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Title: Delivering services and influencing policy: health care professionals join forces to improve maternal, newborn, and child health.
Author: Health Care Professional Association Writing Group
Source: International Journal of Gynaecology and Obstetrics. 2009 Jun;105(3):271-4.
Abstract: This article reviews the major activities of health care professional organizations (HCPAs), and emphasizes the role they can play in advocating for women and children and influencing maternal, newborn, and child health (MNCH) programs and policies. The ICM/FIGO joint effort to prevent postpartum hemorrhage and the 40-year partnership between the American Academy of Pediatrics (AAP) and the Indian Health Service (IHS) are highlighted as examples of how and why HCPAs should assume a leadership role in advocacy work. The action-oriented multicountry HCPA workshops organized by the Partnership for Maternal, Newborn, and Child Health (PMNCH) and the international HCPAs are also described. These capacity building workshops are aimed at strengthening the ability of HCPAs to organize, coordinate activities, and become more involved in program and policy development.
Language: English
Keywords:
INDIA | RESEARCH REPORT | HEALTH PERSONNEL | CAPACITY BUILDING | MATERNAL HEALTH | CHILD HEALTH | ANTENATAL CARE | HEALTH POLICY | Asia, Southern | Asia | Developing Countries | Delivery of Health Care | Health | Program Sustainability | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Policy | Political Factors | Sociocultural Factors
Document Number: 341372

Title: Global action for health system strengthening: Policy recommendations to the G8 Task Force on Global Action for Health System Strengthening.
Author: Japan Center for International Exchange. Task Force on Global Action for Health System Strengthening
Source: Tokyo, Japan, Japan Center for International Exchange, 2009. 131 p.
Abstract: On January 16, 2009, a high-level working group on global health convened by the Japan Center for International Exchange (JCIE) released a report to the Japanese government outlining measures that the G8 countries should take to set them on a path toward fulfilling their existing commitments to contributing to an overall improvement in the health of individuals and communities around the world. The Working Group on Challenges in Global Health and Japan's Contributions (the "Takemi Working Group") is chaired by Japan's former Senior Vice Minister for Health, Labour and Welfare Keizo Takemi and directed by JCIE President Tadashi Yamamoto. The Japanese government will pass the report to the Italian government, encouraging them to put these recommendations on the agenda of the 2009 G8 Summit in Italy. The report includes chapters by an international team of researchers and advisors on three specific building blocks of health systems-health financing, health information, and the health workforce-that are generally acknowledged to be critical components of any strong health system. While each paper offers specific recommendations for improvements that can be made in each individual building block, they also come to several common conclusions: 1.) While there is still a dire need for more resources-financial, human, and knowledge resources-in the global health field, there is also a critical need to use existing resources more efficiently and more effectively. Recognizing that the current global financial environment will make it even more difficult to secure the resources needed to make health systems work better for everyone, the paper writers recommend complementing the quest for more resources with creative thinking on ways to achieve better health outcomes with the resources we already have. 2.) The human security concept, which has become a pillar of Japan's foreign policy, is identified as a promising approach that can be adopted globally for strengthening health systems. Human security's emphasis on the wellbeing of individuals and communities is very much in line with the ultimate goal of health system strengthening: improving people's health and making health services available to all so that they can be healthy, productive members of society. Human security also responds to the complexity of health system strengthening with its focus on integrating community empowerment with protection strategies and its recognition of the dynamic way in which health is interconnected with many other human security challenges. 3.) In all areas of health system strengthening, donor countries tend to tell their partners in developing countries how they should behave and make decisions. This can lead to confusion, with contradicting instructions often coming from multiple donors and even from single donors, and loss of motivation for stakeholders in partner countries to take ownership of processes to improve their own health sectors. Contributing to this challenge, capacity for making informed decisions on health is often weak, further discouraging domestic decision making in planning and management of health systems. The paper writers all recommend that donor countries invest in capacity building for health sector decision making at the national and local levels and, at the same time, encourage stakeholders in partner countries to drive their own planning and implementation processes. 4.) Finally, the paper writers all recommend that the G8 follow through on its commitment to accountability by establishing an annual review of its activities and accomplishments within each of these three building blocks. (excerpt)
Language: English
Keywords:
GLOBAL | DEVELOPING COUNTRIES | CONFERENCES AND CONGRESSES | RECOMMENDATIONS | SYSTEMS ANALYSIS | HEALTH PERSONNEL | LABOR FORCE | HEALTH POLICY | FOREIGN AID | CAPACITY BUILDING | GOVERNMENT FINANCING | INFORMATION SERVICES | PRIMARY HEALTH CARE | INTERNATIONAL COOPERATION | COORDINATION | Research Methodology | Delivery of Health Care | Health | Human Resources | Economic Factors | Policy | Political Factors | Sociocultural Factors | Financial Activities | Program Sustainability | Programs | Organization and Administration | Information | Health Services
Document Number: 328416

Title: Laboratory logistics handbook: A guide to designing and managing laboratory logistics systems.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jun. 83 p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: The importance of quality laboratory services is indisputable. The expansion of programs for human immunodeficiency virus and acquired immunodeficiency syndrome (AIDS), tuberculosis, and malaria requires strong and supportive laboratory services. For antiretroviral therapy (ART) in particular, there has been a growing recognition of this importance, given the number of laboratory tests required to effectively diagnose and monitor AIDS treatment. The need to improve laboratory services for all of these disease programs provides an opportunity to strengthen laboratories in health systems overall so they can accommodate the needs of the communities they serve. This document describes the function and organization of laboratory services and the commodities needed for laboratory services, and it discusses supply chain considerations for management of laboratory commodities.
Language: English
Keywords:
GLOBAL | MANUAL | LABORATORY | LOGISTICS | EQUIPMENT AND SUPPLIES | INGREDIENTS AND CHEMICALS | INFORMATION RETRIEVAL SYSTEMS | STANDARDS | QUALITY CONTROL | STORAGE AND WAREHOUSES | PERSONNEL MANAGEMENT | HEALTH POLICY | FINANCIAL ACTIVITIES | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Organization and Administration | Data Storage and Retrieval | Information Processing | Information | Research Methodology | Policy | Political Factors | Sociocultural Factors | Economic Factors
Document Number: 331659

7.
Title: Reducing health inequities through action on the social determinants of health.
Author: World Health Assembly (62nd: 2009: Geneva)
Source: Geneva, Switzerland, World Health Assembly, 2009 May 22. 5 p. (WHA62.14) Agenda item 12.5
Abstract: The Sixty-second World Health Assembly calls upon the international community, including United Nations agencies, intergovernmental bodies, civil society and the private sector: (1) to take note of the final report of the Commission on Social Determinants of Health and its recommendations; (2) to take action in collaboration with WHO's Member States and the WHO Secretariat on assessing the impacts of policies and programmes on health inequities and on addressing the social determinants of health; (3) to work closely with WHO's Member States and the WHO Secretariat on measures to enhance health equity in all policies in order to improve health for the entire population and reduce inequities; (4) to consider health equity in working towards achievement of the core global development goals and to develop indicators to monitor progress, and to consider strengthening international collaboration in addressing the social determinants of health and in reducing health inequities. (Excerpts)
Language: English
Keywords:
GLOBAL | CONFERENCES AND CONGRESSES | WHO | HEALTH | INEQUALITIES | SOCIOECONOMIC FACTORS | HEALTH POLICY | SOCIAL POLICY | GOALS | INTERNATIONAL COOPERATION | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Economic Factors | Policy | Planning | Organization and Administration
Document Number: 331421

Title: Promoting health and equity: Evidence, policy and action: Cases from the Western Pacific Region.
Author: World Health Organization [WHO]. Regional Office for the Western Pacific
Source: Manila, Philippines, WHO, Regional Office for the Western Pacific, 2009 Mar. [173] p.
Abstract: Recent years have seen a growth in the evidence base on policies and actions to promote health equity. Despite efforts, however, the evidence shows that inequalities are increasing rather than decreasing in many countries. This may partly be due to faulty policy decisions. There is clearly need for a better evidence-based approach on health policies to achieve equity. At the same time, understanding is inadequate on how policy-makers can best make use of the growing evidence base on promoting equity in health. There is a need for stronger links between evidence and health policy-making and implementation. To respond in part to this need, the WHO Western Pacific Regional Office convened the High Level Meeting on Promoting Health Equity: Evidence, Policy and Action from 16-18 October 2007 in Phnom Penh, hosted by the Royal Government of Cambodia, to provide an opportunity to exchange experiences and identify ways to promote the more systematic use of equity research in health policy and action. Health ministers and other stake holders engaged in the evidence-to-policy process were invited to submit case studies that illustrate the process. This book compiles the nine cases presented at the meeting. An introductory chapter comprises a synthesis of the cases and the lessons learned from them.
Language: English
Keywords:
CAMBODIA | CHINA | VIETNAM | NEW ZEALAND | MALAYSIA | MONGOLIA | SUMMARY REPORT | CASE STUDIES | DELIVERY OF HEALTH CARE | PRIMARY HEALTH CARE | TREATMENT | HEALTH POLICY | HEALTH SERVICES | TUBERCULOSIS | CAPACITY BUILDING | PREVENTION AND CONTROL | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southeastern | Asia | Asia, Eastern | Oceania | Developed Countries | Asia, Northern | Studies | Research Methodology | Health | Medical Procedures | Medicine | Policy | Political Factors | Sociocultural Factors | Infections | Diseases | Program Sustainability | Programs | Organization and Administration | Program Evaluation
Document Number: 331453

Title: Wealth Index association with gender issues and the reproductive health of Egyptian women.
Author: Afifi M
Source: Nursing and Health Sciences. 2009 Mar;11(1):29-36.
Abstract: This study investigated the association of the Wealth Index of married women in Egypt with a number of gender and reproductive health issues found in the 2005 Egypt Demographic Health Survey. The data from a subsample of 5249 currently married women from a total of 19,474 was examined using logistic regression analysis. The women's lowest wealth quintile predicted the intention to continue female genital cutting for their daughters, exposure to physical and sexual marital violence, not being empowered in household decisions, having a higher number of children, having an unintended last child, mothers' maltreatment of their children, the perception of a lack of health-care providers or drugs as an obstacle to receiving care, and not being covered by health insurance. The association of poverty with the aforementioned adverse health outcomes are discussed. Physicians should understand the effect of poverty on health and endeavour to influence policy-makers to reduce the poverty burden on health.
Language: English
Keywords:
EGYPT | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | GENDER ISSUES | REPRODUCTIVE HEALTH | POVERTY | ANTENATAL CARE | SOCIOECONOMIC FACTORS | WOMEN'S HEALTH | HEALTH POLICY | Developing Countries | Africa, North | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Sociocultural Factors | Health | Economic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Policy | Political Factors
Document Number: 342089

10.

Title: A case study of reproductive health supplies in Ghana.
Author: Akitobi E; Leahy E; Nerquaye-Tetteh J
Source: Washington, D.C., Population Action International, 2009 Jun. 30 p.
Abstract: This paper, together with five additional case studies from other countries and information from other sources, provides an evidence base for national level advocacy. Each case study is written with generalist advocates in mind. These can include, but are not limited to, civic leaders, parliamentarians, faith-based leaders, and community leaders. This report provides overview of how RH supplies, specifically contraceptives and condoms, are programmed, managed and funded in Ghana. It presents a distillation of information on policies, systems, budgets and key actors to help raise awareness of experienced advocates -- who may lack technical knowledge about contraceptives -- so that they strategically choose advocacy actions and targets. This information should also facilitate collaboration and coordination with advocacy efforts at the global and regional levels. Information and issues from one country may be useful to other countries facing similar challenges. (Excerpt)
Language: English
Keywords:
GHANA | SUMMARY REPORT | CASE STUDIES | RESEARCH METHODOLOGY | REPRODUCTIVE HEALTH | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | HEALTH POLICY | PUBLIC SECTOR | LOGISTICS | MANAGEMENT | FINANCIAL ACTIVITIES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Health | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Distributional Activities | Program Activities | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Macroeconomic Factors | Economic Factors
Document Number: 331428

11.
Title: [Vulnerabilities in the use of contraceptive methods among youth: intersections between public policies and healthcare] Vulnerabilidades no uso de metodos contraceptivos entre adolescentes e jovens:
Author: Alves CA; Brandao ER
Source: Ciencia and Saude Coletiva. 2009 Mar-Apr;14(2):661-70.
Abstract: This article discusses the moments of vulnerability in the utilization of contraceptive methods in the affective-sexual relations in adolescence and youth. The analyzed material consists of 17 semi-structured interviews with young people between 18 and 24 years (9 females and 8 males) of the middle-class of the city of Rio de Janeiro that had passed though at least one episode of pregnancy during adolescence. We also discuss the recent implementation of public policies focused on the sexuality and reproductive health of adolescents and the position of health professionals with respect to this subject within the scope of the Program of Integrated Healthcare for Women, Children and Adolescents (PAISMCA/SES-RJ). The results of the study show discontinuities in the use of contraceptive methods due to the strong gender hierarchy in the relationships between adolescents and the absence of appropriate sexual education in the family and school environments. There is little space for dealing with the sexual questions of the young in health services and schools. There are also cultural barriers that make it difficult for the society to approach the subject in a less prejudicial way, thus turning sexual initiation into a process full of silence and moral disapproval.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | INTERVIEWS | YOUTH | PRIMARY HEALTH CARE | HEALTH POLICY | CONTRACEPTIVE METHODS | ADOLESCENT PREGNANCY | Developing Countries | South America, Eastern | South America | Latin America | Americas | Data Collection | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Policy | Political Factors | Sociocultural Factors | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics
Document Number: 330130

12.

Peer Reviewed

Title: Structural barriers and human rights related to HIV prevention and treatment in Zimbabwe.
Author: Amon JJ; Kasambala T
Source: Global Public Health. 2009 Mar 26;:1-17.
Abstract: There has long been recognition that individual risk factors can only partially explain vulnerability to HIV infection, and that a broader range of socioeconomic, cultural and political factors must be taken into account. More recently this understanding has been applied to addressing obstacles to accessing HIV treatment. Yet, while structural interventions aimed at contextual factors related to HIV prevention and treatment have been shown to be effective, they have not been widely implemented. Using the situation of Zimbabwe as an example, we will present an illustration of how contextual barriers can be understood in human rights terms, and how using a human rights analysis can specifically help define 'structural-rights' interventions and compel their implementation.
Language: English
Keywords:
ZIMBABWE | CRITIQUE | EVALUATION | PERSONS LIVING WITH HIV/AIDS | POLICYMAKERS | HUMAN RIGHTS | HIV PREVENTION | AIDS PREVENTION | SOCIOECONOMIC FACTORS | CULTURE | POLITICAL FACTORS | INTERVENTIONS | SOCIAL PROBLEMS | HEALTH POLICY | SOCIAL POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Administrative Personnel | Organization and Administration | Sociocultural Factors | AIDS | Economic Factors | Programs | Policy
Document Number: 341476

13.
Peer Reviewed

Title: HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies.
Author: April MD; Walensky RP; Chang Y; Pitt J; Freedberg KA; Losina E; Paltiel AD; Wood R
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jul 1;51(3):310-6.
Abstract: BACKGROUND: Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population. METHODS: We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates. RESULTS: HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001). CONCLUSIONS: Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | DATA LINKAGE | STATISTICAL STUDIES | HIV TESTING | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | SCREENING | HEALTH POLICY | CENSUS | HIV INFECTIONS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Studies | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Population Statistics | Measurement
Document Number: 342149

14.

15.

16.

Peer Reviewed

Title: Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature.
Author: Bollini P; Pampallona S; Wanner P; Kupelnick B
Source: Social Science and Medicine. 2009 Feb;68(3):452-61.
Abstract: Immigrant mothers in developed countries often experience worse pregnancy outcomes than native women. Several epidemiological studies have described the pregnancy outcome of immigrant women in European receiving countries, with conflicting results. The present systematic review makes a quantitative synthesis of available evidence on the association between pregnancy outcomes and integration policies. We reviewed all epidemiological studies comparing the pregnancy outcome of native versus immigrant women in European countries from 1966 to 2004 and retained 65 for analysis, from 12 host countries. Overall, as compared to native women, immigrant women showed a clear disadvantage for all the outcomes considered: 43% higher risk of low birth weight, 24% of pre-term delivery, 50% of perinatal mortality, and 61% of congenital malformations. The risks were clearly and significantly reduced in countries with a strong integration policy. This trend was maintained even after adjustment for age at delivery and parity. On the basis of an analysis of naturalisation rates, five countries in our sample could be categorised as having a strong policies promoting the integration of immigrant communities. The mechanisms through which integration policies may be protective include the increased participation of immigrant communities in the life of the receiving society, and the decreased stress and discrimination they may face. The results of this study highlight a serious problem of equity in perinatal health across European countries. Immigrant women clearly need targeted attention to improve the health of their newborn, but a deep societal change is also necessary to integrate and respect immigrant communities in receiving societies.
Language: English
Keywords:
EUROPE | RESEARCH REPORT | LITERATURE REVIEW | PREGNANT WOMEN | FETUS | PREGNANCY | MIGRATION | ANTENATAL CARE | HEALTH POLICY | PREGNANCY OUTCOMES | Developed Countries | Population Characteristics | Demographic Factors | Population | Reproduction | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Policy | Political Factors | Sociocultural Factors
Document Number: 331051

17.
Title: Conflicting policies in China's fight against HIV/AIDS.
Author: Burki T
Source: Lancet Infectious Diseases. 2009 Feb;9(2):84.
Abstract: The police and security forces are hampering Chinese efforts to address the HIV/AIDS epidemic, according to a Human Rights Watch (HRW) report published on Dec 9. "The government has expanded prevention and treatment programmes for drug users" said Joe Amon, HIV/AIDS programme director at HRW, "but at the same time, police are detaining drug users trying to access these services, and putting drug users in so-called drug rehabilitation centres where they are provided no drug dependency treatment". The report focuses on Guangxi province in southern China, but noted that the issues with which it dealt "stem from national laws and policies". HRW claim that police routinely wait outside methadone clinics and pharmacies to arrest suspected drug users. By placing them in mandatory confinement, the report says, the Chinese authorities were discouraging intravenous drug users from engaging with voluntary drug treatment programmes. HRW commented that the rehabilitation centres-which have a country wide population of over 340 000-"subject drug users to abusive, inhuman, and degrading treatment. They not only fail to provide HIV prevention and treatment to drug users, but facilitate its spread". The report added that HIV-positive detainees do not have their CD4 count monitored. According to official figures, there are roughly 700 000 cases of HIV/AIDS in China, and between 3 and 6 million drug users. Unsafe injection practices are a major source of HIV transmission, accounting for nearly half of new cases. "China has been very open-minded in rolling out drug substitution policies" Joseph Schumacher (University of Alabama, USA) told TLID. Since 2000, over 500 methadone clinics have been established in the country. Several nongovernmental organisations run needle exchange programmes. "More NGOs are opening and making voluntary HIV testing and counselling available", Schumacher pointed out. In China, drug addiction is widely regarded as an offence against society. The rehabilitation centres-some of which are known as "re-education through labour" centres-are emblematic of this. Schumacher suggests adjusting their function. "Instead of using these camps or re-education programmes as punishment", he says "integrate evidence-based therapies into the programmes. Use them more as treatment than as incarceration". In a related story, researchers report that improper care and the overuse of anti-tuberculosis drugs, throughout the country, have propelled Chinese rates of drug-resistant tuberculosis to almost twice the global average. (full-text)
Language: English
Keywords:
CHINA | CRITIQUE | EVALUATION | POLICE | POLICYMAKERS | IV DRUG USERS | HIV PREVENTION | AIDS PREVENTION | HEALTH POLICY | DRUG USE AND ABUSE | VOLUNTARY COUNSELING AND TESTING | Asia, Eastern | Asia | Developing Countries | Corrections Officers | Government | Political Factors | Sociocultural Factors | Administrative Personnel | Organization and Administration | Behavior | HIV Infections | Viral Diseases | Diseases | AIDS | Policy | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330595

18.

Peer Reviewed

Title: Political feasibility of scaling-up five evidence-informed HIV interventions in Pakistan: a policy analysis.
Author: Buse K; Lalji N; Mayhew SH; Imran M; Hawkes SJ
Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii37-ii42.
Abstract: Background: Drawing on policy theories, an assessment was made of the perceived political feasibility of scaling-up five evidence-based interventions to curb Pakistan's HIV epidemic: needle and syringe exchange programmes; targeted behaviour change communication; sexual health care for male and transgender sex workers; sexual and reproductive health care for female sex workers; and promoting and protecting the rights of those at greatest risk. Method: A questionnaire was emailed to 40 stakeholders and completed by 22. They expressed their level of agreement with 15 statements for each intervention (related to variables associated with policy success). Semi-structured interviews were conducted with 12 respondents. Results: The interventions represent considerable change from the status quo, but are perceived to respond to widely acknowledged problems. These perceptions, held by the HIV policy elite, need to be set in the context of the prevailing view that the AIDS response is not warranted given the small and concentrated nature of the epidemic and that the interventions do not resonate closely with values held by society. The interventions were perceived to be evidence-based, supported by at least one donor and subject to little resistance from frontline staff as they will be implemented by contracted non-government organisations. The results were mixed in terms of other factors determining political feasibility, including the extent to which interventions are easy to explain, exhibit simple technical features, require few additional funds, are supported and not opposed by powerful stakeholders. Conclusion: The interventions stand a good chance of being implemented although they depend on donor support. The prospects for scaling them would be improved by ongoing policy analysis and strengthening of domestic constituencies among the target groups.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | THEORETICAL MODELS | KAP SURVEYS | POLICYMAKERS | IV DRUG USERS | SEX WORKERS | HIV PREVENTION | BEHAVIOR CHANGE COMMUNICATION | POLICY DEVELOPMENT | HEALTH POLICY | INTERVENTIONS | CAPACITY BUILDING | SEXUALLY TRANSMITTED DISEASE PREVENTION | SYRINGE | NEEDLE SHARING | SOCIAL POLICY | Developing Countries | Asia, Southern | Asia | Research Methodology | Surveys | Sampling Studies | Studies | Administrative Personnel | Organization and Administration | Drug Use and Abuse | Behavior | Sex Behavior | HIV Infections | Viral Diseases | Diseases | Communication Programs | Communication | Behavior Change | Planning | Policy | Political Factors | Sociocultural Factors | Programs | Program Sustainability | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Behavior
Document Number: 340114

19.

Peer Reviewed

Title: The national response to the HIV/AIDS epidemic in Peru: accomplishments and gaps--a review.
Author: Caceres CF; Mendoza W
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51 Suppl 1:S60-6.
Abstract: In Peru, after the first case of AIDS was reported in 1983, nearly 20,000 AIDS cases have been notified to date and between 20,000 and 79,000 persons are estimated to be living with HIV. Despite a relatively low HIV prevalence in the general population, the epidemic has importantly mobilized social actors and economic resources and has helped articulate a very active field within the Peruvian health sector. In recent years, the country has become the largest recipient of HIV funding from the Global Fund for AIDS, Tuberculosis, and Malaria in Latin America, for which a substantial national counterpart has been committed. Peru's predictable selection as one of the 12 focal countries for the 5-year impact evaluation of the Global Fund suggested that an analysis of the response to the HIV epidemic in Peru may provide significant lessons on the possibilities of international aid in the AIDS field, particularly in the Latin American context. This article presents an analysis of the impact of the HIV/AIDS epidemic and the nature of the response articulated by the State and civil society in Peru, based on the Universal Access Principles proposed by World Health Organization, UNAIDS, and others. Relying on a number of recent secondary sources, we focus not only on the impact of the epidemic on morbidity and death but also on the changes in society as a whole, particularly in social movements and their dynamic relationship with the State. We start with an epidemiological overview and move to describe the role of social actors in response to the epidemic and then propose a framework for the analysis of the scope and limitations of the national response and elaborate on potential courses of action that may lead to strengthen accomplishments and resolve remaining gaps.
Language: English
Keywords:
PERU | RESEARCH REPORT | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | MORBIDITY | DEATH RATE | HEALTH POLICY | PUBLIC HEALTH | EPIDEMIOLOGY | EVALUATION | Developing Countries | South America, Western | South America | Latin America | Americas | Measurement | Research Methodology | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Policy | Political Factors | Sociocultural Factors | Health
Document Number: 341319

20.

Peer Reviewed

Title: Engaging parliamentarians as advocates for women's health: findings from Kenya and Namibia.
Author: Caffrey P; Weiss E; Wood L; Connor E; Orza L; Trasi R
Source: Global Public Health. 2009;4(3):271-83.
Abstract: Members of parliament (MPs) are well placed to promote national health policies that improve women's access to quality health care, including HIV services. To catalyse political will and leadership, the International Centre for Research on Women, Centre for the Study of AIDS at the University of Pretoria, International Community of Women Living with HIV/AIDS and Realising Rights: The Ethical Globalization Initiative, conducted the Parliamentarians for Women's Health project in select African countries. This paper focus on participatory community assessments - a methodology used by the project to improve MPs' understanding of women's health issues, particularly HIV/AIDS, and to increase their engagement with civil society in order to better represent women's health needs and concerns. In-depth interviews with eight MPs from Kenya and Namibia highlight the value of the assessments in identifying women's health problems and service gaps. The MPs reported that they undertook various activities after the assessments, including gathering more information about women's health from local communities, pushing for new parliamentary committees to be a platform for health issues, using the information from the assessments to inform policy, more carefully reviewing budget allocations and establishing relationships with civil society. Participatory methods can be used to meet political leaders' needs for information and communities' needs to influence policymaking that affects their lives.
Language: English
Keywords:
KENYA | NAMIBIA | RESEARCH REPORT | GOVERNMENT OFFICIALS | WOMEN'S HEALTH | ADVOCACY | CIVIL SOCIETY | HEALTH POLICY | HIV PREVENTION | PARTICIPATION | WORKSHOPS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Administrative Personnel | Organization and Administration | Health | Communication | Economic Factors | Policy | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Social Behavior | Behavior | Education
Document Number: 341393

21.

Peer Reviewed

Title: Saving the lives of South Africa's mothers, babies, and children: can the health system deliver?
Author: Chopra M; Daviaud E; Pattinson R; Fonn S; Lawn JE
Source: Lancet. 2009 Sep 5;374(9692):835-46.
Abstract: South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ECONOMIC MODEL | EXCESS MORTALITY | CAUSES OF DEATH | HIV INFECTIONS | INTERVENTIONS | IMPLEMENTATION | HEALTH POLICY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Mortality | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Health Services | Delivery of Health Care | Health | Management
Document Number: 342802

22.
Title: HIV: time for the medical community to move forward [editorial]
Author: Chua AC
Source: Annals of the Academy of Medicine, Singapore. 2009 Feb;38(2):97-8.
Abstract: As we encourage more people to undergo HIV testing, it is important to understand the implications of an HIV diagnosis and to respect confidentiality and the voluntary consent process. Regarding HIV testing, 50% believe that it should be voluntary and 62.5% believe that mandatory HIV tests should be conducted on men who have sex with men (unpublished data -data available upon request from author). How do we begin to address these issues in our medical profession? We need sound policies and to challenge traditional medical education. (excerpt)
Language: English
Keywords:
SINGAPORE | SUMMARY REPORT | SCREENING | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HIV TESTING | HIV PREVENTION | TREATMENT | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH POLICY | INFORMED CONSENT | Asia, Southeastern | Asia | Developed Countries | Examinations and Diagnoses | Medical Procedures | Medicine | Health | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Policy | Political Factors | Sociocultural Factors
Document Number: 341548

23.

Peer Reviewed

Title: Estimating inequalities in ownership of insecticide treated nets: does the choice of socio-economic status measure matter?
Author: Chuma J; Molyneux C
Source: Health Policy and Planning. 2009 Mar;24(2):83-93.
Abstract: Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the Abuja targets. The validity of different SES measures has only been tested in a limited number of settings, however, and there is little information on how choice of welfare measure influences study findings, conclusions and policy recommendations. In this paper, we demonstrate that household SES classification can depend on the SES measure selected. Using data from a household survey in coastal Kenya (n = 285 rural and 467 urban households), we first classify households into SES quintiles using both expenditure and asset data. Household SES classification is found to differ when separate rural and urban asset indices, or a combined asset index, are used. We then use data on bednet ownership to compare inequalities in ownership within each setting by the SES measure selected. Results show a weak correlation between asset index and monthly expenditure in both settings: wider inequalities in bednet ownership are observed in the rural sample when expenditure is used as the SES measure [Concentration Index (CI) = 0.1024 expenditure quintiles; 0.005 asset quintiles]; the opposite is observed in the urban sample (CI = 0.0518 expenditure quintiles; 0.126 asset quintiles). We conclude that the choice of SES measure does matter. Given the practical advantages of asset approaches, we recommend continued refinement of these approaches. In the meantime, careful selection of SES measure is required for every study, depending on the health policy issue of interest, the research context and, inevitably, pragmatic considerations.
Language: English
Keywords:
KENYA | RESEARCH REPORT | LOW INCOME POPULATION | SOCIOECONOMIC STATUS | EXPENDITURES | BED NETS | MALARIA PREVENTION | HEALTH STATUS INDEXES | HEALTH POLICY | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Social Class | Socioeconomic Factors | Economic Factors | Financial Activities | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 331225

24.

25.

26.

Peer Reviewed

Title: A global fund for the health MDGs?
Author: Cometto G; Ooms G; Starrs A; Zeitz P
Source: Lancet. 2009 May 2;373(9674):1500-2.
Abstract: The world is off track to achieve the health-related targets of the Millennium Development Goals (MDGs) by 2015. Maternal mortality has stagnated for two decades, child mortality is not declining fast enough, HIV/AIDS still infects people faster than the pace of antiretroviral treatment roll-out, and inequalities are widening within and across countries. Addressing these crises will require increased funding and more efficient spending. The next Board meetings of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance, scheduled for May and June, respectively, present an opportunity to tackle these issues. We propose that the exceptional approach created for the fight against AIDS should be expanded: the entire global health agenda must adopt a rights-based approach, which in some countries requires challenging the model of national financial autonomy. We therefore recommend that the Global Fund and the GAVI Alliance gradually move towards becoming a global fund for all the health MDGs, which will require substantially greater resources to address the broader mandate. As a first step the next Global Fund and GAVI Alliance board meetings should expand the review of their architecture to provide greater support to national health plans, including co-financing non-disease-specific human resources for health. A global fund for the health MDGs would eventually allow the delivery of prevention and treatment services for specific diseases through revamped general health services, reducing transaction costs and streamlining the global health architecture. Such radical, yet rational, action is our best chance of meeting-or at least making significant progress toward-the health-related MDG targets by 2015.
Language: English
Keywords:
DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | POLICYMAKERS | GOALS | DEVELOPMENT POLICY | HEALTH POLICY | FUNDS | FOREIGN AID | INTERNATIONAL COOPERATION | COORDINATION | WHO | Administrative Personnel | Organization and Administration | Planning | Policy | Political Factors | Sociocultural Factors | Financial Activities | Economic Factors | UN | International Agencies | Organizations
Document Number: 341099

27.

Title: Global health and the Bill & Melinda Gates Foundation [letter]
Author: Dabade G; Puliyel J
Source: Lancet. 2009 Jun 27;373(9682):2195-6.
Abstract: David McCoy and colleagues note that half of all Gates Foundation funding goes towards vaccination. US$1.5 billion provided by the Gates Foundation and some donor countries go to fund the GAVI Alliance's "advance marketing commitments" to purchase vaccines and provide them at subsidised costs in developing countries. The advance marketing commitments for pneumococcal vaccine illustrate the problem with this policy quite lucidly. Madhi and colleagues have calculated that 1000 children have to be vaccinated to prevent approximately four cases of pneumonia. Given that the vaccine costs $250 per child, $250 000 will be spent to prevent these four cases of pneumonia. Treatment of four children with pneumonia with oral cotrimoxazole, in accordance with the WHO protocol, will cost $1 in India. The hope that GAVI's funding of vaccines would push down their prices has been belied. One review found that prices actually went up after GAVI funding, meaning that the higher costs are borne by poor nations when GAVI funding is withdrawn. Entering into advance commitments to market this vaccine in developing countries allows GAVI to divert Gates Foundation money to vaccine manufacturers, without providing commensurate benefits to the children it is supposed to help. We agree with McCoy and colleagues that, given the substantial public subsidies that the foundation receives in the form of tax exemptions, its programmes must be subjected to public scrutiny. (full-text)
Language: English
Keywords:
GLOBAL | CRITIQUE | FUNDS | DECISION MAKING | HEALTH POLICY | DISEASE PREVENTION | VACCINES | PROGRAM ACTIVITIES | RESEARCH AND DEVELOPMENT | INTERNATIONAL COOPERATION | Financial Activities | Economic Factors | Behavior | Policy | Political Factors | Sociocultural Factors | Prevention and Control | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Technology
Document Number: 342052

28.

Peer Reviewed

Title: Task shifting for emergency obstetric surgery in district hospitals in Senegal.
Author: De Brouwere V; Dieng T; Diadhiou M; Witter S; Denerville E
Source: Reproductive Health Matters. 2009 May;17(33):32-44.
Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care.
Spanish Abstract: Debido a la prolongada escasez de obstetras, el Ministerio de Salud de Senegal y el Departamento Obst�trico de la Universidad de Dakar acordaron, en 1998, capacitar a equipos distritales integrados por un anestesista, un m�dico general y un auxiliar quir�rgico en cirug�a obst�trica de emergencia. En 2006, se realiz� una evaluaci�n de la pol�tica en tres distritos, donde se examinaron las tendencias en las tasas de intervenciones obst�tricas importantes, los resultados en reci�n nacidos y madres, y los puntos de vista de informantes clave, miembros de la comunidad y estudiantes de medicina en su �ltimo a�o acad�mico. Del 2000 al 2006, 11 equipos quir�rgicos fueron capacitados, pero s�lo seis funcionaban en 2006. El ritmo actual de capacitaci�n no es suficientemente r�pido para abarcar todos los distritos al cabo del 2015. Se observ� un aumento en el �ndice de intervenciones tan pronto se establec�a un equipo, pero la necesidad insatisfecha persisti�. Las autoridades decisorias centrales estimaron que esta pol�tica era m�s viable que capacitar ginec�logos en los hospitales distritales. Entre los obst�culos figuraban la resistencia de los m�dicos acad�micos s�nior, la percibida falta de ascenso profesional entre los m�dicos capacitados y la falta de coordinaci�n del programa. Los m�dicos estimaron el trabajo valioso, pero se quejaban de la baja paga adicional y de no ser sustituidos durante la capacitaci�n. Las comunidades estaban agradecidas porque los servicios salvaron vidas y ahorraron dinero, pero solicitaron mejor informaci�n y mayor continuidad de servicios.
French Abstract: Face au manque d'obst�triciens � long terme, le Minist�re s�n�galais de la sant� et le D�partement d'obst�trique de l'Universit� de Dakar ont convenu en 1998 de former des �quipes de district compos�es d'un anesth�siste, d'un m�decin g�n�raliste et d'un assistant en chirurgie obst�tricale d'urgence. En 2006, une �valuation de la politique a �t� men�e dans trois districts pour analyser les tendances des principales interventions obst�tricales, les r�sultats pour les nouveau-n�s et les m�res et les opinions des informateurs cl�s, des membres des communaut�s et des �tudiants en derni�re ann�e de m�decine. De 2001 � 2006, 11 �quipes chirurgicales ont �t� form�es mais six seulement fonctionnaient encore en 2006. Le rythme actuel de formation n'est pas assez rapide pour couvrir tous les districts d'ici � 2015. Une augmentation du taux d'interventions a �t� not�e d�s la mise en place d'une �quipe, mais les besoins insatisfaits demeuraient. Pour les d�cideurs centraux, cette politique �tait plus viable que la formation de gyn�cologues pour les h�pitaux de district, mais elle se heurtait � la r�sistance des professeurs cliniciens, � un manque per�u de possibilit�s d'avancement pour les m�decins form�s et � une coordination insuffisante entre programmes. Les praticiens estimaient que le travail �tait utile, mais d�ploraient la faible r�mun�ration compl�mentaire et regrettaient de ne pas �tre remplac�s pendant la formation. Les communaut�s se f�licitaient que les services sauvent des vies et �conomisent de l'argent, mais demandaient davantage d'information et une plus grande continuit� des soins.
Language: English
Keywords:
SENEGAL | RESEARCH REPORT | HEALTH PERSONNEL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | HOSPITALS | CESAREAN SECTION | TRAINING PROGRAMS | PROGRAM EVALUATION | HEALTH POLICY | OBSTACLES | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Health Services | Surgery | Treatment | Medical Procedures | Medicine | Health Facilities | Education | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors
Document Number: 342013

29.

Peer Reviewed

Title: Gendered empowerment and HIV prevention: policy and programmatic pathways to success in the MENA region.
Author: Dworkin SL; Kambou SD; Sutherland C; Moalla K; Kapoor A
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jul 1;51 Suppl 3:S111-8.
Abstract: Although HIV in the Middle East and North Africa is currently characterized as a low seroprevalence epidemic, there are numerous factors that are present in the region that could prevent-or exacerbate-the epidemic. The time to invest substantially in prevention-and gender-specific prevention in particular-is now. Given that most policy makers do not make gender-specific plans as epidemics progress, our research team-which draws upon expertise from both within and outside the region-worked together to make programmatic and policy suggestions in the Middle East and North Africa region in 5 key areas: (1) gender-specific and gender transformative HIV prevention interventions; (2) access to quality education and improvements in life skills and sex education; (3) economic empowerment; (4) property rights; and (5) antiviolence. In short, this work builds upon many ongoing efforts in the region and elucidates some of the links between gendered empowerment and health outcomes around the world, particularly HIV and AIDS.
Language: English
Keywords:
MIDDLE EAST | AFRICA, NORTH | RESEARCH REPORT | GENDER RELATIONS | HIV PREVENTION | INTERVENTIONS | HEALTH POLICY | WOMEN'S EMPOWERMENT | PROGRAM ACTIVITIES | Africa | Developing Countries | Gender Issues | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Women's Status | Socioeconomic Factors | Economic Factors
Document Number: 342681


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