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PubMed1997

International assistance and health care reform in Poland: barriers to project development and implementation.

The restoration of democracy in Poland initiated a major system transformation including reform of the health sector. The international community were quick to respond to the need for assistance. Polish proposals were supported by international experts and projects were developed together with international development agencies and donors. Donors had no experience of central and eastern Europe, these countries had never been beneficiaries of aid and neither side had experience working together. Progress and absorption of funds was slow. Comparative experience from developing countries was used to analyze the barriers encountered in project development and implementation in Poland. The conditions necessary for implementation were not satisfied. Insufficient attention was paid to the project process. Barriers originate on the side of both donors and recipients and additionally from programme characteristics. The most serious problems experience in Poland were lack of government commitment to health care reform leading to failure to provide counterpart funds and low capacity for absorption of aid. Rent seeking attitudes were important. Donor paternalistic attitudes, complex procedures and lack of innovative approach were also present. Poor coordination was a problem on both sides. Multi-lateral projects were too complex and it was not always possible to integrate project activities with routine ones. External consultants played an excessive role in project development and implementation, absorbing a large portion of funds. The barriers have been operationalised to create a checklist which requires validation elsewhere and may be useful for those working in this field.

Financing, Organized↗
PubMed1982

Training of trainers in the Caribbean Basin Water Management Project.

This article discusses the Caribbean Basin Water Management Project, a joint venture of 10 Caribbean countries, the Canadian International Development Agency (CIDA), the Government of the Netherlands, and PAHO. In 1977 an assessment of the project revealed that though training activities were carried out, most of them were designed for engineers and technicians-a small percentage of all employees-who did not pass on their knowledge to their coworkers. The training of trainers program was initiated to encourage improved communication among staff members. The fundamental precept of this program is that training should be a basic component of management activities. The article outlines the criteria for selecting participants for the training workshops, stressing that the prospective candidates should be in supervisory positions where training is part of their job. Instructors should also be carefully selected, and, as in the case of the participants, should have a long-term commitment to the water utility. At the end of the workshop series, the trainees should be able to make a task analysis, write and evaluate performance objectives, demonstrate communication techniques, use training aids, develop and implement an instructional sequence, and apply evaluation mechanisms. The article summarizes the benefits of the program, such as increased productivity of the supervisors, better communication between supervisors and the staff, and improved attitudes on the part of the staff toward their work.

International Cooperation↗
PubMed1990

Nepal: integrating traditional and modern health services in the remote area of Bashkharka.

Within a framework of Primary Health Care (PHC) and Health Promotion (HP), the focus of this paper is on integrating traditional and modern health care in the remote area of Bashkharka, Nepal. The relevance to integrated health care of factors such as geography, ethnicity, religion, national infrastructure and international development agencies are discussed. Issues concerning the relationship between the theory and practice of PHC and HP are raised.

Health Policy↗
PubMed1999

HIV infection associated with drug injecting in the newly independent states, eastern Europe: the social and economic context of epidemics.

AIMS: We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred. METHODS: Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies. FINDINGS: Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition. CONCLUSIONS: An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.

Europe, Eastern↗
PubMed2002

Linking research and practice: participation of nurses in research to influence policy.

In this article, the authors describe research conducted by the Pakistan Nursing Council (PNC) in Islamabad, Pakistan. The research was carried out through collaboration of two components of a large multicomponent Canadian International Development Agency (CIDA)-funded project--the Development of Women Health Professionals Program (DWHP)--with the Colleges of Nursing and the Pakistan Nursing Council. The research was guided by staff of the DWHP and performed by eight nurses undergoing a research course as part of a Diploma in Teaching Administration (DTA) at a postgraduate College of Nursing in the Northwest Frontier Province (NWFP), Pakistan. Research questions related to the collection and analysis of nursing workforce statistics were asked and partially answered, while students gained experience in conducting research. A description of the context in which the research was conducted is provided. Finally, results of the research and the potential benefits for influencing health workforce policy are discussed.

Data Collection↗
PubMed2006

Living among strangers: the needs and functioning of persons with schizophrenia residing in an assisted living facility.

OBJECTIVES: The purposes of this research were to describe the quality of care for severe and persistent mentally ill persons with schizophrenia who reside in an assisted living facility and to explore the characteristics related to the identification of need and the level of functioning of these individuals. The specific objectives of the study were to (a) describe characteristics of the residents, (b) identify relationships among characteristics of residents and the level of functioning, and (c) analyze relationships among these characteristics and resident needs. DESIGN: Correlational, quasi-experimental design. POPULATION/ SAMPLE/SETTING: Face-to-face semistructured interviews were conducted with 58 ALF residents with schizophrenia and eight direct caregivers from eight assisted living facilities in Florida, resulting in representation of 20% of the public assisted living facilities in one county. METHOD: Face to face, semi-structured interviews utilizing multiple scales and instruments. FINDINGS: Findings indicated that the profile of a typical resident living in a public ALF consisted of a 43-year-old, never married Caucasian male who dropped out of high school and had suffered from a psychiatric illness for over 21 years. The most frequent reported current mental health treatment modality of residents was attendance at a community mental health center. This average resident had five inpatient psychiatric hospitalizations, had not been an inpatient at a state psychiatric facility, and was prescribed an average of four different psychiatric medications. Spearman correlational coefficients and stepwise multiple regression analyses revealed that significant relationships existed between level of functioning and the following characteristics: positive symptoms (p = 0.0003), negative symptoms (p = 0.003), medication knowledge (p = 0.0001), and GAF scores, current (p = 0.01) and past (p = 0.009). No significant relationships were indicated among resident characteristics and resident needs. CONCLUSIONS: This descriptive, correlational study provides the foundation for further research on the quality of care for individuals with severe and persistent mental illnesses who reside in assisted living facilities. Understanding the interactions among symptoms of schizophrenia, level of functioning, and unmet needs may provide a future focus for mental health treatment planning and intervention. IMPLICATIONS: National and international agencies develop and implement assisted living facility standards that impact the lives of residents with moderate levels of functioning and multiple unmet needs, having implications for both practice and mental health policy.

Activities of Daily Living↗
PubMedDate not supplied

Rural women and power in Pakistan.

Perceptions of power in women living in rural villages in Pakistan were explored. The Lee-Hezekiah Power Perception Scale was developed by the authors to measure women's perception of their power. The instrument was administered in interviews conducted by a group of Lady Health Visitors who were participating in a project funded by the Canadian International Development Agency. Sixty-nine women ranging in age from 20 to 65 were interviewed. One-way analysis of variance revealed that the oldest group perceived themselves to have more power than the youngest group perceived themselves to have. Stepwise multiple regression indicated that the number of male children a woman had was predictive of the amount of power she perceived herself to have. The results are discussed in relation to existing literature on women and power in developing countries. Implications for further research on women's perceptions of power and health are discussed.

Adult↗
PubMed2000

The ambiguous role of alcohol in economic and social development.

An increased and industrialized alcohol supply in a developing society is usually assumed to have positive effects on economic development, although it may be recognized that the effects on public health and order will be negative. There has been little attention to the potential for negative effects on the economic side. This paper directs attention to such factors as unemployment for cottage producers (often female heads of household) and reduced industrial employment as highly-automated "turnkey" brewers are installed. On the other hand, changes in the mode of production of alcoholic beverages may have little impact on the much larger work-force involved in serving or selling alcohol in retail trade. The net contribution of an increased and industrialized alcohol supply in terms of economic development is unclear, but industrialization and development bring with them increased demands for attention and sobriety, e.g. in motorized traffic and on the production line, which increased drinking may undercut. Decisions by international development agencies on investment in alcohol production and distribution should take account of both the positive and negative impacts on economic development as well as on public health. In line with this, the World Bank has recently decided to invest in alcohol industry projects only when there is a strong positive development impact and the project is "consistent with public health issues and social policy concerns".

Alcoholic Beverages↗
PubMed2005

An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study.

BACKGROUND: An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program. AIM: The objective was to compare the issues, risk factors, social determinants, and challenges in women's occupational health, according to the status of economic development as defined by the World Bank. METHOD: Data were collected through 27 key informant interviews of high-ranking government officials and senior researchers, self-administered questionnaires on country or regional statistics and 16 courtesy calls. RESULTS: Results indicated that women's occupational health problems common in these countries or regions included women's long hours of work (double workday), shift work and a caring role for family and friends. Problems reported in developing countries but not developed countries included poor access to training and protective equipment, and insufficient legislation to protect women's rights. Problems reported in developed countries but not in developing countries included obesity, smoking and not including women in health research. CONCLUSION: This paper provides insights into the changing environment in the workplace, such as increasing participation of women in the paid workforce and changes in gender differences due to the changing country economy, for improving women's occupational health.

Adult↗
PubMed1990

Postcolonial nursing education in Trinidad and Tobago.

In this article the impact of the developed nations on basic nursing education in Trinidad and Tobago in the postcolonial period is discussed and analyzed. Subsequent to self-government in 1956, the national government, in its efforts to become independent of its reliance on Great Britain, turned to the United States and Canada for technical and financial aid. Consequently, sources such as the World Bank, Inter-American Development Bank, Pan American Health Organization/World Health Organization, and the Canadian International Development Agency were major avenues for the provision of ideas, concepts, and values in health planning and policy making with primary health care endorsed by the government. Nursing education was thus influenced by these industrialized concepts and values. The impact of socioeconomic and nursing events in the Caribbean region coupled with local initiatives taken by the indigenous leadership to improve nursing education resulted in a program that was an amalgamation of British, North American, and indigenous features.

Curriculum↗
PubMed1994

Oral health status and treatment needs in different age groups in two regions of Tanzania.

The present study was conducted in two regions of Tanzania, where development of oral health services is supported by the Danish International Development Agency (Danida). The study comprised 6035 subjects in five age groups (5-6 yr, 12 yr, 18 yr, 35-44 yr, 55+ yr). Data were collected using WHO's survey methodology. Dental caries affected the primary dentition of one third to one fourth of the 5-6-yr-olds and mean dft was less than 1.0 in both regions. DMFT for 12-yr-olds was also low (< 1.5 DMFT), but was higher in older age groups, mainly due to more missing teeth. The F-component was negligible in all age groups. Treatment need was mainly simple fillings and extractions. Most periodontal sextants in all age groups were affected by bleeding or calculus. Periodontal pockets were rare and loss of teeth limited. It is concluded that the oral health situation in Tanzania is better than that foreseen in the goals for oral health in Tanzania in the year 2002. On the basis of these findings and the severe economic constraints prevailing within the health services in Tanzania, a revision of The National Plan for Oral Health seems urgent. A realistic estimate of the cost and the possible sources of funding of the plan is mandatory.

Adolescent↗
PubMed2000

[Impact of Streptococcus pneumoniae on pneumonia in Latin American children. SIREVA-Vigía Group].

Community-acquired pneumonia is one of the leading causes of infant morbidity and mortality. Studies conducted in developing countries indicate that the most serious symptoms of pneumonia are associated with bacterial causes, mainly Streptococcus pneumoniae, followed by Haemophilus influenzae type b. Managing those infections in children under two years of age is hindered by the lack of appropriate vaccines and by the decreased susceptibility of S. pneumoniae to penicillin and other antibiotics. In 1993, at the initiative of the Regional System for Vaccines of the Pan American Health Organization, and with funding from the Canadian International Development Agency, a study was designed to identify the S. pneumoniae capsular types that cause invasive disease in Latin American children under 5 years of age. The objective of the study was to determine the ideal composition of a conjugate vaccine that could be used in Latin America, and the penicillin susceptibility of the S. pneumoniae isolates. The initiative was undertaken in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. This report analyzes the information that the participating countries generated on pneumococcal pneumonia. A total of 3,393 children were found with systemic S. pneumoniae infections, of which 1,578 corresponded to pneumonias. The analysis focused on 1,409 cases of pneumonia in Argentina, Brazil, Colombia, Mexico, and Uruguay. Of the children, 63.8% of them were under two years of age. Twelve prevalent capsular types were identified, of which serotypes 14, 5, and 1 were the three most common in the majority of the countries. At the beginning of the study the highest level of penicillin resistance was found in Mexico (47.0%), and the lowest in Colombia (12.1%). Over the 1993-1998 period, resistance to penicillin increased in the five countries. Penicillin resistance was associated with a small number of capsular serotypes, mainly 14 and 23F. The first of those serotypes was resistant to penicillin and to trimethoprim-sulfamethoxazole, and the second was multiresistant. The frequency of resistance to trimethoprim-sulfamethoxazole was high in all of the countries; Argentina had the highest level, 58.0%. A decrease in susceptibility to chloramphenicol was uncommon, except in Colombia, where there was a resistance level of 23.4%. Resistance to erythromycin was low in all the countries, and all the isolates were susceptible to vancomycin.

Child, Preschool↗
PubMed2000

Volta watertight VIP latrine.

The Danish International Development Agency (DANIDA) is assisting the government of Ghana to provide potable water and improved sanitation facilities to about 50% of the Volta Region's population over a 10-year Community Water and Sanitation Programme (CWSP). Sanitation options include designs for household Ventilated Improved Pit (VIP) latrines. However, areas along the coastal belt of the region have a high water table, between 1-1.5 m (3.3-4.95 ft). In addition, about 80% of the inhabitants in these areas depend on shallow hand-dug wells for domestic purposes and irrigation of vegetable gardens. With the construction of these sanitation options under promotion, pollution of the groundwater is inevitable. Circumventing the problem by the programme led to the modification of the present designs into the "Volta Watertight VIP Latrine (VVIP)". The design considerations and the components that have been incorporated to enable it function effectively are presented in this paper for discussion. Five (5) demonstration units were built, and used for a year. Used pits were covered and pit contents examined after a period of six months. Observations made at the end of this fallow led to the conclusion that the VVIP could be adapted for high water table areas to prevent groundwater pollution, baring any constructional defects and inefficiencies.

Developing Countries↗
PubMed2001

Verbal autopsy: a necessary solution for the paucity of mortality data in the less-developed countries.

Although global disease burden can best be described using accurate and reliable mortality data, many investigators rely solely on death certificates, despite the fact that many of the less-developed countries (LDCs) do not have mandated death certifications. In many of these LDCs, particularly in remote areas, verbal autopsy (VA) may be a surrogate for death certificates in ascertaining causes of death. The main benefit of using VA stems from the fact that it is based on laypersons' observations of the diseased, and therefore does not require medical training. Because of human and economic resource constraints in many LDCs, investments in infrastructures for collecting mortality data needed for the planning, monitoring, and evaluation of health are unlikely in the immediate future. Investment in rural health workers who are trained in VA may prove useful in increasing the quality and availability of mortality data from many LDCs. Rural health workers are essentially 'foot doctors' in many of these countries, whose familiarity with nooks and crannies of villages would be beneficial in the collection of needed mortality data. There is a need for international development agencies, such as the World Health Organization, to devote resources for training rural health workers in order to increase the availability of mortality data for describing worldwide disease burdens.

Cause of Death↗
PubMed2002

The future of information technology for health in developing countries.

What is the future of communication technology for health in developing countries? This chapter sets out to answer this question by first considering the background and potential of information technology, identifying some of the issues and trends in communication, and finally following with some challenges and opportunities of how communication technologies can make a difference in health in developing countries. Past research has shown that communication can contribute to all aspects of population, health, and nutrition programs and is relevant in a number of contexts. Some of the trends in using information technology can be classified in the following categories: competition, cognitive-based presentations, comprehensive translation, convergence, and culture. Challenges include finding a way to include the South in the exchange of ideas and information. In addition, reaching a consensus on worldwide quality standards will not be easy. Yet, beyond these challenges, there are many opportunities being created for international development agencies to increase their capacity for impact.

Biomedical Technology↗
PubMed2003

Role of WHO recruited consultants in successful implementation and expansion of the DOTS programme in India.

For successful implementation of DOTS in India, many factors have played important part and one of which is the use of WHO-contracted local consultants. WHO had recruited consultants known as RNTCP Medical Consultants (RMCs) and assigned them to States and districts to provide technical assistance to the State and District TB Officers. In the districts the RMCs assist in preparation of action plans and interact with district and State authorities. The RMC network is funded by WHO and the Canadian International Development Agency. The assignment of RMCs has resulted in much more rapid implementation of the DOTS strategy with sustainable improvement in the quality of the programme in implementing districts.

Antitubercular Agents↗
PubMed2005

[Immunization coverage in the Monkey Bay Head zone Malawi].

OBJECTIVE: To assess the immunization coverage of children in the Monkey Bay head zone, Malawi where the Icelandic International Development Agency (ICEIDA) has been working to improve health care services in the recent years. MATERIALS AND METHODS: A 30 by 7 cluster sample survey, as defined by WHO's Expanded Programme on Immunization (EPI) was conducted to estimate immunization coverage of children aged 12-23 months for tuberculosis (BCG), diphtheria, tetanus and pertussis (DTP), polio (OPV) and measles immunizations. The Head Zone consists of 97 villages with a population of around 105,000 inhabitants. Five health centres provide immunization services in the area. In total were 217 children in 30 clusters randomly selected and their immunization status by card or history registered. RESULTS: Immunization coverage by card or history was 97% for BCG, and 99%, 95% and 85% for DTP1, DTP2 and DTP3 respectively. Coverage of OPV1, OPV2 and OPV3 by card or history was 99%, 93% and 85% respectively. Coverage for measles by card or history was 78%. Fully immunized children by card or history were 152 or 70%. Two children had not received any immunizations. Drop-out rate from DTP1 to DTP3 vaccination by immunization card or history was 14.5%, and drop-out from DTP1 to Measles by card or history was 21%. CONCLUSION: These results indicate that access to childhood immunization in the Monkey Bay head zone is good while drop-out rate is high. This indicates that access to health services is adequate. However, the coverage of measles appears to be insufficient to prevent outbreaks, and must be improved. The efficacy in delivering immunization can be improved and enhanced utilization of the services offered should be sought.

BCG Vaccine↗
PubMed1991

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗