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‣ Securing Maternal Health Through Comprehensive Reproductive Health Services: Lessons from Bangladesh

Jahan, Rounaq
Fonte: © American Journal of Public Health 2007 Publicador: © American Journal of Public Health 2007
Tipo: Artigo de Revista Científica
Publicado em /07/2007 Português
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During the past decade, there has been a noticeable reduction of maternal mortality in Bangladesh, in part because of government policy and program initiatives. Of particular note is the comprehensive reproductive health strategy adopted in 1996 under the country’s first Health and Population Sector Strategy and the 5-year Health and Population Sector Programme (1998–2003). The latter includes actions in most of the areas recommended in the World Health Organization’s 2004 report, Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets. After assessing Bangladesh’s achievements and challenges in the design and implementation of a maternal health strategy, I concluded that mobilizing and nurturing political will is the key to sustaining policy commitment to comprehensive reproductive health.

‣ A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context

Say, Lale; Raine, Rosalind
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica
Publicado em /10/2007 Português
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Two decades after the Safe Motherhood campaign’s 1987 launch in India, half a million women continue to die from pregnancy-related causes every year. Key health-care interventions can largely prevent these deaths, but their use is limited in developing countries, and is reported to vary between population groups. We reviewed the use of maternal health-care interventions in developing countries to assess the extent, strength and implications of evidence for variations according to women’s place of residence and socioeconomic status. Studies with data on use of a skilled health worker at delivery, antenatal care in the first trimester of pregnancy and medical settings for delivery were assessed. We identified 30 eligible studies, 12 of which were of high or moderate quality, from 23 countries. Results of these studies showed wide variation in use of maternal health care. Methodological factors (e.g. inaccurate identification of population in need or range of potential confounders controlled for) played a part in this variation. Differences were also caused by factors related to health-care users (e.g. age, education, medical insurance, clinical risk factors) or to supply of health care (e.g. clinic availability, distance to facility)...

‣ Measuring the Value of Public Health Systems: The Disconnect Between Health Economists and Public Health Practitioners

Neumann, Peter J.; Jacobson, Peter D.; Palmer, Jennifer A.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /12/2008 Português
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We investigated ways of defining and measuring the value of services provided by governmental public health systems. Our data sources included literature syntheses and qualitative interviews of public health professionals. Our examination of the health economic literature revealed growing attempts to measure value of public health services explicitly, but few studies have addressed systems or infrastructure. Interview responses demonstrated no consensus on metrics and no connection to the academic literature. Key challenges for practitioners include developing rigorous, data-driven methods and skilled staff; being politically willing to base allocation decisions on economic evaluation; and developing metrics to capture “intangibles” (e.g., social justice and reassurance value). Academic researchers evaluating the economics of public health investments should increase focus on the working needs of public health professionals.

‣ The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

Johnson, Mallory O.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /02/2011 Português
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In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities.

‣ The Challenge of Attribution: Responsibility for Population Health in the Context of Accountable Care

Gourevitch, Marc N.; Cannell, Thomas; Boufford, Jo Ivey; Summers, Cynthia
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Português
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One of the 3 goals for accountable care organizations is to improve population health. This will require that accountable care organizations bridge the schism between clinical care and public health. But do health care delivery organizations and public health agencies share a concept of “population”? We think not: whereas delivery systems define populations in terms of persons receiving care, public health agencies typically measure health on the basis of geography. This creates an attribution problem, particularly in large urban centers, where multiple health care providers often serve any given neighborhood. We suggest potential innovations that could allow urban accountable care organizations to accept accountability, and rewards, for measurably improving population health.

‣ Education: A Missed Opportunity for Public Health Intervention

Cohen, Alison Klebanoff; Syme, S. Leonard
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Português
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Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education—from preschool to beyond college—is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity.

‣ Sex, Gender, Genetics, and Health

Short, Susan E.; Yang, Yang Claire; Jenkins, Tania M.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Português
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This article addresses 2 questions. First, to what extent are sex and gender incorporated into research on genetics and health? Second, how might social science understandings of sex and gender, and gender differences in health, become more integrated into scholarship in this area? We review articles on genetics and health published in selected peer-reviewed journals. Although sex is included frequently as a control or stratifying variable, few articles articulate a conceptual frame or methodological justification for conducting research in this way, and most are not motivated by sex or gender differences in health. Gender differences in health are persistent, unexplained, and shaped by multilevel social factors. Future scholarship on genetics and health needs to incorporate more systematic attention to sex and gender, gender as an environment, and the intertwining of social and biological variation over the life course. Such integration will advance understandings of gender differences in health, and may yield insight regarding the processes and circumstances that make genomic variation relevant for health and well-being.

‣ Soft data, hard effects. Strategies for effective policy on health impact assessment: an example from the Netherlands

Broeder,Lea den; Penris,Manon; Put,Gerard Varela
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 Português
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Health impact assessment (HIA) on a strategic level focuses on the broad determinants of health. However, the evidence with regard to the health impacts is often necessarily "soft". The example of a health impact review on national housing policy in the Netherlands shows that HIA can be effective even in the absence of hard data. Strategies used to overcome the problem of not having hard data are outlined. The authors argue that, for HIA to be effective, it does not necessarily have to be limited to easy-to-measure, easy-to-quantify programmes and health effects.

‣ Evaluation as a key part of health impact assessment: the English experience

Quigley,Robert J.; Taylor,Lorraine C.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 Português
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Health impact assessment (HIA) is an approach that has experienced increased activity and wide support within England. This is reflected in the large number of HIAs being undertaken at local and regional levels, by the advocacy of HIA in many national policy documents, and by the setting up of specialized HIA posts and centres. To continue this level of support, and to justify any increase, the approach of HIA must show whether and how the HIA approach informs the decision-making process and, in particular, whether it improves health and reduces health inequalities. The first steps in answering these questions have been taken by the partial evaluation of some completed HIAs within England. A description of these evaluations is presented. Work is also progressing on promising practice guidance for practitioners on the topic of evaluating HIAs. The further development of evaluation within HIA is required, at both a practitioner and research level, and provides an exciting opportunity for people and groups to advance the evidence base for HIA, while also proving its place as an effective public health intervention.

‣ Possible illnesses: assessing the health impacts of the Chad Pipeline Project

Leonard,Lori
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 Português
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Health impact assessments associated with large-scale infrastructure projects, such as the Chad-Cameroon Petroleum Development and Pipeline Project, monitor pre-existing conditions and new diseases associated with particular industries or changes in social organization. This paper suggests that illness self-reports constitute a complementary set of benchmarks to measure the health impacts of these projects, and presents data gathered in ongoing household and health service surveys in Ngalaba, a village near a major oilfield in Chad. In an initial 16-week period of weekly data collection, 363 people reported few of the clinically chronic or asymptomatic conditions expected according to health transition theory, and the overall level of illness reporting was low. Illnesses often were described by symptoms or lay diagnoses. Health care practitioners were consulted rarely; when they were, resources for diagnosis and treatment were limited. Clinically acute, short-duration illnesses (e.g. parasitic infections, toothaches, or hernias) were experienced as chronic conditions and were reported week after week. The low levels of illness reporting and lack of clinically chronic conditions are not taken to mean that rural Chadians are healthy. Rather...

‣ Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

AbouZahr,C.; Vaughan,J.P.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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The use of the disability-adjusted life year (DALY) as the unit in which to calculate the burden of disease associated with reproductive ill-health has given rise to considerable debate. Criticisms include the failure to address the problem of missing and inadequate epidemiological data, inability to deal adequately with co-morbidities, and lack of transparency in the process of ascribing disability weights to sexual and reproductive health conditions. Many of these criticisms could be addressed within the current DALY framework and a number of suggestions to do so are made. These suggestions include: (1) developing an international research strategy to determine the incidence and prevalence of reproductive ill-health and diseases, including the risk of long-term complications; (2) undertaking a research strategy using case studies, population-based surveillance data and longitudinal studies to identify, evaluate and utilize more of the existing national data sources on sexual and reproductive health; (3) comprehensively mapping the natural history of sexual and reproductive health conditions - in males and in females - and their sequelae, whether physical or psychological; (4) developing valuation instruments that are adaptable for both chronic and acute health states...

‣ Investing in children's health: what are the economic benefits?

Belli,Paolo C.; Bustreo,Flavia; Preker,Alexander
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2005 Português
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This paper argues that investing in children's health is a sound economic decision for governments to take, even if the moral justifications for such programmes are not considered. The paper also outlines dimensions that are often neglected when public investment decisions are taken. The conclusion that can be drawn from the literature studying the relationship between children's health and the economy is that children's health is a potentially valuable economic investment. The literature shows that making greater investments in children's health results in better educated and more productive adults, sets in motion favourable demographic changes, and shows that safeguarding health during childhood is more important than at any other age because poor health during children's early years is likely to permanently impair them over the course of their life. In addition, the literature confirms that more attention should be paid to poor health as a mechanism for the intergenerational transmission of poverty. Children born into poor families have poorer health as children, receive lower investments in human capital, and have poorer health as adults. As a result, they will earn lower wages as adults, which will affect the next generation of children who will thus be born into poorer families.

‣ WHO Framework Convention on Tobacco Control: a global ‘‘good’’ for public health

Taylor,Allyn L.; Bettcher,Douglas W.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2000 Português
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Although the application of legal instruments to international health issues - relative to other areas of international concern - is still at a rudimentary stage of development, the transnational health impacts of globalization provide a rationale for the codification and implementation of global norms to deal with shared problems. The experience of promulgating international agreements in other areas closely related to international health - the environment, for example - demonstrates how evidence-based international agreements can effectively address a range of problems that cross national boundaries. The framework convention-protocol approach is a legally binding, incremental approach to international law-making that has frequently been employed to deal with environmental threats, and is now being adapted to serve purely public health ends. Experience with the recently initiated WHO Framework Convention on Tobacco Control provides a case study of how transnational public health problems can be addressed by an international legal approach. Scientific evidence in public health and economics has provided the foundation for the elaboration of this evidence-based strategy. The present tobacco epidemic poses a range of transnational challenges that are best addressed through coordinated action. In this article...

‣ Skill mix in the health care workforce: reviewing the evidence

Buchan,James; Dal Poz,Mario R.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2002 Português
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This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined - identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a "universal" ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations...

‣ Integration of basic dermatological care into primary health care services in Mali

Mahé,Antoine; Faye,Ousmane; N'Diaye,Hawa Thiam; Konaré,Habibatou Diawara; Coulibaly,Ibrahima; Kéita,Somita; Traoré,Abdel Kader; Hay,Roderick J
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2005 Português
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OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases - a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries.

‣ Mental health policy developments in Latin America

Alarcón,R.D.; Aguilar-Gaxiola,S.A.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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New assessment guidelines for measuring the overall impact of mental health problems in Latin America have served as a catalyst for countries to review their mental health policies. Latin American countries have taken various steps to address long-standing problems such as structural difficulties, scarce financial and human resources, and social, political, and cultural obstacles in the implementation of mental health policies and legislation. These policy developments, however, have had uneven results. Policies must reflect the desire, determination, and commitment of policy-makers to take mental health seriously and look after people’s mental health needs. This paper describes the development of mental health policies in Latin American countries, focusing on published data in peer-reviewed journals, and legislative change and its implementation. It presents a brief history of mental health policy developments, and analyzes the basis and practicalities of current practice.

‣ Translating words into actions: are governments acting on the advice of the World health report?

McCoy,David C
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2006 Português
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Every year, WHO produces the World health report: the 2005 report concentrated on maternal, neonatal and child health. But what is the value of these reports? Are they ritualistic publications designed to promote WHO, or are they worthy of proper discussion and debate? One would think that given the current crises in global health, the annual report of the UN's primary agency for health would be important. However, unless there is evidence that these reports are taken seriously, discussed and debated, and shown to have an effect, a conclusion might be drawn that they are largely insignificant. And that would consign WHO to a level of insignificance that it does not warrant. In this discussion of the 2005 report, I aim to provoke a response from both WHO and the international health community to demonstrate that the annual World health reports are meaningful. Furthermore, I suggest here that WHO shows its commitment to the recommendations of the 2005 report by monitoring how well recommendations have been taken forward.

‣ Making research matter: a civil society perspective on health research

Sanders,David; Labonte,Ronald; Baum,Fran; Chopra,Mickey
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2004 Português
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Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research. We suggest that there are at least three ways in which the participation of CSOs in research can be increased: namely, influencing commissioning and priority-setting; becoming involved in the review process and in conducting research; and through formal partnerships between communities and universities that link CSOs with academic researchers.

‣ Barriers to sustainable tuberculosis control in the Russian Federation health system

Atun,R.A.; Samyshkin,Y.A.; Drobniewski,F.; Skuratova,N.M.; Gusarova,G.; Kuznetsov,S.I.; Fedorin,I.M.; Coker,R.J.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2005 Português
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The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries)...

‣ Information and communication technologies and health in low income countries: the potential and the constraints

Chandrasekhar,C.P.; Ghosh,J.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 Português
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This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However...