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Lobbying for international health: the link between good ideas and funded programs: Bread for the World and the Agency for International Development.

Historically, the Agency for International Development (AIDS) health budget has been closely tied to overall development spending. A large increase in the international health appropriations in 1984 broke this pattern. Investigation shows that active grass roots organizing and congressional lobbying are the most likely responsible factors in the increase. Maintenance and expansion of this success will require increased recognition of and participation in these activities by individuals and organizations involved in international health.

Child Health Services

A new Canadian health care initiative in Tanzania.

One of the main conclusions of the World Bank's World Development Report 1993--Investing in Health was that equitable access to a package of essential clinical and public health services could significantly reduce the overall burden of disease in low-income countries. The report argued that more rational and effective decisions with regard to the allocation of limited resources could be made on the basis of burden-of-disease and cost-effectiveness analyses. In collaboration with the Canadian International Development Agency and several other organizations, the International Development Research Centre has developed the Essential Health Interventions Project to test the feasibility of this approach in a few districts in Tanzania. Outcome assessment wil focus on improved planning at the district level and on changes to the health status of the study population.

Canada

Future role of the Agency for International Development in world-wide malaria control programs.

The world-wide importance of malaria in restricting economic growth, labor productivity and social progress in many less developed portions of the world and A.I.D.'s past, present and future role in the control of this disease is briefly reviewed. In developing its future role in a changing and dynamic setting, the A.I.D. has developed and established new policies for malaria control which interlink more closely with the Primary Health Care systems and directly relate, in many cases, to other A.I.D. health projects in child survival. These new policies and criteria are summarized. A review of the three emphasis areas of research, training and program design is provided. Intersectorial coordination is stressed as is cooperation in its assistance efforts with multilateral and other bilateral agencies in combatting this disease. The paper concludes that malaria remains an important health interest of the A.I.D. and support for technology development, transfer and adaptation is expected due to the economic and social importance of the disease.

Global Health

Faculty development: a transcultural experience.

A collaborative education program between Schools of Nursing at the Jordan University of Science and Technology and the University of Windsor, funded by the Canadian International Development Agency (CIDA), provides advanced clinical and theoretical education for Jordanian faculty and thus enriches the education of nursing students. This article describes the preparation of the faculty development proposal and the implementation of the project in a transcultural context, and identifies strengths and limitations of the project. Recommendations for effective strategies regarding international development in nursing education are made and a discussion of the benefits that ensued to both faculties is included.

Canada

Cultural differences in Canadian-Chinese nursing.

The Schools of Nursing of Tianjin Medical College and the University of Ottawa have been partners in a Canadian-Chinese linkage project funded by the Canadian International Development Agency (CIDA) and the Chinese Government since 1989, at teh instigation of Canadian faculty member Nancy Johnson who saw the need for academic support for the Chinese nursing community.

Acupuncture Therapy

Training of trainers in the Caribbean Basin Water Management Project.

This article discusses the Caribbean Basin Water Management Project, a joint venture of 10 Caribbean countries, the Canadian International Development Agency (CIDA), the Government of the Netherlands, and PAHO. In 1977 an assessment of the project revealed that though training activities were carried out, most of them were designed for engineers and technicians-a small percentage of all employees-who did not pass on their knowledge to their coworkers. The training of trainers program was initiated to encourage improved communication among staff members. The fundamental precept of this program is that training should be a basic component of management activities. The article outlines the criteria for selecting participants for the training workshops, stressing that the prospective candidates should be in supervisory positions where training is part of their job. Instructors should also be carefully selected, and, as in the case of the participants, should have a long-term commitment to the water utility. At the end of the workshop series, the trainees should be able to make a task analysis, write and evaluate performance objectives, demonstrate communication techniques, use training aids, develop and implement an instructional sequence, and apply evaluation mechanisms. The article summarizes the benefits of the program, such as increased productivity of the supervisors, better communication between supervisors and the staff, and improved attitudes on the part of the staff toward their work.

International Cooperation

Nepal: integrating traditional and modern health services in the remote area of Bashkharka.

Within a framework of Primary Health Care (PHC) and Health Promotion (HP), the focus of this paper is on integrating traditional and modern health care in the remote area of Bashkharka, Nepal. The relevance to integrated health care of factors such as geography, ethnicity, religion, national infrastructure and international development agencies are discussed. Issues concerning the relationship between the theory and practice of PHC and HP are raised.

Health Policy

Rural women and power in Pakistan.

Perceptions of power in women living in rural villages in Pakistan were explored. The Lee-Hezekiah Power Perception Scale was developed by the authors to measure women's perception of their power. The instrument was administered in interviews conducted by a group of Lady Health Visitors who were participating in a project funded by the Canadian International Development Agency. Sixty-nine women ranging in age from 20 to 65 were interviewed. One-way analysis of variance revealed that the oldest group perceived themselves to have more power than the youngest group perceived themselves to have. Stepwise multiple regression indicated that the number of male children a woman had was predictive of the amount of power she perceived herself to have. The results are discussed in relation to existing literature on women and power in developing countries. Implications for further research on women's perceptions of power and health are discussed.

Adult

Postcolonial nursing education in Trinidad and Tobago.

In this article the impact of the developed nations on basic nursing education in Trinidad and Tobago in the postcolonial period is discussed and analyzed. Subsequent to self-government in 1956, the national government, in its efforts to become independent of its reliance on Great Britain, turned to the United States and Canada for technical and financial aid. Consequently, sources such as the World Bank, Inter-American Development Bank, Pan American Health Organization/World Health Organization, and the Canadian International Development Agency were major avenues for the provision of ideas, concepts, and values in health planning and policy making with primary health care endorsed by the government. Nursing education was thus influenced by these industrialized concepts and values. The impact of socioeconomic and nursing events in the Caribbean region coupled with local initiatives taken by the indigenous leadership to improve nursing education resulted in a program that was an amalgamation of British, North American, and indigenous features.

Curriculum

Oral health status and treatment needs in different age groups in two regions of Tanzania.

The present study was conducted in two regions of Tanzania, where development of oral health services is supported by the Danish International Development Agency (Danida). The study comprised 6035 subjects in five age groups (5-6 yr, 12 yr, 18 yr, 35-44 yr, 55+ yr). Data were collected using WHO's survey methodology. Dental caries affected the primary dentition of one third to one fourth of the 5-6-yr-olds and mean dft was less than 1.0 in both regions. DMFT for 12-yr-olds was also low (< 1.5 DMFT), but was higher in older age groups, mainly due to more missing teeth. The F-component was negligible in all age groups. Treatment need was mainly simple fillings and extractions. Most periodontal sextants in all age groups were affected by bleeding or calculus. Periodontal pockets were rare and loss of teeth limited. It is concluded that the oral health situation in Tanzania is better than that foreseen in the goals for oral health in Tanzania in the year 2002. On the basis of these findings and the severe economic constraints prevailing within the health services in Tanzania, a revision of The National Plan for Oral Health seems urgent. A realistic estimate of the cost and the possible sources of funding of the plan is mandatory.

Adolescent

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent

Establishment of smoke-free offices worldwide--U.S. Peace Corps.

The Peace Corps (PC) of the United States is a government-sponsored international development agency with more than 6000 volunteers in approximately 70 developing countries. Since July 1988, PC headquarters in the District of Columbia has been a smoke-free workplace. From February through March 1991, all overseas PC full-time staff members were surveyed regarding cigarette smoking and attitudes toward a proposed smoke-free policy (complete ban) for PC offices worldwide. In addition, the directors of all overseas offices were surveyed regarding existing restrictions on smoking in the workplace. This report summarizes results of the survey.

Developing Countries