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Title: Community-based distribution of injectable contraceptives. Approaches that work.
Author: Futures Group International. Health Policy Initiative
Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Apr. [1] p.
Abstract: Contraceptive prevalence rates in many sub-Saharan African countries surged in the mid-1990s. Much of this increase can be attributed to additional resources devoted to family planning (FP) programs and the uptake of specific methods, including injectable contraceptives. For example, use of injectables in Malawi grew from 2 percent in 1992 to 18 percent in 2004. Surveys in many African countries have found that women prefer injectable contraceptives; in some cases, preference for injectables is 2-1 over oral contraceptives and other methods. In recent years, however, these same countries have experienced a stagnation or decline in overall contraceptive prevalence. Particularly in rural areas, modern contraceptives are often scarce, and few trained professionals are available to provide FP services. One way to increase access to and use of family planning is to promote community-based distribution (CBD) of injectables. Countries struggling with stagnating contraceptive prevalence can begin to alterthis trend by training and empowering community-based workers to provide injectable contraceptives.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CONTRACEPTIVE PREVALENCE | INJECTABLES | ORAL CONTRACEPTIVES | COMMUNITY-BASED DISTRIBUTION | PRIVATE SECTOR | HEALTH SERVICES | Contraceptive Usage | Contraception | Family Planning | Contraceptive Methods | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Macroeconomic Factors | Economic Factors | Delivery of Health Care | Health
Document Number: 331532

Title: The U.S. commitment to global health: Recommendations for the public and private sectors.
Author: Institute of Medicine. Committee on the U.S. Commitment to Global Health
Source: Washington, D.C., Institute of Medicine, 2009 May. 4 p. (Report Brief)
Abstract: In 2008, the Institute of Medicine convened the expert Committee on the U.S. Commitment to Global Health to investigate the U.S. commitment to global health and to articulate a vision for future U.S. investments in this arena. The committee concludes that the U.S. government and U.S.-based commercial entities, foundations, universities, and other nonprofit organizations have an opportunity to improve global health. The committee initially issued an interim report with recommendations aimed specifically at the U.S. government, such as prioritizing global health as a pillar of foreign policy. This subsequent report addresses other sectors as well as government. The committee identifies five areas for action by the interdisciplinary team: 1. Scale-up existing interventions to achieve significant health gains; 2. Generate and share knowledge to address problems prevalent in poor countries; 3. Invest in people, institutions, and capacity building with global partners; 4. Increase U.S. financial commitments to global health; 5. Set the example of engaging in respectful partnerships. (Excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | RECOMMENDATIONS | GOVERNMENT | ORGANIZATIONS | PRIVATE SECTOR | HEALTH | FOREIGN AID | CAPACITY BUILDING | KNOWLEDGE | LEADERSHIP | INTERNATIONAL COOPERATION | Developed Countries | North America | Americas | Political Factors | Sociocultural Factors | Macroeconomic Factors | Economic Factors | Financial Activities | Program Sustainability | Programs | Organization and Administration
Document Number: 331419

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Title: The quality of family planning services and client satisfaction in the public and private sectors in Kenya.
Author: Agha S; Do M
Source: International Journal For Quality In Health Care. 2009 Apr;21(2):87-96.
Abstract: OBJECTIVE: To compare the quality of family planning services delivered at public and private facilities in Kenya. METHODS: Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. RESULTS: Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. CONCLUSIONS: Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities.
Language: English
Keywords:
KENYA | RESEARCH REPORT | DATA ANALYSIS | CLIENTS | FAMILY PLANNING | SATISFACTION | PUBLIC SECTOR | PRIVATE SECTOR | QUALITY OF HEALTH CARE | HEALTH SERVICES | REPRODUCTIVE HEALTH | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Psychological Factors | Behavior | Macroeconomic Factors | Economic Factors | Health Services Evaluation | Delivery of Health Care | Health
Document Number: 342098

Title: Compensation for the brain drain from developing countries [editorial]
Author: Agwu K; Llewelyn M
Source: Lancet. 2009 May 16;373(9676):1665-6.
Abstract: This article examines the consequences and roots of health-worker migration from Sub-Saharan Africa to the developed world, especially to UK, USA and Canada. It explores the results of the major transfer of riches from poor societies to the affluent and discusses a compensation proposal for global justice.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | BRAIN DRAIN | RISK FACTORS | MATERNAL MORTALITY | INFANT MORTALITY | EMPLOYMENT | IMPACT | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Mortality | Macroeconomic Factors | Economic Factors | Communication
Document Number: 341604

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

7.
Peer Reviewed

Title: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh.
Author: Anwar I; Kalim N; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):139-55.
Abstract: This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.
Language: English
Keywords:
BANGLADESH | RURAL AREAS | RESEARCH REPORT | OBSTETRICS | EMERGENCY SERVICES | IMPLEMENTATION | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | OBSTACLES | HEALTH FACILITIES | PUBLIC SECTOR | HUMAN RESOURCES | BLOOD SUPPLY | SAFE MOTHERHOOD | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Evaluation | Program Evaluation | Macroeconomic Factors | Economic Factors | Equipment and Supplies | Medical Procedures | Maternal Health
Document Number: 341937

Peer Reviewed

Title: Women's use of private and government health facilities for childbirth in Nairobi's informal settlements.
Author: Bazant ES; Koening MA; Fotso JC; Mills S
Source: Studies in Family Planning. 2009 Mar;40(1):39-50.
Abstract: The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home.
Language: English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | REFUGEES | TRADITIONAL BIRTH ATTENDANTS | HOUSEHOLDS | CHILDBIRTH | REFUGEE CAMPS | UTILIZATION OF HEALTH CARE | PRIVATE SECTOR | GOVERNMENT PROGRAMS | HEALTH FACILITIES | DEMOGRAPHIC FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Population | Migrants | Migration | Population Dynamics | Health Personnel | Delivery of Health Care | Health | Family and Household | Sociocultural Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Residence Characteristics | Population Distribution | Geographic Factors | Health Services | Macroeconomic Factors | Programs | Organization and Administration
Document Number: 341077

Peer Reviewed

Title: Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda.
Author: Castelnuovo B; Babigumira J; Lamorde M; Muwanga A; Kambugu A; Colebunders R
Source: International Journal of STD and AIDS. 2009 Feb;20(2):123-4.
Abstract: Antiretroviral treatment roll-out programmes in Africa often have difficulties to cope with the increasing number of clients. Based on the findings of a survey carried out in 2005 that showed long waiting times, innovative organizational changes (nurse visits and pharmacy-only refill visits) were introduced in our clinic. In August 2007, the survey was repeated to evaluate the impact of these changes. During both surveys we used the same standardized questionnaire. In 2007, 400 patients visited the clinic on the study day compared to 250 in 2005. The median time spent at the clinic decreased from 157 minutes in 2005 (range 22-426) to 124 minutes (15-314). All the waiting times for different services decreased except the time between the visit to the triage nurse and the doctors' visit. A similar methodology could be used by other health services to evaluate and compare different models of care.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | SURVEYS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | CLINIC VISITS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | CAPACITY BUILDING | TIME FACTORS | ORGANIZATION AND ADMINISTRATION | WAITING AREAS AND QUEUES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Service Statistics | Program Activities | Programs | HIV | AIDS | Program Sustainability | Population Dynamics | Workplace | Employment | Macroeconomic Factors | Economic Factors
Document Number: 331091

10.

Peer Reviewed

Title: Project AID Khmer: addressing the health impact of HIV/AIDS on Cambodia through rural capacity building.
Author: Chang M; Kong NB; Phal V; Pugatch D; Allen S
Source: Global Public Health. 2009 May 27;:1-12.
Abstract: HIV/AIDS prevention efforts in Cambodia have largely focussed on urban populations. This focus, however, has diverted attention from the impact of the disease on rural communities, where poverty and a lack of basic infrastructure forced many to migrate to urban areas. Rural communities thus play a crucial part in the understanding of HIV/AIDS transmission dynamics in Cambodia. This paper will provide an analysis of socio-economic and health-related needs of rural communities in Cambodia, giving a different context for understanding the national burden of HIV/AIDS. These concepts will be illustrated with experiences from Project AID Khmer, a Cambodian non-governmental organisation that is working to improve Cambodian health through education programmes and community capacity building in rural Takeo province.
Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | EVALUATION | RURAL POPULATION | NONGOVERNMENTAL ORGANIZATIONS | CAPACITY BUILDING | HIV PREVENTION | SOCIOECONOMIC FACTORS | PROGRAM EVALUATION | POVERTY | AGRICULTURE | LAND TENURE | RURAL-URBAN MIGRATION | HIV TRANSMISSION | RISK FACTORS | Developing Countries | Asia, Southeastern | Asia | Population Characteristics | Demographic Factors | Population | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Economic Factors | Macroeconomic Factors | Migration | Population Dynamics | Health
Document Number: 341470

11.

Peer Reviewed

Title: Youth, unemployment, and male gender predict mortality in AIDS patients started on HAART in Nigeria.
Author: DeSilva MB; Merry SP; Fischer PR; Rohrer JE; Isichei CO; Cha SS
Source: AIDS Care. 2009 Jan;21(1):70-7.
Abstract: This retrospective study identifies risk factors for mortality in a cohort of HIV-positive adult patients treated with highly active antiretroviral therapy (HAART) in Jos, Nigeria. We analyzed clinical data from a cohort of 1552 patients enrolled in a HIV/acquired immune deficiency syndrome treatment program and started on HAART between December 2004 and 30 April 2006. Death was our study endpoint. Patients were followed in the study until death, being lost to follow-up, or the end of data collection, 1 December 2006. Baseline patient characteristics were compared using Wilcoxon Rank Sum Test for continuous variables and Pearson Chi-Square test for categorical variables to determine if certain demographic factors were associated with more rapid progression to death. The Cox proportional hazard multivariate model analysis was used to find risk factors. As of 1 December 2006, a total of 104 cases progressed to death. In addition to the expected association of CD4 count less than 50 at initiation of therapy and active tuberculosis with mortality, the patient characteristics independently associated with a more rapid progression to death after initiation of HAART were male gender, age less than 30 years old, and unemployment or unknown occupation status. Future research is needed to identify the confounding variables that may be amenable to targeted interventions aimed at ameliorating these health disparities.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | YOUTH | MEN | PERSONS LIVING WITH HIV/AIDS | UNEMPLOYMENT | AIDS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | MORTALITY | DEATH | GENDER ISSUES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors | HIV | Population Dynamics | Sociocultural Factors
Document Number: 331211

12.

Peer Reviewed

Title: Utilization of skilled birth attendants in public and private sectors in Vietnam.
Author: Do M
Source: Journal of Biosocial Science. 2009 May;41(3):289-308.
Abstract: The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women's decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women's household wealth, education, antenatal care and community's wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | CHILDBIRTH | PRIVATE SECTOR | PUBLIC SECTOR | PROGRAM ACCESSIBILITY | SOCIOECONOMIC STATUS | Asia, Southeastern | Asia | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors
Document Number: 341399

13.

Title: A learning agenda.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :79-86.
Abstract: What elements of performance incentive programs lead to success? What pitfalls can be avoided? When do performance-based programs generate more bang for the buck than other approaches? What tools are needed to help governments and nongovernmental organizations (NGOs) put performance-based financing in place? Moving beyond the monitoring and evaluation that should be a part of any performance-based program (chapter 4), here we propose an agenda for learning that extends beyond any individual country or program. It is about developing knowledge and tools that can be used widely, rigorously measuring and understanding what works across settings, and creating an ongoing way to share and learn among those who are implementing and studying performance-based programs. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | HEALTH PERSONNEL | NEEDS ASSESSMENT | WAGES | HEALTH SERVICES | EVALUATION | HEALTH SERVICES ADMINISTRATION | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Management | Organization and Administration
Document Number: 331464

14.

Title: Making payment for performance work.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :51-78.
Abstract: Here we discuss key issues to consider when designing and the steps to implementing a performance incentives program. Among our examples are those that went wrong as well as those that went right, because valuable lessons can be learned from each. While some of the issues may seem complicated, it is not necessary to get all the details right at the outset: refinements can and should be introduced along the way. Fundamentally different from many traditional approaches to improving the delivery of health services, performance incentives are about establishing what the results should be and then letting the key actors -- the patients, the providers -- figure out how to achieve them. Along the way, learning and fine-tuning are part and parcel of the process. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | INCENTIVES | HEALTH SERVICES | QUALITY OF HEALTH CARE | WAGES | DELIVERY OF HEALTH CARE | MONITORING | EVALUATION | HEALTH SERVICES ADMINISTRATION | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Macroeconomic Factors | Economic Factors
Document Number: 331463

15.

Peer Reviewed

Title: Assessing HIV Risk in Workplaces for Prioritizing HIV Preventive Interventions in Karnataka State, India.
Author: Halli SS; Buzdugan R; Ramesh BM; Gurnani V; Sharma V; Moses S; Blanchard JF
Source: Sexually Transmitted Diseases. 2009 Jul 16;
Abstract: OBJECTIVE:: To develop a modelfor prioritizing economic sectors for HIV preventive intervention programs in the workplace. METHODS:: This study was undertaken in Karnataka state, India. A 3-stage survey process was undertaken. In the first stage, we reviewed secondary data available from various government departments, identified industries in the private sector with large workforces, and mapped their geographical distribution. In the second stage, an initial rapid risk assessment of industrial sectors was undertaken, using key-informant interviews conducted in relation to a number of enterprises, and in consultation with stakeholders. In the third stage, we used both quantitative (polling booth survey) and qualitative methods (key informant interviews, in-depth interviews, focus group discussions) to study high-risk sectors in-depth, and assessed the need and feasibility of HIV workplace intervention programs. RESULTS:: The highest risk sectors were found to be mining, garment/textile, sugar, construction/infrastructure, and fishing industries. Workers in all sectors had at best partial knowledge about HIV/AIDS, coupled with common misconceptions about HIV transmission. There were intersector and intrasector variations in risk and vulnerability across different geographical locations and across different categories of workers. This has implications for the design and implementation of workplace intervention programs. CONCLUSIONS:: There is tremendous scope for HIV preventive interventions in workplaces in India. Given the variation in HIV risk across economic sectors and limited available resources, there will be increased pressure to prioritize intervention efforts towards high-risk sectors. This study offers a model for rapidly assessing the risk level of economic sectors for HIV intervention programs.
Language: English
Keywords:
INDIA | RESEARCH REPORT | WORKERS | WORKPLACE | HIV PREVENTION | INTERVENTIONS | SOCIOECONOMIC FACTORS | PROGRAM EVALUATION | Asia, Southern | Asia | Developing Countries | Labor Force | Human Resources | Economic Factors | Employment | Macroeconomic Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 342228

16.

Title: Midwives in China: 'jie sheng po' to 'zhu chan shi'.
Author: Harris A; Belton S; Barclay L; Fenwick J
Source: Midwifery. 2009 Apr;25(2):203-12.
Abstract: We explore the position of midwifery in contemporary China, and draw on fieldwork conducted in Shanxi and Sichuan Provinces during 2005 and 2006, the available literature in English and to a lesser extent in Mandarin. We also explore the historical antecedents to the present-day professional status, practices and position within the health-care system of midwifery in China. We consider the effect on midwifery of the place of biomedicine in the modernising project of the post-reform State, the shift of birth from the private to the public domain, the rise of the medical profession, the medicalisation of birth and the increasing use of technology, and trace changes in the nature of relations between midwives, doctors and the State from Imperial China to the present day. In particular, we examine the changes that have occurred as midwifery has moved from the arena of the lay practitioner ('jie sheng po') to the professional ('zhu chan shi'). We draw out and critique some ways that midwives act to differentiate themselves and lay claim to a variant body of practice-based knowledge, yet question the capacity of midwifery in China today to assert, in any substantial way, a professional identity that distinguishes it from medical obstetric practice.
Language: English
Keywords:
CHINA | RESEARCH REPORT | MIDWIVES AND MIDWIFERY | HEALTH PERSONNEL | PUBLIC SECTOR | CHANGES | Asia, Eastern | Asia | Developing Countries | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Social Change | Sociocultural Factors
Document Number: 341368

17.

Title: A case study of reproductive health supplies in Mexico.
Author: Indacochea CM
Source: Washington, D.C., Population Action International, 2009 Jun. 36 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 Mexico. 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:
MEXICO | SUMMARY REPORT | CASE STUDIES | RESEARCH METHODOLOGY | REPRODUCTIVE HEALTH | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | HEALTH POLICY | PUBLIC SECTOR | LOGISTICS | MANAGEMENT | FINANCIAL ACTIVITIES | FUNDS | North America | Americas | Developing Countries | 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: 331429

18.

Title: A case study of reproductive health supplies in Nicaragua.
Author: Indacochea CM; Leahy E
Source: Washington, D.C., Population Action International, 2009 Jun. 36 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 Nicaragua. 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:
NICARAGUA | SUMMARY REPORT | CASE STUDIES | RESEARCH METHODOLOGY | REPRODUCTIVE HEALTH | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | HEALTH POLICY | PUBLIC SECTOR | LOGISTICS | MANAGEMENT | FINANCIAL ACTIVITIES | ADVOCACY | PROMOTION | KNOWLEDGE | Developing Countries | Central America | Latin America | Americas | 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 | Communication | Marketing
Document Number: 331430

19.

Title: The hidden figure: sexual intimate partner violence among Pakistani women.
Author: Kapadia MZ; Saleem S; Karim MS
Source: European Journal of Public Health. 2009 Aug 7;
Abstract: BACKGROUND: The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. METHODS: Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. RESULTS: Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78; 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64; CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76; CI 0.58-0.98). CONCLUSION: One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner.
Language: English
Keywords:
DEVELOPING COUNTRIES | PAKISTAN | RESEARCH REPORT | WOMEN | CLIENTS | TERTIARY SECTOR | HOSPITALS | DOMESTIC VIOLENCE | RISK FACTORS | SEXUAL ABUSE | SOCIAL PROTECTION | Asia, Southern | Asia | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Macroeconomic Factors | Economic Factors | Health Facilities | Delivery of Health Care | Health | Crime | Social Problems | Sociocultural Factors | Political Factors
Document Number: 342536

20.

Peer Reviewed

Title: The health worker shortage in Africa: are enough physicians and nurses being trained?
Author: Kinfu Y; Poz MR; Mercer H; Evans DB
Source: Bulletin of the World Health Organization. 2009 Feb 10;87:225-230.
Abstract: Objective: To estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of pre-service training in the region suffice to address this serious problem, taking into account population increases and attrition of health workers due to premature death, retirement, resignation and dismissal. Methods: Data on the current numbers and types of health workers and outputs from training programmes are from the 2005 WHO health workforce and training institutions' surveys. Supplementary information on population estimates and mortality is from the United Nations Population Division and WHO databases, respectively, and information on worker attrition was obtained from the published literature. Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa. Findings: Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account. Even if attrition were limited to involuntary factors such as premature mortality, with current workforce training patterns it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1000 population for the countries taken as a whole -and some countries would never reach it. Conclusion: Pre-service training needs to be expanded as well as combined with other measures to increase health worker inflow and reduce the rate of outflow.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | PHYSICIANS | NURSES AND NURSING | HEALTH PERSONNEL | BRAIN DRAIN | RETIREMENT | DEATH | UNEMPLOYMENT | EMPLOYMENT | HUMAN RESOURCES | Developing Countries | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Employment Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Macroeconomic Factors
Document Number: 340208

21.

Title: A case study of reproductive health supplies in Tanzania.
Author: Leahy E; Druce N; Akitobi E; Hardee K; Vogel CG
Source: Washington, D.C., Population Action International, 2009 Jun. 32 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 Tanzania. 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:
TANZANIA | SUMMARY REPORT | CASE STUDIES | RESEARCH METHODOLOGY | REPRODUCTIVE HEALTH | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | HEALTH POLICY | PUBLIC SECTOR | LOGISTICS | MANAGEMENT | FINANCIAL ACTIVITIES | PROMOTION | KNOWLEDGE | Developing Countries | Africa, Eastern | 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 | Marketing
Document Number: 331431

22.

Title: A case study of reproductive health supplies in Uganda.
Author: Leahy E; Akitobi E
Source: Washington, D.C., Population Action International, 2009 Jun. 34 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 Uganda. 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:
UGANDA | SUMMARY REPORT | CASE STUDIES | RESEARCH METHODOLOGY | REPRODUCTIVE HEALTH | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | HEALTH POLICY | PUBLIC SECTOR | LOGISTICS | MANAGEMENT | FINANCIAL ACTIVITIES | PROMOTION | INFORMATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | 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 | Marketing
Document Number: 331432

23.

24.

Title: Blind optimism: Challenging the myths about private health care in poor countries.
Author: Marriott A
Source: Oxford, United Kingdom, Oxfam International, 2009 Feb. 55 p. (Oxfam Briefing Paper No. 125)
Abstract: 'The realization of the right to health for millions of people in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. The private sector can play a role in health care. But this paper shows there is an urgent need to reassess the arguments used in favor of scaling-up private-sector provision in poor countries. The evidence shows that prioritizing this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | EVALUATION | POPULATION | PRIVATE SECTOR | HEALTH SERVICES EVALUATION | PROGRAM ACCESSIBILITY | INEQUALITIES | CAPACITY BUILDING | WORLD BANK | GOVERNMENT PROGRAMS | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors | Program Sustainability | International Agencies | Organizations | Political Factors | Sociocultural Factors | Health
Document Number: 331349

25.

Peer Reviewed

Title: WEALTH, INTELLIGENCE, POLITICS AND GLOBAL FERTILITY DIFFERENTIALS.
Author: Meisenberg G
Source: Journal of Biosocial Science. 2009 Mar 27;41:519-535.
Abstract: SummaryDemographic trends in today's world are dominated by large fertility differentials between nations, with 'less developed' nations having higher fertility than the more advanced nations. The present study investigates whether these fertility differences are related primarily to indicators of economic development, the intellectual level of the population, or political modernity in the form of liberal democracy. Results obtained with multiple regression, path models and latent variable models are compared. Both log-transformed GDP and measures of intelligence independently reduce fertility across all methods, whereas the effects of liberal democracy are weak and inconsistent. At present rates of fertility and mortality and in the absence of changes within countries, the average IQ of the young world population would decline by 1.34 points per decade and the average per capita income would decline by 0.79% per year.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | MATHEMATICAL MODEL | STATISTICAL REGRESSION | POPULATION | FERTILITY RATE | DIFFERENTIAL FERTILITY | POLITICAL FACTORS | ECONOMIC DEVELOPMENT | DEMOCRACY | GROSS NATIONAL PRODUCT | FERTILITY DETERMINANTS | DEATH RATE | INTELLIGENCE | Theoretical Models | Research Methodology | Data Analysis | Birth Rate | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Sociocultural Factors | Economic Factors | Political Systems | Production | Macroeconomic Factors | Mortality | Personality | Psychological Factors | Behavior
Document Number: 341480

26.

Peer Reviewed

Title: "HIV is irrelevant to our company": everyday practices and the logic of relationships in HIV/AIDS management by Japanese multinational corporations in northern Thailand.
Author: Michinobu R
Source: Social Science and Medicine. 2009 Mar;68(5):941-8.
Abstract: Multinational corporations (MNCs) are important participants in workplace initiatives on HIV/AIDS as they collaborate with international organizations to globally promote various policies and guidelines. To date, MNCs have enacted the majority of such initiatives in North America, Europe and South Africa, but we have little information on how MNCs elsewhere, especially in Japan, have responded to the issue of HIV/AIDS in the workplace. This study examines the actual on the ground situation of HIV/AIDS management in Japanese MNCs, specifically investigating everyday corporate practices in the context of internal interactions and relationships and the resulting practices and outlook concerning HIV/AIDS. It is based on a secondary analysis of ethnographic case studies conducted in 10 Japanese-affiliated companies in northern Thailand. Japanese managers, Thai managers and ordinary Thai workers all considered HIV/AIDS to be "irrelevant" to their company and/or themselves. HIV/AIDS measures in the companies were limited to provision of information. This perception and management of HIV/AIDS developed from their everyday interactions governed by the logic of relationships in the companies. In these interactions, they categorized others based on their ascriptive status, primarily based on class, ethnicity and nationality. They sought scapegoat groups that were lower than them in the class- and ethnicity/nationality-based hierarchical system, and cast the risk of HIV infection upon the scapegoat groups, thus reducing their own sense of risk. The paper shows that the relational logic, not ideals or principles, influences their views of and actions concerning HIV/AIDS management in the companies. This is why Japanese companies are unable to deal with HIV/AIDS in terms of international policies and guidelines that are based on the logic of human rights and the logic of business principles. The results suggest a need for international policymakers to pay more attention to everyday practices in the actual field of policy dissemination.
Language: English
Keywords:
JAPAN | THAILAND | RESEARCH REPORT | KAP SURVEYS | ADMINISTRATIVE PERSONNEL | PERSONS LIVING WITH HIV/AIDS | WORKERS | MANAGEMENT | PRIVATE SECTOR | PERCEPTION | ORGANIZATION AND ADMINISTRATION | OCCUPATIONAL HEALTH | SOCIAL CLASS | HUMAN RIGHTS | INTERNATIONAL COOPERATION | Asia, Eastern | Asia | Developed Countries | Developing Countries | Asia, Southeastern | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Labor Force | Human Resources | Economic Factors | Macroeconomic Factors | Psychological Factors | Behavior | Health | Socioeconomic Status | Socioeconomic Factors | Political Factors | Sociocultural Factors
Document Number: 341173

27.

Title: Correlates of the intention to remain sexually inactive among male adolescents in an Islamic country: case of the Republic of Iran.
Author: Mohtasham G; Shamsaddin N; Bazargan M; Anosheravan K; Elaheh M; Fazlolah G
Source: Journal of School Health. 2009 Mar;79(3):123-9.
Abstract: BACKGROUND: There are very few studies that have examined sexual intentions and behaviors of adolescents in Islamic countries. This study employs the Health Belief Model to assess the correlates of the intention to remain sexually inactive among male adolescents in the Republic of Iran. METHODS: This cross-sectional study was performed with a sample of 314 adolescents recruited from 3 high schools from Tehran, Iran. RESULTS: Fifty-seven percent of this sample planned to remain abstinent until marriage. Another 23% rejected the notion of remaining abstinent and 20% were uncertain. Multinomial logistic regression revealed that students whose mothers were employed and who received a higher daily allowance were more likely to report that they would not remain abstinent. No significant independent relationship between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-related knowledge and an intention to remain abstinent was detected. However, consistent with previous studies conducted in Asia, Africa, and in Western countries, we documented that (1) perceived subjective norms, (2) self-efficacy, (3) and perceived susceptibility to contracting the HIV virus all are associated with the intention to remain sexually inactive among adolescents. CONCLUSIONS: It seems abstinence until marriage is more likely to be practiced in traditional families. However, Iranian society is changing rapidly and traditional family structures, values, and norms may not sufficiently protect adolescents from HIV infection. The data from this study support previous studies conducted in Western countries, which found that intervention programs that focus on knowledge alone are ineffective in their ability to alter adolescents' intentions to postpone sexual activity.
Language: English
Keywords:
IRAN | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CROSS SECTIONAL ANALYSIS | MULTIVARIATE ANALYSIS | ADOLESCENTS, MALE | STUDENTS | ABSTINENCE | ISLAM | SECONDARY SCHOOLS | PREVALENCE | INCOME | EMPLOYMENT | VALUE ORIENTATION | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Family Planning, Behavioral Methods | Family Planning | Religion | Sociocultural Factors | Schools | Measurement | Socioeconomic Factors | Economic Factors | Macroeconomic Factors | Psychological Factors | Behavior
Document Number: 341162

28.
Peer Reviewed

Title: Public-sector maternal health programmes and services for rural Bangladesh.
Author: Mridha MK; Anwar I; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):124-38.
Abstract: Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation.
Language: English
Keywords:
BANGLADESH | RURAL AREAS | HISTORICAL REVIEW | MATERNAL HEALTH SERVICES | PUBLIC SECTOR | HEALTH POLICY | OBSTETRICS | EMERGENCY SERVICES | NEEDS | COORDINATION | HUMAN RESOURCES | TRAINING PROGRAMS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Policy | Political Factors | Sociocultural Factors | Medicine | Organization and Administration | Education
Document Number: 341938

29.

30.

Peer Reviewed

Title: Changing global essential medicines norms to improve access to AIDS treatment: lessons from Brazil.
Author: Nunn A; Fonseca ED; Gruskin S
Source: Global Public Health. 2009;4(2):131-49.
Abstract: Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.
Language: English
Keywords:
BRAZIL | CRITIQUE | INTERNATIONAL AGENCIES | AIDS | HEALTH POLICY | COMMERCE | ANTIRETROVIRAL DRUGS | PROGRAM ACCESSIBILITY | PRICING | HUMAN RIGHTS | INTERNATIONAL COOPERATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Policy | Macroeconomic Factors | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Marketing
Document Number: 341397


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