La médecine basée sur les preuves peut-elle servir un projet de santé publique?

Evidence-based medicine is a fashionable topic although the discussions is open regarding whether it has any practical interest for daily medical practice or public health policy. One needs therefore to focus on the way evidence-based medicine can improve matters for physicians, but also on some serious challenges facing health professionals. Upon close examination, it appears that evidence-based medicine provides us with concepts and methods likely to be useful in three directions: improvement of the health care decision-making process, reinforcement of professional accountability dedicated to the promotion of human rights, implementation of fair health policy regulations taking into account the intricate relationships between participants dealing with individual or community oriented interventions. When facing these challenges, evidence-based medicine certainly deserves further attention in the field of community and public health.Le projet d'une médecine basée sur les preuves est attrayant, mais un doute persiste dans le corps médical quant à son intérêt réel pour la pratique individuelle ou collective. Il est donc nécessaire d'en évaluer la pertinence pour le praticien et de considérer attentivement les enjeux sociaux importants qu'il révèle. À l'examen, il apparaît que la médecine basée sur les preuves propose des concepts et une méthode susceptibles de contribuer effectivement à l'amélioration du processus de prise de décision en médecine, à l'exercice d'une responsabilité professionnelle soucieuse de la défense des droits de la personne, et à la mise en oeuvre d'une politique de santé régulée en vue du maintien d'un juste équilibre entre les aspirations individuelles et les projets de la société. Dans cette perspective, la médecine basée sur les preuves peut certainement servir un projet de santé publique

Surveillance de la croissance et prévention de la morbidité du jeune enfant en milieu rural africain: éléments d'évaluation épidémiologique

Doctorat en Sciences de la santé publiqueinfo:eu-repo/semantics/nonPublishe

[Is evidence-based medicine useful for public health?]

Evidence-based medicine is a fashionable topic although the discussions is open regarding whether it has any practical interest for daily medical practice or public health policy. One needs therefore to focus on the way evidence-based medicine can improve matters for physicians, but also on some serious challenges facing health professionals. Upon close examination, it appears that evidence-based medicine provides us with concepts and methods likely to be useful in three directions: unprovement of the health care decision-making process, reinforcement of professional accountability dedicated to the promotion of human rights, implementation of fair health policy regulations taking into account the intricate relationships between participants dealing with individual or community oriented interventions. When facing these challenges, evidence-based medicine certainly deserves further attention in the field of community and public health

Maîtriser un espace sanitaire cohérent et performant dans les villes d'Afrique subsaharienne: le district de santé à l'épreuve.

BACKGROUND: Urban health is a fashionable topic which generates a bulk of research work most often focused on particularities of health problems in urban settings. This focus distracts from the importance of research on how local urban health systems are organized and managed. OBJECTIVE: To analyse the conceptual, managerial and technical problems faced by urban health system policy and organization in sub-Saharan Africa, in order to make recommendations. METHODS: We report here on a research programme carried out to review the available evidence on health system policy and organization in urban areas, and to learn lessons from a number of case studies. RESULTS: First, while the health district approach is usually regarded as a means of implementing primary health care in rural areas, we argue that it is likewise appropriate - theoretically and empirically - for the formulation and implementation of a coherent and effective health system in urban areas. Secondly, we concentrate on a number of contextual features that have to be taken into account in order to strengthen district organization and management in the urban context. Spatial, managerial and technical constraints which do not exist in rural areas, proliferation and fragmentation of uncontrolled health services in the private sector, lack of control over political power of the large national and university hospitals, insufficient governance and leadership of the urban health authorities are pointed out for attention. Having noted and thoroughly analysed these issues is not to suggest therefore that the health district approach has to be rejected but that it has to be modified and adapted in key respects. Thirdly, we outline district health system strengthening in the cities as a policy option less fashionable but more appropriate, including the World Bank agenda for reform, the sector-wide approaches for health development, the health promotion approaches based on the Ottawa Charter, and the poverty reduction approaches focusing on coping strategies of local actors. CONCLUSION: Greater achievements could be reached by urban health systems in sub-Saharan Africa if they were organized and structured according to a health district policy. Key elements of such an organizational and managerial strategy should be realistically understood and assessed so as to provide health managers with a suitable tool for the successful development of primary health care in urban settings. Given the identified contextual constraints, implementation of a district health system in an urban context appears to depend mainly on political will and decision. It calls only incidentally for technical solutions. The following are among the most important requirements that have to be taken into account: ensuring appropriate allocation of resources to a legitimate urban health authority responsible for effective co-ordination of the many actors involved in urban health, setting out key developmental guidelines for the big city hospitals and effective communication channels with these institutions, ensuring development regulation and good governance of the private health sector. The role of the state remains crucial in this perspective.Situation du problème : La santé dans les villes est un thème d'actualité en santé publique mais l'organisation des systèmes de santé urbains n'est pas l'objet d'une attention suffisante. Objectif : Analyser les problèmes posés par l'organisation des systèmes de santé dans les villes d'Afrique subsaharienne et proposer un outil pour résoudre ces problèmes. Méthode : Exposé d'une thèse basée sur une revue de l'expérience internationale en matière d'organisation des services et soins de santé en ville et sur plusieurs études de cas. Résultats : Nous défendons l'idée que le modèle du district de santé doit être réexaminé dans la perspective de la maîtrise d'un espace sanitaire cohérent et performant en ville. Nous examinons ensuite les menaces particulières qui pèsent sur le district de santé dans le contexte urbain et nous soutenons la thèse que la prise au sérieux de celles‐ci impose de procéder à certaines adaptations du modèle de district de santé mais n'oblige aucunement à l'abandonner. Nous précisons enfin dans quelle mesure cette option pour un système local de santé intégré fondé sur la notion de district de santé se distingue d'autres options plus actuelles, comme la réforme du secteur de la santé préconisée par la Banque mondiale, les approches sectorielles du financement durable des dépenses de santé, les approches dites émergentes basées sur la promotion de la santé et les stratégies de survie des acteurs dans un contexte défavorable. Conclusion : Une plus grande maîtrise de l'espace sanitaire dans les villes d'Afrique subsaharienne peut être acquise en structurant le système de santé sur la base des zones de responsabilité que sont les districts sanitaires, à condition d'utiliser le modèle de district avec un recul critique suffisant et de faire l'effort de préciser les éléments permettant de juger la fonctionnalité du district de santé dans le contexte urbain. La mise en œuvre de cette stratégie nécessite avant tout de prendre des décisions à caractère politique et n'appelle qu'accessoirement des solutions techniques. Il s'agit, entre autres, de légitimer une autorité sanitaire urbaine coordonnant les divers acteurs et disposant des moyens matériels et humains adéquats, de redéfinir le rôle des grands établissements hospitaliers, et de réguler la privatisation du secteur de la santé

Un cas de monstre Rhino-cyclocéphalien

info:eu-repo/semantics/publishe

Health information systems for leprosy control programmes: a case for quality assessment.

A qualitative study was carried out aimed at checking the level of understanding and the actual use of the indicators recommended in leprosy control programmes by either the World Health Organization or the International Federation of Anti-Leprosy Associations. Two successive questionnaires were sent to 268 leprosy control programme managers. The first one concerned information about the main characteristics of the programme, the information system in operation, and the data regarded as indispensable or useful for programme monitoring. The respondents to the first questionnaire (n = 64) proposed an extraordinarily wide range of indicators, mainly ill-defined. The respondents to the second questionnaire (n = 37) to whom a limited list of precisely defined indicators was submitted did not succeed in reaching a complete agreement on any of these indicators. Although the question of programme monitoring has been dealt with at an international level for years, there is an urgent need for a real agreement of international agencies and managers of leprosy control programmes on the indicators to be used. Programme managers in the field are obviously open to the idea of greater intervention by international organizations to improve data collection and to encourage standardization of computerized information systems