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PubMed2000

Improving the monitoring of immunization services in Kyrgyzstan.

Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

Child↗
PubMed1994

Indigenous perceptions and quality of care of family planning services in Haiti.

This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.

Community Health Centers↗
PubMed1994

Donor funding for health reform in Africa: is non-project assistance the right prescription?

During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria suggest these programmes have proved more difficult to implement than expected. When a country has in place a high level of fiscal accountability and high institutional capacity, programmes of conditioned non-project assistance may be more effective in achieving reforms than traditional project assistance. However, when these elements are lacking, as they were in Niger, non-project assistance offers nothing inherently superior than traditional project assistance. Non-project assistance may be most effective for assisting the implementation of policy reforms adopted by the host government.

Cost-Benefit Analysis↗
PubMed2006

Having the rug pulled from under your feet: one project's experience of the US policy reversal on sex work.

After the election of President George W Bush in 2000, US government policy toward sexual and reproductive health changed dramatically. In May 2003, the Global AIDS Act was passed and prohibits allocation of US government funds to organizations that 'promote or advocate' legalization and practice of prostitution and sex trafficking. There are few documented examples of early impacts of this policy reversal on USAID-funded programmes already working with sex worker communities. This paper offers an anecdotal account of one programme in Cambodia that found itself caught in the ideological cross-fire of US politics, and describes consequent negative effects on the project's ability to offer appropriate and effective HIV prevention services to vulnerable migrant sex workers.

Cambodia↗
PubMed1993

Changes in use of health services in a rural health zone in Zaire.

As part of the Combatting Childhood Communicable Diseases (CCCD) project funded by the US Agency for International Development (USAID), the Zairian CCCD programme conducted surveys in the rural health zones of Kingandu and Pai-Kongila, Zaire, in 1984-1985 and 1988-1989 to determine whether a strategy of selective primary health care would affect childhood mortality. This paper describes the changes in the medical care infrastructure and the increasing coverage of selected services. The strategies evaluated were vaccination, oral rehydration therapy, and treatment of febrile episodes with antimalarial drugs for children; and tetanus vaccination and malaria prophylaxis for pregnant women. The health infrastructure in the Kingandu and Pai-Kongila Health Zones expanded considerably from 1984 to 1989, with health centres increasing from 7 to 18. During this period, economic conditions deteriorated moderately, with the nation experiencing nearly 700% inflation. Medical care costs remained stable because of external subsidies. Use of health services was assessed in 1984, 1988, and 1989. Between 1984 and 1989, the proportion of children aged 12-23 months vaccinated against measles increased from 22% to 71%. Coverage with other vaccine antigens increased similarly. Women's knowledge of the correct recipe for the preparation of sugar-salt solution increased from 0% to 61%. Reported treatment at home with sugar-salt or oral rehydration solution increased from 6% to 53%. The proportion of children with febrile episodes who were treated presumptively for malaria with chloroquine remained unchanged (47% in 1984; 44% in 1988). We conclude that, despite a moderate deterioration in economic conditions, Kingandu and Pai-Kongila Health Zones achieved remarkable increases in use of selected health services between 1984 and 1989, especially in vaccination coverage.

Adolescent↗
PubMed2002

Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger.

OBJECTIVE: The 1998 evaluation sought to assess the Quality Assurance Project (QAP) in Niger since 1993 and the degree of quality assurance institutionalization in the Tahoua Department, and to summarize lessons from introducing the Integrated Management of Childhood Illness (IMCI) guidelines in a quality management (QM) environment. DESIGN: This evaluation collected data from interviews with staff and managers, from focus groups conducted in the communities, and from medical records. The data were then compared with three sources of evaluation criteria. A pre-project assessment provided a baseline across certain impact indicators for tracking progress. Other measures were derived from the objectives and indicators from the QAP/Tahoua project plan, the joint QAP/BASICS (Basic Support for Institutionalizing Child Survival Project) project plan, and from an additional US Agency for International Development (USAID) objective that the joint project be a model for West Africa. SETTING: The evaluation took place in the two departments of Niger in which the joint project was carried out: Tahoua and Dosso. The QA Project launched a pilot program in Niger in 1993 to strengthen newly decentralized regional and district management, and to improve the quality of primary health care in Tahoua. The principal QA Project approach was QM. The BASICS Project became active in Niger in 1995, helping to improve child health services. In 1997, the projects merged in Niger to form the joint QAP/BASICS Project. The Ministry of Public Health (MPH) planned to implement IMCI in 1998, and wished to determine whether QM facilitated the introduction of IMCI. RESULTS: The evaluation team found that QM had been effectively implemented in Tahoua and that there were related improvements in health program indicators. The team also found that the joint project had met most of its objectives and that QM facilitated the introduction of IMCI. A follow-up evaluation 2 years later found continued practice of QM by Nigerien health care providers. CONCLUSION: Several factors contributed to the success of the Tahoua QA program and the joint project: teamwork, focus on patients, clarity of roles through standards, and synergy between the QA Project and the BASICS Project.

Child Health Services↗
PubMed2006

Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues.

The United States Public Law 480 Title II food aid program is the largest U.S. government program directed at reducing hunger, malnutrition, and food insecurity in the developing world. USAID and Title II implementing partners face challenges in measuring the success of Title II programs in reducing household food insecurity because of the technical difficulty and cost of collecting and analyzing data on traditional food security indicators, such as per capita income and caloric adequacy. The Household Food Insecurity Access Scale (HFIAS) holds promise as an easier and more user-friendly approach for measuring the access component of household food security. To support the consistent and comparable collection of the HFIAS, efforts are under way to develop a guide with a standardized questionnaire and data collection and analysis instructions. A set of domains have been identified that is deemed to capture the universal experience of the access component of household food insecurity across countries and cultures. Based on these domains, a set of questions has been developed with wording that is deemed to be universally appropriate, with minor adaptation to local contexts. These underlying suppositions, based on research in multiple countries, are being verified by potential users of the guide. The key remaining issue relates to the process for creating a categorical indicator of food insecurity status from the HFIAS.

Anxiety↗
PubMed1994

Knowledge and use of maternal and child health services by mothers in Papua New Guinea.

A survey was conducted in the coastal area of Morobe Province in Papua New Guinea between March to April 1992 in order to obtain and examine the current health knowledge and practices of mothers with children under two years of age. The purpose of the survey was to gather data for the detailed planning and implementation of a Child Survival Intervention Project funded by USAID. A total of 30 villages in the area were selected utilizing the WHO 30-cluster sampling technique. The results indicated that breastfeeding was a very common practice. However, because nutritional intake was not increased during pregnancy and lactation for many of the women, it is likely that their nutritional intake was insufficient. Although many mothers knew the importance of immunization, they were unclear about the importance of completing immunization series. The utilization of contraceptive methods was very low among women who did not want to have another child within the subsequent two years. The most common methods were injections and pills. The dissemination of health education to isolated rural villages is one of the most important interventions in reducing maternal and infant mortality. As there currently is no health education unit at the Morobe Provincial Department of Health. It is crucial to establish the unit and to emphasize the importance of health education as the tool for disease prevention and health promotion.

Adolescent↗
PubMedDate not supplied

Innovative intersectoral approach reduces blood leads levels of children and workers in Romania.

With the support of the U.S. Agency for International Development (USAID), an intersectoral approach involving the community, governmental and nongovernmental agencies, and the management of the local copper smelting plant succeeded in reducing the blood lead levels of plant workers and of young children living in the vicinity of a copper smelter, Zlatna, Romania. Specifics of the collaborative effort, which attracted enthusiastic responses from all participants, are provided.

Air Pollutants↗
PubMed2006

Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project.

BACKGROUND: In response to the growing HIV epidemic in Nigeria, the U.S. Agency for International Development (USAID) initiated the VISION Project, which aimed to increase use of family planning, child survival, and HIV/AIDS services. The VISION Project used a mass-media campaign that focused on reproductive health and HIV/AIDS prevention. This paper assesses to what extent program exposure translates into increased awareness and prevention of HIV/AIDS. METHODS: This analysis is based on data from the 2002 and 2004 Nigeria (Bauchi, Enugu, and Oyo) Family Planning and Reproductive Health Surveys, which were conducted among adults living in the VISION Project areas. To correct for endogeneity, two-stage logistic regression is used to investigate the effect of program exposure on 1) discussion of HIV/AIDS with a partner, 2) awareness that consistent condom use reduces HIV risk, and 3) condom use at last intercourse. RESULTS: Exposure to the VISION mass media campaign was high: 59%, 47%, and 24% were exposed to at least 1 VISION radio, printed advertisement, or TV program about reproductive health, respectively. The differences in outcome variables between 2002 baseline data and the 2004 follow-up data were small. However, those with high program exposure were almost one and a half (Odds Ratio [O.R.] = 1.47, 95% Confidence Interval [C.I.] 1.01-2.16) times more likely than those with no exposure to have discussed HIV/AIDS with a partner. Those with high program exposure were over twice (O.R. = 2.20, C.I. 1.49-3.25) as likely as those with low exposure to know that condom use can reduce risk of HIV infection. Program exposure had no effect on condom use at last sex. CONCLUSION: The VISION Project reached a large portion of the population and exposure to mass media programs about reproductive health and HIV prevention topics can help increase HIV/AIDS awareness. Programs that target rural populations, females, and unmarried individuals, and disseminate information on where to obtain condoms, are needed to reduce barriers to condom use. Improvements in HIV/AIDS prevention behaviour are likely to require that these programmatic efforts be continued, scaled up, done in conjunction with other interventions, and targeted towards individuals with specific socio-demographic characteristics.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Schistosomiasis vaccine development: progress and prospects.

The undisputed, worldwide success of chemotherapy notwithstanding, schistosomiasis continues to defy control efforts in as much rapid reinfection demands repeated treatment, sometimes as often as once a year. There is thus a need for a complementary tool with effect for the longer term, notably a vaccine. International efforts in this direction have been ongoing for several decades but, until the recombinant DNA techniques were introduced, antigen production remained an insurmountable bottleneck. Although animal experiments have been highly productive and are still much needed, they probably do not reflect the human situation adequately and real progress can not be expected until more is known about human immune responses to schistosome infection. It is well-known that irradiated cercariae consistently produce high levels of protection in experimental animals but, for various reasons, this proof of principle cannot be directly exploited. Research has instead been focussed on the identification and testing of specific schistosome antigens. This work has been quite successful and is already at the stage where clinical trials are called for. Preliminary results from coordinated in vitro laboratory and field epidemiological studies regarding the protective potential of several antigens support the initiation of such trials. A series of meetings, organized earlier this year in Cairo, Egypt, reviewed recent progress, selected suitable vaccine candidates and made firm recommendations for future action including pledging support for large-scale production according to good manufacturing practice (GMP) and Phase I trials. Scientists at the American Centers for Disease Control and Prevention (CDC) have drawn up a detailed research plan. The major financial support will come from USAID, Cairo, which has established a scientific advisory group of Egyptian scientists and representatives from current and previous international donors such as WHO, NIAID, the European Union and the Edna McConnell Clark Foundation.

Animals↗
PubMed1978

Nutrition, development, and foreign aid: a case study of U.S.-directed health care in Colombian plantation zone.

Based on a case study of some aspects of Rockefeller and USAID intervention in the Cauca Valley, Colombia, this article is aimed at drawing attention to the political characteristics and inadequacies of U.S.-sponsored health care planning and research in the Third World, particularly as regards nutrition in rural regions of intensive economic development. By contrasting an historical analysis of the politicoeconomic development of agriculture and nutrition in the southern Cauca Valley with the assumptions guiding U.S. intervention in the health field there, a more complete picture of the causes of malnutrition is obtained, among which should be counted the intervention of the U.S. itself. Inter alia, other approaches to the malnutrition problem are suggested.

Agriculture↗
PubMedDate not supplied

The primary health care services in Nigeria: constraints to optimal performance.

BACKGROUND: This paper examined the management of the Primary Health Care Services in Nigeria using both Primary and Secondary data. METHODS: The Primary data were generated from social survey, interviews and participant observation while secondary data were sourced from health institutions. Data gathered were analysed using quantitative and descriptive methods. RESULTS: The findings of the study showed a low level of interaction and coordination among tiers of government which resulted in poor performance of PHC at the grassroot. The Primary Health Care Programme was grossly underfunded which manifested in the low performance of the PHC delivery facilities. The research identified some institutional impediments such as conflicts between Local and State Governments resulting in a strained relationship, poor collaboration and weak linkage. Community participation which is a sine qua non in the attainment of the objectives of the programme was very low. Finally, the participation of international organisations like UNICEF and USAID in PHC Programme was responsible for most of the achievement made so far. CONCLUSION: The research recommended among others that the three tiers of government must relate to one another to ensure that a harmonious relationship exists at all times through official interactions on all issues that affect the three levels of government especially the policy formulation, implementation, and evaluation, and evaluation of the Primary Health care programme.

Budgets↗
PubMed1998

Qualitative evaluation of a health management education partnership.

Results of ongoing cooperation of four educational institutions in the field of Health Management Education in Slovakia are reviewed. The specific benefit of multilateral collaboration for the situation in central Europe is discussed in the context of a Health Management Education Partnership (HMEP). The project is based on a grant from the United States Agency for International Development (USAID) with assistance from the American International Health Alliance (AIHA). The U.S. partner is the University of Scranton, Scranton, Pennsylvania. Three organizations are involved in the partnership from the Slovak Republic: Trnava University, University of Matej Bel in Banska Bystrica and the Health Management School (HMS) in Bratislava, each having specific priority and focus in health management education. The HMEP program is designed to reach about 30 teachers of health administration as well as 200 undergraduates, senior and middle managers from health service organizations every year. The collaborative endeavor stimulates the communication and creation of personal and human relations, not only on an individual and institutional level, but on a community as well as national and international level. The project supports the development of knowledge and skills, professional identity and educational processes in health management. The emphasis is on increasing the quality of education and training in Slovakia through multilateral collaboration, curricula development, professional development, symposia, support of consultancies and accreditation. Specific areas of content are designed to address health policy, law, ethics, insurance and quality improvement.

Accreditation↗
PubMedDate not supplied

[The prevention of HIV/AIDS among injection narcotics users in the city of Odessa].

Since August 1996 the realization of the first Ukrainian Project "HIV/AIDS Preventive Maintenance among Injecting Drug Users", based on the strategy of harm reduction, has been started in Odessa with a view to the effective counteraction to the spread of HIV/AIDS among injecting drug users (IDU). The project is being realized with the advisory and financial support of UNAIDS, UNICEF and USAID. The basic organization for the realization of the Project is the Public Movement "Faith, Hope, Love". The Project is aimed at decreasing the rate of the spread of HIV infection in cases of the non-medical use of narcotic drugs by the elaboration and adoption of measures conductive to changes in hazardous behavior. The realization of the project includes the following stages: the rapid evaluation of the situation with the injecting use of drugs in Odessa, the elaboration and adoption of preventive measures.

Acquired Immunodeficiency Syndrome↗
PubMed1984

DeLucca named project director in Guatemala.

Mike Delucca, a social marketing specialist since 1978, has been named director of a new contraceptive social marketing effort in Guatemala. The project is sponsored by Importadora de Productos Farmaceuticos (IPROFA), S.A., a group of private-sector community leaders who came together specifically to set up the project. IPROFA plan to being marketing 1 brand of oral contraceptive, condom, and foaming tablet in early 1985. Efforts will first be targeted at economically and socially disadvantaged fertile couples between the ages of 18-44 in large urban areas. By the end of 1985 marketing will begin in rural and small urban areas. DeLucca is on assignment IPROFA from Juarez and Associates, a marketing and research firm in Los Angeles. He was formerly with Development Associates of Arlington, Virginia, and served as project director for the social marketing project in El Salvador. He joined the Guatemala project in May 1984, overseeing prelaunch activities that included development of the marketing plan. After the product launch he will coordinate sales and follow-up marketing studies. The project is the result of a cooperative agreement between IPROFA and US Agency for International Development (USAID) signed in April 1982.

Administrative Personnel↗
PubMedDate not supplied

House okays $330 million for population.

A total of $330 million for international population assistance has been approved by the US House of Representatives in the foreign operations appropriations bill for fiscal 1993. The legislation, which includes $20 million for the UNFPA, is expected to be considered by the Senate in the late summer or early autumn. The bill stipulated that the amount earmarked for UNFPA must be used solely for the provision of FDA-approved contraceptives and related logistics. Other restrictions placed on the funds specify that; none of the funds may be used in the People's Republic of China; they must be placed in a separate account and not co-mingled with any other funds; they may not be use to carry out any program, project or activity disapproved by the US Ambassador to the UN; the full amount must be refunded if UNFPA provides more than $57 million for its 5-year family planning program in china that began in 1990 and for which funds already have been committed. Once the largest donor to UNFPA, the US government has not contributed to the Fund since 1985 after the Reagan Administration and antifamily planning forces in Congress lashed out against UNFPA for its support of the allegedly coercive Chinese national family planning program. 2 USAID probes were unable to trace UNFPA funds to the forced abortions the Chinese government program was charged with encouraging and carrying out. Nevertheless, after Congress approved the 1989 foreign operations bill with $15 million earmarked for UNFPA, President Bush vetoed the measure. In his veto message, the President said that UNFPA "participates in and strongly defends the program of a particular foreign government which relies heavily upon compulsory abortion." Pointing out that UNFPA has received no US assistance since 1985 "precisely because of its involvement in this coercive abortion policy," Bush said the 1989 bill represented "a radical and unwarranted change in policy." Although the President failed to name the country that "relies heavily upon compulsory abortion" congressional opponents of refunding UNFPA singled out China as that country. The Chinese government has repeatedly issued official denials that force or coercion are involved in its population policy or programs. Meanwhile, the Bush administration has been pushing hard for Congress to grant most favored nation trade status to China, UNFPA is the largest multilateral agency providing population assistance to developing countries. But Dr. Nafis Sadik, executive director of the Fund, says that "requests for assistance from all regions have mounted to a level that can no longer be met by our organization." She pointed out that the demand for UNFPA support already exceeds the Fund's resources by $500 million. Additionally, she said, many countries--particularly in sub-Saharan Africa--want to expand their current population programs, and new requests are coming from the Commonwealth of Independent States, the Baltic States, and Eastern Europe. More than 100 countries contribute to UNFPA, but most of the Fund's resources are derived from a handful of donors--Japan, the Netherlands, Norway, Finland, Germany, Sweden, Denmark, the United Kingdom, and Canada.

Abortion, Induced↗
PubMedDate not supplied

Honduran women received no written information on contraceptive pill.

In the period 1989-1994, Honduran women participating in the Project Health Sector 2 have been exposed to a contraceptive mini-pill, Ovrette. The Institute of Honduran Social Security (IHSS) approved the program (in which Ovrette distribution is included) in May 1990. The program is partly funded by the Population Council, which is funded by USAID Registry with the Department of Health was not required under the Health Code since Ovrette had entered the country as a donation. In June 1993, a Commission of the Honduran Medical Association reported that the women were not given any written information on the drug. Ovrette is an oral contraceptive manufactured by Wyeth. Its active ingredient is a progestagen, Norgestrel. Contraindications for Ovrette include: non-lactating women who exhibit side-effects such as dizziness, water retention, migraine, etc.; non-lactating women with contraindications for estrogen; lactating women who reject other contraceptive drugs. The US Pharmacopeia and the US Food and Drug Administration do not authorize the drug for use by lactating women. As with other progestagens, Norgestrel passes through to the mother's milk. In 1993, the US Pharmacopeia reported that these hormones can cause harmful effects to the child, and recommended switching medications or discontinuation of lactation. In 1983, the WHO expressed concern about the possibility of injury caused by the progestagens. The possibilities included alterations to personality, behavior, anatomy of sexual organs, reproductive capacity, immunological function and development of neoplasia. Possible damages in puberty or during the reproductive age are not known since there is no study of exposed children that are older than 12 years of age.

Americas↗