The burden of road traffic injuries in developing countries: The 1st national injury survey of Pakistan

Objectives: To assess the burden of road traffic injuries in Pakistan-a developing country in South Asia. Methods: A nationally representative household interview survey, to measure the burden of all injuries for all ages and in both genders using a three-month recall period. Results: The overall incidence of injury events was 41 (CI: 39.2-43.8) per 1000 per year and for road traffic injuries 15 (CI: 13.7-16.5) per 1000 per year. The relative risk for road traffic injuries was found to be higher in males, those 16-45 years old, and those in the professional category of laborers and vendors. Conclusions: This first national survey reflects the growing impact of injuries, especially road traffic injuries in Pakistan and portends a challenge for the national health system. © 2003 The Royal Institute of Public Health. All rights reserved

Injury patterns in long-term refugee populations: A survey of Afghan refugees

BACKGROUND: Injuries account for approximately 15% of global disability- adjusted life years lost each year and have an even greater impact on loss of life in vulnerable populations. For refugees, injuries reflect consequences of previous actions in their location of origin, current behavioral trends, and assimilation of risk factors from their adopted location. The Afghan Refugee Injury Survey (ARIS) was undertaken to describe the epidemiology of injuries in the long-term Afghan refugee population residing in Pakistan in 2002. METHODS: ARIS is a cross-sectional survey of injuries, injury-related deaths, and disability administrated on a representative sample of households in selected Afghan refugee camps in Pakistan. The sample design was a stratified, systematic sample of all households in the study area. RESULTS: Altogether, 1,123 households, with 8,809 persons (51% males; mean age, 20 years ± 17 years) were surveyed. One hundred twelve persons (1.27%, 95% CI = 1.0-1.5%) were injured during a 3-month recall period (69% males), reflecting an all-injury incidence of 50.8 per 1,000 persons/year. CONCLUSIONS: Our study provides an epidemiologic profile of injuries in Afghan refugees in Pakistan which can be used to inform policy makers, public health professionals, and healthcare providers to support injury prevention as a component of refugee health care. © 2009 Lippincott Williams & Wilkins, Inc

Framework for assessing governance of the health system in developing countries: Gateway to good governance

Governance is thought to be a key determinant of economic growth, social advancement and overall development, as well as for the attainment of the MDGs in low- and middle-income countries. Governance of the health system is the least well-understood aspect of health systems. A framework for assessing health system governance (HSG) at national and sub-national levels is presented, which has been applied in countries of the Eastern Mediterranean. In developing the HSG framework key issues considered included the role of the state vs. the market; role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. Four existing frameworks were considered: World Health Organization's (WHO) domains of stewardship; Pan American Health Organization's (PAHO) essential public health functions; World Bank's six basic aspects of governance; and United Nations Development Programme (UNDP) principles of good governance. The proposed HSG assessment framework includes the following 10 principles--strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics. The framework permits 'diagnoses of the ills' in HSG at the policy and operational levels and points to interventions for its improvement. In the case of Pakistan, where the framework was applied, a positive aspect was the growing participation and consensus orientation among stakeholders, while weaknesses were identified in relation to strategic vision, accountability, transparency, effectiveness and efficiency and rule of law. In using the HSG framework it needs to be recognized that the principles are value driven and not normative and are to be seen in the social and political context; and the framework relies on a qualitative approach and does not follow a scoring or ranking system. It does not directly address aid effectiveness but provides insight on the ability to utilize external resources and has the ability to include the effect of global health governance on national HSG as the subject itself gets better crystallized. The improved performance of the ministries of health and state health departments is at the heart of this framework. The framework helps raise the level of awareness among policymakers of the importance of HSG. The road to good governance in health is long and uneven. Assessing HSG is only the first step; the challenge that remains is to carry out effective governance in vastly different institutional contexts.Governance Health system Assessment framework