccine (e.g. through mobile carts or on‐site vaccination), knowledge and behaviour modification through educational activities and/or reminders and/or incentives, management or organizational changes, such as the assignment of personnel dedicated to the intervention programme, long‐term implementation of the strategy, requiring active declination and mandatory immunization policies. The number of these components applied appeared to be proportional to the increase in uptake. If influenza uptake in hospital HCW is to be increased on sustained basis, hospital managers need to be committed to conduct a well‐designed long‐term intervention programme that includes a variety of co‐ordinated managerial and organizational elements. PMID:22984794

PISA Lends Legitimacy: A Study of Education Policy Changes in Germany and Sweden after 2000

ERIC Educational Resources Information Center

Ringarp, Johanna

2016-01-01

School issues have become increasingly important in public elections and political debates, leading to increased focus on the results students achieve in international large-scale assessments and in the rankings of the involved countries. One of the most important studies of scholastic performance is the Programme for International Student…

Student Perceptions of New Differentiation Policies in Swedish Post-16 Education

ERIC Educational Resources Information Center

Arreeman, Inger Erixon

2014-01-01

In Sweden, and in most other Organisation for Economic Co-operation and Development (OECD) countries, post-16 education is a general requirement to succeed in adult life. By the late 2000s, after about two decades of policies for student choice and publicly funded free schools, students' results in the Programme for International Student…

The United Nations and One Health: the International Health Regulations (2005) and global health security.

PubMed

Nuttall, I; Miyagishima, K; Roth, C; de La Rocque, S

2014-08-01

The One Health approach encompasses multiple themes and can be understood from many different perspectives. This paper expresses the viewpoint of those in charge of responding to public health events of international concern and, in particular, to outbreaks of zoonotic disease. Several international organisations are involved in responding to such outbreaks, including the United Nations (UN) and its technical agencies; principally, the Food and Agriculture Organization of the UN (FAO) and the World Health Organization (WHO); UN funds and programmes, such as the United Nations Development Programme, the World Food Programme, the United Nations Environment Programme, the United Nations Children's Fund; the UN-linked multilateral banking system (the World Bank and regional development banks); and partner organisations, such as the World Organisation for Animal Health (OIE). All of these organisations have benefited from the experiences gained during zoonotic disease outbreaks over the last decade, developing common approaches and mechanisms to foster good governance, promote policies that cut across different sectors, target investment more effectively and strengthen global and national capacities for dealing with emerging crises. Coordination among the various UN agencies and creating partnerships with related organisations have helped to improve disease surveillance in all countries, enabling more efficient detection of disease outbreaks and a faster response, greater transparency and stakeholder engagement and improved public health. The need to build more robust national public human and animal health systems, which are based on good governance and comply with the International Health Regulations (2005) and the international standards set by the OIE, prompted FAO, WHO and the OIE to join forces with the World Bank, to provide practical tools to help countries manage their zoonotic disease risks and develop adequate resources to prevent and control disease outbreaks, particularly at the animal source. All these efforts contribute to the One Health agenda.

Effective promotion of healthy nutrition and physical activity in Europe requires skilled and competent people; European Master's Programme in Public Health Nutrition.

PubMed

Yngve, A; Sjöström, M; Warm, D; Margetts, B; Rodrigo, C P; Nissinen, A

1999-09-01

Scientists in basic research and epidemiology deliver messages to policy makers. Effective population based strategies then require people trained and competent in the discipline of Public Health Nutrition (PHN). Since 1997, a European Master's Programme in PHN has been undergoing planning and implementation with the aid of funding from the European Commission (DGV). PHN is used as a broad term covering Nutrition and Physical Activity as well as Health Promotion and Disease Prevention. The partners in this project are academic departments from 17 countries. The students will undertake core modules and electives for a year and a half, followed by a research project for six months. In order to set up formalised procedures for the evaluation of the quality assurance of individual modules from across Europe, a quality assurance system has been set up. The academic year 1999-2000 will allow an opportunity for Universities and Institutes to start new modules, to develop other modules, assess the movement of students between modules, tackle funding issues and allow further marketing of the programme. Future activities include strengthening of the European Network for Public Health Nutrition (ENPHN), the establishment of a consortium with universities, the co-ordination of programme activities with other European Master's Programmes in Public Health, and the incorporation of new Member States from Eastern Europe. We can look forward to a new brand of professionals, who are truly European in their training, but who also have an integrated view of nutrition and physical activity, health promotion and disease prevention and who are prepared for policy making, action planning, implementation and evaluation.

Clinical experience with the meningococcal B vaccine, Bexsero(®): Prospects for reducing the burden of meningococcal serogroup B disease.

PubMed

Watson, Philip S; Turner, David P J

2016-02-10

Although rare, invasive meningococcal disease remains an important cause of mortality and morbidity in children and young adults. Vaccines have been successfully introduced to help protect against meningococcal disease caused by serogroups A, C, W and Y, but until recently, a vaccine for serogroup B (MenB) was not available. In many industrialised countries, MenB causes the majority of meningococcal disease. Moreover, MenB outbreaks occur unpredictably, particularly in high-risk populations, such as university students. In 2013, Bexsero(®) became the first broad-coverage vaccine to be licensed for active immunisation against MenB disease. Bexsero is now licensed in more than 35 countries worldwide for varying age groups, including the EU, Australia, Brazil, Canada, Chile, Uruguay and the USA. Clinical recommendations for the use of Bexsero have been published in several countries. Recommendations include use in high-risk groups, outbreak control and routine infant immunisation. Since initial licensure, considerable clinical experience has been gained. In Canada, 43,740 individuals received Bexsero during a vaccination programme in the Saguenay-Lac-Saint-Jean region of Quebec, where local disease incidence was high. In the USA, Bexsero was administered to >15,000 individuals during two college outbreaks prior to licensure, under an Investigational New Drug protocol. In the UK, the Joint Committee on Vaccination and Immunisation has recommended the inclusion of Bexsero in the routine immunisation schedule for infants. Publically funded vaccination programmes have been initiated in Italy, and there has been widespread use of the vaccine outside of publically reimbursed programmes. Overall, >1,000,000 doses of Bexsero have been distributed in 19 countries worldwide since 2013. The emerging clinical experience with Bexsero is consistent with findings from pre-licensure clinical studies, and no new safety concerns have been identified. Additional data on length of protection, potential impact on meningococcal carriage and transmission and strain coverage have also been published and will be reviewed. Copyright © 2015 Elsevier Ltd. All rights reserved.

The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries.

PubMed

Howard, Scott C; Zaidi, Alia; Cao, Xueyuan; Weil, Olivier; Bey, Pierre; Patte, Catherine; Samudio, Angelica; Haddad, Laurie; Lam, Catherine G; Moreira, Claude; Pereira, Augusto; Harif, Mhamed; Hessissen, Laila; Choudhury, Salma; Fu, Ligia; Caniza, Miguela A; Lecciones, Julius; Traore, Fousseyni; Ribeiro, Raul C; Gagnepain-Lacheteau, Anne

2018-05-01

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middle-income countries over 10 years. We assessed the impact of the projects in these regions by using baseline assessments that were done in 2006. Based on these data, estimated 5-year survival in 2016 increased by a median of 5·1%, ranging from -1·5% in Venezuela to 17·5% in Ukraine. Of the 26 861 children per year who develop cancer in the ten index countries with My Child Matters projects that were evaluated in 2006, an estimated additional 1343 children can now expect an increase in survival outcome. For example, in Paraguay, a network of paediatric oncology satellite clinics was established and scaled up to a national level and has managed 884 patients since initiation in 2006. Additionally, the African Retinoblastoma Network was scaled up from a demonstration project in Mali to a network of retinoblastoma referral centres in five sub-Saharan African countries, and the African School of Paediatric Oncology has trained 42 physicians and 100 nurses from 16 countries. The My Child Matters programme has catalysed improvements in cancer care and has complemented the efforts of government, civil society, and the private sector to sustain and scale improvements in health care to a national level. Key elements of successful interventions include strong and sustained local leadership, community engagement, international engagement, and capacity building and support from government. Copyright © 2018 Elsevier Ltd. All rights reserved.

Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes.

PubMed

Shrimpton, Roger; du Plessis, Lisanne M; Delisle, Hélène; Blaney, Sonia; Atwood, Stephen J; Sanders, David; Margetts, Barrie; Hughes, Roger

2016-08-01

To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC). Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training. The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes. The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions. Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition. Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.

Teaching ethics in a Masters Program in Public Health in Lithuania

PubMed Central

Jakusovaite, Irayda; Bankauskaite, Vaida

2007-01-01

This article aims to present 10 years of experience of teaching ethics in a Masters Program in Public Health in Lithuania, and to discuss the content, skills, teaching approach and tools of this programme. In addition, the article analyses the links between ethics and law, identifies the challenges of the teaching process and suggests future teaching strategies. The important role of teaching ethics in countries that are in transition owing to a radically changing value system is emphasised. PMID:17601872

Allocating scarce financial resources for HIV treatment: benchmarking prices of antiretroviral medicines in Latin America.

PubMed

Wirtz, Veronika J; Santa-Ana-Tellez, Yared; Trout, Clinton H; Kaplan, Warren A

2012-12-01

Public sector price analyses of antiretroviral (ARV) medicines can provide relevant information to detect ARV procurement procedures that do not obtain competitive market prices. Price benchmarks provide a useful tool for programme managers and policy makers to support such planning and policy measures. The aim of the study was to develop regional and global price benchmarks which can be used to analyse public-sector price variability of ARVs in low- and middle-income countries using the procurement prices of Latin America and the Caribbean (LAC) countries in 2008 as an example. We used the Global Price Reporting Mechanism (GPRM) data base, provided by the World Health Organization (WHO), for 13 LAC countries' ARV procurements to analyse the procurement prices of four first-line and three second-line ARV combinations in 2008. First, a cross-sectional analysis was conducted to compare ARV combination prices. Second, four different price 'benchmarks' were created and we estimated the additional number of patients who could have been treated in each country if the ARV combinations studied were purchased at the various reference ('benchmark') prices. Large price variations exist for first- and second-line ARV combinations between countries in the LAC region. Most countries in the LAC region could be treating between 1.17 and 3.8 times more patients if procurement prices were closer to the lowest regional generic price. For all second-line combinations, a price closer to the lowest regional innovator prices or to the global median transaction price for lower-middle-income countries would also result in treating up to nearly five times more patients. Some rational allocation of financial resources due, in part, to price benchmarking and careful planning by policy makers and programme managers can assist a country in negotiating lower ARV procurement prices and should form part of a sustainable procurement policy.

Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries.

PubMed

Amde, Woldekidan Kifle; Sanders, David; Lehmann, Uta

2014-05-30

Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. The institutions developed and collaboratively implemented a 'Masters Degree programme with a focus on health workforce development'. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key learning points of the paper are:• the need for long-term strategies and engagement;• the need for more investment and attention to developing the capacity of academic institutions;• the need to invest specifically in educational/teaching expertise for innovative approaches to teaching and capacity development more broadly; and• the importance of increasing access and support for students who are working adults in public health institutions throughout Africa.

Public health workforce: challenges and policy issues

PubMed Central

Beaglehole, Robert; Dal Poz, Mario R

2003-01-01

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce. PMID:12904251

Monitoring and surveillance for multiple micronutrient supplements in pregnancy.

PubMed

Mei, Zuguo; Jefferds, Maria Elena; Namaste, Sorrel; Suchdev, Parminder S; Flores-Ayala, Rafael C

2017-12-22

The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a "Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes," which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programmes. Currently, global surveillance and monitoring data show that overall IFA supplementation programmes suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programmes-include weak supply chains, low access to antenatal care services, low-quality behaviour change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programmes. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programmes, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programmes. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews. © 2018 John Wiley & Sons Ltd.

A journey through memory lane of history of tuberculosis in India.

PubMed

Thippanna, G; Narayanamma, S

1994-01-01

Tuberculosis, an infectious disease has got a special place in the medical bibliography. Its history dates back to 5000 B.C. of neolithic period. Even in modern world with advancement of the knowledge of tuberculosis with specific drugs to treat and programmes for its prevention, this diseasse is top listed on public health problems in all the developing countries. Its sad impact was felt by the human race throughout the world and in all ages. Thus the people of all countries and so also India fought back against this disease.

Long-term epidemiological observation of asbestos-related diseases in Poland, 1970-2015.

PubMed

Swiatkowska, B; Szeszenia-Dabrowska, N

2017-04-01

Occupational exposure to asbestos constitutes a major public health concern. Despite this in many countries, data and registration systems for occupational asbestos-related diseases are non-existent or poorly developed. To analyse the incidence of occupational asbestos-related diseases in Poland between the years 1970 and 2015, with particular emphasis on the periods after introduction of a ban on asbestos and following introduction of a surveillance programme. Analysis based on all medically recognized cases, certified as occupational diseases and reported obligatorily from all over the country to the Central Register of Occupational Diseases. During the period 1970-2015, 4983 cases were reported as asbestos-related diseases. The most prevalent were asbestosis, lung cancer, diseases of pleura or pericardium and mesothelioma. A considerable increase in the number of such cases from the beginning of their registration until 2004 occurred after introduction of the Amiantus programme, a nationwide programme of periodic medical examinations for former asbestos workers. Introduction of a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa

PubMed Central

2013-01-01

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability. PMID:23958152

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa.

PubMed

Marinucci, Francesco; Majigo, Mtebe; Wattleworth, Matthew; Paterniti, Antonio Damiano; Hossain, Mian Bazle; Redfield, Robert

2013-08-17

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.

Education of speech-language pathologists around the world: The Scandinavian experience.

PubMed

Söderpalm, Ewa

2006-01-01

The object of this paper is to give an overview of the education and training programmes in logopedics offered in the Scandinavian/Nordic countries and to provide some information about the development of the programmes in Scandinavia since their foundation in the 1920s. In order to collect information about the various programmes, a questionnaire comprising 12 questions was sent to representatives for education programmes and national societies affiliated to the IALP. In the past all the countries used to provide possibilities for teachers to continue their education with courses in logopedics to become 'special teachers'. These programmes no longer exist except in Norway. Degree programmes at bachelor's and/or master's level are now offered in all the Nordic countries. It can be concluded that the education and training in logopedics have developed into university degree programmes, with few exceptions, in the Nordic countries. Copyright (c) 2006 S. Karger AG, Basel.

Effective use of fluorides in the People's Republic of China--a model for WHO Mega Country initiatives.

PubMed

Petersen, P E; Kwan, S; Zhu, L; Zhang, B X; Bian, J Y

2008-12-01

Poor dental health has been reported in the Chinese National Surveys of Oral Health. With the changing lifestyle and growing consumption of sugars, the incidence of dental caries may well continue to rise, compounded by limited access to professional care. The increasing oral disease burden could become a major public health problem in China, leading to considerable personal and health service costs. There is a desperate need for systematic implementation of preventive programmes. Currently, China is strengthening the prevention of chronic diseases, which provides an excellent opportunity to integrate oral disease prevention into the overall non-communicable disease (NCD) prevention programmes. In order to address this growing public health problem, the World Health Organization (WHO) Global Oral Health Programme advocates the effective use of fluoride as an essential approach to prevent dental caries in the 21st century--part of the WHO Global Oral Health Strategy. Population-wide automatic fluoridation measures are considered the most effective, complemented by appropriate use of toothpastes containing fluoride. There are wide variations of fluoride levels in drinking water in China and, in many areas, the levels of fluoride in drinking water are lower than the recommended levels. The use of toothpaste containing fluoride is still too low in some areas and decreases with age. Those who live in rural areas have limited access to affordable toothpastes containing fluoride. In March 2006, as part of the WHO Mega Country Health Promotion Network initiatives, the WHO Global Oral Health Programme organised a three-day symposium in Beijing, People's Republic of China. The aim of the symposium was to bring together international experience and Chinese expertise to facilitate policy development for effective use of fluoride in China, highlighting the benefits of, and barriers to, the implementation of different fluoridation programmes at the strategic levels as well as for operational planning. This article reports the proceedings of the meeting. In summary, China is a Mega country with much diversity and disparity. The situation in China is unique with endemic fluorosis due to other non-water sources of fluoride in some areas and a considerable dental caries burden in others. It is important to regulate the appropriate exposure to fluoride to obtain the benefits and avoid adverse effects of fluorides, controlling enamel fluorosis without jeopardising the prevention of dental caries. Various complementary fluoridation programmes can be considered for different population groups with varying needs, strategies that bring about additive effects. A multi-tier policy making approach at national, regional and provincial levels can be employed, based on sound evidence. The roles of WHO, Ministry of Health and the National Committee for Oral Health (NCOH) were emphasised. Lessons learned from the Chinese experience will prove invaluable to other countries with similar socio demographic characteristics that are in the same process of developing and implementing fluoridation policies and programmes.

Pakistan's experience with kidney transplantation and trade: a call for international solidarity.

PubMed

Moazam, Farhat; Jafarey, Aamir

2014-01-01

Pakistan has taken a long and tortuous road towards curbing the trade in organs within its borders. Yet, despite the phenomenal gains, several challenges remain in this area. For example, robust and sustainable deceased donor programmes must be established to meet the needs of a country which has a high prevalence of kidney disease and failure. Further, it is necessary to offer an alternative source of organs for transplantation to desperate patients who resort to buying these from the "market". Cultural factors and religious beliefs about the sanctity and inviolability of the corpse, as well as the lack of public and professional education regarding the procurement of organs from the deceased, pose considerable barriers that must be surmounted. We believe it is equally important that transplant professionals and the governments of affluent countries consider measures to discourage, if not prevent, their citizens from travelling to impoverished countries such as Pakistan to buy organs. Without a commitment, ethical and legal, to international solidarity in this matter, the goals that are already difficult for developing countries to achieve, ie, establishing deceased donor programmes and bringing an end to organ trafficking, will be even harder to achieve.

Health: an essential component of long-term economic and social development.

PubMed

Drobny, A

1977-01-01

Isolated growth of the economy in a developing country, without due consideration of social aspects, does not necessarily increase the welfare of all its population. In such cases, there will always be a large group with poor education and negligible health care. Health services in these countries should not try to duplicate those of the technologically developed nations and should be more health-oriented than disease-oriented. This entails wider utilization of auxiliary and paramedical personnel and, above all, community involvement. At the same time, the teaching of medicine should be based on the needs of the country rather than try to emulate developed countries' programmes, which can only result in dissatisfaction among physicians and/or in emigration. The Inter-American Development Bank considers that health is a component of long-term economic development; it is therefore fostering and participating in the expansion of rural health services with strong emphasis placed on community participation. In this process health education, both of the public and of local and national authorities, is paramount. Of particular importance is the interaction of health officials and the community itself in order to enlist the rural dweller in spontaneous and active participation that will ensure the success of health programmes.

Income, egalitarianism and attitudes towards healthcare policy: a study on public attitudes in 29 countries.

PubMed

Azar, A; Maldonado, L; Castillo, J C; Atria, J

2018-01-01

To evaluate the relationship between income and egalitarian values and attitudes towards healthcare policy. Cross-sectional and cross-national study. Data for 29 countries from the International Social Survey Programme (ISSP) 2011 were used. The dependent variables are a general attitude towards government involvement in healthcare provision and two attitudes regarding specific policies (taxes and public funding). Income and egalitarianism were also measured by using ISSP. Data were analysed using regression models that account for individual and country-level characteristics, and country-fixed effects. The effect of income is small and non-significant for attitudes towards government involvement and public funding. For willingness to pay (WTP) taxes to improve healthcare services, we find a positive association with income. Results for egalitarianism suggest a positive association with government involvement in healthcare provision and significant interactions with WTP taxes. The distinction of dimensions and mechanisms underlying policy attitudes appears as relevant. Citizens across socioeconomic groups are motivated to support state-funded healthcare, favouring the design of non-selfish policies. These findings suggest that there is space for policymakers who seek to increase healthcare spending encouraging either policies for specific groups or broader institutional changes. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Mental health stigma: what is being done to raise awareness and reduce stigma in South Africa?

PubMed

Kakuma, R; Kleintjes, S; Lund, C; Drew, N; Green, A; Flisher, A J

2010-05-01

Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. The World Health Organization's Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.

Doing well while fighting river blindness: the alignment of a corporate drug donation programme with responsibilities to shareholders.

PubMed

Hernando, Yolanda; Colwell, Kaela; Wright, Brian D

2016-10-01

Using the example of Merck's donations of ivermectin, to show how tax incentives and non-profit collaborators can make corporate largesse consistent with obligations to maximise returns to shareholders. We obtained information from publicly available data and estimated Merck's tax deductions according to the US Internal Revenue Code. Reviews of Merck-Kitasato contracts and personal interviews provided additional information regarding key lessons from this collaboration. Our best estimate of the direct cost to Merck of the ivermectin tablets donated during 2005-2011 is around US$ 600 million, well below the stated value of US$ 3.8 billion. Our calculation of tax write-offs reduces the net cost to around US$ 180 million in that period. Indirect market benefits and effects on goodwill further enhanced the compatibility of Merck's donation programme with the company's profit-maximising objective. The case offers lessons for effective management of collaborations with public and non-profit organisations. Merck's role in the donation of ivermectin for the treatment of onchocerciasis is widely and justly acknowledged as a prime example of corporate largesse in the public interest. It is nevertheless important to note that several public and non-profit collaborators, and United States taxpayers, played significant roles in increasing Merck's incentives, and indeed ability, to conduct the donation programme that changed so many lives in poor countries, while meeting its responsibilities to shareholders. Overall, the record indicates responsible corporate management of Merck's ivermectin programme and demonstrates the feasibility of socially responsible policies in a manner compatible with obligations to shareholders. © 2016 John Wiley & Sons Ltd.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

PubMed Central

Naidoo, Joanne R.

2017-01-01

Background Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. Aim To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Methods Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’. Results Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use – mHealth, family-centred approaches, male involvement, culturally appropriate interventions). Conclusion There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency. PMID:28582993

The global burden of oral diseases and risks to oral health.

PubMed Central

Petersen, Poul Erik; Bourgeois, Denis; Ogawa, Hiroshi; Estupinan-Day, Saskia; Ndiaye, Charlotte

2005-01-01

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries. PMID:16211157

FDI-Unilever Brush Day & Night partnership: 12 years of improving behaviour for better oral health.

PubMed

Kell, Kathryn; Aymerich, Marie-Anne; Horn, Virginie

2018-05-01

Twelve years ago, FDI World Dental Federation and Unilever Oral Care began a partnership to raise awareness of oral health globally. This aim reflects FDI's mission to "lead the world to optimal oral health", and one of the goals set by the Unilever Sustainable Living Plan "to improve health and well-being for more than 1 billion" by 2020. This partnership has developed a series of public health programmes to improve the brushing habits of targeted populations through health promotion and educational campaigns worldwide. Building on the success of the first two phases of the partnership, the third phase (Phase III), named Brush Day & Night, aimed to educate children in brushing twice-daily with fluoride toothpaste via a 21 Day school programme. This article reports the main outcomes of the past 12 years of this partnership, in particular the key outreach and figures of Phase III evaluation. School programmes were implemented in 10 countries, where local teams collected data from children aged between 2 and 12 years to monitor their oral health behaviours using specific indicators. In addition to the school programme, the World Oral Health Day was used as a vehicle to convey oral health awareness to influential governing bodies and the public. As a result, over 4 million people were directly reached by the programme in 2016. © 2018 FDI World Dental Federation.

Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study

PubMed Central

Safreed-Harmon, Kelly; Hetherington, Kristina L.

2018-01-01

Background and aims In the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat. Methods Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. Results Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly. Conclusion The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere. PMID:29381697

Policy responses to hepatitis C in the Nordic countries: Gaps and discrepant reporting in the Hep-Nordic study.

PubMed

Safreed-Harmon, Kelly; Hetherington, Kristina L; Aleman, Soo; Alho, Hannu; Dalgard, Olav; Frisch, Tove; Gottfredsson, Magnus; Weis, Nina; Lazarus, Jeffrey V

2018-01-01

In the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden), the prevalence of chronic hepatitis C virus (HCV) infection is relatively low in the general population, but is much higher among people who inject drugs (PWID). We conducted an exploratory study to investigate the extent to which these countries have policies supporting key elements of the public health response that is necessary to achieve the global goal of eliminating HCV as a public health threat. Fourteen stakeholders representing government agencies, medical societies, and civil society organisations (CSOs) in the Nordic countries completed a cross-sectional online survey that included 21 policy questions related to national coordination, prevention, testing, linkage to care, and treatment. We summarised the findings in a descriptive analysis, and noted discrepant responses from stakeholders within the same country. Stakeholders reported that three of the five study countries have national viral hepatitis strategies, while only Iceland has a national HCV elimination goal. The availability of harm reduction services varies, with opioid substitution therapy provided for the general population throughout all countries, but not needle and syringe programmes. No country has access to anonymous HCV testing in all parts of the country. National HCV treatment guidelines are available in all countries except Finland, and all countries provide publicly funded direct-acting antiviral treatment. Disagreement regarding policies was observed across countries, and CSOs were the stakeholder group that most frequently answered survey questions incorrectly. The Nordic region as a whole has not consistently expressed its commitment to tackling HCV, despite the existence of large HCV epidemics among PWID in these countries. Stakeholder alignment and an established elimination goal with an accompanying strategy and implementation plan should be recognised as the basis for coordinated national public health efforts to achieve HCV elimination in the Nordic region and elsewhere.

Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

PubMed

McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

2003-06-01

Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data available.

Harm reduction programmes in the Asia--Pacific Region.

PubMed

Reid, Gary; Devaney, Madonna L; Baldwin, Simon

2008-01-01

This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia-Pacific region. It is based on the report 'Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. Drug use in the Asia--Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. Harm reduction programmes in the Asia--Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes.

The Italian National Health Service expenditure on workplace prevention and safety (2006-2013): a national-level analysis.

PubMed

Signorelli, C; Riccò, M; Odone, A

2016-01-01

The World Health Organization (WHO) stated that countries' health policies should give high priority to primary prevention of occupational health hazards. Scant data are available on health expenditure on workplace prevention and safety services and on its impact on occupational health outcomes in Italy and in other European countries. objective of the present study was to systematically retrieve, analyse and critically appraise the available national-level data on public health expenditure on workplace prevention and safety services as well as to correlate them with occupational health outcomes. National-level data on total public health expenditure on prevention services, its share spent on workplace prevention and safety services as well as on number of workers receiving appropriate health surveillance were derived from the national public health expenditure monitoring system over a 8-year study period (2006-2013). An analytic approach was adopted to explore the association between health expenditure and occupational health services supply. The Italian National Health Service spends almost € 5 billion per year on preventive care, of which 13.3% are spent on workplace prevention and safety programmes (€ 645 million, € 10.6 per capita). There is wide heterogeneity between Italian regions. Our findings are useful for health systems and policies analysis, national and international comparisons as well as for health policy makers to plan, implement and monitor occupational health prevention programmes.

Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

PubMed

Harris, Fiona M; Maxwell, Margaret; O'Connor, Rory; Coyne, James C; Arensman, Ella; Coffey, Claire; Koburger, Nicole; Gusmão, Ricardo; Costa, Susana; Székely, András; Cserhati, Zoltan; McDaid, David; van Audenhove, Chantal; Hegerl, Ulrich

2016-03-15

The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these. A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection. All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention. The QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.

Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy: a qualitative study.

PubMed

Khan, Wasiq Mehmood; Smith, Helen; Qadeer, Ejaz; Hassounah, Sondus

2016-01-01

To understand how national and provincial tuberculosis programme managers in Pakistan perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. National and provincial tuberculosis programme managers play an important role in effective implementation of the Stop TB strategy. A qualitative interview study was conducted with 10 national and provincial tuberculosis programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). National and provincial tuberculosis programme managers in Pakistan. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). National and provincial tuberculosis programmes in Pakistan. 1. Knowledge and perceptions of national and provincial tuberculosis programme managers about the Stop TB strategy 2. Progress in implementing the strategy in Pakistan 3. Significant success factors 4. Significant implementation challenges 5. Lessons learnt to scale up successful implementation. The managers reported that most progress had been made in extending DOTS, health systems strengthening, public -private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were the availability of DOTS services, the public-private partnership approach, comprehensive guidance for TB control and government and donor commitment to TB control. This study identified three main challenges as perceived by national and provincial tuberculosis programme managers in terms of implementing the Stop TB strategy: 1. Inadequate political commitment, 2. Issue pertaining to prioritisation of certain components in the TB strategy over others due to external influences and 3. Limitations in the overall health system. To improve the tuberculosis control programme in the country political commitment needs to be enhanced and public -private partnerships increased. This can be done through government prioritisation of TB control at both national and provincial levels; donor-funded components should not receive undue attention; and partnerships with the private health sector, health institutions not yet covered by DOTS services, non-governmental organisations and patient coalitions should be increased.

Euro 2012 European Football Championship Finals: planning for a health legacy.

PubMed

Smallwood, Catherine A H; Arbuthnott, Katherine G; Banczak-Mysiak, Barbara; Borodina, Mariya; Coutinho, Ana Paula; Payne-Hallström, Lara; Lipska, Elzbieta; Lyashko, Viktor; Miklasz, Miroslaw; Miskiewicz, Paulina; Nitzan, Dorit; Pokanevych, Igor; Posobkiewicz, Marek; Rockenschaub, Gerald; Sadkowska-Todys, Malgorzata; Sinelnik, Svetlana; Smiley, Daniel; Tomialoic, Rysard; Yurchenko, Volodimir; Memish, Ziad A; Heymann, David; Endericks, Tina; McCloskey, Brian; Zumla, Alimuddin; Barbeschi, Maurizio

2014-06-14

The revised international health regulations offer a framework that can be used by host countries to organise public health activities for mass gatherings. From June 8, to July 1, 2012, Poland and Ukraine jointly hosted the Union of European Football Associations European Football Championship Finals (Euro 2012). More than 8 million people from around the world congregated to watch the games. Host countries and international public health agencies planned extensively to assess and build capacity in the host countries and to develop effective strategies for dissemination of public health messages. The effectiveness of public health services was maximised through rapid sharing of information between parties, early use of networks of experienced individuals, and the momentum of existing national health programmes. Organisers of future mass gatherings for sporting events should share best practice and their experiences through the WHO International Observer Program. Research about behaviour of large crowds is needed for crowd management and the evidence base translated into practice. A framework to measure and evaluate the legacy of Euro 2012 is needed based on the experiences and the medium-term and long-term benefits of the tournament. Copyright © 2014 Elsevier Ltd. All rights reserved.

Start-stop funding, its causes and consequences: a case study of the delivery exemptions policy in Ghana.

PubMed

Witter, Sophie; Adjei, Sam

2007-01-01

This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding--such as party politics and intersectoral haggling over resources--are unavoidable, but others, such as communication and management failures can and should be addressed. Copyright (c) 2007 John Wiley & Sons, Ltd.

Winning the battle against the scourge of poliomyelitis in the African Region.

PubMed

Moeti, Matshidiso

2016-10-10

Recently we have recorded some progress against the transmission of poliovirus in the African Region. This is attributable to a number of factors, including commitment of global partnerships against polio, improvement of existing strategies as well as a number of innovations in response to the disease in the Region. The WHO Regional Office in Africa documented these practices that led to the noticeable progress in the polio eradication initiative in the African Region, as lessons learnt and as part of polio legacy planning. The documentation exercise covered eight countries, namely Angola, Chad, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania and Togo. A number of practices were identified. Some of these practices cut across countries while others were peculiar to specific countries. We have thus developed some manuscripts to capture these practices for publication in scientific journal so as to place them in the public domain for use. It is hoped that these practices will be deployed to other public health programmes in the Region and beyond. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes.

PubMed

Haverkate, M; D'Ancona, F; Giambi, C; Johansen, K; Lopalco, P L; Cozza, V; Appelgren, E

2012-05-31

This report provides an updated overview of recommended and mandatory vaccinations in the European Union (EU), Iceland and Norway, considering the differences in vaccine programme implementation between countries. In 2010, the Vaccine European New Integrated Collaboration Effort (VENICE) network, conducted a survey among the VENICE project gatekeepers to learn more about how national vaccination programmes are implemented, whether recommended or mandatory. Information was collected from all 27 EU Member States, Iceland and Norway. In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some countries have a mixed strategy of recommended and mandatory vaccinations. Mandatory vaccination may be considered as a way of improving compliance to vaccination programmes. However, compliance with many programmes in Europe is high, using only recommendations. More information about the diversity in vaccine offer at European level may help countries to adapt vaccination strategies based on the experience of other countries. However, any proposal on vaccine strategies should be developed taking into consideration the local context habits.

Capacity building for global nursing leaders: challenges and experiences.

PubMed

Shin, S; Han, J; Cha, C

2016-12-01

The aim of this article is to describe our experience in operating a capacity-building programme, the Korea International Cooperation Project, for global nursing leaders from developing countries, held during the International Council of Nurses (ICN) Conference in 2015 in Seoul, Korea. Globalization points to the importance of global leadership among nursing leaders. In accordance with the theme of 'Global Citizen, Global Nursing' at the ICN conference in 2015, a capacity-building programme for nursing leaders of developing countries was implemented. The global nursing leadership programme shared experiences during the preparation and operation of the conference. To prepare the programme, this paper describes selecting participants, working with invitation lists from 30 countries, and recruiting and training volunteers. The operation of the programme, orientation, organizing tailored programmes for participant groups, addressing unexpected issues and evaluating the programme are described. ICN could implement capacity-building programmes for nursing leaders of developing countries during its ICN conference for the nursing society. A programme tailored for each continent with similar sociocultural backgrounds and health issues would provide chances for collaboration and networking. A policy to compile global nursing indicators should be developed. This would allow nursing leaders to learn about the strengths and weaknesses of global nursing and provide evidence for collaboration. The programme was successful in introducing and broadening global perspectives of participants on health and education as well as building a network among leaders and next-generation leaders in participating countries for future cooperation and collaboration. © 2016 International Council of Nurses.

Compulsory service programmes for recruiting health workers in remote and rural areas: do they work?

PubMed Central

Mullan, Fitzhugh; Payne, Perry W; Ross, Heather

2010-01-01

Abstract Compulsory service programmes have been used worldwide as a way to deploy and retain a professional health workforce within countries. Other names for these programmes include ”obligatory”, ”mandatory”, ”required” and ”requisite.” All these different programme names refer to a country’s law or policy that governs the mandatory deployment and retention of a heath worker in the underserved and/or rural areas of the country for a certain period of time. This study identified three different types of compulsory service programmes in 70 countries. These programmes are all governed by some type of regulation, ranging from a parliamentary law to a policy within the ministry of health. Depending on the country, doctors, nurses, midwives and all types of professional allied health workers are required to participate in the programme. Some of the compliance-enforcement measures include withholding full registration until obligations are completed, withholding degree and salary, or imposing large fines. This paper aims to explain these programmes more clearly, to identify countries that have or had such programmes, to develop a typology for the different kinds and to discuss the programmes in the light of important issues that are related to policy concepts and implementation. As governments consider the cost of investment in health professionals’ education, the loss of health professionals to emigration and the lack of health workers in many geographic areas, they are using compulsory service requirements as a way to deploy and retain the health workforce. PMID:20461136

An ethics training specific for European public health.

PubMed

Camps, Victoria; Hernández-Aguado, Ildefonso; Puyol, Angel; Segura, Andreu

2015-01-01

Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe's commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population's health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe.

Pathology Residency Programme of a Developing Country--Landscape of Last 25 Years

ERIC Educational Resources Information Center

Siddiqui, Imran; Ali, Natasha; Kayani, Naila

2016-01-01

We report the evolution of a residency programme in Pathology from a developing country. This article highlights the historical perspective of our application procedure, the number of inductions, the programme framework, acheivements and limitations.

Zoonoses and marginalised infectious diseases of poverty: where do we stand?

PubMed

Molyneux, David; Hallaj, Zuhair; Keusch, Gerald T; McManus, Donald P; Ngowi, Helena; Cleaveland, Sarah; Ramos-Jimenez, Pilar; Gotuzzo, Eduardo; Kar, Kamal; Sanchez, Ana; Garba, Amadou; Carabin, Helene; Bassili, Amal; Chaignat, Claire L; Meslin, Francois-Xavier; Abushama, Hind M; Willingham, Arve L; Kioy, Deborah

2011-06-14

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock.

Zoonoses and marginalised infectious diseases of poverty: Where do we stand?

PubMed Central

2011-01-01

Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock. PMID:21672216

Public-private partnerships in neglected tropical disease control: the role of nongovernmental organisations.

PubMed

Bush, S; Hopkins, A D

2011-09-01

Successful public-private partnerships for health control have usually included nongovernmental development organisations (NGDOs), and these have long been in the forefront of pinpointing particular social and health issues. The immensely successful control and elimination programmes for onchocerciasis are a case in point. NGDOs were the driving force in early advocacy for onchocerciasis control in West Africa, leading eventually to the remarkably effective and long lasting partnership of the Onchocerciasis Control Programme (OCP). With the donation of Mectizan(®), NGDOs were the driving force in developing onchocerciasis control in non-OCP countries, especially programmes for community based action. These were, further modified by the African Programme for Onchocerciasis Control (APOC) to become the successful Community Directed Interventions. NGDOs came together to coordinate activities in partnership with the World Health Organisation (WHO). Innovations by NGDOs led to integration of mass drug administration for Vitamin A deficiency and then for other parasitic diseases, leading to the current trend of preventive chemotherapy. The success of the NGDO Group for Onchocerciasis Control has led to the creation of similar groups for trachoma control and lymphatic filariasis elimination. These groups have now come together to form an NGDO Network for Neglected Tropical Disease control. Copyright © 2011 Elsevier B.V. All rights reserved.

Mathematics Teachers' Conceptions and Constraints for Changing Teaching Practices in Brazilian Higher Education: An Analysis through Activity Theory

ERIC Educational Resources Information Center

Campos, Dilhermando Ferreira; Pinto, Márcia Maria Fusaro

2016-01-01

In recent years, changes in the Brazilian economic and social scenario have generated a growing demand for higher education in the country. In response to this new context, the federal government launched in 2007 a programme aiming at expansion of the enrolment to public higher education. In such environment of changes, several proposals have…

More than Nickels and Dimes: The Health Benefits of a Community-Based Lifelong Learning Programme for Older Adults

ERIC Educational Resources Information Center

Narushima, Miya

2008-01-01

In Canada, as in many countries, public continuing education of the non-vocational general interest type for people in post-work languishes on the margins of political discourse. This case study of one such traditional program for seniors run by a school board in Ontario explores the experiences of older adults and the meanings they attach to…

Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey.

PubMed

Deandrea, S; Molina-Barceló, A; Uluturk, A; Moreno, J; Neamtiu, L; Peiró-Pérez, R; Saz-Parkinson, Z; Lopez-Alcalde, J; Lerda, D; Salas, D

2016-10-01

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Science Education and Public Outreach in Asia - experiences in ACCENT

NASA Astrophysics Data System (ADS)

Schuepbach, E.

2006-12-01

ACCENT is the European Network of Excellence in Atmospheric Composition Change (www.accent- network.org). Its Task Training and Education aims at disseminating ACCENT results to a variety of target groups, including emerging countries. Until now, fellowships have been offered for early-career scientists to participate in European science training events. A teacher training workshop has concentrated on cross- cultural aspects of PhD supervision. The involvement of new Associated Partners from Asia has triggered reflections on science education and outreach to politicians and the public in this part of the world. Joint educational and outreach programmes and products are currently developed with China and Mongolia for training activities scheduled in autumn 2006 and autumn 2007. First experiences in joint science education programmes for early-career scientists will be presented, and the challenges associated with communicating science to non-scientists in Asia will be discussed.

Private Practitioners' Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State.

PubMed

Salve, Solomon; Sheikh, Kabir; Porter, John Dh

2016-05-08

Public and private health sectors both play a crucial role in the health systems of low- and middle-income countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector's dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as 'partners with the TB programme.' Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epidemiology in Latin America and the Caribbean: current situation and challenges

PubMed Central

Barreto, Sandhi M; Miranda, Jaime J; Figueroa, J Peter; Schmidt, Maria Inês; Munoz, Sergio; Kuri-Morales, P Pablo; Silva, Jarbas B

2012-01-01

Background This article analyses the epidemiological research developments in Latin America and the Caribbean (LAC). It integrates the series commissioned by the International Epidemiological Association to all WHO Regions to identify global opportunities to promote the development of epidemiology. Methods Health situations of the regions were analysed based on published data on selected mortality, morbidity and risk factors. Epidemiological publication output by country was estimated by Medline bibliometrics. Internet and literature searches and data provided by key informants were used to describe perspectives on epidemiological training, research and funding. Findings Despite important advances in recent decades, LAC remains the world's most unequal region. In 2010, 10% of the LAC's people still lived in conditions of multidimensional poverty, with huge variation among countries. The region has experienced fast and complex epidemiological changes in past decades, combining increasing rates of non-communicable diseases and injuries, and keeping uncontrolled many existing endemic and emerging diseases. Overall, epidemiological publications per year increased from 160 articles between 1961 and 1970 to 2492 between 2001 and 2010. The increase in papers per million inhabitants in the past three decades varied from 57% in Panama to 1339% in Paraguay. Universities are the main epidemiological training providers. There are at least 34 universities and other institutions in the region that offer postgraduate programmes at the master’s and doctoral levels in epidemiology or public health. Most LAC countries rely largely on external funding and donors to initiate and sustain long-term research efforts. Despite the limited resources, the critical mass of LAC researchers has produced significant scientific contributions. Future needs The health research panorama of the region shows enormous regional discrepancies, but great prospects. Improving research and human resources capacity in the region will require establishing research partnerships within and outside the region, between rich and poor countries, promoting collaborations between LAC research institutions and universities to boost postgraduate programmes and aligning research investments and outputs with the current burden of disease. PMID:22407860

Epidemiology in Latin America and the Caribbean: current situation and challenges.

PubMed

Barreto, Sandhi M; Miranda, Jaime J; Figueroa, J Peter; Schmidt, Maria Inês; Munoz, Sergio; Kuri-Morales, P Pablo; Silva, Jarbas B

2012-04-01

This article analyses the epidemiological research developments in Latin America and the Caribbean (LAC). It integrates the series commissioned by the International Epidemiological Association to all WHO Regions to identify global opportunities to promote the development of epidemiology. Health situations of the regions were analysed based on published data on selected mortality, morbidity and risk factors. Epidemiological publication output by country was estimated by Medline bibliometrics. Internet and literature searches and data provided by key informants were used to describe perspectives on epidemiological training, research and funding. Despite important advances in recent decades, LAC remains the world's most unequal region. In 2010, 10% of the LAC's people still lived in conditions of multidimensional poverty, with huge variation among countries. The region has experienced fast and complex epidemiological changes in past decades, combining increasing rates of non-communicable diseases and injuries, and keeping uncontrolled many existing endemic and emerging diseases. Overall, epidemiological publications per year increased from 160 articles between 1961 and 1970 to 2492 between 2001 and 2010. The increase in papers per million inhabitants in the past three decades varied from 57% in Panama to 1339% in Paraguay. Universities are the main epidemiological training providers. There are at least 34 universities and other institutions in the region that offer postgraduate programmes at the master's and doctoral levels in epidemiology or public health. Most LAC countries rely largely on external funding and donors to initiate and sustain long-term research efforts. Despite the limited resources, the critical mass of LAC researchers has produced significant scientific contributions. FUTURE NEEDS: The health research panorama of the region shows enormous regional discrepancies, but great prospects. Improving research and human resources capacity in the region will require establishing research partnerships within and outside the region, between rich and poor countries, promoting collaborations between LAC research institutions and universities to boost postgraduate programmes and aligning research investments and outputs with the current burden of disease.

Building the road to a regional zoonoses strategy: A survey of zoonoses programmes in the Americas

PubMed Central

Freire de Carvalho, Mary H.; Hoet, Armando E.; Vigilato, Marco A. N.; Pompei, Julio C.; Cosivi, Ottorino; del Rio Vilas, Victor J.

2017-01-01

Background In recent years, global public health security has been threatened by zoonotic disease emergence as exemplified by outbreaks of H5N1 and H1N1 influenza, SARS, and most recently Ebola and Zika. Additionally, endemic zoonoses, such as rabies, burden countries year after year, placing demands on limited finances and personnel. To survey the baseline status of the emerging and endemic zoonoses programmes of the Latin American and the Caribbean (LAC) countries, the Pan American Health Organization (PAHO) conducted a survey of priority emerging and endemic zoonoses, countries´ prioritization criteria and methodologies, and suggestions to strengthen countries capacities and regional approaches to zoonoses control. Methods A fillable online questionnaire was sent to the zoonoses programme managers of the Ministries of Health (MOH) and Ministries of Agriculture (MAg) of 33 LAC countries from January to April of 2015. The questionnaire comprised 36 single, multiple choice and open-ended questions to inform the objectives of the survey. A descriptive exploratory analysis was completed. Results Fifty-four ministries (26 MOH, 25 MAg, and 3 combined responses) in 31 LAC countries responded to the survey. Within the ministries, 22 (85%) MOH, 5 (20%) MAg, and 2 (67%) combined entities indicated they had specialized zoonoses units. For endemic zoonoses, 32 of 54 ministries responded that they conduct formal prioritization exercises, most of them annually (69%). The three priority endemic zoonoses for the MOHs were leptospirosis, rabies, and brucellosis while the three priorities for the MAgs were brucellosis, rabies, and tuberculosis. Diagnosis for rabies and leptospirosis were cited as the capacities most in need of development. The most needed cross-cutting capacity was coordination between stakeholders. For emerging zoonoses, 28 ministries performed formal prioritization exercises. The top prioritization criteria were probability of introduction into the country and impact. The three priority emerging zoonoses for the MOHs were Ebola viral disease, avian influenza, and Chikungunya while for the MAgs were avian influenza, bovine spongiform encephalopathy and West Nile virus disease. Surveillance for avian influenza and Ebola, and diagnosis for BSE were quoted as the capacities most needed. For all zoonoses, the majority of respondents (69%) ranked their relationship with the other Ministry as productive or very productive, and 31% minimally productive. Many countries requested a formal regional network, better regional communication and collaboration, and integrated surveillance. Conclusions The survey is the first comprehensive effort to date to inform the status of zoonoses programmes in LAC. The information collected here will be used to develop a regional strategy for zoonoses (both endemic and emerging), increase efforts, advocacy, and promote prompt identification and management of EIDs and improvement of endemic programmes. PMID:28333986

Building the road to a regional zoonoses strategy: A survey of zoonoses programmes in the Americas.

PubMed

Maxwell, Melody J; Freire de Carvalho, Mary H; Hoet, Armando E; Vigilato, Marco A N; Pompei, Julio C; Cosivi, Ottorino; Del Rio Vilas, Victor J

2017-01-01

In recent years, global public health security has been threatened by zoonotic disease emergence as exemplified by outbreaks of H5N1 and H1N1 influenza, SARS, and most recently Ebola and Zika. Additionally, endemic zoonoses, such as rabies, burden countries year after year, placing demands on limited finances and personnel. To survey the baseline status of the emerging and endemic zoonoses programmes of the Latin American and the Caribbean (LAC) countries, the Pan American Health Organization (PAHO) conducted a survey of priority emerging and endemic zoonoses, countries´ prioritization criteria and methodologies, and suggestions to strengthen countries capacities and regional approaches to zoonoses control. A fillable online questionnaire was sent to the zoonoses programme managers of the Ministries of Health (MOH) and Ministries of Agriculture (MAg) of 33 LAC countries from January to April of 2015. The questionnaire comprised 36 single, multiple choice and open-ended questions to inform the objectives of the survey. A descriptive exploratory analysis was completed. Fifty-four ministries (26 MOH, 25 MAg, and 3 combined responses) in 31 LAC countries responded to the survey. Within the ministries, 22 (85%) MOH, 5 (20%) MAg, and 2 (67%) combined entities indicated they had specialized zoonoses units. For endemic zoonoses, 32 of 54 ministries responded that they conduct formal prioritization exercises, most of them annually (69%). The three priority endemic zoonoses for the MOHs were leptospirosis, rabies, and brucellosis while the three priorities for the MAgs were brucellosis, rabies, and tuberculosis. Diagnosis for rabies and leptospirosis were cited as the capacities most in need of development. The most needed cross-cutting capacity was coordination between stakeholders. For emerging zoonoses, 28 ministries performed formal prioritization exercises. The top prioritization criteria were probability of introduction into the country and impact. The three priority emerging zoonoses for the MOHs were Ebola viral disease, avian influenza, and Chikungunya while for the MAgs were avian influenza, bovine spongiform encephalopathy and West Nile virus disease. Surveillance for avian influenza and Ebola, and diagnosis for BSE were quoted as the capacities most needed. For all zoonoses, the majority of respondents (69%) ranked their relationship with the other Ministry as productive or very productive, and 31% minimally productive. Many countries requested a formal regional network, better regional communication and collaboration, and integrated surveillance. The survey is the first comprehensive effort to date to inform the status of zoonoses programmes in LAC. The information collected here will be used to develop a regional strategy for zoonoses (both endemic and emerging), increase efforts, advocacy, and promote prompt identification and management of EIDs and improvement of endemic programmes.

An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa

PubMed Central

Logie, Dorothy E; Harding, Richard

2005-01-01

Background Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. Methods A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. Results Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. Conclusion The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries. PMID:16092958

Hep-CORE: a cross-sectional study of the viral hepatitis policy environment reported by patient groups in 25 European countries in 2016 and 2017.

PubMed

Lazarus, Jeffrey V; Stumo, Samya R; Harris, Magdalena; Hendrickx, Greet; Hetherington, Kristina L; Maticic, Mojca; Jauffret-Roustide, Marie; Tallada, Joan; Simojoki, Kaarlo; Reic, Tatjana; Safreed-Harmon, Kelly

2018-04-01

The first World Health Organization (WHO) global health sector strategy on hepatitis B and C viruses (HBV and HCV) has called for the elimination of viral hepatitis as a major public health threat by 2030. This study assesses policies and programmes in support of elimination efforts as reported by patient groups in Europe. In 2016 and 2017, hepatitis patient groups in 25 European countries participated in a cross-sectional survey about their countries' policy responses to HBV and HCV. The English-language survey addressed overall national response; public awareness/engagement; disease monitoring; prevention; testing/diagnosis; clinical assessment; and treatment. We performed a descriptive analysis of data and compared 2016 and 2017 findings. In 2017, 72% and 52% of the 25 European study countries were reported to not have national HBV and HCV strategies respectively. The number of respondents indicating that their governments collaborated with civil society on viral hepatitis control increased from 13 in 2016 to 18 in 2017. In both 2016 and 2017, patient groups reported that 9 countries (36%) have disease registers for HBV and 11 (44%) have disease registers for HCV. The number of countries reported to have needle and syringe exchange programmes available in all parts of the country dropped from 10 (40%) in 2016 to 8 in 2017 (32%). In both 2016 and 2017, patient groups in 5 countries (20%) reported that HCV treatment is available in non-hospital settings. From 2016 to 2017, the reported number of countries with no restrictions on access to direct-acting antivirals for HCV increased from 3 (12%) to 7 (28%), and 5 fewer countries were reported to refuse treatment to people who are currently injecting drugs. The patient-led Hep-CORE study offers a unique perspective on the readiness of study countries to undertake comprehensive viral hepatitis elimination efforts. Viral hepatitis monitoring should be expanded to address policy issues more comprehensively and to incorporate civil society perspectives, as is the case with global HIV monitoring. Policy components should also be explicitly added to the WHO framework for monitoring country-level progress against viral hepatitis. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Training-of-trainers: A strategy to build country capacity for SLMTA expansion and sustainability

PubMed Central

Yao, Katy; Ndlovu, Nqobile; Moyo, Sikhulile

2014-01-01

Background The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme uses a training-of-trainers (TOT) model to build capacity for programme scale-up. The TOT strategy is designed to maximise utilisation of its graduates whilst minimising inconsistencies and ensuring high programme quality during global expansion. Objectives To describe the SLMTA TOT programme approach. Methods The two-week training, led by carefully selected and trained master trainers, enables effective and authentic implementation of the curriculum by its graduates. The teachback methodology used allows participants to practise teaching the curriculum whilst learning its content. A trainer’s toolkit provides all the materials necessary for teaching and must be followed faithfully during training. Two surveys were conducted to assess the effectiveness of the TOT strategy: one sent to 316 TOT graduates in 25 countries and the other sent to the programme leaders in 10 countries. Results By the end of 2013, 433 SLMTA trainers had been trained who, in turn, taught more than 1900 people to implement SLMTA in 617 laboratories in 47 countries. Ninety-seven percent of the 433 TOT graduates and 87% of the 38 master trainers are based in developing countries. Ninety-two per cent of the graduates have been utilised at least once in programme implementation and, as of August 2013, 87% of them were still actively involved in programme activities. Ninety-seven per cent of the graduates stated that the TOT workshop prepared them well for training or other programme tasks. Conclusion The SLMTA TOT strategy is effective in building local capacity for global programme expansion whilst maintaining programme quality. PMID:26753131

Preventing Child Maltreatment and Crime with Prenatal and Infancy Support of Parents: The Nurse-Family Partnership

PubMed Central

OLDS, DAVID L.

2010-01-01

Pregnancy and the early years of the child’s life offer an opportune time to prevent a host of adverse maternal and child outcomes that are important in their own right, but that also have significant implications for the development of criminal behaviour. This paper summarizes a 30-year programme of research that has attempted to improve the health and development of mothers and infants and their future life prospects with prenatal and infancy home visiting by nurses. The programme, known today as the Nurse-Family Partnership, is designed for low-income mothers who have had no previous live births. The home visiting nurses have three major goals: to improve the outcomes of pregnancy by helping women improve their prenatal health; to improve the child’s health and development by helping parents provide more sensitive and competent care of the child; and to improve parental life-course by helping parents plan future pregnancies, complete their educations, and find work. Given consistent effects on prenatal health behaviours, parental care of the child, child abuse and neglect, child health and development, maternal life-course, and criminal involvement of the mothers and children, the programme is now being offered for public investment throughout the United States, where careful attention is being given to ensuring that the programme is being conducted in accordance with the programme model tested in the randomized trials. The programme also is being adapted, developed, and tested in five countries outside of the US: the Netherlands, Germany, England, Australia, and Canada, where programmatic adjustments are being made to accommodate different populations served and health and human service contexts. We believe it is important to test this programme in randomized controlled trials in these new settings before it is offered for public investment. PMID:20885797

Referral of tuberculosis symptomatic clients from private pharmacies to public sector clinics for diagnosis and treatment in Cambodia.

PubMed

Bell, Carolyn A; Ilomäki, Jenni; Pichenda, Koeut; Duncan, Gregory J; Saini, Bandana

2015-04-01

Cambodia is one of the 22 countries with a high burden of tuberculosis (TB). People often first seek treatment for cough and other TB symptoms through private pharmacies. The National Tuberculosis Programme trained willing private sector pharmacies to refer TB symptomatic clients to their closest public sector clinic for diagnosis and treatment. The study objective was to investigate factors associated with referral of TB symptomatic clients from pharmacies to public sector clinics in Phnom Penh, Cambodia. Face-to-face structured interviews were conducted with staff from a stratified random sample of 180 private pharmacies in Phnom Penh in 2012. Trained interviewers were Khmer speakers. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with self-reported referral during the previous 3 months. Fifty (29.6%) pharmacies reported that they had referred 125 clients (range 1-10) to public sector clinics during the previous 3 months. In total, 164 (96.5%) pharmacies reported that they always referred all TB symptomatic clients to DOTS (directly observed treatment, short course) clinics. More than 6-year participation in the programme (OR 5.23, 95% CI 1.93-14.18) and willingness to always continue referring (OR 12.24, 95% CI 11.61-93.10) were associated with referral of one or more clients in the previous 3 months. Referral to the client's closest clinic was negatively associated with referral (OR 0.45, 95% CI 0.23-0.99). Pharmacies' ongoing commitment to the Referral Programme was strongly associated with referral. Increased advocacy among the high number of non-referring pharmacies may improve programme performance. Factors negatively associated with referral may need investigation. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

The Validity and Reliability of the Cross-National Comparison of Degree Programme Levels in European Countries. What Have Students Learnt?

ERIC Educational Resources Information Center

Rexwinkel, Trudy; Haenen, Jacques; Pilot, Albert

2017-01-01

A cross-national comparison of degree programme levels became relevant when the borders of European countries opened for students and graduates, and higher education institutions were restructured into bachelor's and master's programmes. This new situation foregrounded the questions of what students are learning in the degree programmes of…

The World Health Organization and public health research and practice in tuberculosis in India.

PubMed

Banerji, Debabar

2012-01-01

Two major research studies carried out in India fundamentally affected tuberculosis treatment practices worldwide. One study demonstrated that home treatment of the disease is as efficacious as sanatorium treatment. The other showed that BCG vaccination is of little protective value from a public health viewpoint. India had brought together an interdisciplinary team at the National Tuberculosis Institute (NTI) with a mandate to formulate a nationally applicable, socially acceptable, and epidemiologically sound National Tuberculosis Programme (NTP). Work at the NTI laid the foundation for developing an operational research approach to dealing with tuberculosis as a public health problem. The starting point for this was not operational research as enunciated by experts in this field; rather, the NTI achieved operational research by starting from the people. This approach was enthusiastically welcomed by the World Health Organization's Expert Committee on Tuberculosis of 1964. The NTP was designed to "sink or sail with the general health services of the country." The program was dealt a major blow when, starting in 1967, a virtual hysteria was worked up to mobilize most of the health services for imposing birth control on the people. Another blow to the general health services occurred when the WHO joined the rich countries in instituting a number of vertical programs called "Global Initiatives". An ill-conceived, ill-designed, and ill-managed Global Programme for Tuberculosis was one outcome. The WHO has shown rank public health incompetence in taking a very casual approach to operational research and has been downright quixotic in its thinking on controlling tuberculosis worldwide.

Scale is not an Issue : Opportunities for Collaboration among Geoscientists in Latin America and the Caribbean

NASA Astrophysics Data System (ADS)

Carby, B. E.

2015-12-01

Latin American and Caribbean (LAC) countries face multiple hazards such as earthquakes, volcanoes, accelerated erosion, landslides, drought, flooding, windstorms and the effects of climate variability and change. World Bank (2005) data indicate that seventeen of the top thirty-five countries with relatively high mortality risk from 3 or more hazards are located in LAC, El Salvador has the second highest per cent of its population at risk - 77.7% and 7 of the top 10 countries for population exposure to multiple hazards are in LAC. All LAC countries have half or more of GDP exposed to at least one hazard. The report underscores the need for better data and information on hazards and disasters to inform disaster risk reduction (DRR) and supports the view that reduction of disaster risk is essential for achieving Sustainable Development (SD). This suggests that DRR must be integrated into development planning of countries. However the Global Assessment Report notes that globally, there has been little progress in mainstreaming DRR in national development (UNISDR 2009). Without this, countries will not realise development goals. DRR efforts in LAC require an integrated approach including societal input in deciding priority DRR research themes and interdisciplinary, multi-hazard research informing DRR policy and practice. Jiminez (2015) from a study of countries across LAC reports that efforts are being made to link research to national planning through inclusion of policy makers in some university-led research projects. Research by the author in Jamaica reveals that the public sector has started to apply research on hazards to inform DRR policy, programmes and plans. As most research is done by universities, there is collaboration between the public sector and academia. Despite differences in scale among countries across the region, similarities in exposure to multiple hazards and potential hazard impacts suggest that collaboration among researchers in LAC could be beneficial. It is proposed here that this collaboration should go beyond the scientific community and should include sharing of experiences in linking DRR research to national development needs, inclusion of policy makers in research design and implementation and integration of research results in policy and programme development.

Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries

PubMed Central

2014-01-01

Introduction Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. Methods Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. Case description The institutions developed and collaboratively implemented a ‘Masters Degree programme with a focus on health workforce development’. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. Discussion The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. Conclusions The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key learning points of the paper are: • the need for long-term strategies and engagement; • the need for more investment and attention to developing the capacity of academic institutions; • the need to invest specifically in educational/teaching expertise for innovative approaches to teaching and capacity development more broadly; and • the importance of increasing access and support for students who are working adults in public health institutions throughout Africa. PMID:24886267

The role of global public health strategy in non-profit organisational change at country level: lessons from the joining of Save the Children and Merlin in Myanmar.

PubMed

Campbell, Fiona M; Balabanova, Dina; Howard, Natasha

2018-01-01

The paper presents a case study that critically assesses the role of global strategy 'Public Health on the Frontline 2014-2015' ('the Strategy') in supporting Merlin and Save the Children's organisational change and future programme of the combined organisation in Myanmar. Research was undertaken in 2014 in Myanmar. Twenty-six individual and three group interviews were conducted with stakeholders, and 10 meetings relevant to the country organisational transition process were observed. A conceptual framework was developed to assess the role of the global strategy in supporting the country change process. Several positive aspects of the global strategy were found, as well as critical shortcomings in its support to the organisational change process at country level. The strategy was useful in signalling Save the Children's intention to scale up humanitarian health provision. However, it had only limited influence on the early change process and outcomes in Myanmar. Results highlight several aspects that would enhance the role of a global strategy at country level. Lessons can be applied by organisations undertaking a similar process. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Is there an association between PEPFAR funding and improvement in national health indicators in Africa? A retrospective study.

PubMed

Duber, Herbert C; Coates, Thomas J; Szekeras, Greg; Kaji, Amy H; Lewis, Roger J

2010-06-12

The US President's Emergency Plan for AIDS Relief (PEPFAR) was reauthorized in June 2008 with a three-fold increase in funds, and a broader, more explicit mandate to improve health in the low- and middle-income countries that it funded. However, the ability of a disease-specific, or vertical, programme to have a spill-over effect and improve health outcomes has been questioned. In this study, we sought to examine associations between being designated as a PEPFAR focus country (and receiving increased PEPFAR funding) and non-HIV-specific health outcomes in the World Health Organization (WHO) Africa Region, the area most affected by the HIV/AIDS epidemic. A retrospective analysis of publicly available health outcomes data published by the World Health Organization was performed for all countries in the WHO Africa Region. Fractional changes in health indicators between 2000 and 2006 were calculated, and PEPFAR focus and non-focus countries were then compared. Overall, countries in the WHO Africa Region showed a small worsening in health outcomes status when all indicators were analyzed together and weighted equally. However, more health indicators improved than worsened over this six-year period. A comparison of PEPFAR focus and non-focus countries found no significant difference in the fractional change among 13 of 14 health indicators during the study period. This study suggests that vertical programmes, even one that is the scale of PEPFAR, may have little or no impact on health outcomes not explicitly targeted.

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

PubMed

de Andrade, Luiz Odorico Monteiro; Pellegrini Filho, Alberto; Solar, Orielle; Rígoli, Félix; de Salazar, Lígia Malagon; Serrate, Pastor Castell-Florit; Ribeiro, Kelen Gomes; Koller, Theadora Swift; Cruz, Fernanda Natasha Bravo; Atun, Rifat

2015-04-04

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Rotavirus vaccine RIX4414 (Rotarix™): a pharmacoeconomic review of its use in the prevention of rotavirus gastroenteritis in developing countries.

PubMed

Plosker, Greg L

2011-11-01

This article provides an overview of the clinical profile of rotavirus vaccine RIX4414 (Rotarix™) in the prevention of rotavirus gastroenteritis (RVGE) in developing countries, followed by a comprehensive review of pharmacoeconomic analyses with the vaccine in low- and middle-income countries. RVGE is associated with significant morbidity and mortality among children <5 years of age in developing countries. The protective efficacy of a two-dose oral series of rotavirus vaccine RIX4414 has been demonstrated in several well designed clinical trials conducted in developing countries, and the 'real-world' effectiveness of the vaccine has also been shown in naturalistic and case-control trials after the introduction of universal vaccination programmes with RIX4414 in Latin American countries. The WHO recommends universal rotavirus vaccination programmes for all countries. Numerous modelled cost-effectiveness analyses have been conducted with rotavirus vaccine RIX4414 across a wide range of low- and middle-income countries. Although data sources and assumptions varied across studies, results of the analyses consistently showed that the introduction of the vaccine as part of a national vaccination programme would be very (or highly) cost effective compared with no rotavirus vaccination programme, according to widely used cost-effectiveness thresholds for developing countries. Vaccine price was not known at the time the analyses were conducted and had to be estimated. In sensitivity analyses, rotavirus vaccine RIX4414 generally remained cost effective at the highest of a range of possible vaccine prices considered. Despite these favourable results, decisions regarding the implementation of universal vaccination programmes with RIX4414 may also be contingent on budgetary and other factors, underscoring the importance of subsidized vaccination programmes for poor countries through the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization).

Earth Sciences' Capacity Building In Developing Countries through International Programmes

NASA Astrophysics Data System (ADS)

Eder, W.

2007-12-01

Within the framework of "traditional" programmes, like the joint UNESCO-IUGS "International Geoscience Programme" (IGCP), the "International Continental Scientific Drilling Program" (ICDP), the "Integrated Ocean Drilling Program" (IODP) or the "International Lithosphere Programme" (ILP) numerous opportunities are provided to strengthen postgraduate geo-scientific education of representatives from developing countries. Recently established new initiatives, such as the "International Year of Planet Earth" (IYPE) or UNESCO's Global Network of Geoparks complement these in addition as important components to UNESCO's 'Education for All' programme, notably the youth, as well as to the United Nations Decade of Education for Sustainable Development (2005 - 2014). The "International Year of Planet Earth" is a joint initiative of the International Union of Geological Sciences (IUGS) and UNESCO. The central aims and ambitions of the Year, proclaimed for 2008 by the UN General Assembly, are to demonstrate the great potential of the Earth sciences in building a safer, healthier and wealthier society, and to encourage more widespread and effective application of this potential by targeting politicians and other decision-makers, educational systems, and the general public. Promotion of international collaboration, as well as capacity building and training of students of developing countries in all fields of Earth Sciences seem to be the most appropriate way to meet also the challenges of the IYPE. Another opportunity to improve the international recognition of Earth Scinces, also in developing countries, is the use of Geoparks as a promotional tool for education and popularization of Earth Sciences. Geoparks, notably those included in the European and/or Global Geoparks Networks, provide an international platform of cooperation and exchange between experts and practitioners in geological heritage matters, and are as such excellent instruments in highlighting Earth sciences. The general goal of Geoparks to integrate the preservation of geological heritage into a strategy for regional sustainable socio-economic and cultural development serves ideally the overall objective of the "International Year of Planet Earth" with its subtitle "Earth Sciences for Society". International geo-related cooperation projects, run under the umbrella of international NGOs (like IUGS, IUGG, IGU, IUSS and others) are often supported financially by international and national funding agencies. Out of the broad international spectrum, some German projects devoted to developing countries - summer schools, training and capacity building courses in Earth Sciences, funded by the DFG (German Research Foundation), DAAD (German Academic Exchange Service), InWent (Capacity Building International, Germany) and others - are selected as examples in improving the geo-research capacity and education of developing countries.

International consultation on long-term global health research priorities, research capacity and research uptake in developing countries.

PubMed

Conalogue, David Mc; Kinn, Sue; Mulligan, Jo-Ann; McNeil, Malcolm

2017-03-21

In recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries. An online consultation was used to survey a wide range of participants on global health research priorities. The qualitative data was analysed using a thematic analysis, with frequency of codes in responses tabulated to approximate relative importance of themes and sub-themes. The public consultation yielded 421 responses. The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership. The outcomes from this consultation survey provide valuable insights into how DfID stakeholders prioritise research. The outcomes from this survey were reviewed alongside other elements of a wider DfID consultation process to help inform long-term research prioritisation of global health research. There are limitations in this approach; the opportunistic nature of the survey's dissemination means the findings presented may not be representative of the full range of stakeholders or views.

Consequences of infertility in developing countries.

PubMed

Rouchou, Brittany

2013-05-01

Infertility affects more than 10% of the world's population. In developing countries, there are severe social, psychological and economic consequences for infertile men and women. All of the cited references are compiled from primary peer-reviewed research articles that were conducted through one-to-one interviews or focus groups in countries of developing regions, such as Africa, Asia and the Middle East. The following paper seeks to raise awareness of the consequences of infertility in developing nations and identify infertility as an under-observed, but significant public health issue. It is proposed that education programmes tailored to each society's specific religious beliefs and grounded traditions must be implemented in order to reverse the social stigma, detrimental psychological effects, and loss of economic security that results from infertility.

Self-rated health in Canadian immigrants: analysis of the Longitudinal Survey of Immigrants to Canada.

PubMed

Setia, Maninder Singh; Lynch, John; Abrahamowicz, Michal; Tousignant, Pierre; Quesnel-Vallee, Amelie

2011-03-01

Using a multi-level random effects logistic model, we examine the contribution of source country, individual characteristics and post-migration experiences to the self-rated health (SRH) of 2468 male and 2614 female immigrants from the Longitudinal Survey of Immigrants to Canada (2001-2005). Sex/gender differences were found for all categories of health determinants. Source country characteristics explained away some ethnic differentials in health and had independent negative effects, particularly among women. Thus, women from countries lower on the development index appear at greater risk of poor SRH, and should be at the forefront of public health programmes aimed at new immigrants in Canada. Copyright © 2011 Elsevier Ltd. All rights reserved.

Private sector, human resources and health franchising in Africa.

PubMed

Prata, Ndola; Montagu, Dominic; Jefferys, Emma

2005-04-01

In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. Using data from The World Bank's Health Nutrition and Population Poverty Thematic Reports on 22 countries in Africa, an assessment was made of the use of public and private health services, by asset quintile groups, for treatment of diarrhoea and acute respiratory infections, proxies for publicly subsidized services. The evidence and theory on using franchise networks to supplement government programmes in the delivery of public health services was assessed. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. We argue that based on the established demand for private medical services in Africa, these providers should be included in future planning on human resources for public health. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioural change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programmes in Africa to address critical illnesses of public health importance.

Expansion of Nature Conservation Areas: Problems with Natura 2000 Implementation in Poland?

PubMed Central

Cent, Joanna

2010-01-01

In spite of widespread support from most member countries’ societies for European Union policy, including support for the sustainable development idea, in many EU countries the levels of acceptance of new environmental protection programmes have been and, in particular in new member states, still are considerably low. The experience of the countries which were the first to implement union directives show that they cannot be effectively applied without widespread public participation. The goal of this study was, using the example of Poland, to assess public acceptance of the expansion of nature conservation in the context of sustainable development principles and to discover whether existing nature governance should be modified when establishing new protected areas. The increase in protected areas in Poland has become a hotbed of numerous conflicts. In spite of the generally favourable attitudes to nature which Polish people generally have, Natura 2000 is perceived as an unnecessary additional conservation tool. Both local authorities and communities residing in the Natura areas think that the programme is a hindrance, rather than a help in the economic development of municipalities or regions, as was initially supposed. This lack of acceptance results from many factors, mainly social, historic and economic. The implications of these findings for current approach to the nature governance in Poland are discussed. PMID:21107836

Human immunodeficiency virus type 1 mother-to-child transmission and prevention: successes and controversies.

PubMed

Cavarelli, M; Scarlatti, G

2011-12-01

The World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) estimated that an additional 370 000 new human immunodeficiency virus type 1 (HIV-1) infections occurred in children in 2009, mainly through mother-to-child transmission (MTCT). Intrapartum transmission contributes to approximately 20-25% of infections, in utero transmission to 5-10% and postnatal transmission to an additional 10-15% of cases. MTCT accounts for only a few hundred infected newborns in those countries in which services are established for voluntary counselling and testing of pregnant women, and a supply of antiretroviral drugs is available throughout pregnancy with recommendations for elective Caesarean section and avoidance of breastfeeding. The single-dose nevirapine regimen has provided the momentum to initiate MTCT programmes in many resource-limited countries; however, regimens using a combination of antiretroviral drugs are needed also to effectively reduce transmission via breastfeeding. 2011 The Association for the Publication of the Journal of Internal Medicine.

Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy.

PubMed

Angus, Colin; Scafato, Emanuele; Ghirini, Silvia; Torbica, Aleksandra; Ferre, Francesca; Struzzo, Pierluigi; Purshouse, Robin; Brennan, Alan

2014-02-06

As alcohol-related health problems continue to rise, the attention of policy-makers is increasingly turning to Screening and Brief Intervention (SBI) programmes. The effectiveness of such programmes in primary healthcare is well evidenced, but very few cost-effectiveness analyses have been conducted and none which specifically consider the Italian context. The Sheffield Alcohol Policy Model has been used to model the cost-effectiveness of government pricing and public health policies in several countries including England. This study adapts the model using Italian data to evaluate a programme of screening and brief interventions in Italy. Results are reported as Incremental Cost-Effectiveness Ratios (ICERs) of SBI programmes versus a 'do-nothing' scenario. Model results show such programmes to be highly cost-effective, with estimated ICERs of €550/Quality Adjusted Life Year (QALY) gained for a programme of SBI at next GP registration and €590/QALY for SBI at next GP consultation. A range of sensitivity analyses suggest these results are robust under all but the most pessimistic assumptions. This study provides strong support for the promotion of a policy of screening and brief interventions throughout Italy, although policy makers should be aware of the resource implications of different implementation options.

School food, politics and child health.

PubMed

Bundy, Donald A P; Drake, Lesley J; Burbano, Carmen

2013-06-01

An analysis undertaken jointly in 2009 by the UN World Food Programme, The Partnership for Child Development and the World Bank was published as Rethinking School Feeding to provide guidance on how to develop and implement effective school feeding programmes as a productive safety net and as part of the efforts to achieve Education for All. The present paper reflects on how understanding of school feeding has changed since that analysis. Data on school feeding programme outcomes were collected through a literature review. Regression models were used to analyse relationships between school feeding costs (from data that were collected), the per capita costs of primary education and Gross Domestic Product per capita. Data on the transition to national ownership, supply chains and country examples were collected through country case studies. School feeding programmes increase school attendance, cognition and educational achievement, as well as provide a transfer of resources to households with possible benefits to local agricultural production and local market development. Low-income countries exhibit large variations in school feeding costs, with concomitant opportunities for cost containment. Countries are increasingly looking to transition from externally supported projects to national programmes. School feeding is now clearly evident as a major social programme in most countries with a global turnover in excess of $US 100 billion. This argues for a continuing focus on the evidence base with a view to helping countries ensure that their programmes are as cost-effective as possible. Clear policy advice has never been more important.

Malaria vector control at a crossroads: public health entomology and the drive to elimination.

PubMed

Mnzava, Abraham P; Macdonald, Michael B; Knox, Tessa B; Temu, Emmanuel A; Shiff, Clive J

2014-09-01

Vector control has been at the core of successful malaria control. However, a dearth of field-oriented vector biologists threatens to undermine global reductions in malaria burden. Skilled cadres are needed to manage insecticide resistance, to maintain coverage with current interventions, to develop new paradigms for tackling 'residual' transmission and to target interventions as transmission becomes increasingly heterogeneous. Recognising this human resource crisis, in September 2013, WHO Global Malaria Programme issued guidance for capacity building in entomology and vector control, including recommendations for countries and implementing partners. Ministries were urged to develop long-range strategic plans for building human resources for public health entomology and vector control (including skills in epidemiology, geographic information systems, operational research and programme management) and to set in place the requisite professional posts and career opportunities. Capacity building and national ownership in all partner projects and a clear exit strategy to sustain human and technical resources after project completion were emphasised. Implementing partners were urged to support global and regional efforts to enhance public health entomology capacity. While the challenges inherent in such capacity building are great, so too are the opportunities to establish the next generation of public health entomologists that will enable programmes to continue on the path to malaria elimination. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Expiry of medicines in supply outlets in Uganda.

PubMed

Nakyanzi, Josephine Katabaazi; Kitutu, Freddy Eric; Oria, Hussein; Kamba, Pakoyo Fadhiru

2010-02-01

The expiry of medicines in the supply chain is a serious threat to the already constrained access to medicines in developing countries. We investigated the extent of, and the main contributing factors to, expiry of medicines in medicine supply outlets in Kampala and Entebbe, Uganda. A cross-sectional survey of six public and 32 private medicine outlets was done using semi-structured questionnaires. The study area has 19 public medicine outlets (three non-profit wholesalers, 16 hospital stores/pharmacies), 123 private wholesale pharmacies and 173 retail pharmacies, equivalent to about 70% of the country's pharmaceutical businesses. Our findings indicate that medicines prone to expiry include those used for vertical programmes, donated medicines and those with a slow turnover. Awareness about the threat of expiry of medicines to the delivery of health services has increased. We have adapted training modules to emphasize management of medicine expiry for pharmacy students, pharmacists and other persons handling medicines. Our work has also generated more research interest on medicine expiry in Uganda. Even essential medicines expire in the supply chain in Uganda. Sound coordination is needed between public medicine wholesalers and their clients to harmonize procurement and consumption as well as with vertical programmes to prevent duplicate procurement. Additionally, national medicine regulatory authorities should enforce existing international guidelines to prevent dumping of donated medicine. Medicine selection and quantification should be matched with consumer tastes and prescribing habits. Lean supply and stock rotation should be considered.

The Global Opioid Policy Initiative: a wealth of information, but what is next?

PubMed

Scholten, Willem

2014-03-01

Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. Data from the project will be an important resource for those who advocate for improved access to opioid analgesics. Yet, like so often, many more aspects of inadequate opioid analgesic consumption require exploration and reporting, including legislative barriers. The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.

Public health measures to control hepatitis B virus infection in the developing countries of the Asia-Pacific region.

PubMed

Chen, D S

2000-05-01

Hepatitis B virus (HBV) infection is prevalent in the Asia-Pacific region and the disease burden caused by chronic HBV infection has been enormous. Although vaccination programmes have been implemented in the past decade, and there are extremely successful countries in the region, many countries still cannot afford a control program. These countries are often populous and highly endemic for HBV infection. To overcome this, aid from developed countries or private foundations should be actively sought. In the developing countries of this region, HBV infection in early childhood is the main cause of chronic HBV status, and thus universal vaccination of all infants is the best way to control HBV infection. Because of the expense and extra costs of screening pregnant women, the use of hepatitis B immune globulin may not be essential. To achieve the goal of universal infant vaccination, public education should be done in parallel with education of health professionals and control measures. The Asia Pacific region has more people with chronic hepatitis B than any other part of the world, and control of HBV infection in this region will no doubt be the most important and challenging task to be taken in the beginning of the new millennium.

Global child health priorities: what role for paediatric oncologists?

PubMed

Kellie, Stewart J; Howard, Scott C

2008-11-01

Despite increasing globalisation, international mobility and economic interdependence, 9.7 million children aged less than 5 years in low income countries will die this year, almost all from preventable or treatable diseases. Diarrhoea, pneumonia and malaria account for 5 million of these deaths each year, compared to about 150,000 deaths from childhood cancer in low- and middle-income countries. In high-income countries, 80% of the 50,000 children diagnosed with cancer each year survive, yet cancer remains the leading disease-related cause of childhood death. In low- and middle-income countries, where 80% of children live, the 200,000 children diagnosed with cancer each year have limited access to curative treatment, and only about 25% survive. Some might argue that death from paediatric cancer in poor countries is insignificant compared to death from other causes, and that scarce health resources may be better used in other areas of public health. Is there a role for the treatment of children with cancer in these regions? Do international partnerships or 'twinning' programmes enhance local health care or detract from other public health priorities? What is ethical and what is possible? This review examines the health challenges faced by infants and children in low-income countries, and assesses the role and impact of international paediatric oncology collaboration to improve childhood cancer care worldwide.

The polio-eradication programme and issues of the end game.

PubMed

Minor, Philip D

2012-03-01

Poliovirus causes paralytic poliomyelitis, an ancient disease of humans that became a major public-health issue in the 20th century. The primary site of infection is the gut, where virus replication is entirely harmless; the two very effective vaccines developed in the 1950s (oral polio vaccine, or OPV, and inactivated polio vaccine, or IPV) induce humoral immunity, which prevents viraemic spread and disease. The success of vaccination in middle-income and developing countries encouraged the World Health Organization to commit itself to an eradication programme, which has made great advances. The features of the infection, including its largely silent nature and the ability of the live vaccine (OPV) to evolve and change in vaccine recipients and their contacts, make eradication particularly challenging. Understanding the pathogenesis and virology of the infection is of major significance as the programme reaches its conclusion.

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa.

PubMed

Perrone, L A; Confer, D; Scott, E; Livingston, L; Bradburn, C; McGee, A; Furtwangler, T; Downer, A; Mokdad, A H; Flandin, J F; Shotorbani, S; Asghar, H; Tolbah, H E; Ahmed, H J; Alwan, A; Martin, R

2017-02-01

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries (Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen) in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region.

Progress towards malaria control targets in relation to national malaria programme funding

PubMed Central

2013-01-01

Background Malaria control has been dramatically scaled up the past decade, mainly thanks to increasing international donor financing since 2003. This study assessed progress up to 2010 towards global malaria impact targets, in relation to Global Fund, other donor and domestic malaria programme financing over 2003 to 2009. Methods Assessments used domestic malaria financing reported by national programmes, and Global Fund/OECD data on donor financing for 90 endemic low- and middle-income countries, WHO estimates of households owning one or more insecticide-treated mosquito net (ITN) for countries in sub-Saharan Africa, and WHO-estimated malaria case incidence and deaths in countries outside sub-Saharan Africa. Results Global Fund and other donor funding is concentrated in a subset of the highest endemic African countries. Outside Africa, donor funding is concentrated in those countries with highest malaria mortality and case incidence rates over the years 2000 to 2003. ITN coverage in 2010 in Africa, and declines in case and death rates per person at risk over 2004 to 2010 outside Africa, were greatest in countries with highest donor funding per person at risk, and smallest in countries with lowest donor malaria funding per person at risk. Outside Africa, all-source malaria programme funding over 2003 to 2009 per case averted ($56-5,749) or per death averted ($58,000-3,900,000) over 2004 to 2010 tended to be lower (more favourable) in countries with higher donor malaria funding per person at risk. Conclusions Increases in malaria programme funding are associated with accelerated progress towards malaria control targets. Associations between programme funding per person at risk and ITN coverage increases and declines in case and death rates suggest opportunities to maximize the impact of donor funding, by strategic re-allocation to countries with highest continued need. PMID:23317000

Social participation in health in Brazil and England: inclusion, representation and authority

PubMed Central

Barnes, Marian; Coelho, Vera Schattan

2009-01-01

Abstract Aim  This article offers a brief description and analysis of public participation in health in Brazil and England in order to highlight different motivators and tensions within an acceptance of participation as official policy. Sources/methods  The article draws on a range of research in both countries and an analysis of official documents relating to participation. It is based on collaboration between researchers deriving from broad programmes of work on public participation in which the authors are involved. Argument  There is a tension between different principles underpinning collective public involvement in health both within and between countries. Different aspirations or claims have been made about what such participation will achieve and there are trade‐offs between design principles that have consequences for issues such as who takes part and thus also for what can be achieved. The democratic origins of public participation are more evident in the Brazilian situation than in England, but there are still questions about the inclusivity of the practices through which this is achieved. The English picture is both more diverse and dynamic, but formal decision‐making power of participatory forums is less than in Brazil. Whilst social justice claims for participation have been made in both countries, there is as yet limited evidence that these have been realized. PMID:19754687

Social participation in health in Brazil and England: inclusion, representation and authority.

PubMed

Barnes, Marian; Coelho, Vera Schattan

2009-09-01

This article offers a brief description and analysis of public participation in health in Brazil and England in order to highlight different motivators and tensions within an acceptance of participation as official policy. The article draws on a range of research in both countries and an analysis of official documents relating to participation. It is based on collaboration between researchers deriving from broad programmes of work on public participation in which the authors are involved. There is a tension between different principles underpinning collective public involvement in health both within and between countries. Different aspirations or claims have been made about what such participation will achieve and there are trade-offs between design principles that have consequences for issues such as who takes part and thus also for what can be achieved. The democratic origins of public participation are more evident in the Brazilian situation than in England, but there are still questions about the inclusivity of the practices through which this is achieved. The English picture is both more diverse and dynamic, but formal decision-making power of participatory forums is less than in Brazil. Whilst social justice claims for participation have been made in both countries, there is as yet limited evidence that these have been realized.

The polio eradication campaign: time to shift the goal.

PubMed

Baron, Emmanuel; Magone, Claire

2014-03-01

The social rejection of the polio eradication campaign in endemic countries challenges an assumption underlying the goal itself: the full compliance of an entire population to a public health programme. The polio campaign, which has been an extraordinary public health enterprise, is at risk of becoming irremediably unpopular if the eradication goal is pursued at all costs. The Global Polio Eradication Initiative (GPEI) should not be driven by the fear of failure, because the greatest benefit of the polio campaign is that it has demonstrated how simple, community-wide actions can contribute to a dramatic decrease in the incidence of a disease.

The role of the private sector in the provision of antenatal care: a study of Demographic and Health Surveys from 46 low- and middle-income countries.

PubMed

Powell-Jackson, Timothy; Macleod, David; Benova, Lenka; Lynch, Caroline; Campbell, Oona M R

2015-02-01

To examine the role of the private sector in the provision of antenatal care (ANC) across low- and middle-income countries. Demographic and Health Survey (DHS) data from 46 countries (representing 2.6 billion people) on components of ANC given to 303 908 women aged 15-49 years for most recent birth were used. We identified 79 unique sources of care which were re-coded into home, public, private (commercial) and private (not-for-profit). Use of ANC and a quality of care index (scaled 0-1) were stratified by type of provider, region and wealth quintile. Linear regressions were used to examine the association between provider type and antenatal quality of care score. Across all countries, the main source of ANC was public (54%), followed by private commercial (36%) and home (5%), but there were large variations by region. Home-based ANC was associated with worse quality of care (0.2; 95% CI -0.2 to -0.19) relative to the public sector, while the private not-for-profit sector (0.03; 95% CI 0.02 to 0.04) was better. There were no differences in quality of care between public and private commercial providers. The market for ANC varies considerably between regions. The two largest sectors - public and private commercial - perform similarly in terms of quality of care. Future research should examine the role of the private sector in other health service domains across multiple countries and test what policies and programmes can encourage private providers to contribute to increased coverage, quality and equity of maternal care. © 2014 John Wiley & Sons Ltd.

National tuberculosis programme review: experience over the period 1990-95.

PubMed Central

Pio, A.; Luelmo, F.; Kumaresan, J.; Spinaci, S.

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies. PMID:9509630

National tuberculosis programme review: experience over the period 1990-95.

PubMed

Pio, A; Luelmo, F; Kumaresan, J; Spinaci, S

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies.

One Health research and training and government support for One Health in South Asia.

PubMed

McKenzie, Joanna S; Dahal, Rojan; Kakkar, Manish; Debnath, Nitish; Rahman, Mahmudur; Dorjee, Sithar; Naeem, Khalid; Wijayathilaka, Tikiri; Sharma, Barun Kumar; Maidanwal, Nasir; Halimi, Asmatullah; Kim, Eunmi; Chatterjee, Pranab; Devleesschauwer, Brecht

2016-01-01

Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors' professional networks. Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies.

How do researchers influence decision-makers? Case studies of Mexican policies.

PubMed

Trostle, J; Bronfman, M; Langer, A

1999-06-01

Though the problems translating or applying research in policy-making are legion, solutions are rare. As developing countries increase their capacities to develop effective local solutions to their health problems, they confront the research/policy dilemma. Yet few descriptive studies of research-policy links can be found from developing countries, and the relevance of European and North American models and data is questionable. We report the results of a descriptive study from Mexico of the relationship between health research and policy in four vertical programmes (AIDS, cholera, family planning, immunization). We interviewed 67 researchers and policy-makers from different institutions and levels of responsibility. We analyzed interviewee responses looking for factors that promoted or impeded exchanges between researchers and policy-makers. These were, in turn, divided into emphases on content, actors, process, and context. Many of the promoting factors resembled findings from studies in industrialized countries. Some important differences across the four programmes, which also distinguish them from industrialized country programmes, included extent of reliance on formal communication channels, role of the mass media in building social consensus or creating discord, levels of social consensus, role of foreign donors, and extent of support for biomedical versus social research. We recommend various ways to increase the impact of research on health policy-making in Mexico. Some of the largest challenges include the fact that researchers are but one of many interest groups, and research but one input among many equally legitimate elements to be considered by policy-makers. Another important challenge in Mexico is the relatively small role played by the public in policy-making. Further democratic changes in Mexico may be the most important incentive to increase the use of research in policy-making.

Unequal views of inequality: Cross-national support for redistribution 1985-2011.

PubMed

VanHeuvelen, Tom

2017-05-01

This research examines public views on government responsibility to reduce income inequality, support for redistribution. While individual-level correlates of support for redistribution are relatively well understood, many questions remain at the country-level. Therefore, I examine how country-level characteristics affect aggregate support for redistribution. I test explanations of aggregate support using a unique dataset combining 18 waves of the International Social Survey Programme and European Social Survey. Results from mixed-effects logistic regression and fixed-effects linear regression models show two primary and contrasting effects. States that reduce inequality through bundles of tax and transfer policies are rewarded with more supportive publics. In contrast, economic development has a seemingly equivalent and dampening effect on public support. Importantly, the effect of economic development grows at higher levels of development, potentially overwhelming the amplifying effect of state redistribution. My results therefore suggest a fundamental challenge to proponents of egalitarian politics. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between spending on social protection and tuberculosis burden: a global analysis.

PubMed

Siroka, Andrew; Ponce, Ninez A; Lönnroth, Knut

2016-04-01

The End TB Strategy places great emphasis on increasing social protection and poverty alleviation programmes. However, the role of social protection on controlling tuberculosis has not been examined fully. We analysed the association between social protection spending and tuberculosis prevalence, incidence, and mortality globally. We used publicly available data from WHO's Global Tuberculosis Programme for tuberculosis burden in terms of yearly incidence, prevalence, and mortality per 100,000 people, and social protection data from the International Labour Organization (ILO), expressed as the percentage of national gross domestic product (GDP) spent on social protection programmes (excluding health). Data from ILO were from 146 countries covering the years between 2000 and 2012. We used descriptive assessments to examine levels of social protection and tuberculosis burden for each country, then used these assessments to inform our fully adjusted multivariate regression models. Our models controlled for economic output, adult HIV prevalence, health expenditure, population density, the percentage of foreign-born residents, and the strength of the national tuberculosis treatment programme, and also incorporated a country-level fixed effect to adjust for clustering of datapoints within countries. Overall, social protection spending levels were inversely associated with tuberculosis prevalence, incidence, and mortality. For a country spending 0% of their GDP on social protection, moving to spending 1% of their GDP was associated with a change of -18·33 per 100,000 people (95% CI -32·10 to -4·60; p=0·009) in prevalence, -8·16 per 100,000 people (-16·00 to -0·27; p=0·043) in incidence, and -5·48 per 100,000 people (-9·34 to -1·62; p=0·006) in mortality. This association was mitigated at higher levels of social protection spending, and lost significance when more than 11% of GDP was spent. Our findings suggest that investments in social protection could contribute to a reduced tuberculosis burden, especially in countries that are investing a small proportion of their GDP in this area. However, further research is needed to support these ecological associations. National Institutes of Health National Center for Advancing Translational Science (University of California, Los Angeles [CA, USA] Clinical and Translational Science Institute). Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy: a qualitative study

PubMed Central

Khan, Wasiq Mehmood; Smith, Helen; Qadeer, Ejaz

2016-01-01

Objective To understand how national and provincial tuberculosis programme managers in Pakistan perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. National and provincial tuberculosis programme managers play an important role in effective implementation of the Stop TB strategy. Design A qualitative interview study was conducted with 10 national and provincial tuberculosis programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). Participants National and provincial tuberculosis programme managers in Pakistan. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). Setting National and provincial tuberculosis programmes in Pakistan Main outcome measures 1. Knowledge and perceptions of national and provincial tuberculosis programme managers about the Stop TB strategy 2. Progress in implementing the strategy in Pakistan 3. Significant success factors 4. Significant implementation challenges 5. Lessons learnt to scale up successful implementation. Results The managers reported that most progress had been made in extending DOTS, health systems strengthening, public -private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were the availability of DOTS services, the public-private partnership approach, comprehensive guidance for TB control and government and donor commitment to TB control. Conclusion This study identified three main challenges as perceived by national and provincial tuberculosis programme managers in terms of implementing the Stop TB strategy: 1. Inadequate political commitment, 2. Issue pertaining to prioritisation of certain components in the TB strategy over others due to external influences and 3. Limitations in the overall health system. To improve the tuberculosis control programme in the country political commitment needs to be enhanced and public -private partnerships increased. This can be done through government prioritisation of TB control at both national and provincial levels; donor-funded components should not receive undue attention; and partnerships with the private health sector, health institutions not yet covered by DOTS services, non-governmental organisations and patient coalitions should be increased. PMID:28203383

Building operational research capacity in the Pacific

PubMed Central

Viney, K.; Brostrom, R.; Gounder, S.; Khogali, M.; Kishore, K.; Kool, B.; Kumar, A. M. V.; Manzi, M.; Marais, B.; Marks, G.; Linh, N. N.; Ram, S.; Reid, S.; Roseveare, C.; Tayler-Smith, K.; Van den Bergh, R.; Harries, A. D.

2014-01-01

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges. PMID:26477282

Building operational research capacity in the Pacific.

PubMed

Bissell, K; Viney, K; Brostrom, R; Gounder, S; Khogali, M; Kishore, K; Kool, B; Kumar, A M V; Manzi, M; Marais, B; Marks, G; Linh, N N; Ram, S; Reid, S; Roseveare, C; Tayler-Smith, K; Van den Bergh, R; Harries, A D

2014-06-21

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

PubMed

Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

2017-05-22

Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Do community medicine residency trainees learn through journal club? An experience from a developing country.

PubMed

Akhund, Saima; Kadir, Muhammad Masood

2006-08-22

Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction. Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September 1999-September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience.

Do community medicine residency trainees learn through journal club? An experience from a developing country

PubMed Central

Akhund, Saima; Kadir, Muhammad Masood

2006-01-01

Background Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction. Methods Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September1999–September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. Results The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. Conclusion CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience. PMID:16925800

Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries.

PubMed

Campbell, C; Scott, K

2011-01-01

This paper examines the potential of community health worker (CHW) programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to tackle health worker shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous CHW experiences. The WHO has taken account of five key lessons learnt from past CHW programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the 'community embeddedness' of CHWs, found to be of critical importance to the success of past CHW programmes. We have no doubt that the WHO plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness, CHWs will be unable to successfully perform the socially oriented tasks assigned to them by the WHO, such as health education and counselling. We locate the WHO's neglect of community embeddedness within the context of a broader global public health trend away from community-focused primary healthcare towards biomedically focused selective healthcare.

Comparison of tobacco control policies in the Eastern Mediterranean countries based on Tobacco Control Scale scores.

PubMed

Heydari, G; Talischi, F; Masjedi, M R; Alguomani, H; Joossens, L; Ghafari, M

2012-08-01

This cross-sectional survey aimed to provide an overview of tobacco control strategies in the countries of the Eastern Mediterranean Region (EMR). A questionnaire to collate data on implementation of 6 major policies was developed based on the previously published Tobacco Control Scale and using MPOWER measures of the WHO Tobacco Free Initiative and the Tobacco Atlas. Only 3 of the 21 countries scored higher than 50 out of 100: Islamic Republic of Iran (61), Jordan (55) and Egypt (51) More than half of countries scored less than 26. Highest scores were achieved by Afghanistan in cigarette pricing, Oman in smoking bans in public places, Islamic Republic of Iran in budgeting, prohibition of advertisements and health warnings against smoking and Syrian Arab Republic, Tunisia and Kuwait in tobacco cessation programmes. The low mean total score in EMR countries (29.7) compared with European countries (47.2) highlights the need for better future planning and policy-making for tobacco control in the Region.

Descriptive survey of the contextual support for nursing research in 15 countries.

PubMed

Uys, Leana R; Newhouse, Robin P; Oweis, Arwa; Liang, Xiaokun

2013-01-01

Global research productivity depends on the presence of contextual factors, such as a doctorally prepared faculty, graduate programmes, publication options, that enable the conduct and publication of studies to generate knowledge to inform nursing practice. The current study aimed to develop and test an instrument that measures the level of contextual support for nursing research within a specific country, allowing comparisons between countries. After development of a 20-item survey with seven factors and 11 criteria based on a literature review, a quantitative descriptive e-mail survey design was used. Nurse researchers (N=100) from 22 countries were invited to participate. The response rate was 39% from 15 countries. Ethics approval was obtained by investigators in their country of origin. Results showed wide variation in the level of contextual support. The average total level of support across all countries was 26.8% (standard deviation [SD]=14.97). The greatest variability was in the area of availability of publishing opportunities (ranging between no suitable journals in a country to over 100). The least variability was in the area of availability of local enabling support (SD=7.22). This research showed wide differences in the level of contextual support for nursing research. The survey instrument can be utilised as a country assessment that can be used to strategically plan the building of infrastructure needed to support nursing research. Contextual support for nursing research is an antecedent of strong science. Building infrastructure for nursing science is a priority for global health.

Quality evaluation in the management of child sponsorship programmes.

PubMed

McDonnell, W A; McDonnell, T P

1994-08-01

Programme evaluation tactics for child sponsorship programmes have historically concentrated on quantitative analysis of service units, amount of money invested, number of countries served, the number of projects, and number of children in each project. While these are valuable measures of programme variables, they do not assess the impact of programmes on the lives of the children sponsored. Outcome measures designed to assess programme impact add greatly to the information available to child welfare professionals. This study collected data about the impact of the programme on the lives of the children. The Child Welfare League's Child Well-Being Scales (CWBS) were used to assess programme impact. Twelve scales were chosen as directly related in type to the programmes administered by Children International, a traditional and well established child sponsorship organization located in Kansas City, Missouri. A thirteenth scale was suggested by field workers in India as particularly relevant to Third World populations. The scales were translated into languages appropriate to each population in the programme countries. Social workers in each country were trained to administer and score them. This analysis used the emerging data technology becoming available to programmes in Third World countries. The system enables administrators in the Third World to evaluate, enhance and summarize their programmes in a way understandable across borders. Epi Info (Dean et al., 1990) was customized to provide the framework for the analysis. The population for this study was selected by a 5% random sampling of children currently enrolled as sponsored children (180,000+ worldwide). These were compared with a waiting-list control group selected randomly from lists of children who have applied for sponsorship but have not yet been receiving services (n = 50 from each project).(ABSTRACT TRUNCATED AT 250 WORDS)

Lessons learnt from a three-year pilot field epidemiology training programme.

PubMed

Hoy, Damian; Durand, A Mark; Hancock, Thane; Cash, Haley L; Hardie, Kate; Paterson, Beverley; Paulino, Yvette; White, Paul; Merritt, Tony; Fitzgibbons, Dawn; Gopalani, Sameer Vali; Flint, James; Edwin A Merilles, Onofre; Kashiwabara, Mina; Biaukula, Viema; Lepers, Christelle; Souares, Yvan; Nilles, Eric; Batikawai, Anaseini; Huseynova, Sevil; Patel, Mahomed; Saketa, Salanieta T; Durrheim, David; Henderson, Alden; Roth, Adam

2017-01-01

The Pacific region has widely dispersed populations, limited financial and human resources and a high burden of disease. There is an urgent need to improve the availability, reliability and timeliness of useable health data. The purpose of this paper is to share lessons learnt from a three-year pilot field epidemiology training programme that was designed to respond to these Pacific health challenges. The pilot programme built on and further developed an existing field epidemiology training programme for Pacific health staff. The programme was delivered in country by epidemiologists working for Pacific Public Health Surveillance Network partners. The programme consisted of five courses: four one-week classroom-based courses and one field epidemiology project. Sessions were structured so that theoretical understanding was achieved through interaction and reinforced through practical hands-on group activities, case studies and other interactive practical learning methods. As of September 2016, 258 students had commenced the programme. Twenty-six course workshops were delivered and one cohort of students had completed the full five-course programme. The programme proved popular and gained a high level of student engagement. Face-to-face delivery, a low student-to-facilitator ratio, substantial group work and practical exercises were identified as key factors that contributed to the students developing skills and confidence. Close engagement of leaders and the need to quickly evaluate and adapt the curriculum were important lessons, and the collaboration between external partners was considered important for promoting a harmonized approach to health needs in the Pacific.

Lasting impact: insights from a surgical mission-based mentoring training programme in the Republic of Congo

PubMed Central

White, Michelle; Close, Kristin

2016-01-01

The global shortage of surgeons, anaesthetists and obstetricians is significant, especially in low and middle income countries (LMICs). A significant amount of LMIC surgical volume is provided by surgical missions and non-governmental organisations (NGOs) who are often well resourced, making them ideal environments for training. However, there are few publications addressing how to train in this setting, or the long-term impact of such training. Mercy Ships operates the largest non-governmental hospital ship in the world, the Africa Mercy, serving LMICs at the invitation of their President by providing free surgery and training for the surgical workforce. Mercy Ships developed and offered a comprehensive training programme across surgical specialties and disciplines in the Republic of Congo, 2013–2014. In this analysis paper, we present our experiences in developing and implementing the training portion of the programme. We also present the findings of an evaluation of the programme, which show a sustained positive impact and lasting change on personal and organisational practice 12–18 months post-training. We also make recommendations to NGOs and surgical mission organisations seeking to augment the impact of surgical missions with effective surgical training programmes. PMID:28588961

Integrating ethics, health policy and health systems in low- and middle-income countries: case studies from Malaysia and Pakistan.

PubMed

Hyder, Adnan A; Merritt, Maria; Ali, Joseph; Tran, Nhan T; Subramaniam, Kulanthayan; Akhtar, Tasleem

2008-08-01

Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns. The concepts that drive much of public-health practice are shaped by the collective and individual mores that define social systems. This paper seeks to describe the ethics processes in play when public-health mechanisms are established in low- and middle-income countries, by focusing on two cases where ethics played a crucial role in producing positive institutional change in public-health policy. First, we introduce an overview of the relationship between ethics and public health; second, we provide a conceptual framework for the ethical analysis of health system events, noting how this approach might enhance the power of existing frameworks; and third, we demonstrate the interplay of these frameworks through the analysis of a programme to enhance road safety in Malaysia and an initiative to establish a national ethics committee in Pakistan. We conclude that, while ethics are gradually being integrated into public-health policy decisions in many developing health systems, ethical analysis is often implicit and undervalued. This paper highlights the need to analyse public-health decision-making from an ethical perspective.

Public attitudes toward depression and help-seeking: Impact of the OSPI-Europe depression awareness campaign in four European regions.

PubMed

Kohls, Elisabeth; Coppens, Evelien; Hug, Juliane; Wittevrongel, Eline; Van Audenhove, Chantal; Koburger, Nicole; Arensman, Ella; Székely, András; Gusmão, Ricardo; Hegerl, Ulrich

2017-08-01

Public attitudes toward depression and help-seeking behaviour are important factors influencing depressed people to obtain professional help and adequate treatment. OSPI-Europe is a multi-level suicide prevention programme including a public awareness campaign. It was implemented in four regions of four European countries (Germany, Hungary, Ireland and Portugal). This paper reports the results of the evaluation of the campaign, including its visibility and effects of the campaign on stigma associated with depression and help-seeking behaviour. A representative general population survey (N=4004) including measures on personal stigma, perceived stigma, openness to help, perceived value of help, and socio-demographic variables was conducted in the four intervention and four control regions in a cross-sectional pre-post design. The public awareness campaign was considerably more visible in Germany and Portugal compared to Ireland and Hungary. Visibility was further affected by age and years of schooling. Personal stigma, perceived stigma and openness toward professional help varied significantly across the four countries. Respondents in the intervention regions showed significantly less personal depression stigma than respondents in the control regions after the campaign. Respondents of the intervention region who were aware of the campaign reported more openness toward seeking professional help than respondents who were unaware of it. The OSPI-Europe awareness campaign was visible and produced some positive results. At the same time, it proved to be difficult to show strong, measurable and unambiguous effects, which is in line with previous studies. Public awareness campaigns as conducted within OSPI-Europe can contribute to improved attitudes and knowledge about depression in the general public and produce synergistic effects, in particular when the dissemination of awareness campaign materials is simultaneously reinforced by other intervention levels of a multi-level intervention programme. The survey was cross-sectional and based on self-report, so no causal inferences could be drawn. Copyright © 2017 Elsevier B.V. All rights reserved.

A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

PubMed

Bellows, Ben W; Conlon, Claudia M; Higgs, Elizabeth S; Townsend, John W; Nahed, Matta G; Cavanaugh, Karen; Grainger, Corinne G; Okal, Jerry; Gorter, Anna C

2013-12-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes

PubMed Central

Conlon, Claudia M.; Higgs, Elizabeth S.; Townsend, John W.; Nahed, Matta G.; Cavanaugh, Karen; Grainger, Corinne G.; Okal, Jerry; Gorter, Anna C.

2013-01-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

Focus on Vocational Education and Training (VET) Programmes. Education Indicators in Focus. No. 33

ERIC Educational Resources Information Center

OECD Publishing, 2015

2015-01-01

In 2012, in more than one-third of OECD countries, over half of all upper secondary students participated in pre-vocational or vocational programmes but less than 30% of those students were exposed to work-based learning. Countries with well-established and high-quality vocational and apprenticeship programmes have improved youth employment…

Challenging Ideological Environments: International Teachers' Experiences in an Outside-of-Country Teacher Training Programme

ERIC Educational Resources Information Center

Gutierrez, Amanda

2016-01-01

Teacher training for developing nation contexts is often conducted in short, intensive inside and outside-of-country programmes. Concerns have been raised in relation to the uncritical take-up of the western-centric material provided by these programmes, which are usually funded by national and international government organizations. This paper…

Modelo B/Dual Language Programmes in the Basque Country and the USA

ERIC Educational Resources Information Center

Torres-Guzman, Maria E.; Etxeberria, Feli

2005-01-01

In this paper, we undertake a cross-national comparison of early partial immersion programmes, known as dual language or Modelo B programmes, in the USA and the Basque Country in Spain, respectively. We attempt to make sense of their growth, the expanded social uses of the minority languages, and address seemingly contradictory pedagogical…

What Is "Enterprise Education?" An Analysis of the Objectives and Methods of Enterprise Education Programmes in Four European Countries

ERIC Educational Resources Information Center

Hytti, Ulla; O'Gorman, Colm

2004-01-01

This paper explores what constitutes "enterprise education" in four European countries. It proposes a conceptual schema for capturing the various objectives of enterprise education programmes and initiatives. This conceptual schema is then used to categorise the objectives of 50 enterprise programmes from Austria, Finland, Ireland, and…

Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

PubMed

Piette, John D; Lun, K C; Moura, Lincoln A; Fraser, Hamish S F; Mechael, Patricia N; Powell, John; Khoja, Shariq R

2012-05-01

E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients' self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.

Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

PubMed Central

Lun, KC; Moura, Lincoln A; Fraser, Hamish SF; Mechael, Patricia N; Powell, John; Khoja, Shariq R

2012-01-01

Abstract E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients’ self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed. PMID:22589570

Tobacco and oral health--the role of the world health organization.

PubMed

Petersen, Poul Erik

2003-01-01

In addition to several other chronic diseases, tobacco use is a primary cause of many oral diseases and adverse oral conditions. For example, tobacco is a risk factor for oral cancer, periodontal disease, and congenital defects in children whose mothers smoke during pregnancy. The epidemic of tobacco use is one of the greatest threats to global health; sadly the future appears worse because of the globalization of marketing. The World Health Organization (WHO) has strengthened the work for effective control of tobacco use. At the World Health Assembly in May 2003 the Member States agreed on a groundbreaking public health treaty to control tobacco supply and consumption. The treaty covers tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation. Oral health professionals and dental associations worldwide should consider this platform for their future work for tobacco prevention since in several countries they play an important role in communication with patients and communities. The WHO Oral Health Programme gives priority to tobacco control in many ways through the development of national and community programmes which incorporates oral health and tobacco issues, tobacco prevention through schools, tobacco risk assessment in countries, and design of modern surveillance systems on risk factors and oral health. Systematic evaluation of coordinated efforts should be carried out at country and inter-country levels.

Challenges in the management of Chagas disease in Latin-American migrants in Europe.

PubMed

Monge-Maillo, B; López-Vélez, R

2017-05-01

Chagas disease is endemic in Latin America. Due to migration the infection has crossed borders and it is estimated that 68,000-120,000 people with Chagas disease are currently living in Europe and 30% of them may develop visceral involvement. However, up to 90% of Chagas disease cases in Europe remain undiagnosed. The challenges which have to be overcome in Chagas disease in non-endemic countries are focused on related downing barriers to health care access, and related to screening, diagnostic tools and therapeutic management. The aim of this review is to highlight how healthcare management for Latin American migrants with Chagas disease in Europe may be improved. Medical literature was searched using PubMed. No limits were placed with respect to the language or date of publication although most of the articles selected were articles published in the last five years. Chosen search terms were "Chagas disease" AND ("migrants" OR "screening" OR "transmission" OR "treatment"; OR "knowledge" OR "non-endemic countries"); migrants AND ("Public health" OR "Health Service Accessibility" OR "Delivery of Health care"); and "Congenital Chagas disease". Healthcare management of migrant populations with Chagas disease in Europe has to be improved: -Surveillance programmes are needed to measure the burden of the disease; -screening programmes are needed; -administrative and cultural barriers in the access to health care for migrants should be reduced; -education programmes on Chagas disease should be performed -research on new diagnostic tools and therapeutic options are required. This review highlights the needs of profound changes in the health care of Latin American migrants with Chagas disease in Europe. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Health workforce development: a needs assessment study in French speaking African countries.

PubMed

Chastonay, Philippe; Moretti, Roberto; Zesiger, Véronique; Cremaschini, Marco; Bailey, Rebecca; Pariyo, George; Kabengele, Emmanuel Mpinga

2013-05-01

In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation's health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.

Paediatric liver transplantation for children treated at public health facilities in South Africa: time for change.

PubMed

Lala, S G; Britz, R; Botha, J; Loveland, J

2014-11-01

Paediatric liver transplantation (PLT) is the only therapeutic option for many children with end-stage chronic liver disease or irreversible fulminant hepatic failure, and is routinely considered as a therapy by paediatric gastroenterologists and surgeons working in developed countries. In South Africa (SA), a PLT programme has been available at Red Cross War Memorial Children's Hospital in Cape Town since November 1991, and another has rapidly developed at the Wits Donald Gordon Medical Centre in Johannesburg over the past decade. However, for most children with progressive chronic liver disease who are reliant on the services provided at state facilities in SA, PLT is not an option because of a lack of resources in a mismanaged public health system. This article briefly outlines the services offered at Chris Hani Baragwanath Academic Hospital--which is typical of state facilities in SA--and proposes that resources be allocated to establish an innovative, nationally funded centre that would enable greater numbers of children access to a PLT programme.

Implementation research: towards universal health coverage with more doctors in Brazil

PubMed Central

Oliveira, Aimê; Trindade, Josélia Souza; Barreto, Ivana CHC; Palmeira, Poliana Araújo; Comes, Yamila; Santos, Felipe OS; Santos, Wallace; Oliveira, João Paulo Alves; Pessoa, Vanira Matos; Shimizu, Helena Eri

2017-01-01

Abstract Objective To evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil. Methods The Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n = 1450) and not enrolled (n = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed. Findings By September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period. Conclusion Other countries having shortages of physicians could benefit from the lessons of Brazil’s programme towards achieving universal right to health. PMID:28250510

Organizational capacity for chronic disease prevention: a survey of Canadian public health organizations.

PubMed

Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Paradis, Gilles; Cameron, Roy

2010-04-01

There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.

PubMed

Lewis, Trevor; Synowiec, Christina; Lagomarsino, Gina; Schweitzer, Julian

2012-05-01

To describe how information communication technology (ICT) is being used by programmes that seek to improve private sector health financing and delivery in low- and middle-income countries, including the main uses of the technology and the types of technologies being used. In-country partners in 16 countries directly searched systematically for innovative health programmes and compiled profiles in the Center for Health Market Innovations' database. These data were supplemented through literature reviews and with self-reported data supplied by the programmes themselves. In many low- and middle-income countries, ICT is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programmes, 42% use it to extend geographic access to health care, 38% to improve data management and 31% to facilitate communication between patients and physicians outside the physician's office. Other purposes include improving diagnosis and treatment (17%), mitigating fraud and abuse (8%) and streamlining financial transactions (4%). The most common devices used in technology-enabled programmes are phones and computers; 71% and 39% of programmes use them, respectively, and the most common applications are voice (34%), software (32%) and text messages (31%). Donors are the primary funders of 47% of ICT-based health programmes. Various types of ICT are being employed by private organizations to address key health system challenges. For successful implementation, however, more sustainable sources of funding, greater support for the adoption of new technologies and better ways of evaluating impact are required.

Building capacity for tobacco control research and policy

PubMed Central

Stillman, F; Yang, G; Figueiredo, V; Hernandez‐Avila, M; Samet, J

2006-01-01

The Fogarty International Center (FIC) initiative, “International Tobacco and Health Research Capacity Building Program” represents an important step in US government funding for global tobacco control. Low‐ and middle‐income countries of the world face a rising threat to public health from the rapidly escalating epidemic of tobacco use. Many are now parties to the Framework Convention on Tobacco Control (FCTC) and capacity development to meet FCTC provisions. One initial grant provided through the FIC was to the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to support capacity building and research programmes in China, Brazil, and Mexico. The initiative's capacity building effort focused on: (1) building the evidence base for tobacco control, (2) expanding the infrastructure of each country to deliver tobacco control, and (3) developing the next generation of leaders as well as encouraging networking throughout the country and with neighbouring countries. This paper describes the approach taken and the research foci, as well some of the main outcomes and some identified challenges posed by the effort. Individual research papers are in progress to provide more in‐depth reporting of study results. PMID:16723670

New tuberculosis technologies: challenges for retooling and scale-up.

PubMed

Pai, M; Palamountain, K M

2012-10-01

The availability of new tools does not mean that they will be adopted, used correctly, scaled up or have public health impact. Experience to date with new diagnostics suggests that many national tuberculosis programmes (NTPs) in high-burden countries are reluctant to adopt and scale up new tools, even when these are backed by evidence and global policy recommendations. We suggest that there are several common barriers to effective national adoption and scale-up of new technologies: global policy recommendations that do not provide sufficient information for scale-up, complex decision-making processes and weak political commitment at the country level, limited engagement of and support to NTP managers, high cost of tools and poor fit with user needs, unregulated markets and inadequate business models, limited capacity for laboratory strengthening and implementation research, and insufficient advocacy and donor support. Overcoming these barriers will require enhanced country-level advocacy, resources, technical assistance and political commitment. Some of the BRICS (Brazil, Russia, India, China, South Africa) countries are emerging as early adopters of policies and technologies, and are increasing their investments in TB control. They may provide the first opportunities to fully assess the public health impact of new tools.

Tuberculosis treatment outcome monitoring in European Union countries: systematic review

PubMed Central

van Hest, Rob; Ködmön, Csaba; Verver, Suzanne; Erkens, Connie G.M.; Straetemans, Masja; Manissero, Davide; de Vries, Gerard

2013-01-01

Treatment success measured by treatment outcome monitoring (TOM) is a key programmatic output of tuberculosis (TB) control programmes. We performed a systematic literature review on national-level TOM in the 30 European Union (EU)/European Economic Areas (EEA) countries to summarise methods used to collect and report data on TOM. Online reference bibliographic databases PubMed/MEDLINE and EMBASE were searched to identify relevant indexed and non-indexed literature published between January 2000 and August 2010. The search strategy resulted in 615 potentially relevant indexed citations, of which 27 full-text national studies (79 data sets) were included for final analysis. The selected studies were performed in 10 EU/EEA countries and gave a fragmented impression of TOM in the EU/EEA. Publication year, study period, sample size, databases, definitions, variables, patient and outcome categories, and population subgroups varied widely, portraying a very heterogeneous picture. This review confirmed previous reports of considerable heterogeneity in publications of TOM results across EU/EEA countries. PubMed/MEDLINE and EMBASE indexed studies are not a suitable instrument to measure representative TOM results for the 30 EU/EEA countries. Uniform and complete reporting to the centralised European Surveillance System will produce the most timely and reliable results of TB treatment outcomes in the EU/EEA. PMID:22790913

The impact of the financial crisis on human resources for health policies in three southern-Europe countries.

PubMed

Correia, Tiago; Dussault, Gilles; Pontes, Carla

2015-12-01

The public health sector has been the target of austerity measures since the global financial crisis started in 2008, while health workforce costs have been a source of rapid savings in most European Union countries. This article aims to explore how health workforce policies have evolved in three southern European countries under external constraints imposed by emergency financial programmes agreed with the International Monetary Fund, Central European Bank and European Commission. The selected countries, Greece, Portugal and Cyprus, show similarities with regard to corporatist systems of social protection and comprehensive welfare mechanisms only recently institutionalized. Based on document analysis of the Memoranda of Understanding agreed with the Troika, our results reveal broadly similar policy responses to the crisis but also important differences. In Cyprus, General Practitioners have a key position in reducing public expenditure through gatekeeping and control of users' access, while Portugal and Greece seeks to achieve cost containment by constraining the decision-making powers of professionals. All three countries lack innovation as well as monitoring and assessment of the effects of the financial crisis in relation to the health workforce. Consequently, there is a need for health policy development to use human resources more efficiently in healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Private sector, human resources and health franchising in Africa.

PubMed Central

Prata, Ndola; Montagu, Dominic; Jefferys, Emma

2005-01-01

In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. Using data from The World Bank's Health Nutrition and Population Poverty Thematic Reports on 22 countries in Africa, an assessment was made of the use of public and private health services, by asset quintile groups, for treatment of diarrhoea and acute respiratory infections, proxies for publicly subsidized services. The evidence and theory on using franchise networks to supplement government programmes in the delivery of public health services was assessed. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. We argue that based on the established demand for private medical services in Africa, these providers should be included in future planning on human resources for public health. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioural change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programmes in Africa to address critical illnesses of public health importance. PMID:15868018

Control of intestinal parasitic infections in Seychelles: a comprehensive and sustainable approach.

PubMed Central

Albonico, M.; Shamlaye, N.; Shamlaye, C.; Savioli, L.

1996-01-01

Intestinal parasitic infections have been perceived as a public health problem in Seychelles for decades. A comprehensive strategy to reduce morbidity and, in the long term, transmission of intestinal parasites has been implemented successfully since 1993. Management of the programme is integrated into the well established primary health care system, with control activities being undertaken through existing health facilities. The strategy is based on periodic chemotherapy of schoolchildren, intense health education and improvement of sanitation and safe water supply. The initial objectives of the control programme were met after 2 years of activities, with an overall reduction in prevalence of intestinal parasitic infections of 44%. The intensity of infection with Trichuris trichiura, the commonest parasite, was halved (from 780 to 370 eggs per g of faeces). The programme's integrated approach, in concert with political commitment and limited operational costs, is a warranty for the future sustainability of control activities. The programme can be seen as a model for other developing countries, even where health and socioeconomic conditions are different and the control of parasitic infections will need a much longer-term commitment. PMID:9060217

Violence as a public health problem: An ecological study of 169 countries☆

PubMed Central

Wolf, Achim; Gray, Ron; Fazel, Seena

2014-01-01

Individual level risk factors for violence have been widely studied, but little is known about country-level determinants, particularly in low and middle-income countries. We hypothesized that income inequality, through its detrimental effects on social cohesion, would be related to an increase in violence worldwide, and in low and middle-income countries in particular. We examined country-level associations of violence with socio-economic and health-related factors, using crime statistics from the United Nations Office on Drugs and Crime, and indicators from the Human Development Report published by the United Nations Development Programme. Using regression models, we measured relationships between country-level factors (age, education, measures of income, health expenditure, and alcohol consumption) and four violent outcomes (including measures of violence-related mortality and morbidity) in up to 169 countries. We stratified our analyses comparing high with low and middle-income countries, and analysed longitudinal data on homicide and income inequality in high-income countries. In low and middle-income countries, income inequality was related to homicide, robbery, and self-reported assault (all p's < 0.05). In high-income countries, urbanicity was significantly associated with official assault (p = 0.002, β = 0.716) and robbery (p = 0.011, β = 0.587) rates; income inequality was related to homicide (p = 0.006, β = 0.670) and self-reported assault (p = 0.020, β = 0.563), and longitudinally with homicide (p = 0.021). Worldwide, alcohol consumption was associated with self-reported assault rates (p < 0.001, β = 0.369) suggesting public policy interventions reducing alcohol consumption may contribute to reducing violence rates. Our main finding was that income inequality was related to violence in low and middle-income countries. Public health should advocate for global action to moderate income inequality to reduce the global health burden of violence. PMID:24581081

[Assessment of the pharmaceutical expenditure in Hungary].

PubMed

Inotai, András; Merész, Gergo; Kaló, Zoltán

2010-01-01

Scarcity of health care resources draws attention to the expenditure on pharmaceuticals, as drugs are considered to be one of the major growth drivers of health care spending. This article assesses the Hungarian expenditure on pharmaceuticals by taking into account the economic status of the country and benchmarks from other OECD countries with special focus on indicators of Visegrad V4 countries (Czech Republic, Slovakia, Poland and Hungary). Our results highlight the heterogeneity of pharmaceutical expenditure data derived from different indicators among observed countries. Pharmaceutical spending is relatively higher in middle-income countries, mainly due the price convergence of innovative drug's, on contrary manpower cost of health care services are adjusted to local price levels, therefore the price differential of health care services between middle income and developed countries is greater. International trends of the global pharmaceutical market are also valid in Hungary. Increased private funding, mainly out of pocket payments above the average of V4 countries, has been the major growth driver of pharmaceutical expenditure recently in Hungary. Increased private pharmaceutical expenditure was mainly derived from the severe cost-containment measures in 2006. The annual growth rate of the National Health Insurance Fund's pharmaceutical budget for drug reimbursement was 1.37% in real terms between 1994 and 2009. This is much beneath the expansion of global pharmaceutical market. Consequently, cost-containment of public pharmaceutical spending was very successful in the last fifteen years, and the burden of market growth has been shifted to households. Public health programmes, investment into preventive care, with consideration on unfavourable Hungarian morbidity and mortality indicators, however, necessitate the increase of public pharmaceutical budget. In order to improve the allocative efficiency of health care spending, available resources should be spent only on effective, cost-effective, economically affordable medicines.

Population health and status of epidemiology in Western European, Balkan and Baltic countries.

PubMed

Seniori Costantini, Adele; Gallo, Federica; Pega, Frank; Saracci, Rodolfo; Veerus, Piret; West, Robert

2015-02-01

This article is part of a series commissioned by the International Epidemiological Association, aimed at describing population health and epidemiological resources in the six World Health Organization (WHO) regions. It covers 32 of the 53 WHO European countries, namely the Western European countries, the Balkan countries and the Baltic countries. The burdens of mortality and morbidity and the patterns of risk factors and inequalities have been reviewed in order to identify health priorities and challenges. Literature and internet searches were conducted to stock-take epidemiological teaching, research activities, funding and scientific productivity. These countries have among the highest life expectancies worldwide. However, within- and between-country inequalities persist, which are largely due to inequalities in distribution of main health determinants. There is a long tradition of epidemiological research and teaching in most countries, in particular in the Western European countries. Cross-national networks and collaborations are increasing through the support of the European Union which fosters procedures to standardize educational systems across Europe and provides funding for epidemiological research through framework programmes. The number of Medline-indexed epidemiological research publications per year led by Western European countries has been increasing. The countries accounts for nearly a third of the global epidemiological publication. Although population health has improved considerably overall, persistent within- and between-country inequalities continue to challenge national and European health institutions. More research, policy and action on the social determinants of health are required in the region. Epidemiological training, research and workforce in the Baltic and Balkan countries should be strengthened. European epidemiologists can play pivotal roles and must influence legislation concerning production and access to high-quality data. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Major cultural-compatibility complex: considerations on cross-cultural dissemination of patient safety programmes.

PubMed

Jeong, Heon-Jae; Pham, Julius C; Kim, Minji; Engineer, Cyrus; Pronovost, Peter J

2012-07-01

As the importance of patient safety has been broadly acknowledged, various improvement programmes have been developed. Many of the programmes with proven efficacy have been disseminated internationally. However, some of those attempts may encounter unexpected cross-cultural obstacles and may fail to harvest the expected success. Each country has different cultural background that has shaped the behavior of the constituents for centuries. It is crucial to take into account these cultural differences in effectively disseminating these programmes. As an organ transplantation requires tissue-compatibility between the donor and the recipient, there needs to be compatibility between the country where the program was originally developed and the nation implementing the program. Though no detailed guidelines exist to predict success, small-scale pilot tests can help evaluate whether a safety programme will work in a new cultural environment. Furthermore, a pilot programme helps reveal the source of potential conflict, so we can modify the original programme accordingly to better suit the culture to which it is to be applied. In addition to programme protocols, information about the cultural context of the disseminated programme should be conveyed during dissemination. Original programme designers should work closely with partnering countries to ensure that modifications do not jeopardise the original intention of the programme. By following this approach, we might limit barriers originating from cultural differences and increase the likelihood of success in cross-cultural dissemination.

Global Obesity Study on Drivers for Weight Reduction Strategies

PubMed Central

Grebitus, Carola; Hartmann, Monika; Reynolds, Nikolai

2015-01-01

Objective To assess factors determining the reaction of individuals to the threats of overweight and obesity and to examine the interdependencies between weight-reducing strategies. Methods Cross-country survey covering 19 countries and 13,155 interviews. Data were analysed using a bivariate probit model that allows simultaneously analysing two weight-reducing strategies. Results Results show that weight-reducing strategies chosen are not independent from each other. Findings also reveal that different strategies are chosen by different population segments. Women are more likely to change their dietary patterns and less likely to become physically active after surpassing a weight threshold. In addition, the probability of a dietary change in case of overweight differs considerably between countries. The study also reveals that attitudes are an important factor for the strategy choice. Conclusions It is vital for public health policies to understand determinants of citizens’ engagement in weight reduction strategies once a certain threshold is reached. Thus, results can support the design of public health campaigns and programmes that aim to change community or national health behaviour trends taking into account, e.g., national differences. PMID:25765165

Active case detection for malaria elimination: a survey among Asia Pacific countries

PubMed Central

2013-01-01

Background Moving from malaria control to elimination requires national malaria control programmes to implement strategies to detect both symptomatic and asymptomatic cases in the community. In order to do this, malaria elimination programmes follow up malaria cases reported by health facilities to carry out case investigations that will determine the origin of the infection, whether it has been imported or is due to local malaria transmission. If necessary, the malaria programme will also carry out active surveillance to find additional malaria cases in the locality to prevent further transmission. To understand current practices and share information on malaria elimination strategies, a survey specifically addressing country policies on case investigation and reactive case detection was carried out among fourteen countries of the Asia Pacific Malaria Elimination Network (APMEN). Methods A questionnaire was distributed to the malaria control programme managers amongst 14 countries in the Asia Pacific who have national or sub-national malaria elimination goals. Results Results indicate that there are a wide variety of case investigation and active case detection activities employed by the 13 countries that responded to the survey. All respondents report conducting case investigation as part of surveillance activities. More than half of these countries conduct investigations for each case. Over half aim to accomplish the investigation within one to two days of a case report. Programmes collect a broad array of demographic data during investigation procedures and definitions for imported cases are varied across respondents. Some countries report intra-national (from a different province or district) importation while others report only international importation (from a different country). Reactive case detection in respondent countries is defined as screening households within a pre-determined radius in order to identify other locally acquired infections, whether symptomatic or asymptomatic. Respondents report that reactive case detection can be triggered in different ways, in some cases with only a single case report and in others if a defined threshold of multiple cases occurs. The spatial range of screening conducted varies from a certain number of households to an entire administrative unit (e g, village). Some countries target symptomatic people whereas others target all people in order to detect asymptomatic infections. The majority of respondent programmes collect a range of information from those screened for malaria, similar to the range of information collected during case investigation. Conclusion Case investigation and reactive case detection are implemented in the malaria elimination programmes in the Asia Pacific, however practices vary widely from country to country. There is little evidence available to support countries in deciding which methods to maintain, change or adopt for improved effectiveness and efficiency. The development and use of common evaluation metrics for these activities will allow malaria programmes to assess performance and results of resource-intensive surveillance measures and may benefit other countries that are considering implementing these activities. PMID:24103345

The public health effects of water and sanitation in selected West African countries.

PubMed

Alagidede, P; Alagidede, A N

2016-01-01

This paper examines access to water and improved sanitation target under the Millennium Development Goal 7c (MDG 7c) for six West African countries: Chad, Niger, Nigeria, Mauritania, Sierra Leone and Togo. The article outlines some possible causes for the slow progress in achieving the MDG 7c, examines the public health effects of missing the targets, and charts paths for policy makers to consider in bringing these targets to acceptable levels. The study is based on secondary data analysis of trends in water and sanitation indicators for the six countries from 2000 to 2014. The data are drawn from the World Development Indicators (WDI) of the World Bank, and the World Health Organisation Joint Monitoring Programme (WHO JMP) and WaterAid Africa Wash Map. The performance of each country in the two indicators is presented and judged against the target set under MDG 7c. Forecasts based on the expiry of the MDG's in 2015 and the time required to achieve the targets are carried out. The study showes that while some progress has been made in improved water, sanitation showed slow progress for all the countries between 2000 and 2014. The goal of attaining acceptable sanitation shows that the six West African countries have lagged behind the MDG 7c target and the progress is equally slow. At the current rate of progress if strong public and private sector intervention mechanisms are not instituted across the board, the six West African countries under study would continue to lag behind the rest of the world in terms of access to improved water and sanitation. This has consequences for poverty alleviation and the risk of the re-emergence of neglected tropical diseases. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process.

PubMed

Shen, Angela K; Farrell, Marguerite M; Vandenbroucke, Mary F; Fox, Elizabeth; Pablos-Mendez, Ariel

2015-07-01

As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.

Technology transfer in human vaccinology: a retrospective review on public sector contributions in a privatizing science field.

PubMed

Hendriks, Jan

2012-09-28

As health intervention, vaccination has had a tremendous impact on reducing mortality and morbidity caused by infectious diseases. Traditionally vaccines were developed and made in the western, industrialised world and from there on gradually and with considerable delay became available for developing countries. Today that is beginning to change. Most vaccine doses are now produced in emerging economies, although industrialised countries still have a lead in vaccine development and in manufacturing innovative vaccines. Technology transfer has been an important mechanism for this increase in production capacity in emerging economies. This review looks back on various technology transfer initiatives and outlines the role of WHO and other public and private partners. It goes into a more detailed description of the role of the National Institute of Public Health and the Environment (RIVM) in Bilthoven, the Netherlands. For many decades RIVM has been providing access to vaccine technology by capacity building and technology transfer initiatives not only through multilateral frameworks, but also on a bilateral basis including a major project in China in the 90 s of the previous century. Looking forward it is expected that, in a globalizing world, the ambition of BRICS countries to play a role in global health will lead to an increase of south-south technology transfers. Further, it is argued that push approaches including technology transfer from the public domain, connecting innovative enabling platforms with competent developing country vaccine manufacturers (DCVM), will be critical to ensure a sustainable supply of affordable and quality vaccines to national immunization programmes in developing countries. Copyright © 2012 Elsevier Ltd. All rights reserved.

Current status and future prospects of epidemiology and public health training and research in the WHO African region.

PubMed

Nachega, Jean B; Uthman, Olalekan A; Ho, Yuh-Shan; Lo, Melanie; Anude, Chuka; Kayembe, Patrick; Wabwire-Mangen, Fred; Gomo, Exnevia; Sow, Papa Salif; Obike, Ude; Kusiaku, Theophile; Mills, Edward J; Mayosi, Bongani M; Ijsselmuiden, Carel

2012-12-01

To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend < 0.001]. The most common topics were HIV/AIDS (11.3%), malaria (8.6%) and tuberculosis (7.1%). Similarly, numbers of first authors (APC = 7.3%, P for trend < 0.001), corresponding authors (APC = 8.4%, P for trend < 0.001) and last authors (APC = 8.5%, P for trend < 0.001) from Africa increased during the same period. However, an overwhelming majority of respondents (>90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were 'in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and 'number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continent.

Instrumental Aid by Japanese Official Development Assistance for Astronomy in Developing Countries

NASA Astrophysics Data System (ADS)

Kitamura, Masatoshi

In order to promote education and research in developing countries, the Japanese Government has been providing developing countries with high-grade equipment under the framework of the Official Development Assistance (ODA) cooperation programme since 1982. Under this successful cooperation programme, 24 astronomical instruments have been donated to 19 developing countries up to the end of the Japanese fiscal year 2003. The instruments donated included university-level reflecting telescopes, as well as modern planetaria used for educational purposes, together with various accessories. This paper describes a continuation of the previous ODA donations (Astronomical Herald 1997) and the subsequent follow-up programmes provided with the assistance of Japan International Cooperation Agency (JICA).

Temporary authorization for use: does the French patient access programme for unlicensed medicines impact market access after formal licensing?

PubMed

Degrassat-Théas, Albane; Paubel, Pascal; Parent de Curzon, Olivier; Le Pen, Claude; Sinègre, Martine

2013-04-01

To reach the French market, a new drug requires a marketing authorization (MA) and price and reimbursement agreements. These hurdles could delay access to new and promising drugs. Since 1992, French law authorizes the use of unlicensed drugs on an exceptional and temporary basis through a compassionate-use programme, known as Temporary Authorization for Use (ATU). This programme was implemented to improve early access to drugs under development or authorized abroad. However, it is suspected to be inflationary, bypassing public bodies in charge of health technology assessment (HTA) and of pricing. The aim of this study is to observe the market access after the formal licensing of drugs that went through this compassionate-use programme. We included all ATUs that received an MA between 1 January 2005 and 30 June 2010. We first examined market access delays from these drugs using the standard administrative path. We positioned this result in relation to launch delays observed in France (for all outpatient drugs) and in other major European markets. Second, we assessed the bargaining power of a hospital purchaser after those drugs had obtained an MA by calculating the price growth rate after the approval. During the study period, 77 ATUs were formally licensed. The study concluded that, from the patient's perspective, licensing and public bodies' review time was shortened by a combined total of 36 months. The projected 11-month review time of public bodies may be longer than delays usually observed for outpatient drugs. Nonetheless, the study revealed significant benefits for French patient access based on comparable processing to launch time with those of other European countries with tight price control policies. In return, a 12 % premium, on average, is paid to pharmaceutical companies while drugs are under this status (sub-analysis on 56 drugs). In many instances, the ATU programme responds to a public health need by accelerating the availability of new drugs even though this study suggests an impact of the programme on the market access of these drugs for which the standard administrative path is longer than usual. In addition, pharmaceutical companies seem to market compassionate-use drugs with a presumed benefit/risk ratio at a price that guarantees a margin for future negotiation.

The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases

PubMed Central

2010-01-01

The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF6) was held 1-3 June, 2010 in Seoul, Korea, with 150 participants from 38 countries. The year 2010 marks the midpoint between the first GAELF meeting, in 2000, and the World Health Organization (WHO) 2020 goal of global elimination of lymphatic filariasis (LF) as a public health problem. The theme of the meeting, "Half-time in LF Elimination: Teaming Up with Neglected Tropical Diseases (NTDs)," reflected significant integration of LF elimination programmes into a comprehensive initiative to control NTDs. Presentations on LF epidemiology, treatment, research, and programmes highlighted both accomplishments and remaining challenges. The WHO strategy to interrupt LF transmission is based on annual mass drug administration (MDA) using two-drug combinations. After mapping the geographic distribution of LF, MDA is implemented for ≥ 5 years, followed by a period of post-MDA surveillance, and, ultimately, verification of LF elimination. Morbidity management further reduces disease burden. Of 81 countries considered LF-endemic in 2000, 52 (64.2%) have begun MDA; 10 (12.3%) others with low-level transmission are unlikely to require MDA. In 2008, ~695 million people were offered treatment (51.7% of the at-risk population); ~496 million participated. Approximately 22 million people have been protected from LF infection and disease, with savings of ~US $24.2 billion. Morbidity management programmes have been implemented in 27 (33.3%) countries. Significant challenges to LF elimination remain. These include: initiating MDA in the remaining 19 countries that require it; achieving full geographic coverage in countries where MDA has started; finding alternative strategies to address the problem of Loa loa co-endemicity in Central Africa; developing strategies to treat urban populations; initiating and sustaining MDA in settings of armed conflict; developing refined guidelines and procedures for stopping MDA, for post-MDA surveillance, and for verifying the elimination of LF; and integrating morbidity management into all LF elimination programmes. Scientific research and enhanced advocacy for NTDs remain critical for addressing these challenges. GAELF6 was characterized by enthusiasm and recognition that "teaming up with NTDs" offers opportunities for new partnerships, fresh perspectives, enhanced advocacy, and greater programmatic integration in a rapidly changing global health environment. PMID:20961435

Naming asteroids for the popularisation of astronomy

NASA Astrophysics Data System (ADS)

Naranjo, O. A.

2008-06-01

We give a detailed description of how the naming of asteroids was used as a prize in competitions run by educational institutions and museums. There were two events, one in Venezuela and one in Brazil, which used this as an attractive alternative method for the popularisation of astronomy. The first competition, named Bautizo Espacial (Space Baptism), consisted of scientific stories written by high school students. The second, called Grande Desafio (Big Challenge), was a competition where teams of students were challenged to design and build prototype equipment to fight forest fires. Nationally, both events received wide publicity through newspapers, radio, TV and web pages, reaching many people in both countries. As part of both the events, several activities promoting the public knowledge of astronomy were held. The asteroids that were named in these competitions are just some of the many discovered in a search programme developed by the Group of Theoretical Astrophysics of University of Los Andes in Mérida, Venezuela (Grupo de Astrofisica Teórica de la Universidad de Los Andes) as a mainstream research programme. Finally, Asteroids for the Popularisation of Astronomy has been formally proposed to the IAU as a worldwide programme during the celebration of the International Year of Astronomy in 2009 (IYA2009).

The introduction of the meningococcal B (MenB) vaccine (Bexsero®) into the national infant immunisation programme--New challenges for public health.

PubMed

Ladhani, Shamez N; Campbell, Helen; Parikh, Sydel R; Saliba, Vanessa; Borrow, Ray; Ramsay, Mary

2015-12-01

The United Kingdom is the first country to introduce Bexsero(®) (GSK Biologicals), a multicomponent, protein-based vaccine against meningococcal group B (MenB), into the national infant immunisation programme. This vaccine is like no other licensed vaccine and poses a number of implementation and surveillance challenges in England. From 01 September 2015, UK infants were offered a reduced two dose primary immunisation schedule at 2 and 4 months followed by a booster at 12 months. Because of high rates of fever post-vaccination, parents were advised to give their infants three doses of prophylactic paracetamol, with the first dose given as soon as possible after the primary MenB vaccination dose. Since the vaccine only protects against 73-88% of MenB strains causing invasive disease in England, clinical isolates and PCR-positive samples will require extensive characterisation by the Meningococcal Reference Unit (MRU) at Public Health England (PHE) in order to monitor vaccine effectiveness and identify potential vaccine failures. PHE is also conducting detailed clinical and epidemiological surveillance to assess the impact of the MenB immunisation programme on the morbidity and mortality associated with invasive meningococcal disease in infants and young children. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Building mental health workforce capacity through training and retention of psychiatrists in Zimbabwe.

PubMed

Abas, Melanie A; Nhiwatiwa, Sekai M; Mangezi, Walter; Jack, Helen; Piette, Angharad; Cowan, Frances M; Barley, Elizabeth; Chingono, Alfred; Iversen, Amy; Chibanda, Dixon

2014-08-01

Despite the need to improve the quantity and quality of psychiatry training in sub-Saharan Africa (SSA), very little is known about the experiences of psychiatric trainees in the region. This is the first study examining psychiatric trainees in a low-income country in SSA. It was carried out as part of the needs assessment for a unique Medical Education Partnership Initiative (MEPI) programme to find African solutions for medical shortages in Africa. We approached all doctors who had trained in post-graduate psychiatry in Zimbabwe in 2010 and conducted in-depth qualitative interviews with all except one (n = 6). We analysed the data using constant comparison and thematic analysis. Trainees described the apprenticeship model as the programme's primary strength, through providing clinical exposure and role models. Programme weaknesses included shortages in information sources, trainee salaries, trainers, public health education, and in the mental health service. Most respondents were, however, eager to continue practising psychiatry in Zimbabwe, motivated by family ties, national commitment and helping vulnerable, stigmatized individuals. Respondents called for sub-speciality training and for infrastructure and training to do research. Resources need to be made available for psychiatric trainees in more SSA settings to develop public health competencies. However, investment in psychiatry training programmes must balance service provision with trainees' educational needs. Directing investment towards needs identified by trainees may be a cost-effective, context-sensitive way to increase retention and learning outcomes.

“Accommodating” smoke‐free policies: tobacco industry's Courtesy of Choice programme in Latin America

PubMed Central

Sebrié, Ernesto M; Glantz, Stanton A

2007-01-01

Objective To understand the implementation and effects of the Courtesy of Choice programme designed to “accommodate” smokers as an alternative to smoke‐free polices developed by Philip Morris International (PMI) and supported by RJ Reynolds (RJR) and British American Tobacco (BAT) since the mid‐1990s in Latin America. Methods Analysis of internal tobacco industry documents, BAT “social reports”, news reports and tobacco control legislation. Results Since the mid‐1990s, PMI, BAT and RJR promoted Accommodation Programs to maintain the social acceptability of smoking. As in other parts of the world, multinational tobacco companies partnered with third party allies from the hospitality industry in Latin America. The campaign was extended from the hospitality industry (bars, restaurants and hotels) to other venues such as workplaces and airport lounges. A local public relations agency, as well as a network of engineers and other experts in ventilation systems, was hired to promote the tobacco industry's programme. The most important outcome of these campaigns in several countries was the prevention of meaningful smoke‐free policies, both in public places and in workplaces. Conclusions Courtesy of Choice remains an effective public relations campaign to undermine smoke‐free policies in Latin America. The tobacco companies' accommodation campaign undermines the implementation of measures to protect people from second‐hand smoke called for by the World Health Organization Framework Convention on Tobacco Control, perpetuating the exposure to tobacco smoke in indoor enclosed environments. PMID:17897975

Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity.

PubMed

Beeres, Dorien T; Cornish, Darren; Vonk, Machiel; Ravensbergen, Sofanne J; Maeckelberghe, Els L M; Boele Van Hensbroek, Pieter; Stienstra, Ymkje

2018-03-02

With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition 'to return good in proportion to the good we receive, and to make reparations for the harm we have done', as a mid-level principle in infectious disease screening policies. More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers' participation and the benefits for the control of public health. The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.

Introducing vouchers for malaria prevention in Ghana and Tanzania: context and adoption of innovation in health systems.

PubMed

de Savigny, Don; Webster, Jayne; Agyepong, Irene Akua; Mwita, Alex; Bart-Plange, Constance; Baffoe-Wilmot, Aba; Koenker, Hannah; Kramer, Karen; Brown, Nick; Lengeler, Christian

2012-10-01

There are striking similarities in health system and other contexts between Tanzania and Ghana that are relevant to the scaling up of continuous delivery of insecticide treated nets (ITNs) for malaria prevention. However, specific contextual factors of relevance to ITN delivery have led implementation down very different pathways in the two countries. Both countries have made major efforts and investments to address this intervention through integrating consumer discount vouchers into the health system. Discount vouchers require arrangements among the public, private and non-governmental sectors and constitute a complex intervention in both health systems and business systems. In Tanzania, vouchers have moved beyond the planning agenda, had policies and programmes formulated, been sustained in implementation at national scale for many years and have become as of 2012 the main and only publicly supported continuous delivery system for ITNs. In Ghana national-scale implementation of vouchers never progressed beyond consideration on the agenda and piloting towards formulation of policy; and the approach was replaced by mass distribution campaigns with less dependency on or integration with the health system. By 2011, Ghana entered a phase with no publicly supported continuous delivery system for ITNs. To understand the different outcomes, we compared the voucher programme timelines, phases, processes and contexts in both countries in reference to the main health system building blocks (governance, human resources, financing, informatics, technologies and service delivery). Contextual factors which provided an enabling environment for the voucher scheme in Tanzania did not do so in Ghana. The voucher scheme was never seen as an appropriate national strategy, other delivery systems were not complementary and the private sector was under-developed. The extensive time devoted to engagement and consensus building among all stakeholders in Tanzania was an important and clearly enabling difference, as was public sector support of the private sector. This contributed to the alignment of partner action behind a single co-ordinated strategy at service delivery level which in turn gave confidence to the business sector and avoided the 'interference' of competing delivery systems that occurred in Ghana. Principles of systems thinking for intervention design correctly emphasize the importance of enabling contexts and stakeholder management.

Impact of animal health programmes on poverty reduction and sustainable livestock development.

PubMed

Pradere, J P

2017-04-01

Based on data from publications and field observations, this study analyses the interactions between animal health, rural poverty and the performance and environmental impact of livestock farming in low-income countries and middle-income countries. There are strong statistical correlations between the quality of Veterinary Services, livestock productivity and poverty rates. In countries with effective Veterinary Services, livestock growth stems mainly from productivity gains and poverty rates are the lowest. Conversely, these analyses identify no statistical link between the quality of Veterinary Services and increased livestock production volumes. However, where animal diseases are poorly controlled, productivity is low and livestock growth is extensive, based mainly on a steady increase in animal numbers. Extensive growth is less effective than intensive growth in reducing poverty and aggravates the pressure of livestock production on natural resources and the climate.

Adopting public health approaches to communication disability: challenges for the education of speech-language pathologists.

PubMed

Wylie, Karen; McAllister, Lindy; Davidson, Bronwyn; Marshall, Julie; Law, James

2014-01-01

Public health approaches to communication disability challenge the profession of speech-language pathology (SLP) to reconsider both frames of reference for practice and models of education. This paper reviews the impetus for public health approaches to communication disability and considers how public health is, and could be, incorporated into SLP education, both now and in the future. The paper describes tensions between clinical services, which have become increasingly specialized, and public health approaches that offer a broader view of communication disability and communication disability prevention. It presents a discussion of these tensions and asserts that public health approaches to communication are themselves a specialist field, requiring specific knowledge and skills. The authors suggest the use of the term 'communication disability public health' to refer to this type of work and offer a preliminary definition in order to advance discussion. Examples from three countries are provided of how some SLP degree programmes are integrating public health into the SLP curriculum. Alternative models of training for communication disability public health that may be relevant in the future in different contexts and countries are presented, prompting the SLP profession to consider whether communication disability public health is a field of practice for speech-language pathologists or whether it has broader workforce implications. The paper concludes with some suggestions for the future which may advance thinking, research and practice in communication disability public health. © 2015 S. Karger AG, Basel.

Advancing the science of health research capacity strengthening in low-income and middle-income countries: a scoping review of the published literature, 2000–2016

PubMed Central

Dean, Laura; Gregorius, Stefanie; Pulford, Justin

2017-01-01

Objectives Substantial development assistance and research funding are invested in health research capacity strengthening (HRCS) interventions in low-income and middle-income countries, yet the effectiveness, impact and value for money of these investments are not well understood. A major constraint to evidence-informed HRCS intervention has been the disparate nature of the research effort to date. This review aims to map and critically analyse the existing HRCS effort to better understand the level, type, cohesion and conceptual sophistication of the current evidence base. The overall goal of this article is to advance the development of a unified, implementation-focused HRCS science. Methods We used a scoping review methodology to identify peer-reviewed HRCS literature within the following databases: PubMed, Global Health and Scopus. HRCS publications available in English between the period 2000 and 2016 were included. 1195 articles were retrieved of which 172 met the final inclusion criteria. A priori thematic analysis of all included articles was completed. Content analysis of identified HRCS definitions was conducted. Results The number of HRCS publications increased exponentially between 2000 and 2016. Most publications during this period were perspective, opinion or commentary pieces; however, original research publications were the primary publication type since 2013. Twenty-five different definitions of research capacity strengthening were identified, of which three aligned with current HRCS guidelines. Conclusions The review findings indicate that an HRCS research field with a focus on implementation science is emerging, although the conceptual and empirical bases are not yet sufficiently advanced to effectively inform HRCS programme planning. Consolidating an HRCS implementation science therefore presents as a viable option that may accelerate the development of a useful evidence base to inform HRCS programme planning. Identifying an agreed operational definition of HRCS, standardising HRCS-related terminology, developing a needs-based HRCS-specific research agenda and synthesising currently available evidence may be useful first steps. PMID:29217727

Lessons learnt from a three-year pilot field epidemiology training programme

PubMed Central

Durand, A Mark; Hancock, Thane; Cash, Haley L; Hardie, Kate; Paterson, Beverley; Paulino, Yvette; White, Paul; Merritt, Tony; Fitzgibbons, Dawn; Gopalani, Sameer Vali; Flint, James; Edwin A Merilles, Onofre; Kashiwabara, Mina; Biaukula, Viema; Lepers, Christelle; Souares, Yvan; Nilles, Eric; Batikawai, Anaseini; Huseynova, Sevil; Patel, Mahomed; Saketa, Salanieta T; Durrheim, David; Henderson, Alden; Roth, Adam

2017-01-01

Problem The Pacific region has widely dispersed populations, limited financial and human resources and a high burden of disease. There is an urgent need to improve the availability, reliability and timeliness of useable health data. Context The purpose of this paper is to share lessons learnt from a three-year pilot field epidemiology training programme that was designed to respond to these Pacific health challenges. The pilot programme built on and further developed an existing field epidemiology training programme for Pacific health staff. Action The programme was delivered in country by epidemiologists working for Pacific Public Health Surveillance Network partners. The programme consisted of five courses: four one-week classroom-based courses and one field epidemiology project. Sessions were structured so that theoretical understanding was achieved through interaction and reinforced through practical hands-on group activities, case studies and other interactive practical learning methods. Outcome As of September 2016, 258 students had commenced the programme. Twenty-six course workshops were delivered and one cohort of students had completed the full five-course programme. The programme proved popular and gained a high level of student engagement. Discussion Face-to-face delivery, a low student-to-facilitator ratio, substantial group work and practical exercises were identified as key factors that contributed to the students developing skills and confidence. Close engagement of leaders and the need to quickly evaluate and adapt the curriculum were important lessons, and the collaboration between external partners was considered important for promoting a harmonized approach to health needs in the Pacific. PMID:29051838

Introducing a new monitoring manual for home fortification and strengthening capacity to monitor nutrition interventions.

PubMed

Jefferds, Maria Elena D; Flores-Ayala, Rafael

2015-12-01

Lack of monitoring capacity is a key barrier for nutrition interventions and limits programme management, decision making and programme effectiveness in many low-income and middle-income countries. A 2011 global assessment reported lack of monitoring capacity was the top barrier for home fortification interventions, such as micronutrient powders or lipid-based nutrient supplements. A Manual for Developing and Implementing Monitoring Systems for Home Fortification Interventions was recently disseminated. It is comprehensive and describes monitoring concepts and frameworks and includes monitoring tools and worksheets. The monitoring manual describes the steps of developing and implementing a monitoring system for home fortification interventions, including identifying and engaging stakeholders; developing a programme description including logic model and logical framework; refining the purpose of the monitoring system, identifying users and their monitoring needs; describing the design of the monitoring system; developing indicators; describing the core components of a comprehensive monitoring plan; and considering factors related to stage of programme development, sustainability and scale up. A fictional home fortification example is used throughout the monitoring manual to illustrate these steps. The monitoring manual is a useful tool to support the development and implementation of home fortification intervention monitoring systems. In the context of systematic capacity gaps to design, implement and monitor nutrition interventions in many low-income and middle-income countries, the dissemination of new tools, such as monitoring manuals may have limited impact without additional attention to strengthening other individual, organisational and systems levels capacities. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Smoking cessation after 12 months with multi-component therapy.

PubMed

Raich, Antònia; Martínez-Sánchez, Jose Maria; Marquilles, Emili; Rubio, Lídia; Fu, Marcela; Fernández, Esteve

2015-03-01

Smoking is one of the most important causes of morbidity and mortality in developed countries. One of the priorities of public health programmes is the reduction of its prevalence, which would involve millions of people quitting smoking, but cessation programs often have modest results, especially within certain population groups. The aim of this study was to analyze the variables determining the success of a multicomponent therapy programme for smoking cessation. We conducted the study in the Smoking Addiction Unit at the Hospital of Manresa, with 314 patients (91.4% of whom had medium or high-level dependency). We observed that higher educational level, not living with a smoker, following a multimodal programme or smoking cessation with psychological therapy, and pharmacological treatment are relevant factors for quitting smoking. Abstinence rates are not associated with other factors, such as sex, age, smoking behaviour characteristics or psychiatric history. The combination of pharmacological and psychological treatment increased success rates in multicomponent therapy. Psychological therapy only also obtained positive results, though somewhat more modest.

The impact of economic recession on infection prevention and control.

PubMed

O'Riordan, M; Fitzpatrick, F

2015-04-01

The economic recession that began in 2007 led to austerity measures and public sector cutbacks in many European countries. Reduced resource allocation to infection prevention and control (IPC) programmes is impeding prevention and control of tuberculosis, HIV and vaccine-preventable infections. In addition, higher rates of infectious disease in the community have a significant impact on hospital services, although the extent of this has not been studied. With a focus on quick deficit reduction, preventive services such IPC may be regarded as non-essential. Where a prevention programme succeeds in reducing disease burden to a low level, its very success can undermine the perceived need for the programme. To mitigate the negative effects of recession, we need to: educate our political leaders about the economic benefits of IPC; better quantify the costs of healthcare-associated infection; and evaluate the effects of budget cuts on healthcare outcomes and IPC activities. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Rabies prevention and management of cats in the context of trap-neuter-vaccinate-release programmes.

PubMed

Roebling, A D; Johnson, D; Blanton, J D; Levin, M; Slate, D; Fenwick, G; Rupprecht, C E

2014-06-01

Domestic cats are an important part of many Americans' lives, but effective control of the 60-100 million feral cats living throughout the country remains problematic. Although trap-neuter-vaccinate-return (TNVR) programmes are growing in popularity as alternatives to euthanizing feral cats, their ability to adequately address disease threats and population growth within managed cat colonies is dubious. Rabies transmission via feral cats is a particular concern as demonstrated by the significant proportion of rabies post-exposure prophylaxis associated with exposures involving cats. Moreover, TNVR has not been shown to reliably reduce feral cat colony populations because of low implementation rates, inconsistent maintenance and immigration of unsterilized cats into colonies. For these reasons, TNVR programmes are not effective methods for reducing public health concerns or for controlling feral cat populations. Instead, responsible pet ownership, universal rabies vaccination of pets and removal of strays remain integral components to control rabies and other diseases. © 2013 Blackwell Verlag GmbH.

Status of national diabetes programmes in the Americas.

PubMed Central

White, F.; Nanan, D.

1999-01-01

Reported are the responses in the latter half of 1997 of all ministries of health in the Region of the Americas to the Declaration of the Americas on Diabetes, which was adopted by the Directing Council of the Pan American Health Organization (PAHO) in 1996 as a basis for national programme development in diabetes. The short-term targets were the designation of national focal points, the preparation of national estimates of the disease burden, and the development and implementation of national strategies and plans to deal with diabetes. The survey found that most countries recognized diabetes as a significant public health problem. In terms of global relevance, a number of lessons have been learned from this exercise: the role of broadly based participation in gaining recognition at the national health policy level; the wide acceptance of an integrated programme model; the relevance of process-related targets to achieve short-term success; and the critical role of having a designated focal point within the managerial approach. PMID:10680245

Improving patient safety in Libya: insights from a British health system perspective.

PubMed

Elmontsri, Mustafa; Almashrafi, Ahmed; Dubois, Elizabeth; Banarsee, Ricky; Majeed, Azeem

2018-04-16

Purpose Patient safety programmes aim to make healthcare safe for both patients and health professionals. The purpose of this paper is to explore the UK's patient safety improvement programmes over the past 15 years and explore what lessons can be learnt to improve Libyan healthcare patient safety. Design/methodology/approach Publications focusing on UK patient safety were searched in academic databases and content analysed. Findings Several initiatives have been undertaken over the past 15 years to improve British healthcare patient safety. Many stakeholders are involved, including regulatory and professional bodies, educational providers and non-governmental organisations. Lessons can be learnt from the British journey. Practical implications Developing a national patient safety strategy for Libya, which reflects context and needs is paramount. Above all, Libyan patient safety programmes should reference internationally approved guidelines, evidence, policy and learning from Britain's unique experience. Originality/value This review examines patient safety improvement strategies adopted in Britain to help developing country managers to progress local strategies based on lessons learnt from Britain's unique experience.

Overview of the Higher Education Systems in the Tempus Partner Countries: Central Asia. A Tempus Study. Issue 05

ERIC Educational Resources Information Center

Ruffio, Philippe; Heinamaki, Piia; Tchoukaline, Claire Chastang; Manthey, Anja; Reichboth, Veronika

2011-01-01

The main aim of the Tempus programme is to support the modernisation of higher education in Partner Countries outside the European Union. The targeted regions include Eastern Europe, Central Asia, Western Balkans and the Southern Mediterranean, with a total of 29 Partner Countries participating in the programme. In the field of cooperation in…

The World Health Organization-United Nations Population Fund Strategic Partnership Programme's implementation of family planning guidelines and tools in Asia-Pacific countries.

PubMed

Mody, Sheila K; Ba-Thike, Katherine; Gaffield, Mary E

2013-04-01

The aim of this study was to assess the impact of the Strategic Partnership Programme, a collaboration between the World Health Organization and the United Nations Population Fund to improve evidence-based guidance for country programs through the introduction of selected practice guidelines to improve sexual and reproductive health. Information for this report is from questionnaires sent to Ministries of Health in 2004 (baseline assessment) and in 2007 (assessment of outcome), annual country reports and personal communication with focal points from Ministries of Health and World Health Organization regional and country offices. Following the Strategic Partnership Programme, family planning guidance was used extensively to: formulate and update reproductive health policy; update standards and guidelines; improve training curricula; conduct training activities; develop advocacy and communication materials; and promote change in service. The Strategic Partnership Programme was successful in promoting the introduction of evidence-based guidelines for reproductive health in several Asian countries. The countries that adapted the family planning guidance observed an increase in demand for contraceptives commodities. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

Controversies in chicken-pox immunization.

PubMed

Bhave, Swati Y

2003-06-01

Chicken-pox is one more newer vaccine in our armamentarium against infectious diseases. Due to its extremely contagious nature, varicella is experienced by almost every child or young adult in the world. Each year from 1990 to 1994, prior to availability of varicella vaccine, about 4 million cases of varicella occurred in the United States. Of these cases approximately 10,000 required hospitalization and 100 died. Although varicella is not commonly perceived as an important public health problem, the socioeconomic consequences in industrialized countries of a disease that affects practically every child and causes the carrier absence from work should not be underestimated. The varicella vaccines available in the market are safe and effective. A recent cost-benefit analysis in USA showed that routine chicken-pox vaccination is likely to save five times the investment. Even when only direct costs were considered, benefits almost balanced the costs. At present similar studies from developing countries are not available. The public health impact of varicella and zoster may be increasing in regions with high endemic rates of HIV infection. Varicella vaccine may be used either at an individual level to protect susceptible adolescents and adults, or at a population level, to cover all children as part of a national immunization programme. Vaccination of adolescents and adults will protect at-risk individuals, but will not have a significant impact on the epidemiology of the disease on a population basis. On the other hand, extensive use as a routine vaccine in children will have a significant impact on the epidemiology of the disease. If sustained high coverage can be achieved, the disease may virtually disappear. If only partial coverage can be obtained, the epidemiology may shift, leading to an increase in the number of cases in older children and adults. Hence, routine childhood varicella immunization programmes should emphasize high, sustained coverage. At present, this vaccine will have a lower priority in the National Immunization Schedule that does not have MMR and typhoid, which have a greater socioeconomic impact. Hence, at the present time WHO does not recommend the inclusion of varicella vaccination into the routine immunization programmes of developing countries.

Public Health & Nutrition in the Asia-Pacific: reflections on a quarter century.

PubMed

Cavalli-Sforza, Luca Tommaso

2015-01-01

Some reflections from work in the Asia Pacific Region, mostly with WHO, in the past 25 years, and the changes in nutrition seen in this time are shared. In 1988-89 I helped to start a Centre for Child Nutrition in Chengdu, Sichuan, through the Italian Development Cooperation. The nutritional problems in urban and rural China, 25 years ago, were similar to those elsewhere in the Region. Like China, these countries underwent rapid economic development and changes in health patterns, within two decades. The main problems for child nutrition had to do with infant feeding practices and less breastfeeding: anaemia, protein energy malnutrition and rickets were frequent. How did China and other countries tackle these and other nutrition problems? In the 1990s the global nutrition community started working on a problem-solving framework. In 1992, at the 1st FAO/WHO International Conference on Nutrition, 159 countries agreed to develop national nutrition plans. In 2014, 22 years later, FAO and WHO invited countries to review their national nutrition situation and plans. The epidemiological picture today is profoundly different. Many Asia-Pacific countries have achieved remarkable progress in socio-economic development, including malnutrition reduction. To reach the MDGs and the post-MDG goals being formulated, the remaining under-nutrition problems need to be alleviated, inequalities between sectors of society reduced, and also the growing threat of overweight/obesity and NCDs prevented and controlled. Assessing, monitoring and evaluating programmes to improve progress, now requires focusing not only on biological outcomes, but also on food security, programme process, and the policy environment.

Achieving high coverage in Rwanda's national human papillomavirus vaccination programme.

PubMed

Binagwaho, Agnes; Wagner, Claire M; Gatera, Maurice; Karema, Corine; Nutt, Cameron T; Ngabo, Fidele

2012-08-01

Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275,000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years. In 2011, Rwanda's Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a "public-private community partnership" to ensure effective and equitable delivery. Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12-23 months receive all basic immunizations recommended by the World Health Organization. In 2011, Rwanda's HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose. Through a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda's strong vaccination system and human resources framework. Following the GAVI Alliance's decision to begin financing HPV vaccination, Rwanda's example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context.

A developing country perspective on vaccine-associated paralytic poliomyelitis.

PubMed

John, T Jacob

2004-01-01

When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV). Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP). Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP. Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio. To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV. Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV. Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking. Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin.

Investing in African research training institutions creates sustainable capacity for Africa: the case of the University of the Witwatersrand School of Public Health masters programme in epidemiology and biostatistics

PubMed Central

2012-01-01

Background Improving health in Africa is a high priority internationally. Inadequate research capacity to produce local, relevant research has been identified as a limitation to improved population health. Increasing attention is being paid to the higher education sector in Africa as a method of addressing this; evidence that such investment is having the desired impact is required. A 1998 3-year investment by the Special Programme for Research and Training in Tropical Diseases (TDR) in research training at the School of Public Health, University of the Witwatersrand, South Africa was reviewed to assess its' impact. Methods A descriptive cross-sectional survey of the 70 students registered for the masters programme in epidemiology & biostatistics from 2000-2005 was conducted. Data were collected from self-administered questionnaires. Results Sixty percent (42/70) of students responded. At the time of the survey 19% of respondents changed their country of residence after completion of the masters course, 14% migrated within Africa and 5% migrated out of Africa. Approximately half (47%) were employed as researchers and 38% worked in research institutions. Sixty percent reported research output, and four graduates were pursuing PhD studies. Government subsidy to higher education institutions, investments of the University of the Witwatersrand in successful programmes and ongoing bursaries for students to cover tuition fees were important for sustainability. Conclusions Investing in African institutions to improve research training capacity resulted in the retention of graduates in Africa in research positions and produced research output. Training programmes can be sustained when national governments invest in higher education and where that funding is judiciously applied. Challenges remain if funding for students bursaries is not available. PMID:22475629

Current Situation of Leprosy in India and its Future Implications.

PubMed

Rao, P Narasimha; Suneetha, Sujai

2018-01-01

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication.

Current Situation of Leprosy in India and its Future Implications

PubMed Central

Rao, P. Narasimha; Suneetha, Sujai

2018-01-01

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication. PMID:29644191

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

PubMed

Katz, Itamar; Glandon, Douglas; Wong, Wendy; Kargbo, Brima; Ombam, Regina; Singh, Shanti; Ramsammy, Leslie; Tal-Dia, Anta; Seck, Ibrahima; Osika, John S

2014-05-01

In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

How to create and terminate a school of public health.

PubMed

Köhler, Lennart; Karlberg, Ingvar

2015-08-01

The famous preamble to the Constitution of the World Health Organization (WHO) from 1948, stating that health is not only the absence of disease, has been one of the most influential political statements of our time. The follow-up, reaching a position where health is viewed as instrumental to a good life and not as a goal in itself, as set out in the Ottawa Charter of 1986, has likewise been of the utmost importance for the global development of public health, as well as developing the concept of health promotion. The focus on public health sparked by the WHO was paralleled by expansion of the academic interest in the topic, beginning in the USA and successively adopted around the world. In the Nordic countries the pioneering of an academic platform for public health studies and research began in 1953. This was later followed by a stepwise expansion to a full academic institution with postgraduate studies, work-related training, research and development. From the start, the resultant institution called the Nordic School of Public Health (NHV) was a joint Nordic project financed by the Nordic governments. The NHV became a leader in public health studies in Nordic countries and also a role model for the development of an academic community. A large campus and a select and erudite staff, together with thousands of students, paved the way for the NHV having a major impact on public health policy in Nordic countries. One effect of this was increasing awareness of the need for systematic policy supporting public health research and, with this, the founding of institutions of public health in all of the separate Nordic countries. Ironically, the impact made by the NHV in spreading the idea of public health as an important part of academic study has made the NHV superfluous. It is true that courses and programmes in public health are now available at most universities in the five Nordic countries, but they are directed at young students fresh from high school. There is no institution that offers a broad and high-quality postgraduate education and training in public health, adapted to the special needs of mid-career professionals in a multi-professional and internordic setting. With the NHV closing, a research institute focusing public health in a Nordic context will disappear, as will an internationally leading School of Public Health, a centre of excellence and relevance in public health, which has evaluated, assessed and promoted the goals and evaluated the success of the Nordic welfare societies. © 2015 the Nordic Societies of Public Health.

Medical Physics Challenges for the Implementation of Quality Assurance Programmes in Radiation Oncology.

PubMed

Meghzifene, A

2017-02-01

The importance of quality assurance in radiation therapy, as well as its positive consequences on patient treatment outcome, is well known to radiation therapy professionals. In low- and middle-income countries, the implementation of quality assurance in radiation therapy is especially challenging, due to a lack of staff training, a lack of national guidelines, a lack of quality assurance equipment and high patient daily throughput. According to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres, the proportion of linear accelerators compared with Co-60 machines has increased significantly in recent years in low- and middle-income countries. However, this increase in the proportion of relatively more demanding technology is not always accompanied with the necessary investment in staff training and quality assurance. The IAEA provides supports to low- and middle-income countries to develop and strengthen quality assurance programmes at institutional and national level. It also provides guidance, through its publications, on quality assurance and supports implementation of comprehensive clinical audits to identify gaps and makes recommendations for quality improvement in radiation therapy. The new AAPM TG100 report suggests a new approach to quality management in radiation therapy. If implemented, it will lead to improved cost-effectiveness of radiation therapy in all income settings. Low- and middle-income countries could greatly benefit from this new approach as it will help direct their scarce resources to areas where they can produce the optimum impact on patient care, without compromising patient safety. Copyright © 2016. Published by Elsevier Ltd.

Haemoglobinopathies in Greece: prevention programme over the past 35 years.

PubMed

Loukopoulos, Dimitris

2011-10-01

At present, prevention of thalassaemia and sickle cell disease is the only realistic approach to control the birth of new patients in countries having high numbers of carriers. This is fully justified because avoiding the birth of an ever increasing number of patients may allow a more effective use of the available resources in improving the management of the patients surviving today and alleviate the already overloaded public health system from the inevitable tremendous and ever increasing cost. Moreover, prenatal diagnosis may help couples at risk to have non-thalassaemic children. Greece is one of the countries where the mean frequency of carriers is approximately 7.5 per cent (population 11 million) and has set up a nationwide programme for carrier identification in the early seventies; this is provided through a dozen of specific Units attached to the major Blood Transfusion Services of the country, on a voluntary basis and free of charge. Spread of information through mass media, the schools, and other groups has greatly contributed in creating the necessary sensitization; obstetricians and antenatal Clinics are also instrumental to this effect. Prenatal diagnosis is offered centrally (Athens) and covers satisfactorily the estimated needs (500-600 annually); the total number has already exceeded 35,000. According to information obtained from the major paediatric hospitals all over the country, the number of thalassaemia major or SCD admitted for treatment over the last ten years has been around 15 yearly (instead of an estimate of 120-130).

Establishing a Master׳s for Europe--A transnational model for higher education.

PubMed

Fleming, V; Luyben, A

2016-02-01

Over the last 50 years leading international organisations have been emphasising the key role that midwives play in the provision of quality care for women and babies throughout the pregnancy continuum. Midwifery education, however, generally remained at pre-university level until recently when Bachelors' programmes were developed. In Europe this development was taken further with the awarding of a European Union Lifelong Learning Programme grant to a consortium of five universities in four countries to develop a joint Master's degree in midwifery. The first students, drawn not only from the countries of the partner institutions but also from other European countries and from countries outside of Europe, commenced their studies in 2009. DOES THE PROGRAMME MEET ITS OBJECTIVES AND THOSE SET OUT IN THE LANCET SERIES?: The objectives of the programme were in line with the requirements for effective midwifery care and evidence based practice as discussed in the Lancet series. As an EU funded project all the goals were met. However, in terms of its long-term sustainability problems arose due to the need for universities to rationalise programmes. The number of students has remained steady but low with the projected growth not taking place thus it has been impossible to perceive an impact on midwifery practice and the health of women and children where graduates are working. Despite limitations, the programme serves as an exemplary model of how a Master's programme in midwifery can be successfully built through a collaboration of interested parties from different countries, and can be applied at a global level in other regions of the world, with sufficient political and economic support. Copyright © 2015 Elsevier Ltd. All rights reserved.

National infection prevention and control programmes: Endorsing quality of care.

PubMed

Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

2014-01-01

Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

Defining the Impact of Public Administration Programmes for Public Sector Organizations

ERIC Educational Resources Information Center

Broucker, Bruno

2015-01-01

In times of financial and economic crises, public organizations seem to cut their budgets for training and education, especially when the impact of a programme is questioned. Therefore, PA programmes need to clarify what impact can be expected and what individual and organizational processes are influencing the impact of a PA programme on the…

Adult Education and Training in Europe: Programmes to Raise Achievement in Basic Skills. Country Descriptions. Eurydice Report

ERIC Educational Resources Information Center

Kocanova, Daniela

2015-01-01

This inventory of adult basic education and basic skills programmes takes the form of 35 system descriptions, covering 32 countries (all EU Member States as well as Iceland, Liechtenstein, Norway and Turkey). Its main goal is to support mutual understanding and dialogue between countries. The document has been drafted on the basis of a standalone…

"Making it personal": ideology, the arts, and shifting registers in health promotion.

PubMed

Ruthven, Jessica S

2016-01-01

In South Africa, health promotion related to HIV/AIDS has been characterised as a component of public health prevention. It has heavily utilised global health ideology to construct promotional messages that rely on neoliberal models of individual, responsible health citizenship. However, after nearly 30 years of public health messaging, there have been only minor shifts in the country's HIV prevalence rates; it has become apparent that there is disconnect between policy, programmes, and target audiences. Debates about where this disconnect occurs tend to focus on the role of problems in biomedical knowledge translation or with structural inequalities that lead to health inequity. As debates increase, artists involved in health have emerged to address an additional reason: audience interpellation. In this article, I interrogate relationships between health promotion ideology and processes of interpellation. I suggest that disconnect between the two has roots in the tone of programming, the ways sociality is constructed within health promotion, and the kind of subject which global prevention programmes seek to constitute. Using a case study, I illustrate how public health ideology is made actionable through arts practice. While conventional health promotion programmes address populations in a way that allows individuals to distance themselves, members of South Africa's arts sector have worked to integrate prevention and care in a way that bolsters interpellation through making messages personal. The case study presents one performance but is informed by my broader research with over 20 theatrical groups conducted during 18 months of fieldwork. Analysis of the production reveals that artists act as mediators between population-level public health messages and individuals through the embodied technologies of applied theatre. However, I argue that artists also create space for participants to reimagine configurations of care, responsibility, and intimacy within health practices.

Open Online Courses in Public Health: experience from Peoples-uni.

PubMed

Heller, Richard F; Zurynski, Robert; Barrett, Alan; Oaiya, Omo; Madhok, Rajan

2017-01-01

Open Online Courses (OOCs) are offered by Peoples-uni at http://ooc.peoples-uni.org to complement the courses run on a separate site for academic credit at http://courses.peoples-uni.org. They provide a wide range of online learning resources beyond those usually found in credit bearing Public Health courses. They are self-paced, and students can enrol themselves at any time and utilise Open Educational Resources free of copyright restrictions.  In the two years that courses have been running, 1174 students from 100 countries have registered and among the 1597 enrolments in 14 courses, 15% gained a certificate of completion. Easily accessible and appealing to a wide geographical and professional audience, OOCs have the potential to play a part in establishing global Public Health capacity building programmes.

Open Online Courses in Public Health: experience from Peoples-uni

PubMed Central

Heller, Richard F.; Zurynski, Robert; Barrett, Alan; Oaiya, Omo; Madhok, Rajan

2017-01-01

Open Online Courses (OOCs) are offered by Peoples-uni at http://ooc.peoples-uni.org to complement the courses run on a separate site for academic credit at http://courses.peoples-uni.org. They provide a wide range of online learning resources beyond those usually found in credit bearing Public Health courses. They are self-paced, and students can enrol themselves at any time and utilise Open Educational Resources free of copyright restrictions.  In the two years that courses have been running, 1174 students from 100 countries have registered and among the 1597 enrolments in 14 courses, 15% gained a certificate of completion. Easily accessible and appealing to a wide geographical and professional audience, OOCs have the potential to play a part in establishing global Public Health capacity building programmes. PMID:28491283

Role of salt intake in prevention of cardiovascular disease: controversies and challenges.

PubMed

He, Feng J; MacGregor, Graham A

2018-06-01

Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to <5 g daily. This recommendation has been challenged by several studies, including cohort studies, which have suggested a J-shaped relationship between salt intake and CVD risk. However, these studies had severe methodological problems, such as reverse causality and measurement error due to assessment of salt intake by spot urine. Consequently, findings from such studies should not be used to derail vital public health policy. Gradual, stepwise salt reduction as recommended by the WHO remains an achievable, affordable, effective, and important strategy to prevent CVD worldwide. The question now is how to reduce population salt intake. In most developed countries, salt reduction can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. The UK has pioneered a successful salt-reduction programme by setting incremental targets for >85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings.

Special Education in Arab Countries: Current Challenges

ERIC Educational Resources Information Center

Hadidi, Muna S.; Al Khateeb, Jamal M.

2015-01-01

Arab countries have undertaken various measures to develop special education programmes and services over the last three decades; nevertheless, major challenges remain regarding the expansion of these programmes and services and improving their quality. "This article provides an update on disability and special education in Arab…

One Health research and training and government support for One Health in South Asia

PubMed Central

McKenzie, Joanna S.; Dahal, Rojan; Kakkar, Manish; Debnath, Nitish; Rahman, Mahmudur; Dorjee, Sithar; Naeem, Khalid; Wijayathilaka, Tikiri; Sharma, Barun Kumar; Maidanwal, Nasir; Halimi, Asmatullah; Kim, Eunmi; Chatterjee, Pranab; Devleesschauwer, Brecht

2016-01-01

Introduction Considerable advocacy, funding, training, and technical support have been provided to South Asian countries to strengthen One Health (OH) collaborative approaches for controlling diseases with global human pandemic potential since the early 2000s. It is essential that the OH approach continues to be strengthened given South Asia is a hot spot for emerging and endemic zoonotic diseases. The objectives of this article are to describe OH research and training and capacity building activities and the important developments in government support for OH in these countries to identify current achievements and gaps. Materials and methods A landscape analysis of OH research, training, and government support in South Asia was generated by searching peer-reviewed and grey literature for OH research publications and reports, a questionnaire survey of people potentially engaged in OH research in South Asia and the authors’ professional networks. Results Only a small proportion of zoonotic disease research conducted in South Asia can be described as truly OH, with a significant lack of OH policy-relevant research. A small number of multisectoral OH research and OH capacity building programmes were conducted in the region. The governments of Bangladesh and Bhutan have established operational OH strategies, with variable progress institutionalising OH in other countries. Identified gaps were a lack of useful scientific information and of a collaborative culture for formulating and implementing integrated zoonotic disease control policies and the need for ongoing support for transdisciplinary OH research and policy-relevant capacity building programmes. Discussion Overall we found a very small number of truly OH research and capacity building programmes in South Asia. Even though significant progress has been made in institutionalising OH in some South Asian countries, further behavioural, attitudinal, and institutional changes are required to strengthen OH research and training and implementation of sustainably effective integrated zoonotic disease control policies. PMID:27906123

Violence as a public health problem: an ecological study of 169 countries.

PubMed

Wolf, Achim; Gray, Ron; Fazel, Seena

2014-03-01

Individual level risk factors for violence have been widely studied, but little is known about country-level determinants, particularly in low and middle-income countries. We hypothesized that income inequality, through its detrimental effects on social cohesion, would be related to an increase in violence worldwide, and in low and middle-income countries in particular. We examined country-level associations of violence with socio-economic and health-related factors, using crime statistics from the United Nations Office on Drugs and Crime, and indicators from the Human Development Report published by the United Nations Development Programme. Using regression models, we measured relationships between country-level factors (age, education, measures of income, health expenditure, and alcohol consumption) and four violent outcomes (including measures of violence-related mortality and morbidity) in up to 169 countries. We stratified our analyses comparing high with low and middle-income countries, and analysed longitudinal data on homicide and income inequality in high-income countries. In low and middle-income countries, income inequality was related to homicide, robbery, and self-reported assault (all p's < 0.05). In high-income countries, urbanicity was significantly associated with official assault (p = 0.002, β = 0.716) and robbery (p = 0.011, β = 0.587) rates; income inequality was related to homicide (p = 0.006, β = 0.670) and self-reported assault (p = 0.020, β = 0.563), and longitudinally with homicide (p = 0.021). Worldwide, alcohol consumption was associated with self-reported assault rates (p < 0.001, β = 0.369) suggesting public policy interventions reducing alcohol consumption may contribute to reducing violence rates. Our main finding was that income inequality was related to violence in low and middle-income countries. Public health should advocate for global action to moderate income inequality to reduce the global health burden of violence. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

An analysis of subject areas and country participation for all health-related projects in the EU's FP5 and FP6 programmes.

PubMed

Galsworthy, Michael J; Irwin, Rachel; Charlesworth, Kate; Ernst, Kelly; Hristovski, Dimitar; Wismar, Matthias; McKee, Martin

2014-06-01

Previous analyses concerning health components of European Union (EU)-funded research have shown low project participation levels of the 12 newest member states (EU-12). Additionally, there has been a lack of subject-area analysis. In the Health Research for Europe project, we screened all projects of the EU's Framework Programmes for research FP5 and FP6 (1998-2006) to identify health research projects and describe participation by country and subject area. FP5 and FP6 project databases were acquired and screened by coders to identify health-related projects, which were then categorized according to the 47 divisions of the EU Health Portal (N = 2728 projects) plus an extra group of 'basic/biotech' projects (N = 1743). Country participation and coordination rates for projects were also analyzed. Approximately 20% of the 26 946 projects (value €29.2bn) were health-related (N = 4756. Value €6.04bn). Within the health categories, the largest expenditures were cancer (11.9%), 'other' (i.e. not mental health or cardiovascular) non-communicable diseases (9.5%) and food safety (9.4%). One hundred thirty-two countries participated in these projects. Of the 27 EU countries (and five partner countries), north-western and Nordic states acquired more projects per capita. The UK led coordination with > 20% of projects. EU-12 countries were generally under-represented for participation and coordination. Combining our findings with the associated literature, we comment on drivers determining distribution of participation and funds across countries and subject areas. Additionally, we discuss changes needed in the core EU projects database to provide greater transparency, data exploitation and return on investment in health research. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The economic impacts of foot and mouth disease – What are they, how big are they and where do they occur?

PubMed Central

Knight-Jones, T.J.D.; Rushton, J.

2013-01-01

Although a disease of low mortality, the global impact of foot and mouth disease (FMD) is colossal due to the huge numbers of animals affected. This impact can be separated into two components: (1) direct losses due to reduced production and changes in herd structure; and (2) indirect losses caused by costs of FMD control, poor access to markets and limited use of improved production technologies. This paper estimates that annual impact of FMD in terms of visible production losses and vaccination in endemic regions alone amount to between US$6.5 and 21 billion. In addition, outbreaks in FMD free countries and zones cause losses of >US$1.5 billion a year. FMD impacts are not the same throughout the world:1.FMD production losses have a big impact on the world's poorest where more people are directly dependent on livestock. FMD reduces herd fertility leading to less efficient herd structures and discourages the use of FMD susceptible, high productivity breeds. Overall the direct losses limit livestock productivity affecting food security.2.In countries with ongoing control programmes, FMD control and management creates large costs. These control programmes are often difficult to discontinue due to risks of new FMD incursion.3.The presence, or even threat, of FMD prevents access to lucrative international markets.4.In FMD free countries outbreaks occur periodically and the costs involved in regaining free status have been enormous. FMD is highly contagious and the actions of one farmer affect the risk of FMD occurring on other holdings; thus sizeable externalities are generated. Control therefore requires coordination within and between countries. These externalities imply that FMD control produces a significant amount of public goods, justifying the need for national and international public investment. Equipping poor countries with the tools needed to control FMD will involve the long term development of state veterinary services that in turn will deliver wider benefits to a nation including the control of other livestock diseases. PMID:23958457

Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005-2010 period.

PubMed

Pribluda, Victor S; Barojas, Adrian; Añez, Arletta; López, Cecilia G; Figueroa, Ruth; Herrera, Roxana; Nakao, Gladys; Nogueira, Fernando Ha; Pianetti, Gerson A; Povoa, Marinete M; Viana, Giselle Mr; Gomes, Margarete S Mendonça; Escobar, Jose P; Sierra, Olga L Muñoz; Norena, Susana P Rendon; Veloz, Raúl; Bravo, Marcy Silva; Aldás, Martha R; Hindssemple, Alison; Collins, Marilyn; Ceron, Nicolas; Krishnalall, Karanchand; Adhin, Malti; Bretas, Gustavo; Hernandez, Nelly; Mendoza, Marjorie; Smine, Abdelkrim; Chibwe, Kennedy; Lukulay, Patrick; Evans, Lawrence

2012-06-15

Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country's Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly collected from the public sector, 1,445/1,663 (86.9%). Results indicate that 193/1,663 (11.6%) were found not to meet quality specifications. Most failures were reported during visual and physical inspection, 142/1663 (8.5%), and most of these were due to expired medicines, 118/142 (83.1%). Samples failing TLC accounted for 27/1,663 (1.6%) and those failing disintegration accounted for 24/1,663 (1.4%). Medicines quality failures decreased significantly during the last two years. Basic tests revealed that the quality of medicines in the public sector improved over the years, since the implementation of this type of quality monitoring programme in 2005. However, the lack of consistent confirmatory tests in the quality control (QC) laboratory, utilizing methods that can also evaluate additional quality attributes, could still mask quality issues. In the future, AMI countries should improve coordination with their health authorities and their QC lab consistently, to provide a more complete picture of malaria medicines quality and support the implementation of corrective actions. Facilities in the private and informal sectors also should be included when these sectors constitute an important source of medicines used by malaria patients.

[International Standards of Tuberculosis Care (ISTC)--comments from the German point of view].

PubMed

Castell, S; Bauer, T; Diel, R; Hedrich, A; Magdorf, K; Rüsch-Gerdes, S; Schaberg, T; Loddenkemper, R

2012-04-01

The "International Standards for Tuberculosis Care" (ISTC) were developed by the World Health Organisation (WHO) and others to provide internationally agreed and, if possible, evidence-based standards for tuberculosis care including the care by private providers who are not part of national tuberculosis programmes or health-care systems. Hence, the ISTC primarily address resource-restrained countries with high tuberculosis prevalence. In this article, the German translation of the 21 standards from 2009 is presented - addressing diagnostic and therapeutic standards, co-infection (especially with HIV) and public-health issues. The accompanying comments show how these standards have to be modified for Germany due to the medical resources available here and country-specific characteristics respectively. © Georg Thieme Verlag KG Stuttgart · New York.

Eliminating malaria in Malaysia: the role of partnerships between the public and commercial sectors in Sabah.

PubMed

Sanders, Kelly C; Rundi, Christina; Jelip, Jenarun; Rashman, Yusof; Smith Gueye, Cara; Gosling, Roly D

2014-01-21

Countries in the Asia Pacific region have made great progress in the fight against malaria; several are rapidly approaching elimination. However, malaria control programmes operating in elimination settings face substantial challenges, particularly around mobile migrant populations, access to remote areas and the diversity of vectors with varying biting and breeding behaviours. These challenges can be addressed through subnational collaborations with commercial partners, such as mining or plantation companies, that can conduct or support malaria control activities to cover employees. Such partnerships can be a useful tool for accessing high-risk populations and supporting malaria elimination goals. This observational qualitative case study employed semi-structured key informant interviews to describe partnerships between the Malaysian Malaria Control Programme (MCP), and private palm oil, rubber and acacia plantations in the state of Sabah. Semi-structured interview guides were used to examine resource commitments, incentives, challenges, and successes of the collaborations. Interviews with workers from private plantations and the state of Sabah MCP indicated that partnerships with the commercial sector had contributed to decreases in incidence at plantation sites since 1991. Several plantations contribute financial and human resources toward malaria control efforts and all plantations frequently communicate with the MCP to help monitor the malaria situation on-site. Management of partnerships between private corporations and government entities can be challenging, as prioritization of malaria control may change with annual profits or arrival of new management. Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah. The successes of these partnerships rely on a common understanding that elimination will be a mutually beneficial outcome for employers and the general public. Best practices included consistent communication, developing government-staffed subsector offices for malaria control on-site, engaging commercial plantations to provide financial and human resources for malaria control activities, and the development of new worker screening programmes. The successes and challenges associated with partnerships between the public and commercial sector can serve as an example for other malaria-eliminating countries with large plantation sectors, and may also be applied to other sectors that employ migrant workers or have commercial enterprises in hard to reach areas.

Aid conditionalities, international Good Manufacturing Practice standards and local production rights: a case study of local production in Nepal.

PubMed

Brhlikova, Petra; Harper, Ian; Subedi, Madhusudan; Bhattarai, Samita; Rawal, Nabin; Pollock, Allyson M

2015-06-14

Local pharmaceutical production has been endorsed by the WHO as a means of addressing health priorities of developing countries. However, local producers of essential medicines must comply with international pharmaceutical standards in order to be eligible to compete in donor tenders. These standards determine production rights for on-patent and off-patent medicines, and guide international procurement of medicines. We reviewed the literature on the impact of Good Manufacturing Practice (GMP) on local production; a gap analysis from the literature review indicated a need for further research. Over sixty interviews were conducted with people involved in the Nepali pharmaceutical production and distribution chain from 2006 to 2009 on the GMP areas of relevance: regulatory capacity, staffing, funding and training, resourcing of GMP, inspectors' interpretation of the rules and compliance. Although Nepal producers have increased their overall share of the domestic market, only the public manufacturer, Royal Drugs, focuses on medicines for public health programmes; private producers engage mainly in brand competition for private markets, not essential medicines. Nepali regulators and producers state that implementation of GMP standards is hindered by low regulatory capacity, insufficient training of staff in the industry, financial constraints and lack of investment for upgrading capital. The transition period to mandatory compliance with WHO GMP rules is lengthy. Less than half of private producers had WHO GMP in 2013. Producers are not directly affected by international harmonisation of standards as they do not export medicines and the Nepali regulator does not enforce the WHO standards strictly. Without an international GMP certificate they cannot tender for donor dependent health programmes. In Nepal, local private manufacturers focus mainly on brand competition for private consumption not essential medicines, the government preferentially procures essential medicines from the only public producer while donor funded programmes rely on international manufacturers compliant with international GMP standards. We also found evidence of private hospitals bypassing national medicines approvals process. Policies in support of local pharmaceutical production in developing countries as a source of essential medicines need to examine carefully how GMP regulations impact on regulators, local industry and production of essential medicines in practice.

Integrating GDM management in public health: Pakistan perspective.

PubMed

Riaz, Musarrat; Basit, Abdul

2016-09-01

Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

Financial challenges of immunization: a look at GAVI.

PubMed Central

Kaddar, Miloud; Lydon, Patrick; Levine, Ruth

2004-01-01

Securing reliable and adequate public funding for prevention services, even those that are considered highly cost effective, often presents a challenge. This has certainly been the case with childhood immunizations in developing countries. Although the traditional childhood vaccines cost relatively little, funding in poor countries is often at risk and subject to the political whims of donors and national governments. With the introduction of newer and more costly vaccines made possible under the Global Alliance for Vaccines and Immunization (GAVI), the future financial challenges have become even greater. Experience so far suggests that choosing to introduce new combination vaccines can significantly increase the costs of national immunization programmes. With this experience comes a growing concern about their affordability in the medium term and long term and a realization that, for many countries, shared financial responsibility between national governments and international donors may initially be required. This article focuses on how GAVI is addressing the challenge of sustaining adequate and reliable funding for immunizations in the poorest countries. PMID:15628208

Thailand mental health country profile.

PubMed

Siriwanarangsan, Porntep; Liknapichitkul, Dusit; Khandelwal, Sudhir K

2004-01-01

Thailand, a constitutional monarchy, has undergone a rapid shift in its demography and economy in last two decades. This has put a great burden on the health services, including mental health care of the country. The current emphasis of the Ministry of Public Health is to change its role from health care provider to policymaker and regulator of standards, and to provide technical support to health facilities under its jurisdiction as well as in the private sector. The Department of Mental Health, established in 1994, has laid down a mental health policy that aims to promote mental health care within the community with the help of people's participation in health programmes. Focus has been placed on developing suitable and efficient technology by seeking cooperation both within and outside the Ministry of Public Health. Consequently, the Department of Mental Health has been receiving increasing budgetary allocations. Since there is a paucity of trained manpower, the emphasis is being laid on the utilization of general health care for mental health care. Some of the specific interventions are community services, prison services, psychiatric rehabilitation, and use of media in mental health operations. There have been active efforts towards international cooperation for developing technologies for specific programmes. Private and non-governmental organizations are supported and encouraged to provide mental health care to the marginalized sections of society. Efforts have also been made by the Department of Mental Health to inspect and raise the efficiency of its operations to result in quality service.

The Impact of Lymphatic Filariasis Mass Drug Administration Scaling Down on Soil-Transmitted Helminth Control in School-Age Children. Present Situation and Expected Impact from 2016 to 2020.

PubMed

Mupfasoni, Denise; Montresor, Antonio; Mikhailov, Alexei; King, Jonathan

2016-12-01

Lymphatic filariasis (LF) and soil-transmitted-helminths (STH) are co-endemic in 58 countries which are mostly in Africa and Asia. Worldwide, 486 million school-age children are considered at risk of both diseases. In 2000, the World Health Organization (WHO) established the global programme to eliminate LF by 2020. Since then, the LF elimination programme has distributed ivermectin or diethylcarbamazine citrate (DEC) in combination with albendazole, thereby also treating STH. Consequently, many school-age children have been treated for STH through the LF programme. As treatment targets towards the 2020 LF elimination goal are achieved, many countries are implementing the transmission assessment survey (TAS) and, if the LF prevalence is estimated to be less than 1%, scaling down mass drug administration (MDA). We analysed the 2014 data on preventive chemotherapy (PC) reported from LF STH co-endemic countries and projected the year and location of TAS expected to be conducted between 2016 and 2020 to assess the impact of this scaling down on STH PC. Eighty percent of all co-endemic countries that have already stopped LF MDA nationally were able to establish STH PC through schools. It is estimated that 14% of the total number of children presently covered by the LF programme is at risk of not continuing to receive PC for STH. In order to achieve and maintain the WHO 2020 goal for STH control, there is an urgent need to establish and reinforce school-based deworming programmes in countries scaling-down national LF elimination programmes.

State of Play of the Bologna Process in the Tempus Countries of the Southern Mediterranean (2009/2010). A Tempus Study. Issue 03

ERIC Educational Resources Information Center

Ruffio, Philippe; Heinamaki, Piia; Tchoukaline, Claire Chastang

2010-01-01

The objective of this study is to describe and map the current state of play of the Bologna Process in the nine countries of the Southern Mediterranean participating in the Tempus programme. For the last twenty years, the Tempus programme has supported the modernisation of higher education systems in countries neighbouring the EU by financing…

Patient level cost of diabetes self-management education programmes: an international evaluation

PubMed Central

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-01-01

Objectives The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Setting Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Participants Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary and secondary measures Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. Results We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. Conclusions This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. PMID:28583913

Patient level cost of diabetes self-management education programmes: an international evaluation.

PubMed

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-06-04

The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

PubMed Central

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Parenthood and Happiness: Effects of Work-Family Reconciliation Policies in 22 OECD Countries.

PubMed

Glass, Jennifer; Simon, Robin W; Andersson, Matthew A

2016-11-01

The recent proliferation of studies examining cross-national variation in the association between parenthood and happiness reveal accumulating evidence of lower levels of happiness among parents than nonparents in most advanced industrialized societies. Conceptualizing parenting as a stressor buffered by institutional support, we hypothesize that parental status differences in happiness are smaller in countries providing more resources and support to families. Our analyses of the European Social Surveys (ESS) and International Social Survey Programme (ISSP) reveal considerable variation in the parenthood gap in happiness across countries, with the U.S. showing the largest disadvantage of parenthood. We also find that more generous family policies, particularly paid time off and childcare subsidies, are associated with smaller disparities in happiness between parents and non-parents. Moreover, the policies that augment parental happiness do not reduce the happiness of nonparents. Our results shed light on macro-level causes of emotional processes, with important implications for public policy.

Research for Change: the role of scientific journals publishing mental health research.

PubMed

Saxena, Shekhar; Sharan, Pratap; Saraceno, Benedetto

2004-06-01

There is an enormous gap between the burden of mental disorders and mental health resources in low- and middle-income countries. The Mental Health: Global Action Programme of the World Health Organization (WHO) envisions an active role for research in the multidimensional efforts required to change the current mental health situation in these countries (Research for Change). WHO's strategies to achieve this include developing a research policy and a priority agenda at country level with active collaboration from all stakeholders, building research capacity and infrastructure and involving scientific journals to stimulate and disseminate public health oriented research. A recently agreed joint statement by editors of prominent journals publishing mental health research and WHO sets major objectives and some possible strategies for achieving this. WHO is committed to making Research for Change a reality by working with partners who share this aim.

Research for Change: the role of scientific journals publishing mental health research

PubMed Central

Saxena, Shekhar; Sharan, Pratap; Saraceno, Benedetto

2004-01-01

There is an enormous gap between the burden of mental disorders and mental health resources in low- and middle-income countries. The Mental Health: Global Action Programme of the World Health Organization (WHO) envisions an active role for research in the multidimensional efforts required to change the current mental health situation in these countries (Research for Change). WHO's strategies to achieve this include developing a research policy and a priority agenda at country level with active collaboration from all stakeholders, building research capacity and infrastructure and involving scientific journals to stimulate and disseminate public health oriented research. A recently agreed joint statement by editors of prominent journals publishing mental health research and WHO sets major objectives and some possible strategies for achieving this. WHO is committed to making Research for Change a reality by working with partners who share this aim. PMID:16633460

A new entity for the negotiation of public procurement prices for patented medicines in Mexico.

PubMed

Gómez-Dantés, Octavio; Wirtz, Veronika J; Reich, Michael R; Terrazas, Paulina; Ortiz, Maki

2012-10-01

As countries expand health insurance coverage, their expenditures on medicines increase. To address this problem, WHO has recommended that every country draw up a list of essential medicines. Although most medicines on the list are generics, in many countries patented medicines represent a substantial portion of pharmaceutical expenditure. To help control expenditure on patented medicines, in 2008 the Mexican Government created the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (CCPNM), whose role, as the name suggests, is to enter into price negotiations with drug manufacturers for patented drugs on Mexico's list of essential medicines. Mexico's public expenditure on pharmaceuticals has increased substantially in the past decade owing to government efforts to achieve universal health-care coverage through Seguro Popular, an insurance programme introduced in 2004 that guarantees access to a comprehensive package of health services and medicines. Since 2008, the CCPNM has improved procurement practices in Mexico's public health institutions and has achieved significant price reductions resulting in substantial savings in public pharmaceutical expenditure. The CCPNM has successfully changed the landscape of price negotiation for patented medicines in Mexico. However, it is also facing challenges, including a lack of explicit indicators to assess CCPNM performance; a shortage of permanent staff with sufficient technical expertise; poor coordination among institutions in preparing background materials for the annual negotiation process in a timely manner; insufficient communication among committees and institutions; and a lack of political support to ensure the sustainability of the CCPNM.

The fiscal crisis in the health sector: Patterns of cutback management across Europe.

PubMed

Ongaro, Edoardo; Ferré, Francesca; Fattore, Giovanni

2015-07-01

The article investigates trends in health sector cutback management strategies occurred during the ongoing financial and fiscal crisis across Europe. A European-wide survey to top public healthcare managers was conducted in ten different countries to understand their perception about public sector policy reactions to the financial and economic crisis; answers from 760 respondents from the healthcare sector (30.7% response rate) were analyzed. A multinomial logistic regression was used to assess the characteristics of respondents, countries' institutional healthcare models and the trend in public health resources availability during the crisis associated to the decision to introduce unselective cuts, targeted cuts or efficiency savings measures. Differentiated responses to the fiscal crisis that buffeted public finances were reported both across and within countries. Organizational position of respondents is significant in explaining the perceived cutback management approach introduced, where decentralized positions detect a higher use of linear cuts compared to their colleagues working in central level organizations. Compared to Bismark-like systems Beveridge-like ones favour the introduction of targeted cuts. Postponing the implementation of new programmes and containing expenses through instruments like pay freezes are some of the most popular responses adopted, while outright staff layoffs or reduction of frontline services have been more selectively employed. To cope with the effects of the fiscal crisis healthcare systems are undergoing important changes, possibly also affecting the scope of universal coverage. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries.

PubMed

Zulu, Joseph Mumba; Kinsman, John; Michelo, Charles; Hurtig, Anna-Karin

2014-09-22

Despite the development of national community-based health worker (CBHW) programmes in several low- and middle-income countries, their integration into health systems has not been optimal. Studies have been conducted to investigate the factors influencing the integration processes, but systematic reviews to provide a more comprehensive understanding are lacking. We conducted a systematic review of published research to understand factors that may influence the integration of national CBHW programmes into health systems in low- and middle-income countries. To be included in the study, CBHW programmes should have been developed by the government and have standardised training, supervision and incentive structures. A conceptual framework on the integration of health innovations into health systems guided the review. We identified 3410 records, of which 36 were finally selected, and on which an analysis was conducted concerning the themes and pathways associated with different factors that may influence the integration process. Four programmes from Brazil, Ethiopia, India and Pakistan met the inclusion criteria. Different aspects of each of these programmes were integrated in different ways into their respective health systems. Factors that facilitated the integration process included the magnitude of countries' human resources for health problems and the associated discourses about how to address these problems; the perceived relative advantage of national CBHWs with regard to delivering health services over training and retaining highly skilled health workers; and the participation of some politicians and community members in programme processes, with the result that they viewed the programmes as legitimate, credible and relevant. Finally, integration of programmes within the existing health systems enhanced programme compatibility with the health systems' governance, financing and training functions. Factors that inhibited the integration process included a rapid scale-up process; resistance from other health workers; discrimination of CBHWs based on social, gender and economic status; ineffective incentive structures; inadequate infrastructure and supplies; and hierarchical and parallel communication structures. CBHW programmes should design their scale-up strategy differently based on current contextual factors. Further, adoption of a stepwise approach to the scale-up and integration process may positively shape the integration process of CBHW programmes into health systems.

Does Context Matter? Literacy Disparities in Self-rated Health Using Evidence from 17 Developed Countries.

PubMed

Lee, Yeonjin

2017-05-01

The study examines whether adult literacy skills predict self-rated health status beyond educational credentials in 17 developed countries using a cross-national survey, the Programme for the International Assessment of Adult Competencies (PIAAC). The study uses linear regression models with country-level fixed effects to predict self-rated health to account the unobserved country-level heterogeneity. A total of 73,806 respondents aged 25 to 65 were included in the analysis. Although adult literacy is positively associated with better self-rated health in general, the strength of the relationship varies across nations. The literacy-related health inequalities are less severe in countries with the higher public share of health expenditures that may better address the needs of individuals with limited cognitive abilities. Curriculum standardization also contributes to reducing the literacy gradients in health by decreasing variations in skills obtained in school across individuals with different social origins. Overall, this study reveals that promoting equity in adult literacy skills is an important way to improve a population's health. Country-level differences in the strength of the relationship between literacy and self-rated health are systematically related to between-country differences in health financing and educational systems.

Persistent gender inequities in mathematics achievement and expectations in Australia, Canada and the UK

NASA Astrophysics Data System (ADS)

Forgasz, Helen J.; Leder, Gilah C.

2017-09-01

We report the general public's perceptions and those of 15-year-old school students, about aspects of mathematics learning. For the adult sample, survey data were gathered from pedestrians and Facebook users in Australia, Canada and the UK—countries in which English is the dominant language spoken. Participants responded to items about the teaching and learning of mathematics, the gender stereotyping of mathematics and the perceived importance of studying mathematics for future careers. Collection of the data from the pedestrian samples partially overlapped with the period of data gathering via Facebook and coincided loosely with the administration of the Programme for International Student Assessment [PISA] 2012 in the three countries of interest. We examined participants' views/beliefs by country and by respondent age. We also compared the results of the adult samples with student responses to four PISA 2012 attitudinal items for which the foci were comparable to items administered to the general public. Thus, we were able to compare the responses of three different age groups. While participants considered mathematics to be important for everyone to study, and important for employment, vestiges of traditional gender stereotyped beliefs and expectations were evident, more so among the younger than older respondents.

‘Why do an MPH?’ Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

PubMed Central

Zweigenthal, Virginia E.M.; Marquez, Emma; London, Leslie

2016-01-01

Background Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications. Objectives This study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training. Design A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town. Results Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training. Conclusions The MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment. PMID:27741958

Maternal anaemia in West and Central Africa: time for urgent action.

PubMed

Ayoya, Mohamed Ag; Bendech, Mohamed Ag; Zagré, Noel Marie; Tchibindat, Félicité

2012-05-01

To review the prevalence, severity and determinants of anaemia among women in West and Central Africa (WCA) and raise awareness among policy makers and programme planners in the region. Systematic descriptive review of data in the public domain of the ORC Macro MEASURE Demographic and Health Surveys, national nutrition surveys, oral and technical communications at regional meetings, studies published in scientific journals, and WHO and UNICEF databases. West and Central Africa region. Women of childbearing age. The prevalence of anaemia among pregnant and non-pregnant women is higher than 50 % and 40 %, respectively, in all countries. Within countries, this prevalence varies by living setting (rural v. urban), women's age and education. Across countries, socio-economic and climatic differences have no apparent association with the prevalence of anaemia among women. Several factors contribute either alone or jointly to the high rates of maternal anaemia in this region. These include widespread nutritional deficiencies; high incidence of infectious diseases; low access to and poor quality of health services; low literacy rates; ineffective design, implementation and evaluation of anaemia control programmes; and poverty. Addressing the multiple causes and minimizing the consequences of anaemia on maternal and child health and development in WCA require integrated multifactorial and multisectoral strategies. This also calls for unprecedented, historical and stronger political will and commitment that put adolescent girls and maternal health at the centre of the development agenda.

National Satellite Land Monitoring Systems for REDD+ : the UN-REDD support to countries

NASA Astrophysics Data System (ADS)

Jonckheere, I. G. C.

2015-12-01

REDD+, which stands for 'Reducing Emissions from Deforestation and Forest Degradation in Developing Countries' - is a climate mitigation effort and aims to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports nationally-led REDD+ processes and promotes the imeaningful involvement of all stakeholders, including Indigenous Peoples and other forest-dependent communities, in national and international REDD+ implementation.The Programme supports national REDD+ readiness efforts in partner countries spanning Africa, Asia-Pacific and Latin America, in two ways: (i) direct support to the design and implementation of UN-REDD National Programmes; and (ii) complementary support to national REDD+ action through common approaches, analyses, methodologies, tools, data and best practices. The UN-REDD Programme currently supports 62 partner countries. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. The outcomes about the role of satellite remote sensing technologies as a tool for national monitoring under the REDD+ mechanism are here presented. Some specific country examples will be shown and the current use(fulness) of radar and high resolution data is discussed.

Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts.

PubMed

Onoka, Chima A; Hanson, Kara; Mills, Anne

2016-08-01

There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

The prevalence of common skin infections in four districts in Timor-Leste: a cross sectional survey

PubMed Central

2010-01-01

Background Skin infections are a common public health problem in developing countries; however, they are rarely managed using a population based approach. Recent data on the burden of skin infections in Timor-Leste are limited. Our survey appears to be the only widespread survey conducted in more than 30 years and was designed to determine the baseline prevalence of some common skin infections in Timor-Leste. Methods We conducted a cross sectional survey in 14 sites including community health clinics, schools and hospitals within four different geographical regions. Participants were examined for five conditions (scabies, pyoderma, fungal infections, leprosy and yaws) by a multidisciplinary team. Analyses were conducted using EpiInfo version 6.04d. Results We examined the skin of 1535 participants aged between four months and 97 years. The majority of participants were male, aged between 11 and 20 years and had at least one condition of interest (56.0%, 56.0%, and 63.1%, respectively). Fungal infections were the most common presentation (39.0%) and males were more commonly affected than females (42.3% vs 34.0%, respectively, pvalue < 0.0001). Among those people with more than one condition the two most common co-infections were scabies with either pyoderma or a fungal infection (38.0% and 32.0%, respectively). The survey identified 29 previously undiagnosed cases of leprosy and six cases of yaws. Conclusions Our findings indicate the need for a comprehensive programme to address these conditions. There are successful disease control programmes in place within the country and it is hoped a healthy skin programme could be integrated into an established disease control programme in order to maximise health benefits and resources. PMID:20219136

Health-sector responses to address the impacts of climate change in Nepal.

PubMed

Dhimal, Meghnath; Dhimal, Mandira Lamichhane; Pote-Shrestha, Raja Ram; Groneberg, David A; Kuch, Ulrich

2017-09-01

Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme - Implementation Plan II (NHSP-IP 2) 2010-2015; the National Health Policy 2014; the National Health Sector Strategy 2015-2020 and its implementation plan (2016-2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016-2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.

Current status on health sciences research productivity pertaining to Angola up to 2014.

PubMed

Sambo, Maria do Rosário; Ferreira, Albano V L

2015-07-01

Health research driven by the healthcare demands of the population can provide an informative evidence base to support decision-making processes on health policies, programmes, and practices. This paper surveyed the production of scientific research concerning health in Angola, specifically to access the publication rate over time, the main research topics and scientific fields, and the contribution of Angolan researchers and institutions. The study focused on data collected in a retrospective literature search in Biblioteca Virtual em Saúde (BVS) as of June 8, 2014, with the keyword "Angola" and on content information in correspondent publications deposited in PubMed. BVS generated 1,029 hits, 74.6 % of which were deposited in PubMed where 301 abstracts were described. From 1979 to 2003, there were 62 publications and in 2004-2013 the quantity increased four-fold (n = 232); malaria was the most frequent topic (n = 42). Angola was the country with the largest number of publications, taking into account the primary affiliation of the first author (n = 45). Universities, institutes, or research centres accounted for 65 % of the publications and in descending order Portugal, Brazil, and the United States of America occupied the three first positions. Epidemiology was by far the most frequent field of research (n = 165). The number of publications has increased steadily over the past 10 years, with predominance on malaria topics. Angola was the country with the largest number of major affiliations of the first author, but the contribution of Angolan institutions was relatively low, indicating a need to reinforce academic research institutions in the country.

IAEA international studies on irradiation embrittlement of reactor pressure vessel steels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brumovsky, M.; Steele, L.E.

1997-02-01

In last 25 years, three phases a Co-operative Research Programme on Irradiation Embrittlement of Reactor Pressure Vessel Steels has been organized by the International Atomic Energy Agency. This programme started with eight countries in 1971 and finally 16 countries took part in phase III of the Programme in 1983. Several main efforts were put into preparation of the programme, but the principal task was concentrated on an international comparison of radiation damage characterization by different laboratories for steels of {open_quotes}old{close_quotes} (with high impurity contents) and {open_quotes}advanced{close_quotes} (with low impurity contents) types as well as on development of small scale fracturemore » mechanics procedures applicable to reactor pressure vessel surveillance programmes. This year, a new programme has been opened, concentrated mostly on small scale fracture mechanics testing.« less

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies.

PubMed

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists' licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category.

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies

PubMed Central

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Introduction: Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Materials and methods: A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Results: Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists’ licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Conclusions: Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category. PMID:24266304

Promoting wellbeing and improving access to mental health care through community champions in rural India: the Atmiyata intervention approach.

PubMed

Shields-Zeeman, Laura; Pathare, Soumitra; Walters, Bethany Hipple; Kapadia-Kundu, Nandita; Joag, Kaustubh

2017-01-01

There are limited accounts of community-based interventions for reducing distress or providing support for people with common mental disorders (CMDs) in low and middle-income countries. The recently implemented Atmiyata programme is one such community-based mental health intervention focused on promoting wellness and reducing distress through community volunteers in a rural area in the state of Maharashtra, India. This case study describes the content and the process of implementation of Atmiyata and how community volunteers were trained to become Atmiyata champions and mitras ( friends ). The Atmiyata programme trained Atmiyata champions to provide support and basic counselling to community members with common mental health disorders, facilitate access to mental health care and social benefits, improve community awareness of mental health issues, and to promote well-being. Challenges to implementation included logistical challenges (difficult terrain and weather conditions at the implementation site), content-related challenges (securing social welfare benefits for people with CMDs), and partnership challenges (turnover of public health workers involved in referral chain, resistance from public sector mental health specialists). The case study serves as an example for how such a model can be sustained over time at low cost. The next steps of the programme include evaluation of the impact of the Atmiyata intervention through a pre-post study and adapting the intervention for further scale-up in other settings in India.

Basis for a Waste Management Public Communication Policy: Actual Situation Analysis and Implementation of Corrective Actions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jolivet, L. A.; Maset, E. R.

2002-02-28

Argentina will require new sites for the location of radioactive waste final disposal systems. It is currently mandatory to have social and political consensus to obtain the corresponding agreements. The experience obtained with the cancellation of the project ''Feasibility Study and Engineering Project--Repository for High Level Radioactive Waste'', reinforces even more the necessity to count with the acceptance of the public to carry out projects of this kind. The first phase of the former was developed in the 80's: geological, geophysical and hydrogeological studies were performed in a compact granitic rock located in Sierra del Medio, Chubut province. This projectmore » had to be called off in the early 90's due to strong social rejection. This decision was closely related to the poor attention given to social communication issues. The governmental decision-makers in charge underwent a lot of pressure from social groups claiming for the cancellation of the project due to the lack of information and the fear it triggered. Thus, the lesson learnt: ''social communication activities must be carefully undertaken in order to achieve the appropriate management of the radioactive waste produced in our country.'' The same as in other countries, the specific National Law demands the formulation of a Strategic Plan which will not only include the research into radioactive waste, but the design of a Social Communication Programme as well. The latter will be in charge of informing the population clearly and objectively about the latest scientific and technological advances in the issue. A tentative perception-attitude pattern of the Argentine society about the overall nuclear issue is outlined in this paper. It is meant to contribute to the understanding of the public's adverse reaction to this kind of project. A communication programme is also presented. Its objective is to install the waste management topic in the public's opinion with a positive real outlook.« less

The swine flu vaccine, public attitudes, and researcher interpretations: a systematic review of qualitative research.

PubMed

Carlsen, Benedicte; Glenton, Claire

2016-06-24

During pandemics, health authorities may be uncertain about the spread and severity of the disease and the effectiveness and safety of available interventions. This was the case during the swine flu (H1N1) pandemic of 2009-2010, and governments were forced to make decisions despite these uncertainties. While many countries chose to implement wide scale vaccination programmes, few accomplished their vaccination goals. Many research studies aiming to explore barriers and facilitators to vaccine uptake have been conducted in the aftermath of the pandemic, including several qualitative studies. 1. To explore public attitudes to the swine flu vaccine in different countries through a review of qualitative primary studies. 2. To describe and discuss the implications drawn by the primary study authors. Systematic review of qualitative research studies, using a broadly comparative cross case-study approach. Study quality was appraised using an adaptation of the Critical Appraisal Skills Programme (CASP) quality assessment tool. The review indicates that the public had varying opinions about disease risk and prevalence and had concerns about vaccine safety. Most primary study authors concluded that participants were uninformed, and that more information about the disease and the vaccine would have led to an increase in vaccine uptake. We find these conclusions problematic. We suggest instead that people's questions and concerns were legitimate given the uncertainties of the situation at the time and the fact that the authorities did not have the necessary information to convince the public. Our quality assessment of the included studies points to a lack of reflexivity and a lack of information about study context. We suggest that these study weaknesses are tied to primary study authors' lack of acknowledgement of the uncertainties surrounding the disease and the vaccine. While primary study authors suggest that authorities could increase vaccine uptake through increased information, we suggest instead that health authorities should be more transparent in their information and decision-making processes in future pandemic situations.

Expanded newborn metabolic screening programme in Hong Kong: a three-year journey.

PubMed

Chong, S C; Law, L K; Hui, J; Lai, C Y; Leung, T Y; Yuen, Y P

2017-10-01

No universal expanded newborn screening service for inborn errors of metabolism is available in Hong Kong despite its long history in developed western countries and rapid development in neighbouring Asian countries. To increase the local awareness and preparedness, the Centre of Inborn Errors of Metabolism of the Chinese University of Hong Kong started a private inborn errors of metabolism screening programme in July 2013. This study aimed to describe the results and implementation of this screening programme. We retrieved the demographics of the screened newborns and the screening results from July 2013 to July 2016. These data were used to calculate quality metrics such as call-back rate and false-positive rate. Clinical details of true-positive and false-negative cases and their outcomes were described. Finally, the call-back logistics for newborns with positive screening results were reviewed. During the study period, 30 448 newborns referred from 13 private and public units were screened. Of the samples, 98.3% were collected within 7 days of life. The overall call-back rate was 0.128% (39/30 448) and the false-positive rate was 0.105% (32/30 448). Six neonates were confirmed to have inborn errors of metabolism, including two cases of medium-chain acyl-coenzyme A dehydrogenase deficiency, one case of carnitine-acylcarnitine translocase deficiency, and three milder conditions. One case of maternal carnitine uptake defect was diagnosed. All patients remained asymptomatic at their last follow-up. The Centre of Inborn Errors of Metabolism has established a comprehensive expanded newborn screening programme for selected inborn errors of metabolism. It sets a standard against which the performance of other private newborn screening tests can be compared. Our experience can also serve as a reference for policymakers when they contemplate establishing a government-funded universal expanded newborn screening programme in the future.

The public gets what the public wants: experiences of public reporting in long-term care in Europe.

PubMed

Rodrigues, Ricardo; Trigg, Lisa; Schmidt, Andrea E; Leichsenring, Kai

2014-05-01

Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. There was little evidence to show whether public reporting has a significant impact on driving users' choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Scientific Return of VLT Programmes

NASA Astrophysics Data System (ADS)

Sterzik, M.; Dumas, C.; Grothkopf, U.; Kaufer, A.; Leibundgut, B.; Marteau, S.; Meakins, S.; Patat, F.; Primas, F.; Rejkuba, M.; Romaniello, M.; Stoehr, F.; Tacconi-Garman, L.; Vera, I.

2015-12-01

An in-depth analysis of the publications from 8414 distinct scheduled VLT observing programmes between April 1999 and March 2015 (Periods 63 to 94) is presented. The productivity by mode (Visitor or Service Mode) and type (Normal and Large, Guaranteed Time, Target of Opportunity, Director's Discretionary Time) are examined through their publication records. We investigate how Service Mode rank classes impact the scientific return. Several results derive from this study: Large Programmes result in the highest productivity, whereas only about half of all scheduled observing programmes produce a refereed publication. Programmes that result in a publication yield on average two refereed papers. B rank class Service Mode Programmes appear to be slightly less productive. Follow-up studies will investigate in more detail the parameters that influence the productivity of the Observatory.

Structural adjustment programmes adversely affect vulnerable populations: a systematic-narrative review of their effect on child and maternal health.

PubMed

Thomson, Michael; Kentikelenis, Alexander; Stubbs, Thomas

2017-01-01

Structural adjustment programmes of international financial institutions have typically set the fiscal parameters within which health policies operate in developing countries. Yet, we currently lack a systematic understanding of the ways in which these programmes impact upon child and maternal health. The present article systematically reviews observational and quasi-experimental articles published from 2000 onward in electronic databases (PubMed/Medline, Web of Science, Cochrane Library and Google Scholar) and grey literature from websites of key organisations (IMF, World Bank and African Development Bank). Studies were considered eligible if they empirically assessed the aggregate effect of structural adjustment programmes on child or maternal health in developing countries. Of 1961 items yielded through database searches, reference lists and organisations' websites, 13 met the inclusion criteria. Our review finds that structural adjustment programmes have a detrimental impact on child and maternal health. In particular, these programmes undermine access to quality and affordable healthcare and adversely impact upon social determinants of health, such as income and food availability. The evidence suggests that a fundamental rethinking is required by international financial institutions if developing countries are to achieve the Sustainable Development Goals on child and maternal health.

Nutrition and the Malaysian Healthy Lifestyle Programme: challenges in implementation.

PubMed

Suleiman, T S; Siong, T E

1998-12-01

There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.

Shifts in global immunisation goals (1984-2004): unfinished agendas and mixed results.

PubMed

Hardon, Anita; Blume, Stuart

2005-01-01

The turn of the millennium has been marked by a large-scale mobilisation of resources for immunisation programmes in developing countries. The resources have been generated by public and private sector parties collaborating in the Global Alliance for Vaccines and Immunization (GAVI). GAVI was formed in response to deteriorating immunisation coverage rates occurring in the late 1990s. GAVI is the latest in a line of vaccine initiatives, which have operated over the past 20 years. This article reviews the five most important global immunisation initiatives that have taken place over those past 20 years. It analyses their origins, shifts in global immunisation goals, identifies key actors, assesses the initiatives' capacity to mobilise resources and increase immunisation coverage, and points to possible unintended effects of the initiatives. The study argues that shifts in global immunisation goals lead to fragmentation in the implementation of vaccine programmes at the local level in developing countries. It also suggests that global actors involved in the formulation of these initiatives appear to miss opportunities to build on past experiences and fail to learn from previous mistakes. This raises questions about the initiatives' sustainability and relevance to the overall objective of preventing vaccine-preventable deaths.

Responding to the multidrug-resistant tuberculosis crisis: mainstreaming programmatic management to the Philippine National Tuberculosis Programme.

PubMed

Quelapio, M I D; Mira, N R C; Orillaza-Chi, R B; Belen, V; Muñez, N; Belchez, R; Egos, G E; Evangelista, M; Vianzon, R; Tupasi, T E

2010-06-01

The Philippines ranks eighth among 27 priority countries for multidrug-resistant TB (MDR-TB). To describe a model of public-private partnership in MDR-TB management. An exploratory study of integrating MDR-TB management initiated in private-public mix DOTS into the National TB Programme (NTP). Recognising that MDR-TB was a threat to DOTS, the Tropical Disease Foundation initiated MDR-TB management in 1999. An official mandate for the integration of MDR-TB services into the NTP was issued by the Department of Health in 2008. With an increased government budget augmented by support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, 1294 MDR-TB patients were placed on treatment from 1999 to 2008. The treatment success rate improved from 64% in 1999 to 75% in 2005. There are now five MDR-TB treatment centres with 181 treatment sites in Metro Manila, and three culture centres. People trained include 12 master trainers, 31 trainers, 25 treatment centre and 381 treatment site staff. Mainstreaming into the NTP of this unique model of MDR-TB management through a dynamic public-private collaboration can be considered best practice in implementation science of an evidence-based intervention leading to change in health care policy and practice.

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice

PubMed Central

Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S; Wilson, Nevin C; Kumar, Ajay M V; Oeltmann, John E; Chadha, Vineet K; Nagaraja, Sharath Burugina; Ghosh, Smita; Q Lo, Terrence; Volkmann, Tyson; Willis, Matthew; Shringarpure, Kalpita; Reddy, Ravichandra Chinnappa; Kumar, Prahlad; Nair, Sreenivas A; Rao, Raghuram; Yassin, Mohammed; Mwangala, Perry; Zachariah, Rony; Tonsing, Jamhoih; Harries, Anthony D; Khaparde, Sunil

2018-01-01

ABSTRACT Background: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes. Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects. PMID:29553308

Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice.

PubMed

Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S; Wilson, Nevin C; Kumar, Ajay M V; Moonan, Patrick K; Oeltmann, John E; Chadha, Vineet K; Nagaraja, Sharath Burugina; Ghosh, Smita; Q Lo, Terrence; Volkmann, Tyson; Willis, Matthew; Shringarpure, Kalpita; Reddy, Ravichandra Chinnappa; Kumar, Prahlad; Nair, Sreenivas A; Rao, Raghuram; Yassin, Mohammed; Mwangala, Perry; Zachariah, Rony; Tonsing, Jamhoih; Harries, Anthony D; Khaparde, Sunil

2018-01-01

The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes. In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.

Health status and epidemiological capacity and prospects: WHO Western Pacific Region.

PubMed

Blakely, Tony; Pega, Frank; Nakamura, Yosikazu; Beaglehole, Robert; Lee, Liming; Tukuitonga, Colin Fonotau

2011-08-01

This article on the state of epidemiology in the WHO Western Pacific Region (WPR) is the first in a series of eight articles commissioned by the International Epidemiological Association (IEA) to identify global opportunities to promote the development of epidemiology. Global mortality and disease data were used to summarize the burden of mortality, disease, risk factor and patterns of inequalities in the region. Medline bibliometrics were used to estimate epidemiological publication output by country. Key informant surveys, Internet and literature searches and author knowledge and networks were used to elicit perspectives on epidemiological training, research, funding and workforce. Findings The WPR has the lowest age-standardized disability-adjusted life-years (DALY) rate per 1000 of the six WHO regions, with non-communicable disease making the largest percentage contributions in both low- and middle-income countries (LMICs, 68%) and high-income countries (HICs, 84%) in the WPR. The number of Medline-indexed epidemiological research publications per year was greatest for Japan, Australia and China. However, the rate per head of population was greatest for Micronesia and New Zealand. The substantive focus of research roughly equated with burden of disease patterns. Research capacity (staff, funding, infrastructure) varies hugely between countries. Epidemiology training embedded within academic Masters of Public Health programmes is the dominant vehicle for training in most countries. Field epidemiology and in-service training are also common. The Pacific Island countries and territories, because of sparse populations over large distances and chronic workforce and funding capacity problems, rely on outside agencies (e.g. WHO, universities) for provision of training. Cross-national networks and collaborations are increasing. Communicable disease surveillance and research need consolidation (especially in eastern Asian WPR countries), and non-communicable disease epidemiological capacity requires strengthening to match disease trends. Capacity and sustainability of both training and research within LMICs in WPR are ongoing priorities. China in particular is advancing quickly. One role for the IEA in building capacity is facilitating collaborative networks within WPR.

Tuberculosis drug issues: prices, fixed-dose combination products and second-line drugs.

PubMed

Laing, R O; McGoldrick, K M

2000-12-01

Access to tuberculosis drugs depends on multiple factors. Selection of a standard list of TB drugs to procure is the first step. This paper reviews the advantages and disadvantages of procuring and using fixed-dose combination (FDC) products for both the intensive and continuation phases of treatment. The major advantages are to prevent the emergence of resistance, to simplify logistic management and to reduce costs. The major disadvantage is the need for the manufacturers to assure the quality of these FDCs by bioavailability testing. The paper reports on the inclusion of second-line TB drugs in the 1999 WHO Essential Drug List (EDL). The need to ensure that these drugs are used within established DOTS-Plus programs is stressed. The price of TB drugs is determined by many factors, including producer prices, local taxes and duties as well as mark-ups and fees. TB drug prices for both the public and private sectors from industrialized and developing countries are reported. Price trends over time are also reported. The key findings of this study are that TB drug prices have generally declined in developing countries while they have increased in developed countries, both for the public and private sectors. Prices vary between countries, with the US paying as much as 95 times the price paid in a specific developing country. The prices of public sector first-line TB drugs vary little between countries, although differences do exist due to the procurement methods used. The price of tuberculin, a diagnostic agent, has increased dramatically in the US, with substantial inter-country variations in price. The paper suggests that further research is necessary to identify the reasons for the price disparities and changes over time, and suggests methods which can be used by National Tuberculosis Programme managers to ensure availability of quality assured TB drugs at low prices.

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence.

PubMed

Hyder, Adnan A; Allen, Katharine A; Peters, David H; Chandran, Aruna; Bishai, David

2013-01-01

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

The ''Complex Reality'' of Research Capacity Development in Mathematics Education in Southern African Development Community Countries

ERIC Educational Resources Information Center

Julie, Cyril; Mikalsen, Oyvind; Persens, Jan

2005-01-01

This paper explores how an aid-funded Ph.D.-programme in mathematics education instituted in some Southern African Development Community countries measures up to issues related to research capacity development projects. The research capacity development programme is described and reflected against mutual benefit, relevance, sustainability and…

Evaluation of international case studies within 'Live.Learn.Laugh.': a unique global public-private partnership to promote oral health.

PubMed

Dugdill, Lindsey; Pine, Cynthia M

2011-08-01

The partnership between the Féderation Dentaire International (FDI), and Unilever Oral Care, aims to raise awareness of oral health globally; to enable FDI member associations to promote oral health; and to increase the visibility of the FDI and authority of Unilever oral care brands worldwide. Country Projects between National Dental Associations (NDAs), the member associations of FDI, and Unilever Oral Care local companies have been established as a key strand of the partnership. This paper reports on the evaluation of an in-depth sample of Country Projects (n=5) to determine their potential to impact on oral health. Five country sites were selected as being indicative of different programme delivery types. Each site received a two-day visit during Spring-Summer 2009, which enabled the evaluators to audit what was delivered in practice compared with the original written project briefs and to undertake interviews of study site staff. 39 projects in 36 countries have been initiated. In those examined by site visits, clear evidence was found of capacity building to deliver oral health. In some countries, widespread population reach had been prioritised. Effectiveness of partnership working varied depending on the strength of the relationship between the NDA and local Unilever Oral Care representatives and alignment with national marketing strategy. The quality of internal evaluation varied considerably. Over a million people had been reached directly by Country Projects and this public-private partnership has made a successful start. To move towards improving oral health rather than only awareness raising; future Country Projects would benefit from being limited to certain evidence-based intervention designs, and using an agreed core indicator set in order to allow cross-country comparison of intervention outcomes. © 2011 FDI World Dental Federation.

A survey of public health and consumer health informatics programmes and courses in Canadian universities and colleges.

PubMed

Arocha, Jose F; Hoffman-Goetz, Laurie

2012-12-01

As information technology becomes more widely used by people for health-care decisions, training in consumer and public health informatics will be important for health practitioners working directly with the public. Using information from 74 universities and colleges across Canada, we searched websites and online calendars for programmes (undergraduate, graduate) regarding availability and scope of education in programmes, courses and topics geared to public health and/or consumer health informatics. Of the 74 institutions searched, 31 provided some content relevant to health informatics (HI) and 8 institutions offered full HI-related programmes. Of these 8 HI programmes, only 1 course was identified with content relevant to public health informatics and 1 with content about consumer health informatics. Some institutions (n  =  22) - which do not offer HI-degree programmes - provide health informatics-related courses, including one on consumer health informatics. We found few programmes, courses or topic areas within courses in Canadian universities and colleges that focus on consumer or public health informatics education. Given the increasing emphasis on personal responsibility for health and health-care decision-making, skills training for health professionals who help consumers navigate the Internet should be considered in health informatics education.

Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol.

PubMed

Smith, Stephanie L; Misago, Claire Nancy; Osrow, Robyn A; Franke, Molly F; Iyamuremye, Jean Damascene; Dusabeyezu, Jeanne D'Arc; Mohand, Achour A; Anatole, Manzi; Kayiteshonga, Yvonne; Raviola, Giuseppe J

2017-02-28

Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system. A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members. This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland--a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health.

PubMed

Nowakowski, Andrzej; Śliwczyński, Andrzej; Seroczyński, Przemysław; Cybulski, Marek; Teter, Zbigniew

2016-06-01

Despite implementation of organised screening programme in 2006/2007, cervical cancer (CC) incidence and mortality in Poland are still higher than the average in the European Union. CC and preceding cervical intraepithelial neoplasia (CIN) caused by human papillomaviruses (HPVs) can be prevented by vaccines which are reimbursed in around 20 European countries but not in Poland. CC and CIN can be also detected with the use of HPV tests which are not included in the Polish screening programme. Reimbursement for HPV vaccines and HPV testing requires cost-effectiveness analyses which include country-specific data on the burden and costs of management of cervical neoplasia. Therefore, we investigated the burden of cervical neoplasia and direct costs associated with its detection and management in Poland in 2012 reimbursed by the National Health Fund (NHF) - the only public healthcare insurance institution. We also report administrative costs of the organised screening programme covered by the Ministry of Health. Data on the burden and reimbursed costs of organised and opportunistic screening as well as management of cervical neoplasia were drawn from the NHF databases. Numbers of women reported with CIN and CC were ascertained. In 2012, there were 765,266 and 1,288,358 reimbursed Pap smears collected within and outside the organised screening programme, respectively. Expenditures on medical and administrative procedures in organised screening reached PLN (Polish Zloty) 41,470,664 and 12,150,398 respectively. The number of women with particular diagnosis and reimbursement for the management of these lesions were as follows: glandular ectropion 208,033 and PLN 37,349,515; CIN1 10,521 and PLN 6,616,375; CIN2 5,812 and PLN 5,071,155; CIN3 6,487 and PLN 7,611,062; unspecified grade CIN 36,575 and PLN 12,352,034; and CC 33,482 and PLN 52,377,006, respectively. In women with ectropion and CIN the total number of local excision/ablative therapeutic procedures on the cervix reached 47,658 and the total number of hysterectomies was 1,321. In 2012, management of approximately 93 thousand women with HPV-related cervical lesions reimbursed in Poland amounted to PLN 84,027,632 which makes it a considerable public health problem. The number of women managed for glandular ectropion is considerable and related costs are high. Total reimbursement for detection, treatment and follow-up of all cervical lesions reaches at least PLN 137 million annually. Copyright© by the National Institute of Public Health, Prague 2015.

Strategies and approaches to vector control in nine malaria-eliminating countries: a cross-case study analysis.

PubMed

Smith Gueye, Cara; Newby, Gretchen; Gosling, Roland D; Whittaker, Maxine A; Chandramohan, Daniel; Slutsker, Laurence; Tanner, Marcel

2016-01-04

There has been progress towards malaria elimination in the last decade. In response, WHO launched the Global Technical Strategy (GTS), in which vector surveillance and control play important roles. Country experiences in the Eliminating Malaria Case Study Series were reviewed to identify success factors on the road to elimination using a cross-case study analytic approach. Reports were included in the analysis if final English language draft reports or publications were available at the time of analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for vector control in malaria elimination was developed, reviewed, formatted as a matrix, and case study data was extracted and entered into the matrix. A workshop was convened during which participants conducted reviews of the case studies and matrices and arrived at a consensus on the evidence and lessons. The framework was revised and a second round of data extraction, synthesis and summary of the case study reports was conducted. Countries implemented a range of vector control interventions. Most countries aligned with integrated vector management, however its impact was not well articulated. All programmes conducted entomological surveillance, but the response (i.e., stratification and targeting of interventions, outbreak forecasting and strategy) was limited or not described. Indoor residual spraying (IRS) was commonly used by countries. There were several examples of severe reductions or halting of IRS coverage and subsequent resurgence of malaria. Funding and operational constraints and poor implementation had roles. Bed nets were commonly used by most programmes; coverage and effectiveness were either not measured or not articulated. Larval control was an important intervention for several countries, preventing re-introduction, however coverage and impact on incidence were not described. Across all interventions, coverage indicators were incomparable, and the rationale for which tools were used and which were not used appeared to be a function of the availability of funding, operational issues and cost instead of evidence of effectiveness to reduce incidence. More work is required to fill gaps in programme guidance, clarify the best methods for choosing and targeting vector control interventions, and support to measure cost, cost-effectiveness and cost-benefit of vector surveillance and control interventions.

Quest for harmonisation: differences and similarities in national programmes for GLP monitoring. A senior inspector's viewpoint.

PubMed

Helder, Theo

2008-01-01

The conditions under which safety data may be accepted by regulatory authorities (RAs) in OECD Countries do not only include the obligation to apply the principles of good laboratory practice (GLP) while producing these data, but also must countries, partaking in the Organisation for Economic Cooperation and Development (OECD) system for mutual acceptance of data (MAD), establish a monitoring programme to ensure proper application of the GLP principles. Detailed guidance to this end is given in the OECD GLP documents No. 2 and 3. Nevertheless, this guidance permits countries quite some freedom where it concerns the organisation of their programmes. Monitoring programmes may be embedded in governmental as well as private structures. It appears that GLP compliance monitoring is increasingly charged to accreditation bodies. Inspectors may be full-time or part-time workers, and there are differences in scheduling and performing inspections and study audits. Also the financing of the monitoring programmes is diverging: in some countries the programme is fully or partly paid by the inspected test facilities (TFs), while in other countries the financing comes from the national treasury. Is there a need for harmonisation in this area, as there is and was in the interpretation of the GLP principles themselves? Over the years more than ten consensus and advisory documents have been published by the OECD working group on GLP. The very existence of these documents is however no guarantee that the interpretation of the GLP principles by inspectors is similar, let alone identical. The most important criterion is, in fact, that there be no harm for human health and the environment.

Suicide in women

PubMed Central

Vijayakumar, Lakshmi

2015-01-01

Suicide is a global public health problem. Asia accounts for 60% of the world's suicides, so at least 60 million people are affected by suicide or attempted suicide in Asia each year. The burden of female suicidal behavior, in terms of total burden of morbidity and mortality combined, is more in women than in men. Women's greater vulnerability to suicidal behavior is likely to be due to gender related vulnerability to psychopathology and to psychosocial stressors. Suicide prevention programmes should incorporate woman specific strategies. More research on suicidal behavior in women particularly in developing countries is needed. PMID:26330640

Dissemination of public health information: key tools utilised by the NECOBELAC network in Europe and Latin America

PubMed Central

De Castro, Paola; Marsili, Daniela; Poltronieri, Elisabetta; Calderón, Carlos Agudelo

2012-01-01

Background Open Access (OA) to scientific information is an important step forward in communication patterns, yet we still need to reinforce OA principles to promote a cultural change of traditional publishing practices. The advantages of free access to scientific information are even more evident in public health where knowledge is directly associated with human wellbeing. Objectives An OA ‘consolidation’ initiative in public health is presented to show how the involvement of people and institutions is fundamental to create awareness on OA and promote a cultural change. This initiative is developed within the project NEtwork of COllaboration Between Europe and Latin American Caribbean countries (NECOBELAC), financed by the European Commission. Methods Three actions are envisaged: Capacity building through a flexible and sustainable training programme on scientific writing and OA publishing; creation of training tools based on semantic web technologies; development of a network of supporting institutions. Results In 2010–2011, 23 training initiatives were performed involving 856 participants from 15 countries; topic maps on scientific publication and OA were produced; 195 institutions are included in the network. Conclusions Cultural change in scientific dissemination practices is a long process requiring a flexible approach and strong commitment by all stakeholders. PMID:22630360

The potential Public Health Impact of Mycobacterium avium ssp. paratuberculosis: Global Opinion Survey of Topic Specialists.

PubMed

Waddell, L A; Rajić, A; Stärk, K D C; McEwen, S A

2016-05-01

Global research knowledge has accumulated over the past few decades, and there is reasonable evidence for a positive association between Mycobacterium avium spp. paratuberculosis and Crohn's disease in humans, although its role as a human pathogen has not been entirely accepted. For this reason, management of public health risk due to M. paratuberculosis remains an important policy issue in agri-food public health arenas in many countries. Responsible authorities must decide whether existing mitigation strategies are sufficient to prevent or reduce human exposure to M. paratuberculosis. A Web-based questionnaire was administered to topic specialists to elicit empirical knowledge and opinion on the overall public health impact of M. paratuberculosis, the importance of various routes of human exposure to the pathogen, existing mitigation strategies and the need for future strategies. The questionnaire had four sections and consisted of 20 closed and five open questions. Topic specialists believed that M. paratuberculosis is likely a risk to human health (44.8%) and, given the paucity of available evidence, most frequently ranked it as a moderate public health issue (40.1%). A significant correlation was detected between topic specialists' commitment to M. paratuberculosis in terms of the number of years or proportion of work dedicated to this topic, and the likelihood of an extreme answer (high or low) to the above questions. Topic specialists identified contact with ruminants and dairy products as the most likely routes of exposure for humans. There was consensus on exposure routes for ruminants and what commodities to target in mitigation efforts. Described mandatory programmes mainly focused on culling diseased animals and voluntary on-farm prevention programmes. Despite ongoing difficulties in the identification of subclinical infections in animals, the topic specialists largely agreed that further enhancement of on-farm programmes in affected commodities by the agri-food industry (68.4%) and allocation of resources by governments to monitor the issue (92%) are most appropriate given the current state of evidence. © 2015 Zoonoses and Public Health © 2015 Her Majesty the Queen in Right of Canada Reproduced with the permission of the Minister of the Public Health Agency of Canada.

Reducing alcohol-related harm and social disorder in a university community: a framework for evaluation.

PubMed

Cousins, Kimberly; Connor, Jennie L; Kypri, Kypros

2010-10-01

In New Zealand and other middle to high income countries, university student are at high risk of alcohol-related injury and other problems due to their typical pattern of episodic heavy drinking. In 2007, one university implemented Campus Watch, a novel and extensive programme to reduce social disorder, including alcohol-related injury, in the university area. To quantify the effects of this complex intervention. A large public university campus and surrounding community in New Zealand. A health promotion evaluation model was used, examining: (1) how the programme was developed, introduced and received by the community? (process); (2) whether the programme affected behaviour? (impact); and (3) whether the programme reduced social disorder and alcohol-related harm in particular? (outcome). The outcome phase uses a non-equivalent control group design to measure changes occurring in the Campus Watch area compared with other universities, and with a same-city control site. Programme staff, university students and other community members. Interviews with university administrators and Campus Watch staff; surveys of local residents' views; Campus Watch incident data; national surveys of university students in 2005, 2007 and 2009; police data; fire department data. Prevalence of heavy episodic drinking; number of acute alcohol-related harms; incidence of antisocial behaviour, assault and street fires. Regression analyses will be used to examine changes in the intervention site relative to changes in the control areas.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.

PubMed

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-06-29

Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

"It's a complex mesh"- how large-scale health system reorganisation affected the delivery of the immunisation programme in England: a qualitative study.

PubMed

Chantler, Tracey; Lwembe, Saumu; Saliba, Vanessa; Raj, Thara; Mays, Nicholas; Ramsay, Mary; Mounier-Jack, Sandra

2016-09-15

The English health system experienced a large-scale reorganisation in April 2013. A national tri-partite delivery framework involving the Department of Health, NHS England and Public Health England was agreed and a new local operational model applied. Evidence about how health system re-organisations affect constituent public health programmes is sparse and focused on low and middle income countries. We conducted an in-depth analysis of how the English immunisation programme adapted to the April 2013 health system reorganisation, and what facilitated or hindered the delivery of immunisation services in this context. A qualitative case study methodology involving interviews and observations at national and local level was applied. Three sites were selected to represent different localities, varying levels of immunisation coverage and a range of changes in governance. Study participants included 19 national decision-makers and 56 local implementers. Two rounds of interviews and observations (immunisation board/committee meetings) occurred between December 2014 and June 2015, and September and December 2015. Interviews were audio recorded and transcribed verbatim and written accounts of observed events compiled. Data was imported into NVIVO 10 and analysed thematically. The new immunisation programme in the new health system was described as fragmented, and significant effort was expended to regroup. National tripartite arrangements required joint working and accountability; a shift from the simpler hierarchical pre-reform structure, typical of many public health programmes. New local inter-organisational arrangements resulted in ambiguity about organisational responsibilities and hindered data-sharing. Whilst making immunisation managers responsible for larger areas supported equitable resource distribution and strengthened service commissioning, it also reduced their ability to apply clinical expertise, support and evaluate immunisation providers' performance. Partnership working helped staff adapt, but the complexity of the health system hindered the development of consistent approaches for training and service evaluation. The April 2013 health system reorganisation in England resulted in significant fragmentation in the way the immunisation programme was delivered. Some of this was a temporary by-product of organisational change, other more persistent challenges were intrinsic to the complex architecture of the new health system. Partnership working helped immunisation leaders and implementers reconnect and now the challenge is to assess how inter-agency collaboration can be strengthened.

The success factors of scaling-up Estonian sexual and reproductive health youth clinic network--from a grassroots initiative to a national programme 1991-2013.

PubMed

Kempers, Jari; Ketting, Evert; Chandra-Mouli, Venkatraman; Raudsepp, Triin

2015-01-08

A growing number of middle-income countries are scaling up youth-friendly sexual and reproductive health pilot projects to national level programmes. Yet, there are few case studies on successful national level scale-up of such programmes. Estonia is an excellent example of scale-up of a small grassroots adolescent sexual and reproductive health initiative to a national programme, which most likely contributed to improved adolescent sexual and reproductive health outcomes. This study; (1) documents the scale-up process of the Estonian youth clinic network 1991-2013, and (2) analyses factors that contributed to the successful scale-up. This research provides policy makers and programme managers with new insights to success factors of the scale-up, that can be used to support planning, implementation and scale-up of adolescent sexual and reproductive health programmes in other countries. Information on the scale-up process and success factors were collected by conducting a literature review and interviewing key stakeholders. The findings were analysed using the WHO-ExpandNet framework, which provides a step-by-step process approach for design, implementation and assessment of the results of scaling-up health innovations. The scale-up was divided into two main phases: (1) planning the scale-up strategy 1991-1995 and (2) managing the scaling-up 1996-2013. The planning phase analysed innovation, user organizations (youth clinics), environment and resource team (a national NGO and international assistance). The managing phase examines strategic choices, advocacy, organization, resource mobilization, monitoring and evaluation, strategic planning and management of the scale-up. The main factors that contributed to the successful scale-up in Estonia were: (1) favourable social and political climate, (2) clear demonstrated need for the adolescent services, (3) a national professional organization that advocated, coordinated and represented the youth clinics, (4) enthusiasm and dedication of personnel, (5) acceptance by user organizations and (6) sustainable funding through the national health insurance system. Finally, the measurement and recognition of the remarkable improvement of adolescent SRH outcomes in Estonia would not have been possible without development of good reporting and monitoring systems, and many studies and international publications.

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

PubMed

Kok, Maryse C; Kane, Sumit S; Tulloch, Olivia; Ormel, Hermen; Theobald, Sally; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline E W; de Koning, Korrie A M

2015-03-07

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

A process evaluation of the 'Aware' and 'Supportive Communities' gambling harm-minimisation programmes in New Zealand.

PubMed

Kolandai-Matchett, Komathi; Bellringer, Maria; Landon, Jason; Abbott, Max

2018-04-01

The Gambling Act 2003 mandated a public health strategy for preventing and minimising gambling harm in New Zealand. Aware Communities and Supportive Communities are two public health programmes subsequently implemented nationwide. These programmes differed from common health promotion initiatives such as media or education campaigns as they were community-action based (requiring community involvement in programme planning and delivery). We carried out a process evaluation to determine their implementation effectiveness and inform improvement and future programme planning. Our qualitative dominant mixed methods design comprised analysis of over a hundred implementer progress reports (submitted July 2010 - June 2013), a staff survey and a staff focus group interview. The programmes demonstrated capacity to not only achieve expected outcomes (e.g. enhanced community awareness about harmful gambling), but also to enhance social sustainability at the community level (e.g. established trustful relationships) and achieve some programme sustainability (e.g. community ownership over ongoing programme delivery). The evaluation noted the potential for a sustainable gambling harm-minimisation model. Community-action based harm-minimisation programmes offer programme sustainability potential which in turn offers funding cost-effectiveness when there are continual public health outcomes beyond initial funding. Although resource intensive, the community-action based approach enables culturally appropriate public health programmes suitable for societies where specific ethnic groups have higher gambling risk. Recognition of such harm-minimisation programmes' contribution to social sustainability is important considering the potential for broader public health outcomes (e.g. better life quality, lesser social problems) within socially sustainable societies.

Health, Environment and Social Management in Enterprises programme in the Republic of Macedonia.

PubMed

Karadzinska-Bislimovska, Jovanka; Baranski, Boguslaw; Risteska-Kuc, Snezana

2004-01-01

Macedonia is the first country in the region to launch implementation of the WHO Health, Environment and Social Management in Enterprises (HESME) Programme, following the WHO Ministerial Conference on Environment and Health held in London in 1999. The aim of this paper is to describe the efforts made to implement this programme. Methods are based on integrated management with joint involvement of crucial partners at all levels of activities suggested by the WHO. Commitment to inter-sectorial and interagency collaboration at national level, adoption of a final version of a National HESME Plan, with basic principles, criteria and concrete activities, establishment of a National coordination center for the HESME Project, development of training curricula and specific educational tools for occupational health personnel, preparation of questionnaires and procedures for a national survey to detect high occupational risks, specific occupational hazards and health promotion needs of the working population, and finally setting up quantitative and qualitative indicators for national or provincial workplace health profiles. Building up the concept of cooperation, partnership and common work in HESME activities is a challenge for the new public health view in Europe.

Audit feedback on reading performance of screening mammograms: An international comparison.

PubMed

Hofvind, S; Bennett, R L; Brisson, J; Lee, W; Pelletier, E; Flugelman, A; Geller, B

2016-09-01

Providing feedback to mammography radiologists and facilities may improve interpretive performance. We conducted a web-based survey to investigate how and why such feedback is undertaken and used in mammographic screening programmes. The survey was sent to representatives in 30 International Cancer Screening Network member countries where mammographic screening is offered. Seventeen programmes in 14 countries responded to the survey. Audit feedback was aimed at readers in 14 programmes, and facilities in 12 programmes. Monitoring quality assurance was the most common purpose of audit feedback. Screening volume, recall rate, and rate of screen-detected cancers were typically reported performance measures. Audit reports were commonly provided annually, but more frequently when target guidelines were not reached. The purpose, target audience, performance measures included, form and frequency of the audit feedback varied amongst mammographic screening programmes. These variations may provide a basis for those developing and improving such programmes. © The Author(s) 2016.

Results from a survey of national immunization programmes on home-based vaccination record practices in 2013

PubMed Central

Young, Stacy L.; Gacic-Dobo, Marta; Brown, David W.

2015-01-01

Background Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused. Methods During January 2014, WHO and the United Nations Children's Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013. Results A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was

Results from a survey of national immunization programmes on home-based vaccination record practices in 2013.

PubMed

Young, Stacy L; Gacic-Dobo, Marta; Brown, David W

2015-07-01

Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused. During January 2014, WHO and the United Nations Children's Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013. A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was

Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005–2010 period

PubMed Central

2012-01-01

Background Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Methods Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country’s Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. Results Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly collected from the public sector, 1,445/1,663 (86.9%). Results indicate that 193/1,663 (11.6%) were found not to meet quality specifications. Most failures were reported during visual and physical inspection, 142/1663 (8.5%), and most of these were due to expired medicines, 118/142 (83.1%). Samples failing TLC accounted for 27/1,663 (1.6%) and those failing disintegration accounted for 24/1,663 (1.4%). Medicines quality failures decreased significantly during the last two years. Conclusions Basic tests revealed that the quality of medicines in the public sector improved over the years, since the implementation of this type of quality monitoring programme in 2005. However, the lack of consistent confirmatory tests in the quality control (QC) laboratory, utilizing methods that can also evaluate additional quality attributes, could still mask quality issues. In the future, AMI countries should improve coordination with their health authorities and their QC lab consistently, to provide a more complete picture of malaria medicines quality and support the implementation of corrective actions. Facilities in the private and informal sectors also should be included when these sectors constitute an important source of medicines used by malaria patients. PMID:22704680

Global Fund financing of public-private mix approaches for delivery of tuberculosis care.

PubMed

Lal, S S; Uplekar, Mukund; Katz, Itamar; Lonnroth, Knut; Komatsu, Ryuichi; Yesudian Dias, Hannah Monica; Atun, Rifat

2011-06-01

To map the extent and scope of public-private mix (PPM) interventions in tuberculosis (TB) control programmes supported by the Global Fund. We reviewed the Global Fund's official documents and data to analyse the distribution, characteristics and budgets of PPM approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. We supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report. Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with 'for-profit' private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus. Average and median spending on PPM within grants was 10% and 5% respectively, ranging from 0.03% to 69% of the total grant budget. In China, India, Nigeria and the Philippines, PPM contributed to detecting more than 25% TB cases while maintaining high treatment success rates. In spite of evidence of cost-effectiveness, PPM constitutes only a modest part of overall TB control activities. Scaling up PPM across countries could contribute to expanding access to TB care, increasing case detection, improving treatment outcomes and help achieve the global TB control targets. © 2011 Blackwell Publishing Ltd.

Maternal and neonatal tetanus

PubMed Central

Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

2017-01-01

Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58 000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

Constructions of gender in Vietnam: in pursuit of the 'Three Criteria'.

PubMed

Schuler, Sidney Ruth; Hoang, Tu Anh; Vu, Song Ha; Tan, Hung Minh; Bui, Thi Thanh Mai; Pham, Vu Thien

2006-01-01

Vietnam has advanced far beyond most other developing countries and, indeed, surpasses many developed countries in adopting a legal framework based on gender equality, and in creating institutions and programmes to support women's advancement. Inegalitarian gender norms have also persisted, however. The Vietnam Women's Union promotes women's educational, political and economic advancement but simultaneously exhorts women to pay attention to their Confucian role of maintaining family hierarchy and harmony. This paper presents findings from qualitative research examining gender relations at the grassroots level in central Vietnam. It argues that the Vietnam Women's Union could support women more effectively by promoting greater diversity in gender norms and by initiating a public discussion to address the pressures women face in trying to achieve ideals that are often experienced as contradictory and unattainable.

Public participation in Strategic Environmental Assessment: A practitioners' perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rega, Carlo, E-mail: carlo.rega@jrc.ec.europa.eu; Baldizzone, Giorgio

Public participation is considered a distinguished feature of Strategic Environmental Assessment (SEA), and the SEA literature has traditionally identified several benefits attached to it, from more open and transparent decision-making to greater acceptance of plans/programmes' output by the affected population. However, relatively little empirical evidence has been collected so far on the extent and outcomes of public engagement as it is being carried out in current SEA practice. In this article, we present the results of a study on this theme based on a direct survey of 47 SEA practitioners and scholars from different countries. Respondents were asked to reportmore » their experience about a number of items including: the frequency of SEA process featuring deep public participation; its overall influence on plan/programmme-making; the identification of the main factors impeding it; the correlation of public involvement with environmental outcomes; and the increase of costs. Results indicate that public engagement in current SEA practice is still relatively limited and with limited influence on decision-making. The main impeding factors seem to be: lack of political willingness by proponents; insufficient information on the SEA process by the public; and weakness of the legal frames. However, respondents also report that when effective public engagement takes place, benefits do arise and identify a positive correlation between the degree of public involvement and the environmental performance of plans and programmes. Overall, findings suggest that public involvement has indeed the potential to positively influence both SEA and decision-making, although this should be supported from the policy side by stronger legal frames, higher requirements and improved technical guidance. - Highlights: • 47 SEA scholars and practitioners were surveyed about public participation in SEA. • Current public involvement in SEA is still limited. • Lack of information, political willingness and weaknesses of the legal frame are the main issues. • A positive correlation emerges between public involvement and the environmental outputs of P/P.« less

Global Fund grant programmes: an analysis of evaluation scores.

PubMed

Radelet, Steven; Siddiqi, Bilal

2007-05-26

The Global Fund to Fight AIDS, Tuberculosis and Malaria evaluates programme performance after 2 years to help decide whether to continue funding. We aimed to identify the correlation between programme evaluation scores and characteristics of the programme, the health sector, and the recipient country. We obtained data on the first 140 Global Fund grants evaluated in 2006, and analysed 134 of these. We used an ordered probit multivariate analysis to link evaluation scores to different characteristics, allowing us to record the association between changes in those characteristics and the probability of a programme receiving a particular evaluation score. Programmes that had government agencies as principal recipients, had a large amount of funding, were focused on malaria, had weak initial proposals, or were evaluated by the accounting firm KPMG, scored lowest. Countries with a high number of doctors per head, high measles immunisation rates, few health-sector donors, and high disease-prevalence rates had higher evaluation scores. Poor countries, those with small government budget deficits, and those that have or have had socialist governments also received higher scores. Our results show associations, not causality, and they focus on evaluation scores rather than actual performance of the programmes. Yet they provide some early indications of characteristics that can help the Global Fund identify and monitor programmes that might be at risk. The results should not be used to influence the distribution of funding, but rather to allocate resources for oversight and risk management.

FAO UN-REDD- INPE Joint Programme on Forest Monitoring Systems based on RS and GIS techniques

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD MRV Team

2010-12-01

Capacity Development and Training for National Forest Monitoring Systems for Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD+) REDD+, which stands for ’Reducing Emissions from Deforestation and Forest Degradation in Developing Countries’ - is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports countries to develop capacity to REDD+ and to implement a future REDD+ mechanism in a post-2012 climate regime. The programme works at both the national and global scale, through support mechanisms for country-driven REDD strategies and international consensus-building on REDD+ processes. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD+, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. FAO and INPE (Brazilian Space Agency) have joint forces through a MoU signed last year in Copenhagen. A major joint programme has been agreed upon to set up national forest satellite monitoring systems in the developing countries and to train them in order to get them ready for REDD+. The outcomes about the role of satellite remote sensing technologies as a tool for monitoring, assessment, reporting and verification of carbon credits and co-benefits under the REDD+ mechanism are here presented.

National radon programmes and policies: the RADPAR recommendations.

PubMed

Bochicchio, F; Hulka, J; Ringer, W; Rovenská, K; Fojtikova, I; Venoso, G; Bradley, E J; Fenton, D; Gruson, M; Arvela, H; Holmgren, O; Quindos, L; McLaughlin, J; Collignan, B; Gray, A; Grosche, B; Jiranek, M; Kalimeri, K; Kephalopoulos, S; Kreuzer, M; Schlesinger, D; Zeeb, H; Bartzis, J

2014-07-01

Results from epidemiological studies on lung cancer and radon exposure in dwellings and mines led to a significant revision of recommendations and regulations of international organisations, such as WHO, IAEA, Nordic Countries, European Commission. Within the European project RADPAR, scientists from 18 institutions of 14 European countries worked together for 3 y (2009-12). Among other reports, a comprehensive booklet of recommendations was produced with the aim that they should be useful both for countries with a well-developed radon programme and for countries with little experience on radon issues. In this paper, the main RADPAR recommendations on radon programmes and policies are described and discussed. These recommendations should be very useful in preparing a national action plan, required by the recent Council Directive 2013/59/Euratom. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Setting development goals using stochastic dynamical system models

PubMed Central

Nicolis, Stamatios C.; Bali Swain, Ranjula; Sumpter, David J. T.

2017-01-01

The Millennium Development Goals (MDG) programme was an ambitious attempt to encourage a globalised solution to important but often-overlooked development problems. The programme led to wide-ranging development but it has also been criticised for unrealistic and arbitrary targets. In this paper, we show how country-specific development targets can be set using stochastic, dynamical system models built from historical data. In particular, we show that the MDG target of two-thirds reduction of child mortality from 1990 levels was infeasible for most countries, especially in sub-Saharan Africa. At the same time, the MDG targets were not ambitious enough for fast-developing countries such as Brazil and China. We suggest that model-based setting of country-specific targets is essential for the success of global development programmes such as the Sustainable Development Goals (SDG). This approach should provide clear, quantifiable targets for policymakers. PMID:28241057

Setting development goals using stochastic dynamical system models.

PubMed

Ranganathan, Shyam; Nicolis, Stamatios C; Bali Swain, Ranjula; Sumpter, David J T

2017-01-01

The Millennium Development Goals (MDG) programme was an ambitious attempt to encourage a globalised solution to important but often-overlooked development problems. The programme led to wide-ranging development but it has also been criticised for unrealistic and arbitrary targets. In this paper, we show how country-specific development targets can be set using stochastic, dynamical system models built from historical data. In particular, we show that the MDG target of two-thirds reduction of child mortality from 1990 levels was infeasible for most countries, especially in sub-Saharan Africa. At the same time, the MDG targets were not ambitious enough for fast-developing countries such as Brazil and China. We suggest that model-based setting of country-specific targets is essential for the success of global development programmes such as the Sustainable Development Goals (SDG). This approach should provide clear, quantifiable targets for policymakers.

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

PubMed Central

Fitzpatrick, Christopher; Fleming, Fiona M.; Madin-Warburton, Matthew; Schneider, Timm; Meheus, Filip; Asiedu, Kingsley; Solomon, Anthony W.; Montresor, Antonio; Biswas, Gautam

2016-01-01

Background Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked. Methods We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks. Results We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher. Discussion The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms. PMID:27918573

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application.

PubMed

Fitzpatrick, Christopher; Fleming, Fiona M; Madin-Warburton, Matthew; Schneider, Timm; Meheus, Filip; Asiedu, Kingsley; Solomon, Anthony W; Montresor, Antonio; Biswas, Gautam

2016-12-01

Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering "free" donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked. We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to "predict" country-specific unit cost benchmarks. We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the "last mile", or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher. The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.

The Influence of Supranational Organizations on Educational Programme Planning in the Least Developed Countries: The Case of Nepal

ERIC Educational Resources Information Center

Regmi, Kapil Dev

2015-01-01

Amidst growing criticisms of global financial institutions, primarily the World Bank, this article explores their influence on educational programme planning in some of the impoverished nations known as the Least Developed Countries (LDCs). The domination of these institutions originates not only from their monetary power but also from the…

FIFA 11 for Health Programme: Implementation in Five Countries in Sub-Saharan Africa

ERIC Educational Resources Information Center

Fuller, Colin W.; Junge, Astrid; Amaning, Jacob; Kaijage, Rogasian R.; Kaputa, John; Magwende, George; Pambo, Prince; Dvorak, Jiri

2015-01-01

Objective: To assess the effectiveness of the FIFA 11 for Health programme in increasing children's knowledge about communicable and non-communicable diseases in five countries of Sub-Saharan Africa. Method: A prospective five-cohort study was implemented in schools in Ghana (17), Malawi (12), Namibia (11), Tanzania (18) and Zambia (11). The…

The SLMTA programme: Transforming the laboratory landscape in developing countries

PubMed Central

Maruta, Talkmore; Luman, Elizabeth T.; Nkengasong, John N.

2014-01-01

Background Efficient and reliable laboratory services are essential to effective and well-functioning health systems. Laboratory managers play a critical role in ensuring the quality and timeliness of these services. However, few laboratory management programmes focus on the competencies required for the daily operations of a laboratory in resource-limited settings. This report provides a detailed description of an innovative laboratory management training tool called Strengthening Laboratory Management Toward Accreditation (SLMTA) and highlights some challenges, achievements and lessons learned during the first five years of implementation (2009–2013) in developing countries. Programme SLMTA is a competency-based programme that uses a series of short courses and work-based learning projects to effect immediate and measurable laboratory improvement, while empowering laboratory managers to implement practical quality management systems to ensure better patient care. A SLMTA training programme spans from 12 to 18 months; after each workshop, participants implement improvement projects supported by regular supervisory visits or on-site mentoring. In order to assess strengths, weaknesses and progress made by the laboratory, audits are conducted using the World Health Organization’s Regional Office for Africa (WHO AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist, which is based on International Organization for Standardization (ISO) 15189 requirements. These internal audits are conducted at the beginning and end of the SLMTA training programme. Conclusion Within five years, SLMTA had been implemented in 617 laboratories in 47 countries, transforming the laboratory landscape in developing countries. To our knowledge, SLMTA is the first programme that makes an explicit connection between the performance of specific management behaviours and routines and ISO 15189 requirements. Because of this close relationship, SLMTA is uniquely positioned to help laboratories seek accreditation to ISO 15189. PMID:26752335

Past and Ongoing Tsetse and Animal Trypanosomiasis Control Operations in Five African Countries: A Systematic Review

PubMed Central

Holt, Hannah R.; Selby, Richard; Guitian, Javier

2016-01-01

Background Control operations targeting Animal African Trypanosomiasis and its primary vector, the tsetse, were covering approximately 128,000 km2 of Africa in 2001, which is a mere 1.3% of the tsetse infested area. Although extensive trypanosomiasis and tsetse (T&T) control operations have been running since the beginning of the 20th century, Animal African Trypanosomiasis is still a major constraint of livestock production in sub-Saharan Africa. Methodology/Principal Findings We performed a systematic review of the existing literature describing T&T control programmes conducted in a selection of five African countries, namely Burkina Faso, Cameroon, Ethiopia, Uganda and Zambia, between 1980 and 2015. Sixty-eight documents were eventually selected from those identified by the database search. This was supplemented with information gathered through semi-structured interviews conducted with twelve key informants recruited in the study countries and selected based on their experience and knowledge of T&T control. The combined information from these two sources was used to describe the inputs, processes and outcomes from 23 major T&T control programmes implemented in the study countries. Although there were some data gaps, involvement of the target communities and sustainability of the control activities were identified as the two main issues faced by these programmes. Further, there was a lack of evaluation of these control programmes, as well as a lack of a standardised methodology to conduct such evaluations. Conclusions/Significance Past experiences demonstrated that coordinated and sustained control activities require careful planning, and evidence of successes, failures and setbacks from past control programmes represent a mine of information. As there is a lack of evaluation of these programmes, these data have not been fully exploited for the design, analyses and justification of future control programmes. PMID:28027299

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

PubMed

Dal Poz, Mario Roberto; Sepulveda, Hernan Rodrigo; Costa Couto, Maria Helena; Godue, Charles; Padilla, Monica; Cameron, Rick; Vidaurre Franco, Thais de Andrade

2015-04-28

The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.

Mental health in low- and middle-income countries.

PubMed

Patel, Vikram

2007-01-01

Mental disorders in low- and middle-income countries (LAMIC) do not attract global health policy attention. This article is based on a selective review of research on mental disorders in adults in LAMIC since 2001 and recent analyses of disease burden in developing countries. Mental disorders account for 11.1% of the total burden of disease in LAMIC. Unipolar depressive disorder is the single leading neuropsychiatric cause of disease burden. Alcohol use disorders account for nearly 4% of the attributable disease burden in LAMIC. Mental disorders are closely associated with other public health concerns such as maternal and child health and HIV/AIDS. Poverty, low education, social exclusion, gender disadvantage, conflict and disasters are the major social determinants of mental disorders. Clinical trials demonstrate that locally available, affordable interventions in community and primary care settings are effective for the management of mental disorders. Mental health resources are very scarce and investment in mental health is < 1% of the health budget in many countries. The majority of people with mental disorders do not receive evidence-based care, leading to chronicity, suffering and increased costs of care. Strengthening care and services for people with mental disorders is a priority; this will need additional investment in human resources and piggy backing on existing public health programmes. Campaigns to increase mental health literacy are needed at all levels of the health system.

Nutrition advocacy and national development: the PROFILES programme and its application.

PubMed

Burkhalter, B R; Abel, E; Aguayo, V; Diene, S M; Parlato, M B; Ross, J S

1999-01-01

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies.

The many faces of sex work.

PubMed

Harcourt, C; Donovan, B

2005-06-01

To compile a global typography of commercial sex work. A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work. At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely. Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India.

PubMed

Lépine, Aurélia; Chandrashekar, Sudhashree; Shetty, Govindraj; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Vassall, Anna

2016-02-01

Expanding essential health services through non-government organisations (NGOs) is a central strategy for achieving universal health coverage in many low-income and middle-income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost-effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed-effect panel estimator and a random-intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant-based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

Political epidemiology: strengthening socio-political analysis for mass immunisation - lessons from the smallpox and polio programmes.

PubMed

Taylor, S

2009-01-01

Control and reduction of infectious diseases is a key to attaining the Millennium Development Goals. An important element of this work is the successful immunisation, especially in resource-poor countries. Mass immunisation, most intensively in the case of eradication, depends on a combination of reliable demand (e.g. public willingness to comply with the vaccine protocol) and effective supply (e.g. robust, generally state-led, vaccine delivery). This balance of compliance and enforceability is, quintessentially, socio-political in nature - conditioned by popular perceptions of disease and risk, wider conditions of economic development and poverty, technical aspects of vaccine delivery, and the prevailing international norms regarding power relations between states and peoples. In the past 100 years, three out of six disease eradication programmes have failed. The explanations for failure have focused on biotechnical and managerial or financial issues. Less attention is paid to socio-political aspects. Yet socio-political explanations are key. Eradication is neither inherently prone to failure, nor necessarily doomed in the case of polio. However, eradication, and similar mass immunisation initiatives, which fail to address social and political realities of intervention may be. A comparison of the smallpox and polio eradication programmes illustrates the importance of disease-specific socio-political analysis in programme conceptualisation, design, and management.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017.

PubMed

Anantharaman, Venkataraman

2017-07-01

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest. Copyright: © Singapore Medical Association.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017

PubMed Central

Anantharaman, Venkataraman

2017-01-01

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council’s guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest. PMID:28741008

A new entity for the negotiation of public procurement prices for patented medicines in Mexico

PubMed Central

Wirtz, Veronika J; Reich, Michael R; Terrazas, Paulina; Ortiz, Maki

2012-01-01

Abstract Problem As countries expand health insurance coverage, their expenditures on medicines increase. To address this problem, WHO has recommended that every country draw up a list of essential medicines. Although most medicines on the list are generics, in many countries patented medicines represent a substantial portion of pharmaceutical expenditure. Approach To help control expenditure on patented medicines, in 2008 the Mexican Government created the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (CCPNM), whose role, as the name suggests, is to enter into price negotiations with drug manufacturers for patented drugs on Mexico’s list of essential medicines. Local setting Mexico’s public expenditure on pharmaceuticals has increased substantially in the past decade owing to government efforts to achieve universal health-care coverage through Seguro Popular, an insurance programme introduced in 2004 that guarantees access to a comprehensive package of health services and medicines. Relevant changes Since 2008, the CCPNM has improved procurement practices in Mexico’s public health institutions and has achieved significant price reductions resulting in substantial savings in public pharmaceutical expenditure. Lessons learnt The CCPNM has successfully changed the landscape of price negotiation for patented medicines in Mexico. However, it is also facing challenges, including a lack of explicit indicators to assess CCPNM performance; a shortage of permanent staff with sufficient technical expertise; poor coordination among institutions in preparing background materials for the annual negotiation process in a timely manner; insufficient communication among committees and institutions; and a lack of political support to ensure the sustainability of the CCPNM. PMID:23109747

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

PubMed

Kolandai-Matchett, Komathi; Landon, Jason; Bellringer, Maria; Abbott, Max

2018-03-06

In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

The focused ethnographic study 'assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old' and its use in three countries.

PubMed

Pelto, Gretel H; Armar-Klemesu, Margaret; Siekmann, Jonathan; Schofield, Dominic

2013-01-01

The concept of a focused ethnographic study (FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts (Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children (IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements (LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. © 2012 Blackwell Publishing Ltd.

The scope and practice of behaviour change communication to improve infant and young child feeding in low- and middle-income countries: results of a practitioner study in international development organizations.

PubMed

Pelto, Gretel H; Martin, Stephanie L; Van Liere, Marti; Fabrizio, Cecilia S

2016-04-01

We describe features of the landscape of behaviour change communication (BCC) practice devoted to infant and young child feeding (IYCF) in low- and middle-income countries by practitioners in international development organizations. We used an iterative, snowball sampling procedure to identify participants, and the self-administered questionnaire contained pre-coded questions and open-ended questions, relying primarily on content analysis to derive generalizations. Highlights of findings include (i) IYCF-specific BCC is usually delivered within the context of other public health messages and programmes; (ii) technical assistance with programme development and implementation are primary activities, and evaluation-related work is also common; and (iii) formative research and evaluation is universal, but process evaluation is not. With respect to scaling up nutrition: (i) use of mass media and digital technology generally play only a minor role in BCC activities and are not currently an integral part of BCC programming strategies and (ii) only 58% of the participants report activities related to communication with policy makers. The individuals who comprise the community of BCC leaders in the area of IYCF are a diverse group from the perspective of academic backgrounds and nationalities. In addition to nutrition, public health, agriculture and adult learning are common disciplinary backgrounds. In our view, this diversity is a source of strength. It facilitates continuing growth and maturation in the field by assuring inputs of different perspectives, theoretical orientations and experiences. © 2015 John Wiley & Sons Ltd.

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries.

PubMed

Macht, Michael; Gerlich, Christian; Ellgring, Heiner; Schradi, Martina; Rusiñol, Angels Bayés; Crespo, Maricruz; Prats, Ana; Viemerö, Vappu; Lankinen, Anu; Bitti, Pio Enrico Ricci; Candini, Lorena; Spliethoff-Kamminga, Noëlle; de Vreugd, Janny; Simons, Gwenda; Pasqualini, Marcia Smith; Thompson, Simon B N; Taba, Pille; Krikmann, Ulle; Kanarik, Eve

2007-02-01

To evaluate a newly developed education programme for Parkinson's disease (PD) patients. The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression. The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures. Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD. The present programme will soon be available in seven European languages and can be tested in different health care systems.

Specific features of medicines safety and pharmacovigilance in Africa

PubMed Central

Pal, Shanthi N.; Olsson, Sten; Dodoo, Alexander; Bencheikh, Rachida Soulayami

2012-01-01

The thalidomide tragedy in the late 1950s and early 1960s served as a wakeup call and raised questions about the safety of medicinal products. The developed countries rose to the challenge putting in place systems to ensure the safety of medicines. However, this was not the case for low-resource settings because of prevailing factors inherent in them. This paper reviews some of these features and the current status of pharmacovigilance in Africa. The health systems in most of the 54 countries of Africa are essentially weak, lacking in basic infrastructure, personnel, equipment and facilities. The recent mass deployment of medicines to address diseases of public health significance in Africa poses additional challenges to the health system with notable safety concerns. Other safety issues of note include substandard and counterfeit medicines, medication errors and quality of medicinal products. The first national pharmacovigilance centres established in Africa with membership of the World Health Organization (WHO) international drug monitoring programme were in Morocco and South Africa in 1992. Of the 104 full member countries in the programme, there are now 24 African countries with a further nine countries as associate members. The pharmacovigilance systems operational in African countries are based essentially on spontaneous reporting facilitated by the introduction of the new tool Vigiflow. The individual case safety reports committed to the WHO global database (Vigibase) attest to the growth of pharmacovigilance in Africa with the number of reports rising from 2695 in 2000 to over 25,000 in 2010. There is need to engage the various identified challenges of the weak pharmacovigilance systems in the African setting and to focus efforts on how to provide resources, infrastructure and expertise. Raising the level of awareness among healthcare providers, developing training curricula for healthcare professionals, provisions for paediatric and geriatric pharmacovigilance, engaging the pharmaceutical industries as well as those for herbal remedies are of primary concern. PMID:25083223

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

PubMed

Mohammadi, R; Ekman, R; Svanström, L; Gooya, M M

2006-01-01

To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

Recreational drug use in the Asia Pacific region: improvement in our understanding of the problem through the UNODC programmes.

PubMed

Dargan, P I; Wood, D M

2012-09-01

Until recently, there were limited data available on the epidemiology of recreational drug use in the Asia Pacific region. However, in the last few years, a number of United Nations Office on Drugs and Crime (UNODC) programmes have improved data collection networks, particularly in East and Southeast Asia. There are still significant data gaps from some countries, including India and China, and data reported from some countries in the region are based on expert estimates on recreational drug use rather than formally collected data. However, the availability of improved epidemiological data has enabled many countries in the region, both individually and through regional UNODC programmes, to start to understand the issues that need to be addressed. We will summarise in this mini-review the data available within the UNODC World Drug Report and from the other UNODC programmes in the region on the production and use of recreational drugs in the Asia Pacific region.

2016 President's Plenary International Psycho-Oncology Society: challenges and opportunities for growing and developing psychosocial oncology programmes worldwide.

PubMed

Travado, Luzia; Bultz, Barry D; Ullrich, Andreas; Asuzu, Chioma C; Turner, Jane; Grassi, Luigi; Jacobsen, Paul

2017-09-01

Consistent with the International Psycho-Oncology Society's (IPOS) vision and goals, we are committed to improving quality cancer care and cancer policies through psychosocial care globally. As part of IPOS's mission, upon entering "Official Relations" for a second term with the World Health Organization (WHO), IPOS has dedicated much attention to reaching out to countries, which lack formalized psychosocial care programmes. One of IPOS's strategies to accomplish this goal has been to bring psycho-oncology training programmes to low- and middle-income countries and regions. To this end, the IPOS Board approved a new position on the Board of Directors for a member from a low- to middle-income country (LMIC). The IPOS 2016 President's Plenary focused on challenges and opportunities that exist in growing and developing psychosocial oncology programmes worldwide. The plenary presentations highlight how IPOS and WHO have aligned their goals to help LMICs support cancer patients as an essential element of cancer and palliative care. IPOS country representatives are strongly supported in liaising with national health authorities and with WHO Country Representatives in LMICs. The plenary speakers discussed the role IPOS Federation has taken in building a global network of psychosocial leaders and the impact this had in assisting LMICs in meeting IPOS's psychosocial care objectives. The plenary highlighted the challenges of expanding psychosocial reach into these countries. One significant question remains: Can psychosocial guidelines be adapted to LMICs and regions? Copyright © 2017 John Wiley & Sons, Ltd.

Leprosy: too complex a disease for a simple elimination paradigm.

PubMed Central

Lockwood, Diana N. J.; Suneetha, Sujai

2005-01-01

Can leprosy be eliminated? This paper considers the question against the background of the WHO programme to eliminate leprosy. In 1991 the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. Elimination was defined as reaching a prevalence of < 1 case per 10 000 people. The elimination programme has been successful in delivering highly effective antibiotic therapy worldwide. However, despite this advance, new-case detection rates remain stable in countries with the highest rates of endemic leprosy, such as Brazil and India. This suggests that infection has not been adequately controlled by antibiotics alone. Leprosy is perhaps more appropriately classed as a chronic stable disease than as an acute infectious disease responsive to elimination strategies. In many countries activities to control and treat leprosy are being integrated into the general health-care system. This reduces the stigma associated with leprosy. However, leprosy causes long-term immunological complications, disability and deformity. The health-care activities of treating and preventing disabilities need to be provided in an integrated setting. Detecting new cases and monitoring disability caused by leprosy will be a challenge. One solution is to implement long-term surveillance in selected countries with the highest rates of endemic disease so that an accurate estimate of the burden of leprosy can be determined. It is also critical that broad-based research into this challenging disease continues until the problems are truly solved. PMID:15798849

The adequacy of policy responses to the treatment needs of South Africans living with HIV (1999-2008): a case study

PubMed Central

2009-01-01

Introduction South Africa has the largest HIV/AIDS epidemic of any country in the world. Case description National antiretroviral therapy (ART) policy is examined over the period of 1999 to 2008, which coincided with the government of President Thabo Mbeki and his Minister of Health, Dr Manto Tshabalala-Msimang. The movement towards a national ART programme in South Africa was an ambitious undertaking, the likes of which had not been contemplated before in public health in Africa. Discussion and evaluation One million AIDS-ill individuals were targeted to be enrolled in the ART programme by 2007/08. Fewer than 50% of eligible individuals were enrolled. This failure resulted from lack of political commitment and inadequate public health system capacity. The human and economic costs of this failure are large and sobering. Conclusions The total lost benefits of ART not reaching the people who need it are estimated at 3.8 million life years for the period, 2000 to 2005. The economic cost of those lost life years over this period has been estimated at more than US$15 billion. PMID:20015346

Successful private-public funding of paediatric medicines research: lessons from the EU programme to fund research into off-patent medicines.

PubMed

Ruggieri, L; Giannuzzi, V; Baiardi, P; Bonifazi, F; Davies, E H; Giaquinto, C; Bonifazi, D; Felisi, M; Chiron, C; Pressler, R; Rabe, H; Whitaker, M J; Neubert, A; Jacqz-Aigrain, E; Eichler, I; Turner, M A; Ceci, A

2015-04-01

The European Paediatric Regulation mandated the European Commission to fund research on off-patent medicines with demonstrated therapeutic interest for children. Responding to this mandate, five FP7 project calls were launched and 20 projects were granted. This paper aims to detail the funded projects and their preliminary results. Publicly available sources have been consulted and a descriptive analysis has been performed. Twenty Research Consortia including 246 partners in 29 European and non-European countries were created (involving 129 universities or public-funded research organisations, 51 private companies with 40 SMEs, 7 patient associations). The funded projects investigate 24 medicines, covering 10 therapeutic areas in all paediatric age groups. In response to the Paediatric Regulation and to apply for a Paediatric Use Marketing Authorisation, 15 Paediatric Investigation Plans have been granted by the EMA-Paediatric Committee, including 71 studies of whom 29 paediatric clinical trials, leading to a total of 7,300 children to be recruited in more than 380 investigational centres. Notwithstanding the EU contribution for each study is lower than similar publicly funded projects, and also considering the complexity of paediatric research, these projects are performing high-quality research and are progressing towards the increase of new paediatric medicines on the market. Private-public partnerships have been effectively implemented, providing a good example for future collaborative actions. Since these projects cover a limited number of off-patent drugs and many unmet therapeutic needs in paediatrics remain, it is crucial foreseeing new similar initiatives in forthcoming European funding programmes.

Audience reach of science on television in 10 European countries: An analysis of people-meter data.

PubMed

Lehmkuhl, Markus; Boyadjieva, Pepka; Cunningham, Yvonne; Karamanidou, Christina; Mörä, Tuomo

2016-02-01

Beginning with a differentiation of science programmes into five different editorial concepts, this article explores the audience reach of science on television in 10 European countries with a special emphasis on young audiences aged between 14 and 29 years. In relation to the share of this age group in the entire population, science programmes in all countries reach a considerably smaller proportion of younger viewers. Specific preferences for science content on television do not seem to be relevant in explaining aggregated viewing behaviours especially of young audiences. Unlike all other segments, the young science viewer segment is almost intangible as an aggregated group, as a definable segment of a mass audience that can be targeted by science programme makers. © The Author(s) 2014.

Clean birth kits to improve birth practices: development and testing of a country level decision support tool.

PubMed

Hundley, Vanora A; Avan, Bilal I; Ahmed, Haris; Graham, Wendy J

2012-12-19

Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs.

Salt fortified with diethylcarbamazine (DEC) as an effective intervention for lymphatic filariasis, with lessons learned from salt iodization programmes.

PubMed

Houston, R

2000-01-01

DEC-fortified salt has been used successfully as a principal public health tool to eliminate lymphatic filariasis (LF) in China and, less extensively, in several other countries. Studies from 1967 to the present conducted in Brazil, Japan, Tanzania, India, China, and Taiwan involving administration of DEC salt for 18 days to 1 year, have shown this intervention to be effective for both bancroftian and brugian filariasis, as measured by reductions in both microfilarial density and positivity, and in some studies through reduction in mosquito positivity rates as well. Furthermore, studies suggest specific advantages from using DEC salt, including lack of side effects, particularly for bancroftian filariasis, and ability to reduce prevalence below 1% when used in conjunction with standard regimens of DEC tablets. However, use of DEC salt as a control tool suffers from a concern that health authorities might find it difficult to manage a programme involving a commodity such as salt. In the past decade, the very successful global efforts to eliminate iodine deficiency through universal salt iodization have demonstrated that partnership with the salt industry can be both successful and effective as a public health tool. Use of DEC salt can be most successfully implemented in areas in which (a) there is adequate governmental support for its use and for elimination of filariasis, (b) filariasis-endemic areas are clearly defined, (c) political leaders, health officials and the salt industry agree that DEC salt is an appropriate intervention, (d) the salt industry is well-organized and has known distribution patterns, (e) a successful national salt iodization effort exists, (f) a monitoring system exists that ensures adequacy of salt iodine content during production and that can also measure household coverage, and (g) measurement of impact on transmission of LF with the new antigen or filarial DNA detection methods can be established. There are advantages and disadvantages of using DEC-fortified salt compared with other interventions for LF elimination programmes, but rather than being considered as a 'competing' intervention, DEC salt should be seen as an additional option. Indeed, it is likely that many countries will derive maximal benefit from the synergistic effects of combining different intervention strategies in their national programmes to eliminate lymphatic filariasis.

Male circumcision: towards a World Health Organisation normative practice in resource limited settings

PubMed Central

Hargreave, Tim

2010-01-01

There is now grade 1 evidence that male circumcision (MC) reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18–20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the forceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm. PMID:20639909

Epidemiological Perspective of National Leprosy Eradication Programme in Maharashtra: Focusing on "Tribal Hot-spot" of Tribal District.

PubMed

Katkar, Dhananjay; Mote, Balu Natha; Adhav, Ambadas; Muthuvel, Thirumugam; Kadam, Suhas

2017-01-01

Leprosy or Hansen's disease, a chronic infectious disease caused by Mycobacterium leprae is a serious public health concern because of associated case load, morbidity and stigma attached to it. India achieved elimination of leprosy as a public health problem (prevalence rate [PR]<1 case/10,000 population) at the national level on January 1, 2006, still 19% districts in the country report PR more than one. In Maharashtra, it is found that very few districts within the state or very few pockets within the district are actually having leprosy burden. (1) Identification of region-wise actual "hot-spot" districts/pockets within state of Maharashtra.(2) Further drop-down below the district and block to tribal belt for understanding the actual high risk area/belt within the tribal districts. Secondary data analysis of leprosy patients registered in the State during the period 2008-2015. PR per 10,000 was found more in Vidharbha region followed by rest of Maharashtra and then Marathwada. Analysis showed that, there are tribal districts and tribal area within tribal districts which are having higher leprosy burden as compared to the all other districts indicating need of allocation of programme funds and facilities to these tribal belts for the effective control and elimination of leprosy. National Leprosy Eradication Programme should focus on tribal belt for effective control. Without giving extra attention to these tribal areas within high risk district/pockets efforts of eradication of leprosy by 2018 would be unrealistic and impractical.

Programme coordinators' perceptions of strengths, weaknesses, opportunities and threats associated with school nutrition programmes.

PubMed

Valaitis, Renata F; Hanning, Rhona M; Herrmann, Isabela S

2014-06-01

As part of a larger evaluation of school nutrition programmes (SNP), the present study examined programme coordinators' perceptions of strengths, weaknesses, opportunities and threats (SWOT) regarding their SNP and public health professionals' support. Qualitative interviews were conducted with twenty-two of eighty-one programme coordinators who had completed a programme evaluation survey. Interviews followed a SWOT framework to evaluate programmes and assessed coordinators' perceptions regarding current and future partnerships with public health professionals. The study was conducted in a large, urban region within Ontario. The twenty-two coordinators who participated represented a cross-section of elementary, secondary, Public and Catholic schools. SNP varied enormously in foods/services offered, how they offered them and perceived needs. Major strengths included universality, the ability to reach needy students and the provision of social opportunities. Major weaknesses included challenges in forming funding partnerships, lack of volunteers, scheduling and timing issues, and coordinator workload. Common threats to effective SNP delivery included lack of sustainable funding, complexity in tracking programme use and food distribution, unreliable help from school staff, and conflicts with school administration. Opportunities for increased public health professionals' assistance included menu planning, nutrition education, expansion of programme food offerings, and help identifying community partners and sustainable funding. The present research identified opportunities for improving SNP and strategies for building on strengths. Since programmes were so diverse, tailored strategies are needed. Public health professionals can play a major role through supporting menu planning, food safety training, access to healthy foods, curriculum planning and by building community partnerships.

Lessons from local engagement in Latin American health systems.

PubMed

Meads, Geoffrey D; Griffiths, Frances E; Goode, Sarah D; Iwami, Michiyo

2007-12-01

To examine the management of recent policies for stronger patient and public involvement in Latin American health systems, identifying common features and describing local practice examples of relevance to the UK. Participation is a core principle of many contemporary policies for health system reform. In Latin America, as in the UK, it is frequently associated with innovations in primary care services and their organizational developments. This shared interest in alternative models of local engagement offers new opportunities for collaborative research and policy development. Commissioned by UK policy makers, a 4-year research programme was designed to promote exchanges with international counterparts focusing on how modern reform policies are being implemented. The selected countries possessed comparable principles and timeframes for their reforms. A series of individual country case studies were undertaken. Data were drawn from literature and documentary reviews; semi-structured interviews with national policy makers and expert advisers; and with management representatives at local exemplar sites. The aggregate data were subjected to thematic analysis applying a model for sustainable development. Six common factors were identified in Latin American policies for stronger patient and public involvement. From these the most significant transferable learning for the UK relates to the position and status of professions and non-governmental agencies. Illustrative case exemplars were located in each of the eight countries studied.

Enhancing collaboration between China and African countries for schistosomiasis control.

PubMed

Xu, Jing; Yu, Qing; Tchuenté, Louis-Albert Tchuem; Bergquist, Robert; Sacko, Moussa; Utzinger, Jürg; Lin, Dan-Dan; Yang, Kun; Zhang, Li-Juan; Wang, Qiang; Li, Shi-Zhu; Guo, Jia-Gang; Zhou, Xiao-Nong

2016-03-01

Schistosomiasis remains an important public health issue, with a large number of cases reported across sub-Saharan Africa, and parts of Asia and Latin America. China was once highly endemic, but has made substantial progress and is moving towards elimination of schistosomiasis. Meanwhile, despite long-term, repeated, school-based chemotherapy in many African countries, more than 90% of all schistosomiasis cases are concentrated in Africa, and hence, this continent constitutes the key challenge for schistosomiasis control. Opportunities and issues for international collaboration in the fight against schistosomiasis are outlined with a focus on China's experiences, including the role of public health authorities and intersectoral collaboration, use of new and effective snail control approaches and diagnostic tools adapted to the specific stage of control, as well as the strengthening of risk mapping and surveillance-response mechanisms. Training courses targeting African governmental officials and professionals, coupled with field visits of African scientists and control programme managers to China, and vice versa, are considered important for improved schistosomiasis control and elimination. The crucial question remains whether the Chinese experience can be translated and applied in African countries to improve the effectiveness of health interventions and scale-up. Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes.

PubMed

Nkonki, L; Tugendhaft, A; Hofman, K

2017-02-28

Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.There is a growing body of economic evaluation literature on cost-effectiveness of CHW interventions. However, this is largely for small scale and vertical programmes. There is a need for economic evaluations of larger and integrated CHW programmes in order to achieve the post-2015 Sustainable Development Goal agenda so that appropriate resources can be allocated to this subset of human resources for health. This is the first systematic review to assess the cost-effectiveness of community health workers in delivering child health interventions.

Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies.

PubMed

Resurrección, Davinia Maria; Moreno-Peral, Patricia; Gómez-Herranz, Marta; Rubio-Valera, Maria; Pastor, Luis; Caldas de Almeida, Jose Miguel; Motrico, Emma

2018-06-01

Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.

Diabetes mellitus in Bahrain: an overview.

PubMed

Musaiger, A O

1992-07-01

Bahrain has faced a rapid transition in its socio-economic status, which resulted in great changes both in life-style and in patterns of health and disease. There has been a marked decline in infectious diseases and an increase in chronic diseases. Diabetes mellitus has become one of the most common public health problems in the country. In 1988 it was estimated that 3.4% of total deaths in Bahrain were due to diabetes. A community-based study among mothers aged 18 to 48 years showed that 8.5% of them had diabetes. The percentage was found to be higher among elderly Bahrainis (12.9%). Obesity, lack of physical activity, alteration in food habits, and change in social conditions have all played a vital role in the changing prevalence of diabetes in this country. The current programmes to manage and control diabetes are limited and ineffective. Thus measures to treat diabetes should be given a high priority in the national health policy. Training of physicians in the management of diabetes, public education, epidemiological surveys, and nutritional evaluation of local foods are among the most important measures needed to control diabetes in Bahrain.

The biotechnology and bioeconomy landscape in Malaysia.

PubMed

Arujanan, Mahaletchumy; Singaram, Muthu

2018-01-25

Since 1990s Malaysia aspired to make biotechnology and bioeconomy as her engines of economic growth to utlise the abundance of natural resources and biodiversity. The public sector plays an integral role in developing the sector and various incentives are in place for the private sector to be actively involved and to forge collaboration with the public sector. The country launched its National Biotechnology Policy in 2005 and later launched its National Bioeconomy Programme in 2010 to become the first country in South East Asia and second in Asia after China to have such an initiative. Malaysia is also very proactive in its biosafety law and regulations and has most of the related legal instrument in place. A lot of success has been recorded since the inception of the National Biotechnology Policy in terms of job creation, contribution to GDP through biobusinesses and investment from foreign companies, but the sector is not spared from challenges too. Due to the nature of the discipline that is multidisciplinary and that requires huge amount of investment, expertise and political will, there are a lot of barriers before the country emerges as a bioeconomy player. This paper discusses the public policies, initiatives and funding mechanisms in place in Malaysia that drive its research, development and commercialisation in the area of biotechnology and bioeconomy. The authors also discuss the challenges faced in Malaysia in implementing the policies. Copyright © 2017 Elsevier B.V. All rights reserved.

Parenthood and Happiness: Effects of Work-Family Reconciliation Policies in 22 OECD Countries

PubMed Central

Glass, Jennifer; Simon, Robin W.; Andersson, Matthew A

2016-01-01

The recent proliferation of studies examining cross-national variation in the association between parenthood and happiness reveal accumulating evidence of lower levels of happiness among parents than nonparents in most advanced industrialized societies. Conceptualizing parenting as a stressor buffered by institutional support, we hypothesize that parental status differences in happiness are smaller in countries providing more resources and support to families. Our analyses of the European Social Surveys (ESS) and International Social Survey Programme (ISSP) reveal considerable variation in the parenthood gap in happiness across countries, with the U.S. showing the largest disadvantage of parenthood. We also find that more generous family policies, particularly paid time off and childcare subsidies, are associated with smaller disparities in happiness between parents and non-parents. Moreover, the policies that augment parental happiness do not reduce the happiness of nonparents. Our results shed light on macro-level causes of emotional processes, with important implications for public policy. PMID:28082749

Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue.

PubMed

Hussain, Shoaib Fahad; Boyle, Peter; Patel, Preeti; Sullivan, Richard

2016-10-12

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries - Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan's poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a 'public health emergency of international concern'. Global polio eradication hinges on Pakistan's ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This analysis provides an overview of the GPEI, focusing on the historical and contemporary challenges facing Pakistan's polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented widely throughout Africa, as well as in the Caribbean, Central and South America, and Southeast Asia. Objective We compiled results from local, national and global studies to provide a broad view of the programme and identify directions for the future. The review consists of two companion papers; this paper focuses on content analysis, examining various thematic components of the SLMTA programme and future priorities. Methods A systematic literature search identified 28 published articles about implementing the SLMTA programme. Results for various components of the SLMTA programme were reviewed and summarised. Results Local and national studies provide substantial information on previous experiences with quality management systems; variations on SLMTA implementation; building human resource capacity for trainers, mentors and auditors; the benefits and effectiveness of various types of mentorship; the importance of management buy-in to ensure country ownership; the need to instill a culture of quality in the laboratory; success factors and challenges; and future directions for the programme. Conclusions Local, national and global results suggest that the SLMTA programme has been overwhelmingly successful in transforming laboratory quality management. There is an urgent need to move forward in four strategic directions: progression (continued improvement in SLMTA laboratories), saturation (additional laboratories within countries that have implemented SLMTA), expansion (implementation in additional countries), and extension (adapting SLMTA for implementation beyond the laboratory), to lead to transformation of overall health systems and patient care. PMID:29043200

Implementing the legal provisions for HIA in Slovakia: an exploration of practitioner perspectives.

PubMed

O'Mullane, Monica

2014-07-01

Health Impact Assessment (HIA) is an instrument used in many countries across the world to assess and report on negative and positive health impacts of projects, programmes and policies. It was included in the Protection, Support and Development of Public Health Act (355/2007) of the Slovak Republic in 2007, thus legislating for HIA. Due to this novel move to legislate for HIA, exploratory research was conducted in order to inquire into the perceptions of key informants and practitioners of the upcoming enforcement of the HIA part of legislation (to take place from January 2011). This paper presents results from the survey of practitioners in the Slovak Regional Public Health Authorities. A postal questionnaire was administered to the Heads of Environmental Health Departments of the 37 Regional Public Health Authorities. Open-ended questions were contained in the survey. The response rate was 38%. Results show that a number of respondents are uncertain as to how HIA would be implemented in practice, with varying views on the technical and institutional barriers to comprehensive implementation of HIA. Although the public hygiene and sanitation networks in the public health system in Slovakia operate smoothly, the readiness of the public health infrastructure for HIA, which is based broadly on the social model of health, is dubious. Although HIA is contained within legislation, time will tell whether its implementation in practice will be as comprehensive as is hoped. Recommendations for further integration of HIA into the public health system include further training and education, national HIA resource centres and cross-country support. Copyright © 2014. Published by Elsevier Ireland Ltd.

Cross-country analysis of strategies for achieving progress towards global goals for women's and children's health.

PubMed

Ahmed, Syed Masud; Rawal, Lal B; Chowdhury, Sadia A; Murray, John; Arscott-Mills, Sharon; Jack, Susan; Hinton, Rachael; Alam, Prima M; Kuruvilla, Shyama

2016-05-01

To identify how 10 low- and middle-income countries achieved accelerated progress, ahead of comparable countries, towards meeting millennium development goals 4 and 5A to reduce child and maternal mortality. We synthesized findings from multistakeholder dialogues and country policy reports conducted previously for the Success Factors studies in 10 countries: Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. A framework approach was used to analyse and synthesize the data from the country reports, resulting in descriptive or explanatory conclusions by theme. Successful policy and programme approaches were categorized in four strategic areas: leadership and multistakeholder partnerships; health sector; sectors outside health; and accountability for resources and results. Consistent and coordinated inputs across sectors, based on high-impact interventions, were assessed. Within the health sector, key policy and programme strategies included defining standards, collecting and using data, improving financial protection, and improving the availability and quality of services. Outside the health sector, strategies included investing in girls' education, water, sanitation and hygiene, poverty reduction, nutrition and food security, and infrastructure development. Countries improved accountability by strengthening and using data systems for planning and evaluating progress. Reducing maternal and child mortality in the 10 fast-track countries can be linked to consistent and coordinated policy and programme inputs across health and other sectors. The approaches used by successful countries have relevance to other countries looking to scale-up or accelerate progress towards the sustainable development goals.

Private-public sector co-operation to improve pesticide safety standards in developing countries.

PubMed

Ellis, W W

1998-01-01

This paper draws on the author's experiences of the pilot phase of the Safe Use Project (SUP) in Thailand; this project is a part of a major GIFAP initiative carried out in some developing countries. The SUP's objectives were; i) to raise awareness and compliance in the safe handling and storage of pesticides within the industry, the medical profession and the end-users; ii) to reduce the incidence of pesticide poisoning; iii) to protect the environment; iiii) to help relevant government agencies with resources, expertise and training. To achieve those objectives, the SUP used local-language training resources, provided basic training, lobbied for changes in governmental policies and regulations, and acted as a focal point for pesticide safety-related information. The SUP targeted the whole distribution chain, from importer/formulator, through to the endusers. Also medical profession, teachers and school students were targeted. On the base of independent audit and surveys, a general improvement in awareness has been shown within targeted groups; a longer time frame is required to detect meaningful changes in farmer practice. The SUP key programmes have been: I) training of trainers, retailers and farmers; II) schools programme; III) medical training; IV) protective clothing; V) industry standards; VI) model farm. The main conclusions of the pilot phase were: i) pesticide safety needs to be addressed by all concerned agencies in a joint effort; ii) a rural development perspective must be adopted in improving pesticide safety; iii) integrated pest management training programmes must include precautionary advice for proper handling, use and disposal of pesticides, wherever these are necessary.

Eliminating malaria in Malaysia: the role of partnerships between the public and commercial sectors in Sabah

PubMed Central

2014-01-01

Background Countries in the Asia Pacific region have made great progress in the fight against malaria; several are rapidly approaching elimination. However, malaria control programmes operating in elimination settings face substantial challenges, particularly around mobile migrant populations, access to remote areas and the diversity of vectors with varying biting and breeding behaviours. These challenges can be addressed through subnational collaborations with commercial partners, such as mining or plantation companies, that can conduct or support malaria control activities to cover employees. Such partnerships can be a useful tool for accessing high-risk populations and supporting malaria elimination goals. Methods This observational qualitative case study employed semi-structured key informant interviews to describe partnerships between the Malaysian Malaria Control Programme (MCP), and private palm oil, rubber and acacia plantations in the state of Sabah. Semi-structured interview guides were used to examine resource commitments, incentives, challenges, and successes of the collaborations. Results Interviews with workers from private plantations and the state of Sabah MCP indicated that partnerships with the commercial sector had contributed to decreases in incidence at plantation sites since 1991. Several plantations contribute financial and human resources toward malaria control efforts and all plantations frequently communicate with the MCP to help monitor the malaria situation on-site. Management of partnerships between private corporations and government entities can be challenging, as prioritization of malaria control may change with annual profits or arrival of new management. Conclusions Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah. The successes of these partnerships rely on a common understanding that elimination will be a mutually beneficial outcome for employers and the general public. Best practices included consistent communication, developing government-staffed subsector offices for malaria control on-site, engaging commercial plantations to provide financial and human resources for malaria control activities, and the development of new worker screening programmes. The successes and challenges associated with partnerships between the public and commercial sector can serve as an example for other malaria-eliminating countries with large plantation sectors, and may also be applied to other sectors that employ migrant workers or have commercial enterprises in hard to reach areas. PMID:24443824

Searching for sustainability within public health policy: insights from an injury prevention perspective.

PubMed

Errington, Gail; Evans, Catrin; Watson, Michael C

2017-04-01

Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Voluntarism, public engagement and the role of geoscience in radioactive waste management policy-making

NASA Astrophysics Data System (ADS)

Bilham, Nic

2014-05-01

In the UK, as elsewhere in Europe, there has been a move away from previous 'technocratic' approaches to radioactive waste management (RWM). Policy-makers have recognised that for any RWM programme to succeed, sustained engagement with stakeholders and the public is necessary, and any geological repository must be constructed and operated with the willing support of the community which hosts it. This has opened up RWM policy-making and implementation to a wider range of (often contested) expert inputs, ranging across natural and social sciences, engineering and even ethics. Geoscientists and other technical specialists have found themselves drawn into debates about how various types of expertise should be prioritised, and how they should be integrated with diverse public and stakeholder perspectives. They also have a vital role to play in communicating to the public the need for geological disposal of radioactive waste, and the various aspects of geoscience which will inform the process of implementing this, from identifying potential volunteer host communities, to finding a suitable site, developing the safety case, construction of a repository, emplacement of waste, closure and subsequent monitoring. High-quality geoscience, effectively communicated, will be essential to building and maintaining public confidence throughout the many decades such projects will take. Failure to communicate effectively the relevant geoscience and its central role in the UK's radioactive waste management programme arguably contributed to West Cumbria's January 2013 decision to withdraw from the site selection process, and may discourage other communities from coming forward in future. Across countries needing to deal with their radioactive waste, this unique challenge gives an unprecedented urgency to finding ways to engage and communicate effectively with the public about geoscience.

Developing the public health workforce: training and recognizing specialists in public health from backgrounds other than medicine: experience in the UK.

PubMed

Gray, Selena F; Evans, David

2018-01-01

There is increasing recognition that improving health and tackling inequalities requires a strong public health workforce capable of delivering key public health functions across systems. The World Health Organization in Europe has identified securing the delivery of the Essential Public Health Operations and strengthening public health capacities within this as a priority.It is acknowledged that current public health capacities and arrangements of public health services vary considerably across the World Health Organization in European Region, and investment in multidisciplinary workforce with new skills is essential if public health services are to be delivered. This paper describes the current situation in the UK where there are nationally funded multidisciplinary programmes for training senior public health specialists. Uniquely, the UK provides public health registration for multidisciplinary as well as medical public health specialists. The transition from a predominantly medical to a multidisciplinary public health specialist workforce over a relatively short timescale is unprecedented globally and was the product of a sustained period of grass roots activism aligned with national policy innovation. the UK experience might provide a model for other countries seeking to develop public health specialist workforce capacity in line with the Essential Public Health Operations.

A model for integrating strategic planning and competence-based curriculum design in establishing a public health programme: the UNC Charlotte experience.

PubMed

Thompson, Michael E; Harver, Andrew; Eure, Marquis

2009-08-11

The University of North Carolina at Charlotte, a doctoral/research-intensive university, is the largest institution of higher education in the Charlotte region. The university currently offers 18 doctoral, 62 master's and 90 baccalaureate programmes. Fall 2008 enrolment exceeded 23,300 students, including more than 4900 graduate students. The university's Department of Health Behavior and Administration was established on 1 July 2002 as part of a transformed College of Health & Human Services. In 2003, the Department initiated a series of stakeholder activities as part of its strategic planning and programmatic realignment efforts. The Department followed an empirically derived top-down/bottom-up strategic planning process that fostered community engagement and coordination of efforts across institutional levels. This process culminated in a vision to transform the unit into a Council on Education for Public Health accredited programme in public health and, eventually, an accredited school of public health. To date, the Department has revised its Master of Science in health promotion into an Master of Science in Public Health programme, renamed itself the Department of Public Health Sciences, launched a Bachelor of Science in Public Health major, laid plans for a doctoral programme, and received accreditation from the Council on Education for Public Health as a public health programme. Furthermore, the campus has endorsed the programme's growth into a school of public health as one of its priorities. It is only through this rigorous and cyclical process of determining what society needs, designing a curriculum specifically to prepare graduates to meet those needs, ensuring that those graduates meet those needs, and reassessing society's needs that we can continue to advance the profession and ensure the public's health. Community stakeholders should be active contributors to programme innovation. Lessons learnt from this process include: being connected to your community and knowing its needs, being responsive to your community, remembering that process is as important as product, and preparing for success. The efforts reported here can be informative to other institutions by exemplifying an integrated top-down/bottom-up process of strategic planning that ensures that a department's degree programmes meet current needs and that students graduate with the competences to address those needs.

Control programme for cystic echinococcosis in Uruguay.

PubMed

Irabedra, Pilar; Ferreira, Ciro; Sayes, Julio; Elola, Susana; Rodríguez, Miriam; Morel, Noelia; Segura, Sebastian; Santos, Estela Dos; Guisantes, Jorge A

2016-05-24

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community's participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.

PubMed

Sayed, Shahin; Cherniak, William; Lawler, Mark; Tan, Soo Yong; El Sadr, Wafaa; Wolf, Nicholas; Silkensen, Shannon; Brand, Nathan; Looi, Lai Meng; Pai, Sanjay A; Wilson, Michael L; Milner, Danny; Flanigan, John; Fleming, Kenneth A

2018-05-12

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan. Copyright © 2018 Elsevier Ltd. All rights reserved.

Tackling cancer burden in the Middle East: Qatar as an example.

PubMed

Brown, Robert; Kerr, Karen; Haoudi, Abdelali; Darzi, Ara

2012-11-01

Cancer prevalence is increasing in the Middle East, partly because of increased life expectancy and adoption of western lifestyle habits. Suboptimum delivery of health care also contributes to late diagnosis and poor survival of people with cancer. Public awareness of cancer risk is frequently low and misconceptions high, thereby preventing patients from seeking treatment early and constituting a substantial barrier to improvement of cancer outcomes. Screening programmes might have low uptake in Arab populations because of social and health beliefs about cancer. This review outlines the opportunities available to Middle Eastern countries and their emerging economies to learn from global experiences in cancer care, service provision, and research partnerships. The Middle East has begun to develop several health-care transformation programmes. Qatar, in particular, has published a National Health Strategy, in which cancer is one of the main commitments; this Strategy provides the focus of this review. The development of effective health-care strategies and evidence-based medicine directly linked to innovative cancer research is needed to improve cancer care. Although the full extent of the proposed solutions are not necessarily implementable in all Middle Eastern countries, wealthy states can lead derivation of population-specific approaches that could have effects throughout the region. Key challenges are outlined-namely, human capacity and training, subspecialisation of services, building on international cancer research initiatives, and the need for earlier diagnosis and awareness in the population. Countries in the Gulf Region (ie, countries bordering the Persian Gulf, including Iran, Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, UAE, and Oman) need to address these challenges to be at the forefront of integrated cancer care and research and ensure that the latest innovations and best possible care are delivered to their populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

The post-2015 development agenda for diabetes in sub-Saharan Africa: challenges and future directions.

PubMed

Renzaho, Andre M N

2015-01-01

Diabetes is one of the non-communicable diseases (NCDs) which is rising significantly across sub-Saharan African (SSA) countries and posing a threat to the social, economic, and cultural fabric of the SSA population. The inclusion of NCDs into the post-2015 development agenda along with the global monitoring framework provides an opportunity to monitor progress of development programmes in developing countries. This paper examines challenges associated with dealing with diabetes within the development agenda in SSA and explores some policy options. This conceptual review draws from a range of works published in Medline and the grey literature to advance the understanding of the post-2015 development agenda and how it relates to NCDs. The paper begins with the burden of diabetes in sub-Sahara Africa and then moves on to examine challenges associated with diabetes prevention, treatment, and management in Africa. It finishes by exploring policy implications. With regards to development programmes on NCDs in the SSA sub-continent, several challenges exist: 1) poor documentation of risk factors, 2) demographic transitions (rapid urbanisation and ageing), 3) the complementary role of traditional healers, 4) tuberculosis and the treatment of the acquired immunodeficiency syndrome as risk factors for diabetes, 5) diabetes in complex emergencies, 6) diabetes as an international development priority and not a policy agenda for many SSA countries, and 7) poorly regulated food and beverage industry. For the post-2015 development agenda for NCDs to have an impact, sufficient investments will be needed to address legislative, technical, human, and fiscal resource constraints through advocacy, accountability, political leadership, and effective public-private partnership. Striking the right balance between competing demands and priorities, policies, and implementation strategies hold the key to an effective response to diabetes in SSA countries.

Elaboration of Programmes, Programmes, Plans and Budgets of the National Libraries in Socialist Countries (37th Session, Liverpool, August 1971).

ERIC Educational Resources Information Center

Kanevsky, B. P.

Long-term and short-term planning and programming and budgeting are an important part of the every-day activity of the national libraries in the socialist countries. The libraries extensively apply various types of planning ranging from current annual plans to complicated prognoses for 15-20 years ahead. These libraries display increasing…

Organization and startup of The Gambia's new community-based medical programme.

PubMed

Chávez, José A; Suárez, Lázaro V; Del Rosario, Odalis; Hechavarría, Suiberto; Quiñones, Judith

2012-01-01

The shortage of health professionals in developing countries and especially in their poorest regions imperils the vision of health for all. New training policies and strategies are needed urgently to address these shortages. The Gambia's new Community-Based Medical Programme is one such strategy. KEYWORDS Medical education, access to health care, healthcare disparities, health manpower, rural health, developing countries, The Gambia.

The Global Fund Secretariat's suspension of funding to Uganda: how could this have been avoided?

PubMed Central

Kapiriri, Lydia; Martin, Douglas K.

2006-01-01

In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria (the Global Fund) Secretariat suspended its five grants to Uganda following a PricewaterhouseCoopers audit report that exposed gross mismanagement in the Project Management Unit. How could this have been avoided? How can other countries avoid a similar pitfall? We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries. The "accountability for reasonableness" framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects. PMID:16878232

The use of programme planning and social marketing models by a state public health agency: a case study.

PubMed

Kohr, J M; Strack, R W; Newton-Ward, M; Cooke, C H

2008-03-01

To investigate the use of planning models and social marketing planning principles within a state's central public health agency as a means for informing improved planning practices. Qualitative semi-structured interviews were conducted with 30 key programme planners in selected division branches, and a quantitative survey was distributed to 63 individuals responsible for programme planning in 12 programme-related branches. Employees who have an appreciation of and support for structured programme planning and social marketing may be considered the 'low hanging fruit' or 'early adopters'. On the other hand, employees that do not support or understand either of the two concepts have other barriers to using social marketing when planning programmes. A framework describing the observed factors involved in programme planning on an individual, interpersonal and organizational level is presented. Understanding the individual and structural barriers and facilitators of structured programme planning and social marketing is critical to increase the planning capacity within public health agencies.

Nutrition advocacy and national development: the PROFILES programme and its application.

PubMed Central

Burkhalter, B. R.; Abel, E.; Aguayo, V.; Diene, S. M.; Parlato, M. B.; Ross, J. S.

1999-01-01

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies. PMID:10361758

Quest for quality care and patient safety: the case of Singapore

PubMed Central

Lim, M

2004-01-01



 Quality of care in Singapore has seen a paradigm shift from a traditional focus on structural approaches to a broader multidimensional concept which includes the monitoring of clinical indicators and medical errors. Strong political commitment and institutional capacities have been important factors for making the transition. What is still lacking, however, is a culture of rigorous programme evaluation, public involvement, and patient empowerment. Despite these imperfections, Singapore has made considerable strides and its experience may hold lessons for other small developing countries in the common quest for quality care and patient safety. PMID:14757804

Asian student migration to Australia.

PubMed

Shu, J; Hawthorne, L

1996-01-01

"This paper presents an overview of Asian student migration to Australia, together with an analysis of political and educational aspects of the overseas student programme. It focuses on some significant consequences of this flow for Australia. The characteristics of key student groups are contrasted to provide some perspective of the diversity of historical and cultural backgrounds, with the source countries of Malaysia, Indonesia and PRC [China] selected as case studies. Since the issue of PRC students in Australia has attracted considerable public attention and policy consideration, particular focus is placed on their experience." (SUMMARY IN FRE AND SPA) excerpt

Catching Cosmic Light with the Galileoscope

NASA Astrophysics Data System (ADS)

Fienberg, R. T.; Arion, D. N.

2015-09-01

Created for the 2009 International Year of Astronomy, the Galileoscope solved a long-standing problem: the lack of high quality, low cost telescope kits suitable for both optics education and celestial observation. Through an effort managed entirely by the volunteers who have authored this article almost 240 000 Galileoscope kits have now been distributed in 106 countries across the globe, for use in science teaching and public outreach. The Galileoscope outreach programme for the 2015 International Year of Light is now in full swing, giving tens of thousands of students, teachers and parents their first telescopic look at the Moon's craters and Saturn's rings.

Collaboration between the national tuberculosis programme and a non governmental organisation in TB/HIV care at a district level: experience from Tanzania.

PubMed

Wandwalo, Eliud; Kapalata, Neema; Tarimo, Edith; Corrigan, C Brigid; Morkve, Odd

2004-08-01

The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care. To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/ HIV care at a district level in Tanzania. Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002. A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff. The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

PubMed Central

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-01-01

Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services. PMID:17603898

Major health service transformation and the public voice: conflict, challenge or complicity?

PubMed

Martin, Graham P; Carter, Pam; Dent, Mike

2018-01-01

Objectives Calls for major reconfigurations of health services have been accompanied by recommendations that wide ranging stakeholders be involved. In particular, patients and the wider public are seen as critical contributors as both funders and beneficiaries of public health care. But public involvement is fraught with challenges, and little research has focused on involvement in the health service transformation initiatives. This paper examines the design and function of public involvement in reconfiguration of health services within the English NHS. Methods Qualitative data including interviews, observation and documents were collected in two health service 'transformation' programmes; interviews include involved public and professional participants. Data were analysed using parallel deductive and inductive approaches. Results Public involvement in the programmes was extensive but its terms of reference, and the individuals involved, were restricted by policy pressures and programme objectives. The degree to which participants descriptively or substantively represented the wider public was limited; participants sought to 'speak for' this public but their views on what was 'acceptable' and likely to influence decision-making led them to constrain their contributions. Conclusions Public involvement in two major service reconfiguration programmes in England was seen as important and functional, and could not be characterized as tokenistic. Yet involvement in these programmes fell short of normative ideals, and could inadvertently reduce, rather than enlarge, public influence on health service reconfiguration decisions.

Changing Times: A Changing Public Sector May Require Changes to Public Management Education Programmes

ERIC Educational Resources Information Center

Oldfield, Chrissie

2017-01-01

It is becoming apparent that the environment in which Executive Masters in Public Administration programmes operate has changed dramatically in the wake of economic crisis and subsequent cuts in public spending. Changes in the funding of public sector organisations has been compounded by a broader "crisis" in the wider public sector…

Preparing for introduction of a dengue vaccine: recommendations from the 1st Dengue v2V Asia-Pacific Meeting.

PubMed

Lam, Sai Kit; Burke, Donald; Capeding, Maria Rosario; Chong, Chee Keong; Coudeville, Laurent; Farrar, Jeremy; Gubler, Duane; Hadinegoro, Sri Rezeki; Hanna, Jeffrey; Lang, Jean; Lee, Han Lim; Leo, Yee Sin; Luong, Chan Quang; Mahoney, Richard; McBride, John; Mendez-Galvan, Jorge; Ng, Lee Ching; Nimmannitya, Suchitra; Ooi, Eng Eong; Shepard, Donald; Smit, Jaco; Teyssou, Rémy; Thomas, Laurent; Torresi, Joseph; Vasconcelos, Pedro; Wirawan, Dewa Nyoman; Yoksan, Sutee

2011-11-28

Infection with dengue virus is a major public health problem in the Asia-Pacific region and throughout tropical and sub-tropical regions of the world. Vaccination represents a major opportunity to control dengue and several candidate vaccines are in development. Experts in dengue and in vaccine introduction gathered for a two day meeting during which they examined the challenges inherent to the introduction of a dengue vaccine into the national immunisation programmes of countries of the Asia-Pacific. The aim was to develop a series of recommendations to reduce the delay between vaccine licensure and vaccine introduction. Major recommendations arising from the meeting included: ascertaining and publicising the full burden and cost of dengue; changing the perception of dengue in non-endemic countries to help generate global support for dengue vaccination; ensuring high quality active surveillance systems and diagnostics; and identifying sustainable sources of funding, both to support vaccine introduction and to maintain the vaccination programme. The attendees at the meeting were in agreement that with the introduction of an effective vaccine, dengue is a disease that could be controlled, and that in order to ensure a vaccine is introduced as rapidly as possible, there is a need to start preparing now. Copyright © 2011 Elsevier Ltd. All rights reserved.

The FAIR-INNOVATION dissemination project.

PubMed

Gormley, R

2001-08-01

The goal of the FAIR-INNOVATION dissemination project (FLAIR-FLOW 3) (1997-2000) was to disseminate R&D results from the EU FAIR programme to small and medium-sized food enterprises (SMEs), health professionals (HPs) and consumer groups (CGs) in 19 European countries. The dissemination routes were: (i) one-page technical documents on research results; (ii) their reproduction on the internet; (iii) their reproduction in journals Europe-wide; (iv) workshops on results from EU-supported food research programmes; and (v) lectures and poster presentations by FLAIR-FLOW network personnel. Of the 135 one-pagers produced, 62% were targeted at SMEs, 18% at HPs and 5% at CGs. The remaining 15% were on food safety and were common to the three target groups. There were 1047 publications arising from one-pages in trade journals, and over 8000 requests (paper route) were received for follow-up information. These were in addition to 240 k downloads from the FLAIR-FLOW 3 web site (www.flair-flow.com). Initiatives for HPs included specially collated versions of the one-pagers for major conferences, 20 focused workshops, and interaction with the European Federation of Associations of Dieticians. Currently, dissemination is continuing through FLAIR-FLOW 4 (2001-2003) in 24 countries. FLAIR-FLOW 4 is co-ordinated by M. Jean François Quillien from INRA-CRIAA (FR) at criaa@rennes.inra.fr.

Dissemination of public health information: key tools utilised by the NECOBELAC network in Europe and Latin America.

PubMed

De Castro, Paola; Marsili, Daniela; Poltronieri, Elisabetta; Calderón, Carlos Agudelo

2012-06-01

 Open Access (OA) to scientific information is an important step forward in communication patterns, yet we still need to reinforce OA principles to promote a cultural change of traditional publishing practices. The advantages of free access to scientific information are even more evident in public health where knowledge is directly associated with human wellbeing.  An OA 'consolidation' initiative in public health is presented to show how the involvement of people and institutions is fundamental to create awareness on OA and promote a cultural change. This initiative is developed within the project NEtwork of COllaboration Between Europe and Latin American Caribbean countries (NECOBELAC), financed by the European Commission.  Three actions are envisaged: Capacity building through a flexible and sustainable training programme on scientific writing and OA publishing; creation of training tools based on semantic web technologies; development of a network of supporting institutions.  In 2010-2011, 23 training initiatives were performed involving 856 participants from 15 countries; topic maps on scientific publication and OA were produced; 195 institutions are included in the network.  Cultural change in scientific dissemination practices is a long process requiring a flexible approach and strong commitment by all stakeholders. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group Health Information and Libraries Journal.

Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa.

PubMed

Theiss-Nyland, Katherine; Lynch, Michael; Lines, Jo

2016-05-04

In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels.

Global policy and programme guidance on maternal nutrition: what exists, the mechanisms for providing it, and how to improve them?

PubMed

Shrimpton, Roger

2012-07-01

Undernutrition in one form or another affects the majority of women of reproductive age in most developing countries. However, there are few or no effective programmes trying to solve maternal undernutrition problems. The purpose of the paper is to examine global policy and programme guidance mechanisms for nutrition, what their content is with regard to maternal nutrition in particular, as well as how these might be improved. Almost all countries have committed themselves politically to ensuring the right of pregnant and lactating women to good nutrition through the Convention on the Elimination of all Forms of Discrimination Against Women. Despite this, the World Health Organization (WHO) has not endorsed any policy commitments with regard to maternal nutrition. The only policy guidance coming from the various technical departments of WHO relates to the control of maternal anaemia. There is no policy or programme guidance concerning issues of maternal thinness, weight gain during pregnancy and/or low birthweight prevention. Few if any countries have maternal nutrition programmes beyond those for maternal anaemia, and most of those are not effective. The lack of importance given to maternal nutrition is related in part to a weakness of evidence, related to the difficulty of getting ethical clearance, as well as a generalised tendency to downplay the importance of those interventions found to be efficacious. No priority has been given to implementing existing policy and programme guidance for the control of maternal anaemia largely because of a lack of any dedicated funding, linked to a lack of Millennium Development Goals indicator status. This is partly due to the poor evidence base, as well as to the common belief that maternal anaemia programmes were not effective, even if efficacious. The process of providing evidence-based policy and programme guidance to member states is currently being revamped and strengthened by the Department of Nutrition for Health and Development of WHO through the Nutrition Guidance Expert Advisory Group processes. How and if programme guidance, as well as policy commitment for improved maternal nutrition, will be strengthened through the Nutrition Guidance Expert Advisory Group process is as yet unclear. The global movement to increase investment in programmes aimed at maternal and child undernutrition called Scaling Up Nutrition offers an opportunity to build developing country experience with efforts to improve nutrition during pregnancy and lactation. All member states are being encouraged by the World Health Assembly to scale-up efforts to improve maternal infant and young child nutrition. Hopefully Ministries of Health in countries most affected by maternal and child undernutrition will take leadership in the development of such plans, and ensure that the control of anaemia during pregnancy is given a great priority among these actions, as well as building programme experience with improved nutrition during pregnancy and lactation. For this to happen it is essential that donor support is assured, even if only to spearhead a few flagship countries. © 2012 Blackwell Publishing Ltd.

Exercise-based cardiac rehabilitation in twelve European countries results of the European cardiac rehabilitation registry.

PubMed

Benzer, Werner; Rauch, Bernhard; Schmid, Jean-Paul; Zwisler, Ann Dorthe; Dendale, Paul; Davos, Constantinos H; Kouidi, Evangelia; Simon, Attila; Abreu, Ana; Pogosova, Nana; Gaita, Dan; Miletic, Bojan; Bönner, Gerd; Ouarrak, Taoufik; McGee, Hannah

2017-02-01

Results from EuroCaReD study should serve as a benchmark to improve guideline adherence and treatment quality of cardiac rehabilitation (CR) in Europe. Data from 2.054 CR patients in 12 European countries were derived from 69 centres. 76% were male. Indication for CR differed between countries being predominantly ACS in Switzerland (79%), Portugal (62%) and Germany (61%), elective PCI in Greece (37%), Austria (36%) and Spain (32%), and CABG in Croatia and Russia (36%). A minority of patients presented with chronic heart failure (4%). At CR start, most patients already were under medication according to current guidelines for the treatment of CV risk factors. A wide range of CR programme designs was found (duration 3 to 24weeks; total number of sessions 30 to 196). Patient programme adherence after admission was high (85%). With reservations that eCRF follow-up data exchange remained incomplete, patient CV risk profiles experienced only small improvements. CR success as defined by an increase of exercise capacity >25W was significantly higher in young patients and those who were employed. Results differed by countries. After CR only 9% of patients were admitted to a structured post-CR programme. Clinical characteristics of CR patients, indications and programmes in Europe are different. Guideline adherence is poor. Thus, patient selection and CR programme designs should become more evidence-based. Routine eCRF documentation of CR results throughout European countries was not sufficient in its first application because of incomplete data exchange. Therefore better adherence of CR centres to minimal routine clinical standards is requested. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Stakeholder analysis of the Programme for Improving Mental health carE (PRIME): baseline findings.

PubMed

Makan, Amit; Fekadu, Abebaw; Murhar, Vaibhav; Luitel, Nagendra; Kathree, Tasneem; Ssebunya, Joshua; Lund, Crick

2015-01-01

The knowledge generated from evidence-based interventions in mental health systems research is seldom translated into policy and practice in low and middle-income countries (LMIC). Stakeholder analysis is a potentially useful tool in health policy and systems research to improve understanding of policy stakeholders and increase the likelihood of knowledge translation into policy and practice. The aim of this study was to conduct stakeholder analyses in the five countries participating in the Programme for Improving Mental health carE (PRIME); evaluate a template used for cross-country comparison of stakeholder analyses; and assess the utility of stakeholder analysis for future use in mental health policy and systems research in LMIC. Using an adapted stakeholder analysis instrument, PRIME country teams in Ethiopia, India, Nepal, South Africa and Uganda identified and characterised stakeholders in relation to the proposed action: scaling-up mental health services. Qualitative content analysis was conducted for stakeholder groups across countries, and a force field analysis was applied to the data. Stakeholder analysis of PRIME has identified policy makers (WHO, Ministries of Health, non-health sector Ministries and Parliament), donors (DFID UK, DFID country offices and other donor agencies), mental health specialists, the media (national and district) and universities as the most powerful, and most supportive actors for scaling up mental health care in the respective PRIME countries. Force field analysis provided a means of evaluating cross-country stakeholder power and positions, particularly for prioritising potential stakeholder engagement in the programme. Stakeholder analysis has been helpful as a research uptake management tool to identify targeted and acceptable strategies for stimulating the demand for research amongst knowledge users, including policymakers and practitioners. Implementing these strategies amongst stakeholders at a country level will hopefully reduce the knowledge gap between research and policy, and improve health system outcomes for the programme.

Building leadership capacity and future leaders in operational research in low-income countries: why and how?

PubMed

Zachariah, R; Reid, T; Srinath, S; Chakaya, J; Legins, K; Karunakara, U; Harries, A D

2011-11-01

Very limited operational research (OR) emerges from programme settings in low-income countries where the greatest burden of disease lies. The price paid for this void includes a lack of understanding of how health systems are actually functioning, not knowing what works and what does not, and an inability to propose adapted and innovative solutions to programme problems. We use the National Tuberculosis Control Programme as an example to advocate for strong programme-level leadership to steer OR and build viable relationships between programme managers, researchers and policy makers. We highlight the need to create a stimulating environment for conducting OR and identify some of the main practical challenges and enabling factors at programme level. We focus on the important role of an OR focal point within programmes and practical approaches to training that can deliver timely and quantifiable outputs. Finally, we emphasise the need to measure successful OR leadership development at programme level and we propose parameters by which this can be assessed. This paper 1) provides reasons why programmes should take the lead in coordinating and directing OR, 2) identifies the practical challenges and enabling factors for implementing, managing and sustaining OR and 3) proposes parameters for measuring successful leadership capacity development in OR.

Lot quality assurance sampling techniques in health surveys in developing countries: advantages and current constraints.

PubMed

Lanata, C F; Black, R E

1991-01-01

Traditional survey methods, which are generally costly and time-consuming, usually provide information at the regional or national level only. The utilization of lot quality assurance sampling (LQAS) methodology, developed in industry for quality control, makes it possible to use small sample sizes when conducting surveys in small geographical or population-based areas (lots). This article describes the practical use of LQAS for conducting health surveys to monitor health programmes in developing countries. Following a brief description of the method, the article explains how to build a sample frame and conduct the sampling to apply LQAS under field conditions. A detailed description of the procedure for selecting a sampling unit to monitor the health programme and a sample size is given. The sampling schemes utilizing LQAS applicable to health surveys, such as simple- and double-sampling schemes, are discussed. The interpretation of the survey results and the planning of subsequent rounds of LQAS surveys are also discussed. When describing the applicability of LQAS in health surveys in developing countries, the article considers current limitations for its use by health planners in charge of health programmes, and suggests ways to overcome these limitations through future research. It is hoped that with increasing attention being given to industrial sampling plans in general, and LQAS in particular, their utilization to monitor health programmes will provide health planners in developing countries with powerful techniques to help them achieve their health programme targets.

An in-country model of workforce support for trained mid-level eye care workers in Papua New Guinea and Pacific Islands.

PubMed

Brûlé, Julie; Tousignant, Benoit; Nicholls, Graeme; Pearce, Matthew G

2017-08-11

To alleviate the significant burden of vision impairment and blindness in low-resource settings, addressing the shortage in human resources in eye care is one of the fundamental strategies. With its postgraduate training programmes, The Fred Hollows Foundation New Zealand (FHFNZ) aims to increase workforce capacity in the Pacific Island countries and territories and Papua New Guinea. This paper presents an in-country model to offer support to graduates, an essential element to retain them in the workforce and ensure they are able to perform the tasks they were trained to do. FHFNZ has designed a workforce support programme employing a standardised process, allowing comparable reporting and providing data for FHFNZ to evaluate its training programmes, outputs as well as professional recognition and integration in the workplace.

The effectiveness of family-planning programmes.

PubMed

Mauldin, W P

1989-01-01

By the mid-1960s, countries that accounted for 66% of the population of developing countries had adopted policies designed to reduce their rates of population growth; by 1986, the corresponding figure had reached 78%. In the developing regions as a whole, fertility has fallen by more than 30% since 1950. Contraceptive use has risen sharply, and there has been more than 10-fold increase in the number of couples in developing countries who use contraceptives. There is a very strong association between use of contraception and fertility in developing countries. Social and economic modernization is also taking place, although quite unevenly in the developing regions, so that the relationship of modernization is fertility is not very easy to demonstrate. In general, the experience of the developing countries suggest that a strong family- planning program effort can, and does, lead to a more rapid fertility decline than would be likely based only on socioeconomic variables. The effectiveness of family-planning programs can be enhanced by increasing the range of choice of contraceptive methods offered. However, it is difficult to disentangle the various factors that contribute to the effectiveness of family-planning programs. The public sector is the main supplier of family-planning services in most developing countries, and there is no clear trend towards the reliance on the private sector.

Staphylococcus aureus disease and drug resistance in resource-limited countries in south and east Asia.

PubMed

Nickerson, Emma K; West, T Eoin; Day, Nicholas P; Peacock, Sharon J

2009-02-01

By contrast with high-income countries, Staphylococcus aureus disease ranks low on the public-health agenda in low-income countries. We undertook a literature review of S aureus disease in resource-limited countries in south and east Asia, and found that its neglected status as a developing world pathogen does not equate with low rates of disease. The incidence of the disease seems to be highest in neonates, its range of clinical manifestations is as broad as that seen in other settings, and the mortality rate associated with serious S aureus infection, such as bacteraemia, is as high as 50%. The prevalence of meticillin-resistant S aureus (MRSA) infection across much of resource-limited Asia is largely unknown. Antibiotic drugs are readily and widely available from pharmacists in most parts of Asia, where ease of purchase and frequent self-medication are likely to be major drivers in the emergence of drug resistance. In our global culture, the epidemiology of important drug-resistant pathogens in resource-limited countries is inextricably linked with the health of both developing and developed communities. An initiative is needed to raise the profile of S aureus disease in developing countries, and to define a programme of research to find practical solutions to the health-care challenges posed by this important global pathogen.

Novice Teachers' Experiences of Induction in Selected Primary Schools in Namibia

ERIC Educational Resources Information Center

Dishena, Robert; Mokoena, Sello

2016-01-01

Problem Statement: Many schools use induction programmes with the aim of contributing to novice teachers' well-being and professional development. However, the content of induction programmes varies across schools and countries. Given that existing studies do not conclusively establish the programme components with the greatest potential to affect…

Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices.

PubMed

Soriano-Arandes, Antoni; Angheben, Andrea; Serre-Delcor, Nuria; Treviño-Maruri, Begoña; Gómez I Prat, Jordi; Jackson, Yves

2016-05-01

Identifying pregnant women infected with Trypanosoma cruzi is one of the major challenges for preventing and controlling Chagas disease (CD) in non-endemic countries. The aim of this paper was to perform a policy evaluation of the current practices of congenital Chagas disease (CCD) control in non-endemic countries and to propose specific targets for enhanced interventions to tackle this emerging health problem outside the endemic areas of Latin America. We conducted a mixed method review of CCD policy strategies by searching the literature in the PubMed, Google Scholar and the World Health Organization (WHO) databases using the key terms 'CCD', 'paediatric Chagas disease' and 'non-endemic countries'; as free text and combined as one phrase to increase the search sensitivity. Reviews, recommendations, guidelines and control/surveillance programme reports were included. Of 427 CCD papers identified in non-endemic countries, 44 matched the inclusion. Although local programmes were launched in different countries with large numbers of Latin American immigrants, there were considerable disparities in terms of the programmes' distribution, delivery, integration and appropriated CCD control strategies. Moreover, Catalonia, Spain is the only region/country with an established systematic monitoring of CCD in pregnant women from Latin American countries. Given the worldwide dissemination of CD, the nature of its vertical transmission, and the gaps of the current strategies in non-endemic countries, there is an urgent need to standardise, expand and reinforce the control measures against CCD transmission. © 2016 John Wiley & Sons Ltd.

Time to publication for NIHR HTA programme-funded research: a cohort study

PubMed Central

Chinnery, Fay; Young, Amanda; Goodman, Jennie; Ashton-Key, Martin; Milne, Ruairidh

2013-01-01

Objective To assess the time to publication of primary research and evidence syntheses funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme published as a monograph in Health Technology Assessment and as a journal article in the wider biomedical literature. Study design Retrospective cohort study. Setting Primary research and evidence synthesis projects funded by the HTA Programme were included in the cohort if they were registered in the NIHR research programmes database and was planned to submit the draft final report for publication in Health Technology Assessment on or before 9 December 2011. Main outcome measures The median time to publication and publication at 30 months in Health Technology Assessment and in an external journal were determined by searching the NIHR research programmes database and HTA Programme website. Results Of 458 included projects, 184 (40.2%) were primary research projects and 274 (59.8%) were evidence syntheses. A total of 155 primary research projects had a completion date; the median time to publication was 23 months (26.5 and 35.5 months to publish a monograph and to publish in an external journal, respectively) and 69% were published within 30 months. The median time to publication of HTA-funded trials (n=126) was 24 months and 67.5% were published within 30 months. Among the evidence syntheses with a protocol online date (n=223), the median time to publication was 25.5 months (28 months to publication as a monograph), but only 44.4% of evidence synthesis projects were published in an external journal. 65% of evidence synthesis studies had been published within 30.0 months. Conclusions Research funded by the HTA Programme publishes promptly. The importance of Health Technology Assessment was highlighted as the median time to publication was 9 months shorter for a monograph than an external journal article. PMID:24285634

Developing standards for malaria microscopy: external competency assessment for malaria microscopists in the Asia-Pacific.

PubMed

Ashraf, Sania; Kao, Angie; Hugo, Cecilia; Christophel, Eva M; Fatunmbi, Bayo; Luchavez, Jennifer; Lilley, Ken; Bell, David

2012-10-24

Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia. Surveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists. External assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions. While the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research.