Pregnancy Exposure Registries for Assessing Antimalarial Drug Safety in Pregnancy in Malaria-Endemic Countries

Feiko ter Kuile and colleagues argue that there is an urgent need to develop targeted pharmacovigilance systems to assess the safety of antimalarials in early pregnancy

Health policy and its implementation in small island developing states in the British West Indies

Health policy and its implementation in small island developing states (SIDS) is a neglected area of study, and, seemingly, of little interest. The existing literature is generally characterized by descriptions of failure or incompetence, with little attempt to understand the nature and workings of the policy process in these small, yet complex, societies. The research undertaken in this article was carried out over 6 years in Anguilla (pop. 9000) and the British Virgin Islands (pop. 20 000), two British Overseas Territories in the North East Caribbean. The purpose of the research was to determine to what extent policy theory and the tools of policy analysis could be used to explain the nature and the outcomes of the health policy and implementation process. In trying to analyse and understand the policy process in these small islands it was necessary to understand their socio-politic character. In addition, the development of a model of the public policy and public administration system in the English-speaking Caribbean was an essential part of this process. It was found that the conduct and outcome of the policy and implementation process in these islands varied significantly. It is postulated that the variations are anchored in the nature of the local context, the working practices and ideologies of politicians, senior public servants and the local policy elit

Between Intent and Achievement in Sector-Wide Approaches: Staking a Claim for Reproductive Health

Since 1995, sector-wide approaches (SWAps) to health development have significantly influenced health aid to developing countries. SWAps offer guidelines for new partnerships with international donors led by government, new relationships between donors and shared financing, development and implementation of agreed packages of health sector reforms. These structural and funding changes have significant implications for reproductive health. The early experience of SWAps suggests that the extent of donor commitment is constrained for administrative, philosophical and political reasons, with vertical programmes (including those relevant to reproductive health) protecting their 'core' business, and reproductive health, as an integrative concept, lacking strong advocates. Defining the sector in terms of government health systems focuses resources on building effective district health systems, but with uncertain outcomes for elements of reproductive health that depend on multi-sectoral strategies, e.g. safe motherhood. The context of the reforms remains a determining factor in their success, but despite savings available through increased efficiencies and coordinated services, the total per capita expenditure on health to ensure minimum clinical and public health services often remains beyond the budget available to least developed nations. Despite this, many of the elements of SWAps--government leadership, new donor relationships, better coordination, sectoral reform and service integration--offer the potential for more effective and efficient health services, including those for reproductive health

Análise da implantação da gestão descentralizada em saúde: estudo comparado de cinco casos na Bahia, Brasil The implementation of decentralized health systems: a comparative study of five cases in Bahia, Brazil

A compreensão das repercussões do processo de des-centralização da saúde no Brasil requer a realização de investigações com enfoques diferenciados, visando a captar a complexidade do objeto a partir de distintos ângulos. Assim, o presente estudo teve por objetivo estimar o grau de implantação da gestão descentralizada da saúde, discutir a influência das características de governo e da gestão em relação ao grau de reorganização das práticas e seus efeitos na saúde da população, por meio de cinco estudos de caso em municípios selecionados da Bahia, Brasil. Foi elaborado um mode-lo teórico-lógico, correspondente à definição de uma "imagem-objetivo" da descentralização da saúde que orientou a elaboração de matriz de indicadores. O estudo revelou que a descentralização sozinha não explica o estágio de organização do sistema municipal de saúde e que características do governo revelaram-se importantes para a reorganização das práticas. Os principais problemas encontrados localizavam-se na gestão do sistema e nas práticas assistenciais, revelando serem estas áreas críticas para futuras intervenções, principalmente no que diz respeito à institucionalização do planejamento e da avaliação, bem como em relação aos projetos intersetoriais.<br>Understanding the effects of health decentralization policies in Brazil requires different methodological approaches to capture the issue's complexity from distinct angles. Five case studies were thus performed to evaluate the degree of implementation of components related to decentralization of the health system management in selected municipalities (counties) in Bahia State, Brazil. A logical model was elaborated with definitions related to policy goals. A comparative study of the five municipalities, considered "exemplary cases", showed that decentralization alone does not explain the organizational changes in the municipal health systems. Local government characteristics such as the municipal master plan, governing capacity, and governance proved important for heath care changes. The main problems and insufficiencies were found in the system's management and quality of healthcare delivered to the population. The authors discuss their findings and identify critical areas for future interventions with special emphasis on the institutionalization of planning and evaluation and the development of inter-sector projects