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International health

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International health

  1. 1. INTERNATIONAL HEALTH Global Burden of Disease Study Overview The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is the first major effort since the original GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. By November 2010 the project will produce a final set of estimates. The GBD 2005 Study brings together a community of experts and leaders in epidemiology and other areas of public health research from around the world to measure current levels and recent trends in all major diseases, injuries, and risk factors, and to produce new and comprehensive sets of estimates and easy-to-use tools for research and teaching. It is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization (WHO). This ambitious effort will be conducted systematically and transparently; both its methods and results will be made available to the public. Terminologies- DALYs / YLDs definition Definitions: YLDs = Years Lived with Disability
  2. 2. DALYs = Disability Adjusted Life Years The sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. QALY A year of life adjusted for its quality or its value. A year in perfect health is considered equal to 1.0 qaly. The value of a year inill health would be discounted. For example, a year bedridden might have a value equal to 0.5 qaly. Background The original Global Burden of Disease Study (GBD 1990 Study) was commissioned by the World Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions in 1990. The methods of the GBD 1990 Study created a common metric to estimate the health loss associated with morbidity and mortality. It generated widely published findings and comparable information on disease and injury incidence and prevalence for all world regions. It also stimulated numerous national studies of burden of disease. These results have been used by governments and non-governmental agencies to inform priorities for research, development, policies and funding. The principle guiding the burden of disease approach is that the best estimates of incidence, prevalence, and mortality can be generated by carefully analyzing all available sources of information in a country or region, and correcting for bias. The disability- adjusted life year (DALY) , a time-based measure that combined years of life lost due to premature mortality and years of life lost due to time lived in health states less than ideal health, was developed to assess the burden of disease. The GBD 1990 Study represented a major step in quantifying global and regional effects of diseases, injuries, and risk factors on population health.
  3. 3. In 2000, the World Health Organization began publishing regular GBD updates for the world and 14 regions. These revisions were aided by methodological improvements and more extensive data collection that covered key aspects of the GBD, including mortality estimation, cause of death analysis, and measurement and valuation of functional health status. Standardized concepts and approaches to comparative risk assessment were applied to over 25 risk factors. New estimates for 2001 were published as part of the second revision of the Disease Control Priorities Project. In addition to these continuing efforts for better epidemiological quantification, the philosophical underpinnings for quantifying population health have been extensively explored as part of the overall effort to foster summary measures of population health. Update the GBD estimates The Global Burden of Diseases, Injuries and Risk Factors Study is an evidence-based and scientific pursuit. While various groups have published partial updates of GBD rankings, there has not yet been a comprehensive and systematic revision. As a result, burden estimates today contain some outdated, and often, inconsistent information. Furthermore, patterns of disease and disability and their risk factors have altered dramatically and need to be reassessed in a newly comprehensive study. Today, there is great demand for global burden estimates. Research and advocacy groups have brought new conditions to the awareness of the public health community. The GBD 2005 Study will review the magnitude of these conditions compared to other causes of health burden. Also, researchers have significantly improved methods for burden assessment since the original GBD 1990 Study. These new tools can markedly enhance the validity of estimations, particularly for ranking risk factors and disabilities. More and more researchers, especially in the developing world, are engaged in burden work than ever before. A new structured study will take advantage of the opportunity to bring these global researchers together to communicate and work collaboratively in an environment that is strongly seeking new burden statistics. Moreover, the unprecedented money and
  4. 4. attention now pouring into international health has made the need for an accurate assessment of global health patterns a matter of utmost urgency. A thorough GBD reassessment will ensure that the global health community bases its research and policies on complete, valid, and reliable information. Study Design To achieve maximum impact, the project focuses on both improving knowledge and making it useful for actors shaping the terrain of global health. Under the first of its two major objectives, the GBD 2005 Study will produce new estimates of the global burden of diseases, injuries, and risk factors. It will revise figures for 1990 given new data and improved techniques and generate new estimates for 2005. Spearheaded by a team of public health researchers from a number of leading research institutions and engaging epidemiological experts in every study region, the project will be collaborative at all levels. Under its second key objective, the GBD 2005 Study will develop various sets of tools, each tailored to a specific audience, to standardize and broaden the field of burden research and analysis. Through computer-assisted self-instruction and training workshops, new generations of researchers will be schooled in up-to-date methods. Revised computational tools will allow researchers around the world to apply GBD techniques to produce rigorous and systematic burden estimates. Meanwhile, tailored publications will help policymakers and non-research audiences interpret GBD concepts and utilize study results. A comprehensive publication, website, and CD-ROM will guarantee universal access to GBD methods and results. A Core Team of methodologists will spearhead the study and ensure its steady progress along a 36-month time frame. Composed of senior researchers from the University of Washington, Harvard University, the University of Queensland, Johns Hopkins
  5. 5. University, and the WHO, the core team unites the authors of the original study and engages new leaders in the global health field to design and coordinate research. Carefully selected expert groups in every study region will conduct systematic reviews of incidence and prevalence of disease and disabling sequelae, reporting their figures at defined intervals to core team members. More than 800 experts from around the world are participating in 43 disease expert groups. Responding to critiques and improvements in the field, the new study will make major progress in disability assessment, using new survey instruments to update disability weights and gather data on health states. Consistency checks and peer reviews will occur throughout the study to ensure that estimates of mortality, burden, and risk are systematically and cautiously generated. As an important quality check, the GBD 2005 Study embeds feedback and discourse amongst participants into its design. Improving the health and wellbeing of the world's population is both morally imperative and essential to stability and progress. The vast energies, technologies, and resources pouring into global health have given us the capacity to fight disease, remedy disability, and address deep health inequalities between populations. The new round of the Global Burden of Diseases, Injuries, and Risk Factors will provide the tools and knowledge to unveil the substance of global health and guide the momentum to make truly effective interventions possible. The GBD advantage Four key benefits will maximize the study's utility as both a source of accurate knowledge and a vital tool for informed decision-making. Evidence-based evaluations The GBD separates epidemiological assessment from advocacy, creating evidence-based pictures of patterns in health that can subsequently motivate responsible policy and
  6. 6. research. Major causes of infectious disease like HIV, TB, and malaria have absorbed a great deal of analytical attention while "new" conditions, like hearing loss and migraine, have recently been brought to the public health agenda. The new GBD will use standard measures to ensure that all conditions receive systematic, objective analysis. Changing awareness and validity of different global health conditions The GBD combines information on causes of premature mortality, morbidity, and disability to present a balanced assessment of health problems. The first study brought visibility and legitimacy to conditions like depression and paralysis, which cause great suffering with little associated mortality, and to conditions like road traffic accidents, which were formerly outside the scope of public health. The new study has the potential to change perceptions of global health again in ways that cannot be anticipated yet. Cost-effectiveness analysis The GBD assesses the magnitude of health problems using standard units of measurement, such as disability-adjusted life years (DALYs). This study feature allows for lives in every part of the world to be valued equally and creates a common unit of currency for making decisions about the costs and benefits of various health interventions. Engaging researchers, experts, and policymakers Finally, the study will focus from the outset on education, training, and transparency, incorporating features like an interactive website where experts can post information and actively discuss the study process. Broadening the global community's engagement with health metrics will be a focal point of the project. International health regulations
  7. 7. IHR grew from International Sanitary Conference (1851), recognising that: free movement of people and goods will increase the risk of cross-border transmission quarantine is an impediment to free trade public health arguments can justify trade barriers International Health Regulations (1950) responsibility of WHO: Member States agree to notify specific infectious diseases & abide by measures allowed by countries to protect themselves As mentioned, the classical way to stop the international spread of infectious disease is to erect border controls - for people as well as for goods. At the middle of the 19th century, such quarantine laws in the different European states had become so disparate - and seemed so inept at stopping the spread of cholera - that the First International Sanitary Conference was called in Paris in 1851 by the Foreign Ministers of 14 European countries. That it was the Foreign Ministers and not the Ministers of Health who met is important, since it demonstrates the appreciation that the issue of international infection control is inseparably connected to the issue of traffic. That is, that: (i) the free movement of people and goods will increase the risk of cross-border transmission; (ii) quarantine is an impediment to free trade; and (iii) public health arguments can therefore be used to justify trade barriers. Since 1950, the International Health Regulations (IHR) have been the responsibility of the WHO. They are the only binding international agreement on public health, whereby all the WHO Member States have agreed to notify cases of certain infectious diseases, and to abide by the limits of the allowed counter-measures laid out in the Regulations. The link between public health and trade is stressed by a sentence in the portal paragraph that gives as its purpose to "ensure the maximum security against the international spread of disease with a minimum interference with world traffic". Very briefly, the Regulations oblige Member States of the WHO to notify cases of cholera, plague, and yellow fever to
  8. 8. the Organization, and also state the maximum measures allowed by countries to protect themselves from importation of these diseases. International health Travel The number of people travelling internationally is increasing every year. According to statistics of the World Tourism Organization, international tourist arrivals in the year year 2007 reached 903 million. International tourism receipts rose to US$ 856 billion (625 billion euros) in 2007. By 2010 international arrivals are expected to reach 1 billion, and 1.6 billion by 2020. In 2007, just over half of all international tourist arrivals were motivated by leisure, recreation and holidays(51%) – a total of 458 million. Business travel accounted for some 15% (138 million), and 27% represented travel for other purposes, such as visiting friends and relatives (VFR), religious reasons/pilgrimages, health treatment, etc. (240 million). Slightly less than half of arrivals travelled by air transport (47%) in 2007, while the remainder arrived in their destinations by surface transport (53%) – whether by road (42%), rail (4%) or over water (7%). International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel. Travellers may encounter sudden and signifi cant changes in altitude, humidity, microbes and temperature, which can result in ill-health. In addition, serious health risks may arise in areas where accommodation is of poor quality, hygiene and sanitation are inadequnal Hate, medical services are not well developed and clean water is unavailable. All people planning travel should know about the potential hazards of the countries they are travelling to and learn how to minimize their risk of acquiring these diseases. Forward planning, appropriate preventive measures and careful precautions can substantially reduce the risks of adverse health consequences. Although the medical profession and the travel industry can provide a great deal of help and advice, it is the traveller’s responsibility to ask for information, to understand the risks involved, and to take the necessary precautions for the journey. Travel-related risks
  9. 9. Key factors in determining the risks to which travellers may be exposed are: — mode of transport — destination — duration and season of travel — purpose of travel — standards of accommodation and food hygiene — behaviour of the traveller — underlying health of the traveller. Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks for the health of travellers, unless there is pre-existing illness. This also applies to business travellers and tourists visiting most major cities and tourist centres and staying in goodquality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is unavailable may pose serious risks for the health of travellers. This applies, for example, to personnel from emergency relief and development agencies or tourists who venture into remote areas. In these settings, stringent precautions must be taken to avoid illness. The epidemiology of infectious diseases in the destination country is of importance to travellers. Travellers and travel medicine practitioners should be aware of the occurrence of any disease outbreaks in their international destinations. New risks to international travellers may arise that are not detailed in this book but will be posted on WHO web site ( Unforeseen natural or manmade disasters may occur. Outbreaks of known or newly emerging infectious diseases are often unpredictable. The mode of transportation, duration of the visit and the behaviour and lifestyle of the traveller are important in determining the likelihood of exposure to infectious agents and will infl uence decisions on the need for certain vaccinations or antimalarial medication. The duration of the visit may also determine whether the
  10. 10. traveller may be subjected to marked changes in temperature and humidity during the visit, or to prolonged exposure to atmospheric pollution. The purpose of the visit is critical in relation to the associated health risks. A business trip to a city, where the visit is spent in a hotel and/or conference centre of high standard, or a tourist trip to a well-organized resort involves fewer risks than a visit to a remote rural area, whether for work or pleasure. However, behaviour also plays an important role; for example, going outdoors in the evenings in a malaria-endemic area without taking precautions may result in the traveller becoming infected with malaria. Exposure to insects, rodents or other animals, infectious agents and contaminated food and water, combined with the absence of appropriate medical facilities, makes travel in many remote regions particularly hazardous. Medical consultation before travel Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should take place at least 4–8 weeks before the journey, and preferably earlier if long-term travel or overseas work is envisaged. However, last-minute travellers can also benefi t from a medical consultation, even as late as the day before travel. The consultation will determine the need for any vaccinations and/or antimalarial medication, as well as any other medical items that the traveller may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs. Dental and —for women— gynaecological check-ups are advisable before prolonged travel to developing countries or prolonged travel to remote areas. This is particularly important for people with chronic or recurrent dental or gynaecological/ obstetric problems. Assessment of health risks associated with travel
  11. 11. Medical advisers base their recommendations, including those for vaccinations and other medication, on an assessment of risk for the individual traveller, which takes into account the likelihood of catching a disease and how serious this might be for the traveller concerned. Key elements of this risk assessment are the destination, duration and purpose of the travel as well as the standards of accommodation and the health status of the traveller. For each disease being considered, an assessment is also made of: — availability of prophylaxis, possible side-effects and suitability for the traveller concerned; — any associated public health risks (e.g. the risk of infecting others). Collecting the information required to make a risk assessment involves detailed questioning of the traveller. A checklist or protocol is useful to ensure that all relevant information is obtained and recorded. The traveller should be provided with a personal record of the vaccinations given (patient-retained record) as vaccinations are often administered at different centres. A model checklist, reproducible for individual travellers, is provided. Medical kit and toilet items Suffi cient medical supplies should be carried to meet all foreseeable needs for the duration of the trip. A medical kit should be carried for all destinations where there may be signifi cant health risks, particularly those in developing countries, and/or where the local availability of specifi c medications is not certain. This kit will include basic medicines to treat common ailments, fi rst-aid articles and any other special medical items, such as syringes and needles, that may be needed by the individual traveller. Certain categories of prescription medicine or special medical items should be carried together with a medical attestation, signed by a physician, certifying that the traveller requires the medication or the items for medical conditions. Some countries require not only a physician but also the national health administration
  12. 12. to sign this certifi cate. Toilet items should also be carried in suffi cient quantity for the entire visit unless their availability at the travel destination is assured. These will include items for dental care, eye care including contact lenses, skin care and personal hygiene. Contents of a basic medical kit First-aid items: — adhesive tape — antiseptic wound cleanser — bandages — emollient eye drops — insect repellent — insect bite treatment — nasal decongestant — oral rehydration salts — scissors and safety pins — simple analgesic (e.g. paracetamol) — sterile dressing — clinical thermometer. Additional items according to destination and individual needs: — antidiarrhoeal medication — antifungal powder — antimalarial medication — condoms — medication for any pre-existing medical condition — sedatives — sterile syringes and needles — water disinfectant — other items to meet foreseeable needs, according to the destination and duration of the visit.
  13. 13. Travellers with pre-existing medical conditions and special needs Special groups of travellers Health risks associated with travel are greater for certain groups of travellers, including infants and young children, pregnant women, the elderly, the disabled, and those who have pre-existing health problems. Health risks may also differ depending on the purpose of travel, such as travel for the purpose of visiting friends and relatives (VFR) or for religious purposes/pilgrimages (Chapter 9), for relief work or for business. For all of these travellers, medical advice and special precautions are necessary. They should be well informed about the available medical services at the travel destination. Age Infants and young children have special needs with regard to vaccinations and antimalarial precautions (see Chapters 6 and 7). They are particularly sensitive to ultraviolet radiation and become dehydrated more easily than adults in the event of inadequate fl uid intake or loss of fl uid due to diarrhoea. A child can be overcome by dehydration within a few hours. Air travel may cause discomfort to infants as a result of changes in cabin air pressure and is contraindicated for infants less than 48 hours old. Infants and young children are more sensitive to sudden changes in altitude. They are also more susceptible to infectious diseases. Advanced age is not necessarily a contraindication for travel if the general health status is good. Elderly people should seek medical advice before planning longdistance travel. Pregnancy Travel is not generally contraindicated during pregnancy until close to the expected date of delivery, provided that the pregnancy is uncomplicated and the woman’s health is good. Airlines impose some travel restrictions in late pregnancy and the
  14. 14. neonatal period Pregnant women risk serious complications if they contract malaria. Travel to malaria-endemic areas should be avoided during pregnancy if at all possible. Medication of any type during pregnancy should be taken only in accordance with medical advice.Travel to high altitudes (see also Chapter 3) or to remote areas is not advisable during pregnancy. Disability Physical disability is not usually a contraindication for travel if the general health status of the traveller is good. Airlines have regulations on the conditions for travel for disabled passengers who need to be accompanied (see Chapter 2). Information should be obtained from the airline in advance. Pre-existing illness People suffering from chronic illnesses should seek medical advice before planning a journey. Conditions that increase health risks during travel include: — cardiovascular disorders — chronic hepatitis — chronic infl ammatory bowel disease — chronic renal disease requiring dialysis — chronic respiratory diseases — diabetes mellitus — epilepsy — immunosuppression due to medication or to HIV infection — previous thromboembolic disease — severe anaemia — severe mental disorders
  15. 15. — any chronic condition requiring frequent medical intervention. Any traveller with a chronic illness should carry all necessary medication and medical items for the entire duration of the journey. All medications, especially prescription medications, should be stored in carry-on luggage, in their original containers with clear labels. A duplicate supply carried in the checked luggage is a safety precaution against loss or theft. With heightened airline security, sharp objects and liquids in quantity of more than 100 ml will have to remain in checked luggage. The traveller should carry the name and contact details of their physician on their person with other travel documents, together with information about the medical condition and treatment, and details of medication (generic drug names included) and prescribed doses. A physician’s letter certifying the necessity for any drugs or other medical items (e.g. syringes) carried by the traveller that may be questioned by customs offi cials should also be carried. Insurance for travellers International travellers should be aware that medical care abroad is often available only at private medical facilities and may be costly. In places where good-quality medical care is not readily available, travellers may need to be repatriated in case of accident or illness. If death occurs abroad, repatriation of the body can be extremely expensive and may be diffi cult to arrange. Travellers should be advised (i) to seek information about possible reciprocal health-care agreements between the country of residence and the destination country, and (ii) to obtain special travellers’ health insurance for destinations where health risks are signifi cant and medical care is expensive or not readily available. This health insurance should include coverage for changes to the itinerary, emergency repatriation for health reasons, hospitalization, medical care in case of illness or accident and repatriation
  16. 16. of the body in case of death. Travel agents and tour operators usually provide information about travellers’ health insurance. It should be noted that some countries now require proof of adequate health insurance as a condition for entry. Travellers should know the procedures to follow to obtain assistance and reimbursement. A copy of the insurance certifi cate and contact details should be carried with other travel documents in the hand luggage. Role of travel industry professionals Tour operators, travel agents, airline and shipping companies each have an important responsibility to safeguard the health of travellers. It is in the interests of the travel industry that travellers have the fewest possible problems when travelling to, and visiting, foreign countries. Contact with travellers before the journey provides a unique opportunity to inform them of the situation in each of the countries they are visiting. The travel agent or tour operator should provide the following health-related guidance to travellers: ● Advise the traveller to consult a travel medicine clinic or medical practitioner as soon as possible after planning a trip to any destination where signifi cant health risks may be foreseen, particularly those in developing countries, preferably 4–8 weeks before departure. ● Advise last-minute travellers that a visit should be made to a travel medicine clinic or medical practitioner, even up to the day before departure. ● Inform travellers if the destination presents any particular hazards to personal safety and security and suggest appropriate precautions. ● Encourage travellers to take out comprehensive travellers’ health insurance and provide information on available policies. ● Inform travellers of the procedures for obtaining assistance and reimbursement, particularly if the insurance policy is arranged by the travel agent or company.
  17. 17. ● Provide information on: — mandatory vaccination requirements for yellow fever; — the need for malaria precautions at the travel destination; — the existence of other important health hazards at the travel destination; — the presence or absence of good-quality medical facilities at the travel destination. Responsibility of the traveller Travellers can obtain a great deal of information and advice from medical and travel industry professionals to help prevent health problems while abroad. However, travellers must accept that they are responsible for their health and well-being while travelling and on their return as well as for preventing the transmission of communicable diseases to others. The following are the main responsibilities to be accepted by the traveller: — the decision to travel — recognition and acceptance of any risks involved — seeking health advice in good time, preferably 4–8 weeks before travel — compliance with recommended vaccinations and other prescribed medication and health measures — careful planning before departure — carrying a medical kit and understanding its use — obtaining adequate insurance cover — health precautions before, during and after the journey — responsibility for obtaining a physician’s letter pertaining to any prescription medicines, syringes, etc. being carried — responsibility for the health and well-being of accompanying children — precautions to avoid transmitting any infectious disease to others during and after travel — careful reporting of any illness on return, including information about all
  18. 18. recent travel — respect for the host country and its population. A model checklist for use by travellers, indicating steps to be taken before the journey, is provided at the end of the chapter. Medical examination after travel Travellers should be advised to have a medical examination on their return if they: — suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, chronic respiratory disease; — experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs; — consider that they have been exposed to a serious infectious disease while travelling; — have spent more than 3 months in a developing country. Travellers should provide medical personnel with information on recent travel, including destination, and purpose and duration of visit. Frequent travellers should give details of all journeys that have taken place in the preceding weeks and months. Medical Tourism Definition: Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly- growing practice of traveling across international borders to obtain health care. It also refers pejoratively to the practice of healthcare providers traveling internationally to deliver healthcare
  19. 19. Process The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home International healthcare accreditation Because standards are important when it comes to health care, there are parallel issues around medical tourism, international healthcare accreditation, evidence-based medicine and quality assurance. In the United States, the best known accreditation group is the Joint Commission International (JCI). They have been inspecting and accrediting health care facilities and hospitals outside of the United States since 1999.[17] Many international hospitals today see obtaining JCI accreditation as a way to attract American patients.[18] Joint Commission International is a relative of the Joint Commission in the United States. Both are independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.
  20. 20. In the UK and Hong Kong, the Trent International Accreditation Scheme is a key player. The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them.[20] A forecast by Deloitte Consulting regarding medical tourism published in August 2008 noted the value of accreditation in ensuring quality of healthcare and specifically mentioned JCI, ISQUA and Trent.[12] Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele and Trent for potential British and European clientele. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.[21] Other organizations providing contributions to quality practices include: The Society for International Healthcare Accreditation (SOFIHA), a free-to-join group providing a forum for discussion and for the sharing of ideas and good practice by providers of international healthcare accreditation and users of the same. The primary role of this organisation is to promote a safe hospital environment for patients. HealthCare Tourism International, the first US-based non-profit to accredit the non-clinical aspects of health tourism, such as language issues, business practices, and false or misleading advertising prevention. The group provides accreditation for all major groups involved in the health tourism industry including hotels, recovery facilities, and medical tourism booking agencies. The United Kingdom Accreditation Forum (UKAF) is an established network of accreditation organisations with the intention of sharing experience good practice and new ideas around the methodology for accreditation programmes, covering issues such as developing healthcare quality standards, implementation of
  21. 21. standards within healthcare organisations, assessment by peer review and exploration of the peer review techniques to include the recruitment, training, monitoring and evaluation of peer reviewers and the mechanisms for awards of accredited status to organisations. The International Medical Travel Association, (IMTA, based in Singapore), is a nonprofit association formed to help address quality standards, liability issues, continuity of care, and other issues. Risks Medical tourism carries some risks that locally-provided medical care does not. Some countries, such as India, Malaysia, or Thailand have very different infectious disease- related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West. The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility in a cramped airline cabin are a known risk factor for developing blood clots in the legs such as venous thrombosis or pulmonary embolus economy class syndrome. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if
  22. 22. they sunburn while healing. To minimise these problems, medical tourism patients often combine their medical trips with vacation time set aside for rest and recovery in the destination country. Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients. Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services. Legal issues Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. The limited nature of litigation in various countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity. Ethical issues There can be major ethical issues around medical tourism For example, the illegal purchase of organs and tissues for transplantation has been alleged in countries such as India and China prior to 2007.
  23. 23. Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care". Medical tourism centred on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation International Nurses Standards 1. NURSES AND PEOPLE The nurse’s primary professional responsibility is to people requiring nursing care.In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual,family and community are respected.The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.The nurse holds in confidence personal information and uses judgement in sharing this information.The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction. 2. NURSES AND PRACTICE The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning.The nurse maintains a standard of personal
  24. 24. health such that the ability to provide care is not compromised.The nurse uses judgement regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people. 3. NURSES AND THE PROFESSION The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge.The nurse, acting through the professional organisation, participates in creating and maintaining safe, equitable social and economic working conditions in nursing. 4. NURSES AND CO-WORKERS The nurse sustains a co-operative relationship with co-workers in nursing and other fields.The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a coworker or any other person.4 SUGGESTIONS FOR USE OF THE ICN CODE OF ETHICS FOR NURSES The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society.To achieve its purpose the Code must be understood, internalisedand used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives
  25. 25. APPLYING THE ELEMENTS OF THE ICN CODE OF ETHICS FOR NURSES The four elements of the ICN Code of Ethics for Nurses : nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers, give a framework for the standards of conduct. The following chart will assist nurses to translate the standards into action. Nurses and nursing students can therefore: • Study the standards under each element of the Code. • Reflect on what each standard means to you. Think about how you can apply ethics in your nursing domain: practice, education, research or management. • Discuss the Code with co-workers and others. • Use a specific example from experience to identify ethical dilemmas and standards of conduct as outlined in the Code. Identify how you would resolve the dilemmas. • Work in groups to clarify ethical decision making and reach a consensus on standards of ethical conduct. • Collaborate with your national nurses’ association, co-workers, and others in the continuous application of ethical standards in nursing practice, education, management and research. International Health Programmes Australia Day Therapy Centres Overview Day Therapy Centres offer physiotherapy, occupational and speech therapy, podiatry and other therapy services to older people in a community setting About the Program The Day Therapy Centre Program provides a wide range of therapy services to frail older people living in the community and to residents of Australian Government funded residential aged care facilities.
  26. 26. There is no single model of service provision for services. They may operate across a range of therapy services, intensity and types. Therapy services include: physiotherapy; occupational therapy; podiatry; and speech therapy. These therapy Lifetime Health Cover Lifetime Health Cover is a Government initiative that started on 1 July 2000. It was designed to encourage people to take out hospital insurance earlier in life, and to maintain their cover. Diabetes in New Zealand Diabetes retinal screening workshops - Working together to make your work easier September 2008 The Retinal Screening Advisory Group and the Ministry of Health are holding regional workshops during September 2008 to gain insights, suggestions, and help from those working in retinal screening to help shape the future direction of retinal screening in New Zealand.
  27. 27. The Retinal Screening Advisory Group comprises ophthalmologists and optometrists who have a special interest in diabetic retinal screening. The team with in the Ministry of Health working in this area is the Clinical Service Development Team, Sector Capability and Innovation Directorate. New-Zealand Healthy Eating - Healthy Action Healthy Eating – Healthy Action (HEHA) is the Ministry of Health’s strategic approach to improving nutrition, increasing physical activity and achieving healthy weight for all New Zealanders. The Vision An environment and society where individuals, families and whanau, and communities are supported to eat well, live physically active lives, and attain and maintain a healthy body weight. South Africa Integrated Nutrition Programme (INP) The Integrated Nutrition Programme (INP) was developed from the recommendations of the Nutrition Committee appointed in 1994 by the Minister of Health to develop a nutrition strategy for South Africa. The Committee recommended an integrated approach to nutrition to replace the fragmented food-based approach of the past. Sound nutrition is a basic human right guaranteed in South Africa’s Constitution, through the Bill of Rights. Therefore, the Department of Health has as one of its obligations, to ensure that nutrition security is respected, protected, facilitated and provided to the
  28. 28. people of South Africa. Nutrition security incorporates food security, health security and care security where security refers to sustainability – having food and good nutrition on an ongoing basis. Therefore, sound nutrition involves more than just the availability of food or the consumption of a certain amount of nutrients per day. HEALTH CARE AGENCIES AND THIR ROLES WORLD HEALTH ORGANISATION The World health organization is a specialised ,non-political health agency of the united nations,with head quarters at Geneva.In 1946,the constitution drafted by th’Technical preparatory committee‖under the chairmanship of Rene Sand was approved in the same year by international conference of 51 nationsin New York.The constitution came into force on 7th April 1948 which is celebrated every year as world health day. Objectives of WHO:The main objective of WHO is ―the attainment by all peoples of the highest level of health‖which is set out in the preamble of the constitution. The Preamble of the constitution states: Health is a state of complete physical,mental and social well being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human beingwithout didtinction of race,religion,politica;l belief,e conomic and social condition. The health of all people is fundamental to attainment of peace and security and is dependant upon the fullest cooperation of the individuals and the states. The achievement of any state in the promotion and protection of health is value to all. Unequal development in different countries in the promotion of health and control of disease, especially communicable disease is a common danger.healthy
  29. 29. development of the child is of basic importance; the ability to live harmoniously in achanging total environment is essential to such development. The extension to all people of the benefits of medical, psychological and related knowledge is essential to fullest attainment of health. Informed opinion and active co-operation on the part of the public are utmost importance in the improvement of the health of the people. The WHO is a unique UN specialized agencies in that it has it’s own constitution,own governing bodies,own membership and own budgetit is a part of UN and not a subordinate of the UN. Membership: Membership of the WHO is open to all countries.most of the members of both the UN and the WHO. Territories which are not responsible for the conduct of their relations may be admitted as Associate members.Associate members participate without vote in deliberations of the WHO. Each member contributes yearly to the budget and each is entitled to the services and aid the organization can provide. Work of WHO; 1. PREVENTION AND CONTROL OF SPECIFIC DISEASES WHO has played avital role in preventing the spread of communicable diseases. Eg:the global eradication of smallpox is an outstanding example of international health co-operation. Epidemiological surveillance is an important activity of WHO carried out in case of communicable diseases.
  30. 30. The WHO collects and disseminates epidemological information on diseases subject to International Health Regulations and occasionally other communicable diseases of international importance through an Automatic Telex Reply(ATRS) and the ―Weekly Epidemiological Record‖(WER). Immunization agaist various common childhood diseases is now a priority programme of WHO. 2. DEVELOPMENT OF COMPREHENSIVE SERVICES WHO’s most important function is to promote and support national health policy development and the development of comprehensive national health programmes. This endeavour encompasses a wide range of activities i.e orghanising health systems based on primary health care, building of long term national capability,particularly in areas of health infrastructure development, and managerial capabilities. Appropriate technology for health(ATH) is another new programme launched by WHO to encourage self-sufficiency in solving health problems. 3.FAMILY HEALTH Family health is one of the major programme activities of WHO sice 1970,and is broadly subdivided into maternal and child health care,human reproduction,nutrition and health education. Chief concern is to improve health of family as a unit. 4.ENVIRONMENTAL HEALTH Promotion of environmental health is an important activity of WHO.
  31. 31. WHO advises governments on national health programmes for the provision of basic sanitary services A number of practices have been developed such as ―WHO environmental Health criteria programme‖ and ―WHO Environmental Health Monitoring Programme’ towards improving environmental health. 5.HEALTH STATISTICS Earliest days in 1947,WHO has been concerned with the dissemination of a wide variety of mortality and morbidity statistics relating to health problems. The data is published in the I. Weekly Epidemological Record II. World health statistics quarterly III. World health statistics Statistics of different diseases are compared and formulated by WHO and it publishes it in the issue of ―International Classification of Diseases‖ which is updated every 10th year. 6.BIO-MEDICAL RESEARCH WHO is greatly involved in Research Work . It has established a world-wide network of WHO collaborating centres,besides awarding grants to research workers and institutions for promoting research. A regional advisory committee formulates regional health research priorities for health research in conjunction with a Global advisory committee which in close collaboration with regional committee deals with policy of global import. 7.HEALTH LITERATURE AND INFORMATION
  32. 32. WHO library is one of the satellite centers of the Medical Literature Analysis and Retrieval System(MEDLARS) of the U.S national Library of Medicine. WHO has also a public information service both at headquarters and each of the six regional 6 offices 8.COOPERATION WITH OTHER ORGANISATION WHO collaborates with the UN and with the other specialized agencies, nad maintains various degrees of working relationships. WHO has also established with a number of international governmental organizations. STRUCTURE: WHO consists of three principal organs: 1) The World Health Assembly 2) The Executive Board 3) The Secretariat 1) The World Health Assembly It is the ―Health Parliament‖ of nations and the supreme governing body of the organizations. It meets annualy in the month of May and generally at the Headquarters in Geneva. The Assembly is composed of delegates representing Member states,each of which has one vote. Functions: I. To determine international health policy and programmes II. To review the work of the past year. III. To approve the budget of the following year.
  33. 33. IV. To approve the budget needed for the following year. V. To elect Member states to designate a person to serve for three years on the executive board and to replace the retiring members The Director General is appointed on the nominations provided by the Executive Board. 2) The Executive Board The board had originally 18 members which had been incremented to 31 members by the health assembly. The members of the board are to be technically qualified in the field of health They are designated by their respective governments,but do not represent their respective governments. One third of the membership is renewed every year is renewed evry year. The executive board meets every year in the month of January and May after the meeting of the World Health Assembly. The main work of the board is to give affect to the decisions and policies of the assembly The board also has power to take in an emergency such as epidemics,earthquakes and floods where immediate action is needed. 3) the secretariat the secretariat is headed by Director General who is the chief technical and administrative officer of the organization. The primary function of the secretariat is to provide member states with technical and managerial support for their national development programmes. At WHO there are 5 Assistant Director-Generals each of whom is responsible for the work of such divisions as may from time to time that is assigned by the Director General
  34. 34. The Director Secretriat is comprised of the following divisions: 1) Division of epidemiological surveillance and health situation and trend adjustment. 2) Division of communicable diseases. 3) Division of vector biology and control 4) Division of environmental health 5) Division of public information and education for health division of public information for health 6) Division of mental health 7) Division of diagnostic,therapeutic and rehabilitative technology. 8) Division of strenghthening of health services. 9) Division of family health 10)Division of non-communicable diseases 11)Division of health-manpower development 12)Division of information systems support 13)Division of personnel and general services 14)Division of budget and finance Regions: WHO regional organizations are as follows: Region Headquarters 1. South-East Asia New Delhi(India) 2. Africa Harare(Zimbabwe) 3. The Americas Washington D.C(U.S.A) 4. Europe Copenhagen(Denmark) 5. Eastern Mediterranean Alexandria(Egypt) 6. Western Pacific Manila(Philippines)
  35. 35. The regional offices each are headed by a regional Director, WHO is assisted by technical and administrative officers, and members of the secretariat. There is aregional composedof representative of member states in the region Regional committees meet once in ayear to review the health work in the region and plan it’s continuation and development. Regional plans are amalgamated into overall plans by the Director General of the WHO. The South-East Asia Region(SEARO)-WHO 1) Bangladesh 2) Bhutan 3) India 4) Indonesia 5) Korea(Democratic people’s Republiv) 6) Maldives Islands 7) Myanmar 8) Nepal 9) Sri Lanka 10)Thailand Activities carried out by WHO in SEARO region: 1) Malaria eradication 2) Tuberculosis control 3) Control of other communicable diseases 4) Health laboratory services and other communicable diseases 5) Health statistics 6) Maternal and child health 7) Nursing 8) Health education
  36. 36. 9) Nutrition 10)Mental health 11)Dental health 12)Medical rehabilitation 13)Quality control of drugs and medical education UNICEF UNICEF is one of the specialized agencies of United Nations established in the year 1946 to rehabilitate children in war ravaged countries. UNICEF’s regional office is present at New Delhi,also known as South Central Asian Region.It consists of the following regions: 1) Sri Lanka 2) India 3) Maldives 4) Mongolia 5) Nepal UNICEF is governed by a thirty nation executive board. Headquarters is at United Nations,New York. UNICEF works in close collaboration with WHO,UNDP,FAO and UNESCO in combating problems like malaria,tuberculosis and venereal diseases. It’s assistance to countries covered varied fields such as maternal and child health and environmental sanitation. The Executive Board  The Executive Board is the governing body of UNICEF.  It is responsible for providing inter-governmental support to and supervision of the activities of UNICEF, in accordance with the overall policy guidance of the General Assembly and the Economic and Social Council of the United Nations.
  37. 37.  The Board meets three times each year, in a first regular (January), annual (June) and second regular session (September). The Board, like the governing bodies of other United Nations funds and programmes (UNDP, UNFPA and WFP), is subject to the authority of the Council. Its role is to: Implement the policies formulated by the Assembly and the coordination and guidance received from the Council Receive information from and give guidance to the Executive Director on the work of UNICEF Ensure that the activities and operational strategies of UNICEF are consistent with the overall policy guidance set forth by the Assembly and the Council Monitor the performance of UNICEF Approve programmes, including country programmes Decide on administrative and financial plans and budgets Recommend new initiatives to the Council and, through the Council, to the assembly as necessary Encourage and examine new programme initiatives and Submit annual reports to the Council in its substantive session, which could include recommendations, where appropriate, for improvement of field-level coordination. The Board has 36 members, elected for a three-year term with the following regional allocation of seats: i. 8 African States ii. 7 Asian States iii. 4 Eastern European States iv. 5 Latin American and Caribbean States v. 12 Western European
  38. 38. vi. Other States (including Japan)  The officers of the Board, constituting the Bureau, are elected by the Board at its first regular session of each calendar year from among Board members.  There are five officers—the President and four Vice-Presidents—representing the five regional groups at the United Nations. Officers of the Board are elected for a one-year term. The Board year runs from 1 January to 31 December.  The Economic and Social Council elects States to sit on the UNICEF Executive Board from States Members of the United Nations or of the specialized agencies or of the International Atomic Energy Agency.  Board sessions are held at United Nations Headquarters in New York. All formal meetings of the Board are interpreted in the six official languages of the United Nations (Arabic, Chinese, English, French, Spanish and Russian). A set of established Rules of Procedure facilitates the conduct of meetings.  The Office of the Secretary of the Executive Board (OSEB) is responsible for maintaining effective relationship between the Board and the UNICEF secretariat. Funding UNICEF is funded primarily by voluntary contributions from governmental and non- governmental organizations.Donations from the private sector also fund this organization. Current Events The 2000 Millennium Summit established 8 goals, referred to as the Millennium Development Goals (MDG). At this summit, over 150 heads of state came together at the UN to talk about ways of eliminating poverty, ensuring equal human rights to all people and new goals for the new millennium. The goals include: 1) The eradication of extreme poverty and hunger
  39. 39. 2) Achieving universal primary education 3) Promoting gender equality and empowering women, 4) Reducing child mortality 5) Improving maternal health 6) Combating HIV/AIDS, malaria, and other diseases, 7) Ensuring environmental sustainability 8) Developing a global partnership for development for the new millennium. Services provided by UNICEF: 1) Child health i. UNICEF has provided substantial aid for the production of vaccines and sera in amny countries ii. UNICEF has supported the BCG programme in india since its inception iii. UNICEF has helped in the erection of a pencillin plant near Pune iv. UNICEF assists in environmental sanitation programmes v. UNICEF has been providing primary health care to mother and children through services like immunization,infant and young child care. 2)Child Nutrition  UNICEF gives high priority to child nutrition  In the aid to provide nutrition to the children UNICEF started up with provision of supplementary feeding,development of low cost protein mixtures.  In collaboration with FAO,the UNICEF also started applied nutrition programmes through channels like community development,agricultural extension, schools and health services  UNICEF has also provided equipments to dairy plants in various parts of India(Maharashtra, Gujrat,Karnataka,Uttarpradesh, West-Bengal,Andhrapradesh)  It provides specific nutrition for intervention against nutritional diseases,viz.provision of large doses of vitamin A in areas where xeropthalmia is prevalent;enrichment of areas with salt rich iodine
  40. 40.  Provision of iron and folate supplements  UNICEF collaborates with FAO and WHO for the development of national food and nutritional policies. 3)Family and child Welfare  Their main purpose is to care for children both within their and outside their homes  These include a varied number of services i.e parent education,day care centres,child welfare and youth agencies and women’s clubs  These projects are carried as a part of health, nutrition and education. 4) Education-Formal and non-formal  In collaboration with UNESCO,UNICEF is assisting India in the expansion and improvent of teaching science in India.  It provides science laboratory equipment, workshop tools, library books, audiovisual aids to educational institutions.  UNICEF is providing a campaign known as GOBI which encourages 4 stratergies for ―child health revolution‖: i. G - Growth charts to better monitor child development ii. O - Oral rehydration to treat all mild and moderate dehydrate iii. B - Breast Feeding iv. I - Immunization against measles,diphtheria,polio,pertusis,tetanus and tuberculosis.  UNICEF has been participating in Urban Basic Services(UBS) to upgrade basic services i. Health ii. Nutrition iii. Water supply iv. Sanitation and education
  41. 41. UNDP  United Nations Development Programme was established in the year 1966.It is the main source of funds for technical assistance.  The member countries ,both the rich and the poor meet annually and pledge contributions to the UNDP.  The main objective is to help poorer nations develop their human and natural resources more fully.The UNDP projects cover virtually evry economic and social sector-agriculture,industry,education and science,health,social welfare. World leaders have pledged to achieve the Millennium Development Goals, including the overarching goal of cutting poverty in half by 2015. UNDP's network links and coordinates global and national efforts to reach these Goals. Their focus is helping countries build and share solutions to the challenges of: Democratic Governance Poverty Reduction Crisis Prevention and Recovery Environment and Energy HIV/AIDS
  42. 42. UNDP ORGANISATIONAL CHART FAO The food and agriculture organization(FAO) was formed in the year 1945 with headquarters in Rome.It was United Nations organization specialized agency created to look after several areas of world co-operation.The cheif aims of FAO are as follows; 1)to help nations raise living standards. 2)to improve the nutritional status of people of all countries. 3)to increase the efficiency of farming,forestry anfdfisheries. 4)to better the condition of rural people and better the opportunity of productive work
  43. 43. Activities of FAO: FAO's activities comprise four main areas: 1)Putting information within reach FAO serves as a knowledge network. We use the expertise of our staff - agronomists, foresters, fisheries and livestock specialists, nutritionists, social scientists, economists, statisticians and other professionals - to collect, analyse and disseminate data that aid development. A million times a month, someone visits the FAO Internet site to consult a technical document or read about our work with farmers. We also publish hundreds of newsletters, reports and books, distribute several magazines, create numerous CD-ROMS and host dozens of electronic fora. 2)Sharing policy expertise FAO lends its years of experience to member countries in devising agricultural policy, supporting planning, drafting effective legislation and creating national strategies to achieve rural development and hunger alleviation goals. 3)Providing a meeting place for nations On any given day, dozens of policy-makers and experts from around the globe convene at headquarters or in our field offices to forge agreements on major food and agriculture issues. As a neutral forum, FAO provides the setting where rich and poor nations can come together to build common understanding. 4)Bringing knowledge to the field Our breadth of knowledge is put to the test in thousands of field projects throughout the world. FAO mobilizes and manages millions of dollars provided by industrialized countries, development banks and other sources to make sure the projects achieve their goals. FAO provides the technical know-how and in a few cases is a limited source of funds. In crisis situations, we work side-by-side with
  44. 44. the World Food Programme and other humanitarian agencies to protect rural livelihoods and help people rebuild their lives. ILO In 1919,the International league of nations was established as an affiliate of league of nations to improve working and living conditions of the working population allover the world: The purposes of ILO are as follows: 1) To contribute to the establishment of lasting peace by promoting social justice. 2) To improve through international action ,labor conditions, and living standards. 3) To improve economic and social stability  The international labour code is a collection of international minimum standards related to health,welfare,living and working conditions of workers all over the world.  The ILO provides also assistance to organizations interested in the betterment of living and employment standards.  There is a close collaboration between ILO and WHO in the field of health and labor.  The headquarters of ILO is in Geneva,Switzerland BILATERAL HEALTH AGENCIES USAID The US government extentds aid to India through three agencies: 1)United agency for International development 2)the public law 480 programme 3)the US import bank.
  45. 45. The USAID was created in the year is being administered by the technical cooperative mission The US government is assisting in a number of projects designed to improve the health of Indian people. 1)Malaria eradication 2)Medical education 3)Nursing education 4)Health education 5)Water supply and sanitation 6)Control of communicable diseases 7)Nutrition 8)Family planning COLOMBO PLAN  At a meeting of the common wealth foreign ministers at Colombo in January Colombo in January 1950, a programme was drawn up for cooperative economic development in South Asia and South-East Asia.  Membership comprises 20 developing countries within the region and 6 non-regional members-Australia, Canada, Japan, New-Zealand, UK and USA.  The bulk of Colombo plan assistance goes into industrial and agricultural development.  Colombo plan has been useful in providing Cobalt therapy units to medical institutions in India. SIDA The Swedish international development agency is assisting the national Tuberculosis programme since 1979.
  46. 46. The SIDA assistance is usually spent on procurement of supplies like X-ray unit,microscope and anti-tubercular drugs. SIDA authorities are also supportping the short course Chemotherapy drug Regimens under pilot study,which were introduced in 18 districts of the country during 1983-1984. DANIDA The government of Denmark is providing assistance for the development of services under National Blindness control Programme since 1978. NON-GOVERNMENTAL AND OTHER AGENCIES ROCKFELLER FOUNDATION  Rockfeller foundation is a philanthropic organization chartered in 1913 and endowed by Mr.John .D rockfeller.  It’s purpose is to promote the wellbeing of mankind throughout the world.In it’s yearly years the foundation was actively chiefly in public health.the work of the Rockfeller foundation in india began in 1920 with a skill for control of hookworm infection with the Madras presidency.  The foundation’s programmes included the training of competent teachers and research workers, training abroad of candidates from India through fellowships and travel grants.  The sponsoring of visits of a large number of medical specialists from the USA,providing grants in aid to selected institutions.development of medical libraries,population studies, assistance to research projects and institutions, (eg.National institute of virology at Pune).
  47. 47.  At present the foundation is directing it’s support to the imp rovement of agriculture, family planning and rural training centres as well as to medical education. Ford Foundation The Ford foundation has been active in the development of rural health services and family planning. The ford foundation has helped in the following projects: 1)Orientation training centres at Singoor,Poonamallaietc 2)Research cum action projects.these projects were aimed at improving environmental sanitation problems(eg:Designing and construction of anitary latrines in rural area. 3)Pilot project in rural health services,Gandhigram(tamilnadu).Among arural population of 100,000 which provide auseful model for health administrator in the country. 4)Establishment of NIHAE:In the last few years the ford foundation has supported the national support institute of health administration and education at Delhi. 5)Calcutta water supply and drainage Scheme 6)Ford foundation Supports Family planning for research in reproductive biology. International Red Cross The red cross is anon-political and non-official international humanitarian organization devoted to the service of mankind in peace and war.It was founded by Henrary Dunant,A young swiss businessman in the year 1859. The first Geneva convention took place in 1864 and atreaty was signed for the relief of the wounded and sick of the armies in the field.Thus came into
  48. 48. being the International committee of red cross(ICRC).An independent, neutral institution,the founder organization of the red cross. Role of Red cross: 1)It was largely confined to the victims of the war. 2)mainly it tries to involve itself into activities like first aid in case of war like situations,mch services 3)lately it has tried to extend it’s research in Disaster management and has designed emergency protocols. CARE FOUNDATION The abbreviation when extended is ―Co-operative for assistance and relief everywhere‖ last founded in North America in the wake of the second world war in the year 1945. It is on of the world’s largest independent,non-profit,non-sectarian international relief and development organistaion.CARE provides enmergency aid and long term development assistance. CARE began it’s operation in India in 1950, till the end of 1980’s in India. The primary objectives of CARE in India was to provide food for children in the age group of 6-11 years from mid 1980’s ,CARE-India focused it’s food support in the ICDS programme and in developments of programmes in areas of health and income supplementation. It is helping in the following projects:Integrated nutrition and health projects, better health and nutrition projects, anemia control project,improving women’s health projects,improved health care for adoloscent’s girls projects, child survival projects, Improving
  49. 49. women’s reproductive health and family spacing project,Konkan integrated development project. CARE-India works in partnership with the government of india, state Government, NGO’s etc.Currently it has projects in Andhrapradesh,Bihar,MP,Maharashtra,Orissa and UP and West- Bengal. Indian Red Cross Society Indian Red cross society was Constituted under an Act of Indian Legislative council in 1920 it is auxiliary to the state authorities and armed forces medical services as per statutes of the Red Cross Red Crescent Movement. Organisation/membership/activities The National Headquarters of the Society is located at 1 Red Cross Road, New Delhi. Recognised by the International Committee of the Red Cross (ICRC) on 28th February 1929, it was affiliated with the International Federation of the Red Cross & Red Crescent Societies (then League) on 7th August 1929. The President of India is the President of the Society. Structure At the national level, the management of affairs of the Society rests with the Managing Body comprising of members elected by the Branch Committee, and members, including a Chairman, nominated by the President of the Society. The Managing Body elects a Vice Chairman from among themselves and appoints with the approval of the President of the Society a Treasurer and a Secretary General. The Secretary General is the Chief Executive.
  50. 50. Branches There are State/Union Territory/Regional/District and sub district branches numbering over 700 spread all over the country. The branches of the society are autonomous bodies with control over their own finance though they work under the guidance of the National Headquarters on questions relating to general policies and basic principles of the Red Cross. The National Headquarters is the federal focal point among other things for the purposes of (a) the unity of the organization, (b) guidance and assistance towards promotion and expansion of services, (c) co-ordination of inter-state, national and international efforts; (d) dissemination and application of humanitarian laws and fundamental principles of the Red Cross. Activities The activities of the Indian Red Cross may be broadly grouped under the following categories: - Relief work during floods, famine, earthquake, epidemic etc. - Training health visitors, nurses, dais and public health education - Cooperation with the St. John Ambulance Association in the training of men and women in First Aid, Home Nursing etc. - Running a Home at Bangalore for disabled Ex-servicemen - Welfare services in military hospitals - Medical after-care of ex-service personnel - Maternity & Child Welfare - Junior Red Cross
  51. 51. - Voluntary Blood Donation Membership Members of the Red Cross make the backbone of the Organisation. The Indian Red Cross Society has the following grades of members Patron; Vice Patron; Life Member; Life Associate; Institutional Member; Annual Member; Annual Associate. The membership subscriptions range from Rs.10/- to Rs.20,000/- Current trends and practices in Community health Nursing:  The Millenium Development Goals 2008: The eight Millennium Development Goals have been adopted by the international community as a framework for the development activities of over 190 countries in ten regions which was implemented by the United Nations.  In addition the UN has set specific targets to be met within a specific time limit. The Millenium development Goals: Goal 1: Eradicate poverty and Hunger Target: Halve,between 1990 and2015,the proportion of whose income is less than 1$ per day. Goal 2:Achieve universal primary education. Target: Ensure that, by 2015, children everywhere, boysand girls alike, will be able to complete a full course of primary schooling.
  52. 52. Goal 3:Promote gender equality and empowerwomen Target:Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015. Goal 4: Reduce child mortality Target: Reduce by 2/3rds between 1990 and 2015, the under five mortality rate. Goal 5:Improve maternal health Target: Reduce by three quarters 1990 and 2015, the maternal mortality ratio. Goal 6:Combat HIV,Malaria and other diseases. Target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS Goal 7: Ensure environmental stability Target: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources. Goal 8: Develop a global partnership for development Target: Develop further an open, rule-based, predictable,non-discriminatory trading and financial system.
  53. 53. International Health days January 4: World Braille Day - World Blind Union 19-23: Food allergy and intolerance awareness week -Allergy 22-26: Cancertalk Week - Macmillan Cancer Support 24: Eat a Breakfast, Save a Life Day -Feed the Children 26-30: Be Loud - Beating Bowel Cancer 31: National Bug Busting Day - Community Hygiene Concern February 4: World Braille Day - World Blind Union 19-23: Food allergy and intolerance awareness week -Allergy 22-26: Cancertalk Week - Macmillan Cancer Support 24: Eat a Breakfast, Save a Life Day -Feed the Children 26-30: Be Loud - Beating Bowel Cancer 31: National Bug Busting Day - Community Hygiene Concern March 1-31: Ovarian Cancer Awareness Month - Ovarian Cancer Action 1-31: Prostate Cancer Awareness Month - Prostate Cancer Charity 2-8: Endometriosis Awareness Week - Endometriosis 7: National Doodle Day - Epilepsy Action – TBC 8: International Women’s Day - United Nations 11: No Smoking Day - No Smoking Day the charity 24: World TB Day - TB Alert
  54. 54. April 1-30 - Bowel Cancer Awareness Month - Bowel Cancer 1-30 - International IBS (Irritable Bowel Syndrome) Awareness Month 4-11 - National PSP Awareness Week - Progressive Supranuclear Palsy Association 7 - World Health Day - World Health Organisation 8 - PSP Magnolia Day - Progressive Supranuclear Palsy Association 12-18 - Mental Health Action Week - Mental Health Foundation 12-18 - Arthritis Care Awareness Week - Arthritis Care 16 - World Voice Day - British Voice Association 17 - World Haemophilia Day - The Haemophilia Society 20-26 - Depression Awareness Week - Depression Alliance 20-26 - Parkinson’s Awareness Week - The Parkinson’s Disease Society 20-25 - National Stop Snoring Week - British Snoring and Sleep Apnoea Association 20-26 - European Immunisation Week 27-3 May - National MS Week - MS Society May 1-3: Save a Baby Month - FSID (The Foundation for the Study of Infant Deaths) 4-10: Deaf Awareness Week - Council on Deafness 5: World Asthma Day - Asthma 5-8: National Thrombosis Week 9-17: Cystic Fibrosis Week - Cystic Fibrosis Trust 10: World Lupus Day 10-16: ME Awareness Week - Action for M.E. 10-17: Dystonia Awareness Week - Dystonia Society 11-15: Cancer Prevention Week - World Cancer Research Fund 11-17: National Breastfeeding Awareness Week - NHS 11-17: Sun Awareness Week - British Association of Dermatologists 11-17: Action for Brain Injury Week - Headway Brain Injury Association
  55. 55. 12: Stroke Awareness Day - The Stroke Association 12: International Nurses Day 15: International Day of Families - United Nations 15: Fruity Friday - World Cancer Research Fund 17 - World Hypertension Day 17-23: National Epilepsy Week - Epilepsy Action 17 May-16 June: National Smile Month - British Dental Health Foundation 18-22: National Allergy Week -Allergy 18-22: Xtraordinary People Week - The British Dyslexia Association 18-22: Walk to School Week - Living Streets and Travelwise 23-30: Herbal Medicine Awareness Week - National Institute of Medical Herbalists 30-6 June: Cleft Lip and Palate Awareness Day - Cleft Lip and Palate Association 31: World No Tobacco Day - World Health Organisation June 17 May-16 June: National Smile Month - British Dental Health Foundation 1-30: Everyman Male Cancer Awareness Month - Everyman 1-30: Help a Heart Campaign - British Heart Foundation 1-30: National Osteoporosis Month - National Osteoporosis Society 2-6: National Childcare Week - Daycare Trust 8-13: Tampon Alert Week - Tampon Alert 8-14: Down’s Syndrome Week - Down’s Syndrome Association 8-14: National Glaucoma Awareness Week - International Glaucoma Association 8-14: Carers Week 8-14: Diabetes Week -Diabetes 13-20: Green Transport Week - Environmental Transport Association 13-21:National Bike Week 14: World Blood Donor Day 14-21: Homeopathy Awareness Week - Society of Homeopaths
  56. 56. 15: National Bug Busting Day - Community Hygiene Concern 15-21: National Men’s Health Week - Men’s Health Forum 15-21: National Food Safety Week - Food Standards Agency 21-28: Learning Disability Week - MENCAP 15-21: Breathe Easy Week - British Lung Foundation 20-28: MND Week - Motor Neurone Disease Association 21-28: UK Myeloma Awareness Week Myeloma 22-28: Child Safety Week - Child Accident Prevention Trust 22-28: Deafblind Awareness Week Deafblind 23: National Falls Awareness Day - Help the Aged 26: International Day Against Drug Abuse and Illicit Trafficking - United Nations 28-4 July: National Metabolic Disease Awareness Week - CLIMB July 24: The Samaritans Awareness Day August 2-8: World Breastfeeding Week 3-9: Sexual Health Week - Family Planning Association September 6-12: Migraine Awareness Week 7-13: Know Your Numbers! (National Blood Pressure Testing Awareness Week) 14-20: Lymphatic Cancer Awareness Week 12-19: National Eczema Week 21-27: Meningitis Awareness Week 25: World Alzheimer's Day October 1-31: Breast Cancer Awareness Month 3-11 Get moving week
  57. 57. 10: World Mental Health Day 20: World Osteoporosis Day 31: National Bug Busting Day November 1-30: Lung Cancer Awareness Month 1-30: Mouth Cancer Awareness Month 4: National Stress Awareness Day 9-15: Ask Your Pharmacist Week 9-15: Self Care Week 9-15: Threadworm Action Week 9-15: Scleroderma Awareness Week 14: World Diabetes Day 16-20: Indoor Allergy Week 16-22: Mouth Cancer Awareness Week December 1: World AIDS Day 3: International Day of Persons with Disabilities Bibliography:  Park.K. Textbook of preventive and social medicine..19th ed. Jabalpur:Banarasidas Bhanot Publishers;2007. p.762-68.  www.who.orgWHO The role of WHO in public health.htm  www.UNAIDAbout UNAIDS.htm  www.RockfellerThe Rockefeller Foundation - About Us.htm  www.UNICEFUNICEF - UNICEF Executive Board - About the Executive Board.html  www.who/interhealthregul.html
  58. 58.  www.wikipedia/medtourism.html      www.who/ihr.htm

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