Global Burden of Disease
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.
DALYs / YLDs definition
YLDs = Years Lived with Disability
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.
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.
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.
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
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.
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
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
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
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.
The GBD separates epidemiological assessment from advocacy, creating evidence-based
pictures of patterns in health that can subsequently motivate responsible policy and
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.
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
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
IHR grew from International Sanitary Conference (1851), recognising that:
free movement of people and goods will increase the risk of cross-border
quarantine is an impediment to free trade public health arguments can justify trade
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
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.
Key factors in determining the risks to which travellers may be exposed are:
— mode of transport
— 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 (www.who.int). 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
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
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/
Assessment of health risks associated with travel
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
— 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
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
— adhesive tape
— antiseptic wound cleanser
— 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
— medication for any pre-existing medical condition
— sterile syringes and needles
— water disinfectant
— other items to meet foreseeable needs, according to the destination and
duration of the visit.
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.
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 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
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
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.
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
— immunosuppression due to medication or to HIV infection
— previous thromboembolic disease
— severe anaemia
— severe mental disorders
— 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
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
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
● 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
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
— 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
— 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
— 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
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
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.
Many international hospitals today
see obtaining JCI accreditation as a way to attract American patients.
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.
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.
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
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.
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
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.
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
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
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
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.
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.
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
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
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
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
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
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
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
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.
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:
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
Diabetes in New Zealand
Diabetes retinal screening workshops -
Working together to make your work easier
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
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.
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
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
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
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
Unequal development in different countries in the promotion of health and control
of disease, especially communicable disease is a common danger.healthy
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 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
Epidemiological surveillance is an important activity of WHO carried out in case
of communicable diseases.
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
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
Appropriate technology for health(ATH) is another new programme launched by
WHO to encourage self-sufficiency in solving health problems.
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.
Promotion of environmental health is an important activity of WHO.
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.
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
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
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
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
It meets annualy in the month of May and generally at the Headquarters in
The Assembly is composed of delegates representing Member states,each
of which has one vote.
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.
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
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 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
The Director Secretriat is comprised of the following divisions:
1) Division of epidemiological surveillance and health situation and trend
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
WHO regional organizations are as follows:
Sr.no 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)
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 South-East Asia Region(SEARO)-WHO
5) Korea(Democratic people’s Republiv)
6) Maldives Islands
9) Sri Lanka
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
8) Health education
13)Quality control of drugs and medical education
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
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.
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
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
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.
UNICEF is funded primarily by voluntary contributions from governmental and non-
governmental organizations.Donations from the private sector also fund this organization.
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
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
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.
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
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
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
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
UNICEF has been participating in Urban Basic Services(UBS) to upgrade basic
iii. Water supply
iv. Sanitation and education
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:
Crisis Prevention and Recovery
Environment and Energy
UNDP ORGANISATIONAL CHART
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
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
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
the World Food Programme and other humanitarian agencies to protect rural livelihoods
and help people rebuild their lives.
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
2) To improve through international action ,labor conditions, and living
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
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.
The USAID was created in the year 1961.it 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.
5)Water supply and sanitation
6)Control of communicable diseases
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
Membership comprises 20 developing countries within the region and
6 non-regional members-Australia, Canada, Japan, New-Zealand, UK
The bulk of Colombo plan assistance goes into industrial and
Colombo plan has been useful in providing Cobalt therapy units to
medical institutions in India.
The Swedish international development agency is assisting the
national Tuberculosis programme since 1979.
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.
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 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
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).
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.
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
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
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.
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
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
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
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-
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.
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.
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
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.
The activities of the Indian Red Cross may be broadly grouped under the following
- 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
- Voluntary Blood Donation
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$
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.
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
International Health days
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
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
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
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
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
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
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
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
24: The Samaritans Awareness Day
2-8: World Breastfeeding Week
3-9: Sexual Health Week - Family Planning Association
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
1-31: Breast Cancer Awareness Month
3-11 Get moving week
10: World Mental Health Day
20: World Osteoporosis Day
31: National Bug Busting Day
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
1: World AIDS Day
3: International Day of Persons with Disabilities
Park.K. Textbook of preventive and social medicine..19th
Bhanot Publishers;2007. p.762-68.
www.who.orgWHO The role of WHO in public health.htm
www.RockfellerThe Rockefeller Foundation - About Us.htm
www.UNICEFUNICEF - UNICEF Executive Board - About the Executive