Future Partnership for the Acceleration of Health Development : report of a conference, 18-20 Oct. 1993, Ottawa, Canada

French version available in IDRC Digital Library: Futur partenariat pour accélérer l'amélioration de la santé : rapport de la conférence, 18-20 oct. 1993, Ottawa, Canad

Social Protection to Address the Drivers of Vulnerability: A Bridge too Far?

Social protection has moved high up on the development agenda and is increasingly considered to be an inherent part of the response to poverty reduction. At the same time, it has received criticism for its current tools and interventions not appropriately taking account of social differentiation and differential access to services. This overview addresses questions around the potential of social protection to be more ambitious and actually address underlying drivers of vulnerability across demographic and social groups. It does so by discussing the need for social protection to be ‘sensitive’ and concurrent issues around political commitment, practical implementation and understandings of impact of social protection

Apoyando el desarrollo en la primera infancia : de la ciencia a la aplicación a gran escala

Mensajes clave de la serie: Las consecuencias de salud y económicas de no actuar son elevadas. Un alarmante 43% de los niños menores de cinco años que viven en países de ingresos bajos y medianos (en total, unos 250 millones de niños) están en riesgo de tener un desarrollo inadecuado a causa de la pobreza y el retraso del crecimiento.1,4 En realidad, este porcentaje es más elevado porque hay otros factores que representan riesgos para la salud y el bienestar. Un mal comienzo en la vida puede afectar negativamente la salud, la nutrición y el aprendizaje. Estos efectos negativos se extienden a la edad adulta, resultando en bajos ingresos económicos y generando tensiones sociales. Además, estas consecuencias negativas repercuten no solo en la generación actual, sino también en las futuras. Se calcula que los individuos afectados por un mal comienzo en la vida sufren una pérdida de aproximadamente una cuarta parte del promedio anual de ingresos en la edad adulta, mientras que los países pueden perder hasta el doble de su gasto actual del PIB en salud y educación; Los niños pequeños necesitan recibir, desde el principio, un cuidado cariñoso y sensible a sus necesidades. El desarrollo empieza en el momento de la concepción. Los estudios demuestran que la primera infancia no es solamente el período de mayor vulnerabilidad a los factores de riesgo, sino también una etapa crítica en la que los efectos positivos de las intervenciones tempranas son más marcados y en la que se pueden reducir los efectos de los factores que afectan negativamente al desarrollo. La experiencia que influye más en el desarrollo de los niños pequeños es el cuidado cariñoso y sensible que le procuran sus padres, otros familiares, sus cuidadores y los servicios comunitarios. El cuidado cariñoso y sensible a las necesidades del niño se caracteriza por la existencia de un ambiente estable que facilita la buena salud y la nutrición de los niños, que protege al niño de posibles peligros y le ofrece la posibilidad de empezar su aprendizaje a una edad temprana, a través de relaciones e interacciones cariñosas. Los beneficios del cuidado cariñoso y sensible se extienden a toda la vida y se expresan en una mejor salud, mayor bienestar y mayor capacidad de aprender y de ganarse la vida. Las familias necesitan apoyo para proveer el cuidado cariñoso y sensible, incluyendo recursos materiales y económicos, políticas nacionales, como licencias de paternidad remuneradas, y prestación de diversos servicios, incluyendo servicios de salud, nutrición, educación y la protección infantil y social; Debemos de entregar intervenciones multisectoriales comenzando con el sector salud como punto de partida para llegar a los niños más pequeños. El objetivo de estas intervenciones, entre ellas el apoyo a las familias para que puedan proporcionar un cuidado cariñoso y sensible y hagan frente a los problemas que se puedan presentar, es proteger al niño de diversos riesgos que pueden afectar a su desarrollo. Para ello, se pueden integrar las intervenciones en los servicios de salud materno-infantil existentes. Estos servicios deben satisfacer las necesidades tanto del niño como de su cuidador principal. Por tanto, deben apoyar el desarrollo del niño y la salud y el bienestar de la madre y la familia. Este enfoque viable es un punto de partida esencial para establecer colaboraciones multisectoriales de ayuda a las familias que permitan llegar a los niños más pequeños. Estas intervenciones deben satisfacer necesidades básicas como la nutrición, el apoyo al crecimiento y la salud; la protección de los niños; la prevención de la violencia doméstica, la protección social que asegure la estabilidad económica de la familia y la capacidad para acceder a servicios; y la educación que brinde acceso a oportunidades de aprendizaje de calidad a una edad temprana; Debemos reforzar la capacidad de las autoridades gubernamentales para ampliar los servicios que funcionan. Cuatro estudios de casos realizados en países de distintas regiones del mundo demuestran que se pueden llevar a gran escala programas nacionales que son efectivos y sostenibles. Sin embargo, para que esto suceda es un requisito indispensable el contar con liderazgo de las autoridades y dar prioridad a las políticas adecuadas. Los gobiernos disponen de distintas opciones para alcanzar las metas y los objetivos fijados en relación con el desarrollo en la primera infancia, desde iniciativas que promuevan cambios y abarquen a diversos sectores gubernamentales hasta la ampliación progresiva de servicios existentes. Los servicios y las intervenciones en favor del desarrollo de los niños pequeños son fundamentales para que todos ellos alcancen el máximo de su potencial en el transcurso de su vida y para extender estos efectos a la siguiente generación. Este propósito es un elemento central de los Objetivos de Desarrollo Sostenible

Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review.

OBJECTIVES: Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration. METHODS: Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference abstracts. RESULTS: Sixty-three of 1936 peer-reviewed articles and 70 of 170 abstracts met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on-site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on-site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral-based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report 'outcomes' (e.g. proportion of TB patients tested for HIV); few report downstream 'impacts' such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost-effectiveness. CONCLUSIONS: While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures

Feeding practices of pre-school children and associated factors in Kathmandu, Nepal

Background: In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding prac- tices of pre-school children and their associated factors. Methods: A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured ques- tionnaire was administered to 145 mothers. Descriptive analyses were con- ducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers’ perception of their current feeding practices. Results: We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01–0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices. Conclusions: Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-eco- nomic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures

Effects of global financial crisis on funding for health development in nineteen countries of the WHO African Region

<p>Abstract</p> <p>Background</p> <p>There is ample evidence in Asia and Latin America showing that past economic crises resulted in cuts in expenditures on health, lower utilization of health services, and deterioration of child and maternal nutrition and health outcomes. Evidence on the impact of past economic crises on health sector in Africa is lacking. The objectives of this article are to present the findings of a quick survey conducted among countries of the WHO African Region to monitor the effects of global financial crisis on funding for health development; and to discuss the way forward.</p> <p>Methods</p> <p>This is a descriptive study. A questionnaire was prepared and sent by email to all the 46 Member States in the WHO African Region through the WHO Country Office for facilitation and follow up. The questionnaires were completed by directors of policy and planning in ministries of health. The data were entered and analyzed in Excel spreadsheet. The main limitations of this study were that authors did not ask whether other relevant sectors were consulted in the process of completing the survey questionnaire; and that the overall response rate was low.</p> <p>Results</p> <p>The main findings were as follows: the response rate was 41.3% (19/46 countries); 36.8% (7/19) indicated they had been notified by the Ministry of Finance that the budget for health would be cut; 15.8% (3/19) had been notified by partners of their intention to cut health funding; 61.1% (11/18) indicated that the prices of medicines had increased recently; 83.3% (15/18) indicated that the prices of basic food stuffs had increased recently; 38.8% (7/18) indicated that their local currency had been devalued against the US dollar; 47.1% (8/17) affirmed that the levels of unemployment had increased since the onset of global financial crisis; and 64.7% (11/17) indicated that the ministry of health had taken some measures already, either in reaction to the global financing crisis, or in anticipation.</p> <p>Conclusion</p> <p>A rapid assessment, like the one reported in this article, of the effects of the global financial crisis on a few variables, is important to alert the Ministry of Health on the looming danger of cuts in health funding from domestic and external sources. However, it is even more important for national governments to monitor the effects of the economic crisis and the policy responses on the social determinants of health, health inputs, health system outputs and health system outcomes, e.g. health.</p

Analysing success in the fight against malnutrition in Peru

The prevalence of underweight children worldwide fell from 31per cent in 1990 to 26 per cent in 2008 (UNICEF 2009). However, progress is still slow and very uneven. Half of the countries have made progress on hunger, but levels of malnutrition did not improve in 28 countries and got worse in 24. The case of Peru appears to be an encouraging exception to the rule. With the support of CARE and others organisations from civil society and the donor community, the Peruvian Government has generated the political momentum to overcome obstacles and create national coordination structures and mechanisms, increase public (and private) spending on programs to tackle malnutrition and align social programs with the national nutrition strategy (known as CRECER). This included adding conditionalities on taking children to regular growth monitoring in the Conditional Cash Transfer programme, JUNTOS. The international aid system has also aligned itself around CRECER. After ten years of almost no change in child chronic malnutrition (stunting) rates (25.8 per cent in 1996, and 22.9 per cent in 2005 – with rural rates moving from 40.4 per cent to 40.1 per cent), this change in strategy has started to lead to results: malnutrition rates fell to 17.9 per cent between 2005 and 2010, with reductions mainly occurring in rural areas where malnutrition rates are highest (from 40.1per cent in 2005 to 31.3 per cent in 2010) according to the Peruvian National Statistical Office (INEI). Over 130,000 children under five are now not chronically malnourished who would have been had rates not fallen. Indeed, there is a strong case to be made that these changes would not have occurred without the formation in early 2006 of the Child Nutrition Initiative, and its advocacy success in getting ten Presidential candidates to sign a commitment to reduce chronic malnutrition in children under five by 5 per cent in five years (‘5 by 5 by 5’), followed by the support provided subsequently to the new government to meet that commitment. This paper documents and systematises Peru’s recent experience in tackling malnutrition. Through an intensive review of quantitative and qualitative evidence, it argues that success is not explained by the presence of favourable socioeconomic changes in Peru, and it explores the political determinants of success in three dimensions. Horizontally, it looks at government efforts to form policy coalitions across representatives of different government and non-government agencies; it looks at the vertical integration of agencies and programmes between national, regional and municipal governments, and it analyses the allocation of government resources used to fund the government’s nutrition effort. In closing, the paper identifies some salient challenges to ensure long term sustainability of the initiative and draws policy recommendations and knowledge sharing lessons that could be of use for Southern Governments, donor agencies and civil society organisations. Keywords: Peru; political economy; malnutrition; sub national politics; poverty reduction; political parties

Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia

BACKGROUND: Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA) to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants) was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. METHODS: A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. RESULTS: Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. CONCLUSION: For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce is an important part of human resources for sustainable progress and development

Global poverty and the new bottom billion: what if three-quarters of the world's poor live in middle-income countries?

This paper argues that the global poverty problem has changed because most of the world’s poor no longer live in low income countries (LICs). Previously, poverty was viewed as an LIC issue predominantly; nowadays such simplistic assumptions/ classifications are misleading because some large countries that graduated into the MIC category still have large numbers of poor people. In 1990, we estimate 93 per cent of the world’s poor lived in LICs; contrastingly in 2007–8 three quarters of the world’s poor approximately 1.3bn lived in middle-income countries (MICs) and about a quarter of the world’s poor, approximately 370mn people live in the remaining 39 low-income countries – largely in sub-Saharan Africa. This startling change over two decades implies a new ‘bottom billion’ who do not live in fragile and conflict-affected states, but in stable, middle-income countries. Such global patterns are evident across monetary, nutritional and multi-dimensional poverty measures. This paper argues the general pattern is robust enough to warrant further investigation and discussion

Progressing Gender Equality Post?2015: Harnessing the Multiplier Effects of Existing Achievements

This article argues that international efforts to progress gender equality now and post?2015 need to build on the achievements of the MDGs and other international frameworks, but simultaneously address the gender dynamics that underpin the root causes of poverty. The first half of the article seeks to unpack the ways in which gender inequalities underpin five clusters of MDGs: poverty and sustainable development; service access; care and caregiving; voice and agency; international partnerships and accountability. The analysis then turns to highlight the importance of harnessing the momentum from other global initiatives such as CEDAW (Convention on the Elimination of All Forms of Discrimination against Women) and the Beijing Platform for Action to promote more fundamental change including: the establishment of a more powerful UN agency to champion gender equality; the institutionalisation of gender budgeting and gender?responsive aid effectiveness approaches; and the promotion of gender?sensitive social protection to tackle gender?specific experiences of poverty and vulnerability