The document summarizes a review of health development in Pacific island countries over the past 20 years since adopting a "Healthy Islands" vision. While some health indicators have improved, inequality between the Pacific and rest of world is increasing. Communicable diseases and maternal/child health challenges persist alongside high rates of non-communicable diseases. Low health funding and few skilled workers hamper development. Continuing this trajectory will lead to greater health inequities, requiring substantial investment in health systems and workforce to achieve sustainable development goals.
ISLAND HEALTH REVIEW, PROGRESS AND THE WAY FORWARD IN THE WESTERN PACIFIC REG...Thant Zin
This document summarizes health indicators and issues facing island populations in the Western Pacific region. It finds that 15 islands had health expenditures below $500 per capita, and physician and nurse staffing levels fell below WHO recommendations of 1 doctor and 6 nurses per 1,000 people. These island populations also have higher disease burdens, with non-communicable diseases contributing to elevated mortality rates. The document highlights four key areas for improving island health: sustainable health workforce development, improved maternal and antenatal healthcare, and control of communicable and non-communicable diseases. However, it notes limitations from underreporting of some maternal health data and generalization of reported statistics.
This document discusses the evolution of primary health care models for developing countries from the 1950s-1970s. It describes how the comprehensive primary health care model proposed at the 1978 Alma-Ata conference aimed to achieve health for all through universal access and addressing social determinants of health. However, selective primary health care, focusing on cost-effective disease interventions, was seen as more feasible. Some argue comprehensive primary health care was never truly implemented, while others view it as an experiment that failed. Debate continues on the best policy approach to improving global health.
Role of Health Systems Strengthening in the Implementation of PEN InterventionsChanggyo Yoon
This presentation reviews useful concepts and frameworks for health system strengthening and to be able to achieve UHC and health related SDGs with regard to the Pacific. Given the important role of essential package of health services, the presntation addresses how PEN implementation can be well integrated into health strategy and planning processes to be able to help achieve NCD and health service related SDGs such as 3.4.1 / 3.5.2 / 3.8.1.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
Public health policy development in developing countries Ruby Med Plus
Public Health policy development in developing countries is addressed by four policy questions:
1. Does the introduction of a health policy at national, international level imply corresponding improvement in the quality of health of a country/population?
2. For effective health systems with efficient outcome: should health related policies be locally/nationally or internationally motivated (initiated)?
3. Should developing countries rely on the West for changes in the health of their population?
4. What is the impact of health policies adopted at the international scene on the health of populations in developing countries?
This document summarizes Nepal's progress toward achieving several health-related Sustainable Development Goals by 2030. It finds that Nepal has made progress in reducing poverty, child and maternal mortality, and increasing life expectancy, but still needs to achieve targets for maternal mortality, neonatal and child mortality, tuberculosis, and universal health coverage. It recommends focusing on underserved groups, increasing health funding and workers, strengthening data systems, and encouraging multi-sector partnerships to achieve the remaining goals.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
This document outlines and classifies various national health programmes in India. It divides the programmes into categories such as programmes related to communicable diseases, non-communicable diseases, nutrition, other welfare programmes, and social welfare programmes. For each category, it lists the relevant programmes and the ministry responsible for each one. The document provides an overview of over 50 specific programmes addressing health, nutrition, rural development, employment, and other social welfare issues across multiple Indian government ministries.
ISLAND HEALTH REVIEW, PROGRESS AND THE WAY FORWARD IN THE WESTERN PACIFIC REG...Thant Zin
This document summarizes health indicators and issues facing island populations in the Western Pacific region. It finds that 15 islands had health expenditures below $500 per capita, and physician and nurse staffing levels fell below WHO recommendations of 1 doctor and 6 nurses per 1,000 people. These island populations also have higher disease burdens, with non-communicable diseases contributing to elevated mortality rates. The document highlights four key areas for improving island health: sustainable health workforce development, improved maternal and antenatal healthcare, and control of communicable and non-communicable diseases. However, it notes limitations from underreporting of some maternal health data and generalization of reported statistics.
This document discusses the evolution of primary health care models for developing countries from the 1950s-1970s. It describes how the comprehensive primary health care model proposed at the 1978 Alma-Ata conference aimed to achieve health for all through universal access and addressing social determinants of health. However, selective primary health care, focusing on cost-effective disease interventions, was seen as more feasible. Some argue comprehensive primary health care was never truly implemented, while others view it as an experiment that failed. Debate continues on the best policy approach to improving global health.
Role of Health Systems Strengthening in the Implementation of PEN InterventionsChanggyo Yoon
This presentation reviews useful concepts and frameworks for health system strengthening and to be able to achieve UHC and health related SDGs with regard to the Pacific. Given the important role of essential package of health services, the presntation addresses how PEN implementation can be well integrated into health strategy and planning processes to be able to help achieve NCD and health service related SDGs such as 3.4.1 / 3.5.2 / 3.8.1.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
Public health policy development in developing countries Ruby Med Plus
Public Health policy development in developing countries is addressed by four policy questions:
1. Does the introduction of a health policy at national, international level imply corresponding improvement in the quality of health of a country/population?
2. For effective health systems with efficient outcome: should health related policies be locally/nationally or internationally motivated (initiated)?
3. Should developing countries rely on the West for changes in the health of their population?
4. What is the impact of health policies adopted at the international scene on the health of populations in developing countries?
This document summarizes Nepal's progress toward achieving several health-related Sustainable Development Goals by 2030. It finds that Nepal has made progress in reducing poverty, child and maternal mortality, and increasing life expectancy, but still needs to achieve targets for maternal mortality, neonatal and child mortality, tuberculosis, and universal health coverage. It recommends focusing on underserved groups, increasing health funding and workers, strengthening data systems, and encouraging multi-sector partnerships to achieve the remaining goals.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
This document outlines and classifies various national health programmes in India. It divides the programmes into categories such as programmes related to communicable diseases, non-communicable diseases, nutrition, other welfare programmes, and social welfare programmes. For each category, it lists the relevant programmes and the ministry responsible for each one. The document provides an overview of over 50 specific programmes addressing health, nutrition, rural development, employment, and other social welfare issues across multiple Indian government ministries.
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) aims to prevent and control non-communicable diseases in India through strategies like health promotion, early diagnosis, treatment, and capacity building. Key objectives include preventing and managing common NCDs, providing early diagnosis and affordable treatment, and establishing surveillance systems. The program focuses on lifestyle changes, screening and management of conditions like diabetes, hypertension, cancer and cardiovascular disease at primary health centers, community health centers, and tertiary cancer centers. Achievements include establishing over 290 district NCD clinics and 100 cardiac care units nationwide.
India faces several major health issues that affect its entire population. Communicable diseases like malaria, tuberculosis, diarrheal diseases, acute respiratory infections, leprosy, and filariasis remain significant problems. Non-communicable diseases such as cancer, cardiovascular disease, and diabetes are also increasing. Nutritional deficiencies including anemia, low birth weight, and iodine deficiency disorders are widespread public health issues. Environmental sanitation problems related to water supply and waste disposal are compounded by rapid urbanization and industrialization. There is an inequitable distribution of healthcare resources between urban and rural areas. Population growth further exacerbates these health challenges.
Family planning, Poverty and Economic developmentShikha Basnet
The document discusses family planning and its relationship to poverty reduction and economic development. It provides definitions of family planning and outlines its benefits, including improved health outcomes for mothers and children as well as empowerment of women. Family planning is characterized as a cost-effective intervention. The document then discusses global trends in contraceptive use and unmet need for family planning. It also provides regional overviews of family planning for South and Southeast Asia as well as scenarios specifically for Nepal. Major family planning activities and challenges to uptake are outlined. Poverty is then defined and its multidimensional causes and measurement approaches are briefly explained, followed by the global scenario of poverty.
Healthy People 2010 aims to improve national health through two overarching goals: increasing quality and years of healthy life, and eliminating health disparities. It monitors progress through 467 objectives across 28 focus areas. Achieving its goals requires recognizing that health is determined by interactions between individual behaviors, environments, and policies targeting factors like access to healthcare. Two successful programs that exemplify this systematic approach are Action for Healthy Kids, which promotes healthy school environments, and the 100 Black Men Health Challenge, which empowers communities through lifestyle modeling and education.
This document outlines a presentation on Nepal's National Health Policy 2071, which was approved in July 2014. It provides background on Nepal's past health experiences, current health context, and key problems and challenges in the health system. The presentation describes the need for a new health policy to address these issues. The policy's vision, mission, goals, and 14 policy areas with 120 total strategies are summarized. The presentation also discusses organizational management, financial sources, monitoring, risks, and new areas addressed by the new health policy.
Sexual and reproductive health and rights Shikha Basnet
1) Sexual and reproductive health services are essential in humanitarian and fragile settings to reduce unintended pregnancies, unsafe abortions, and maternal deaths. However, these services often face barriers to access during crises.
2) The Minimum Initial Service Package (MISP) for sexual and reproductive health aims to immediately implement lifesaving services at the onset of emergencies. It includes preventing sexual violence, reducing HIV transmission, and providing contraceptives and maternal/newborn healthcare.
3) Following the 2015 Nepal earthquake, the MISP was activated and services like clean delivery kits, medical camps, and outreach clinics helped address the sexual and reproductive health needs of those affected. Challenges to implementation included
Factors Associated with Anemia among Pregnant Women of Underprivileged Ethnic...Prabesh Ghimire
Abstract
Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education
Evolution of National Family Planning Programme (NFPP) and National Populatio...Dr Kumaravel
This presentation discuss the evolution of India's National Family Planning Program and National Population Policy 2000, significant impact of 1994 Cairo conference on country's Reproductive health approach.
An Expert Committee (1971) of the WHO defined family planning as "a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country“.
Basic Human Rights
Scope of family planning services
Health aspects of family planning:
1. Women's health: Unwanted pregnancies, Limiting the number of births and proper spacing, Timing of births
2. Foetal health
3. Child health: Child mortality, Child growth, development and nutrition, Infectious diseases
The welfare concept
Small-family norm
Eligible couples
Target couples
Couple protection rate (CPR)
This document summarizes the child health program in Nepal. It discusses the main medical causes of infant mortality and morbidity, including low birth weight, respiratory infections, diarrhea, and malnutrition. It then outlines Nepal's national immunization program, which aims to increase vaccination coverage and prevent diseases like polio, measles, and tetanus. The program is guided by national health strategies and goals to reduce child mortality and morbidity from vaccine-preventable illnesses. Key activities discussed include vaccinator training, polio campaigns, and integrated disease surveillance.
This document provides information on family planning in Nepal, including:
1. Definitions of family planning, its aims to improve health and contribute to national development.
2. A history of family planning initiatives in Nepal beginning in 1959 with NGO programs and the government adopting policies in the 1960s-1970s.
3. How family planning can help achieve the Millennium Development Goals by reducing poverty, improving education and gender equality, and decreasing disease and mortality. Meeting family planning needs can prevent maternal and child deaths.
The MDGs originated from the United Nations Millennium Declaration in 2000 where 189 countries agreed to help reduce extreme poverty. The MDGs established 8 goals and 18 targets to improve health, education, and living standards globally by 2015. In India, various policies and programs were implemented to achieve the MDGs. For example, poverty reduction programs helped reduce India's poverty headcount ratio from 47.8% in 1990 to 21.9% in 2012. However, India fell short of fully achieving some targets like reducing hunger and child mortality by 2015. Overall, the MDGs helped focus global efforts on improving living standards for the world's poorest people.
National health programs and policies for prevention and control of ncds in n...Pawan Dhami
This document summarizes several national health programs and policies in Nepal related to the prevention and control of non-communicable diseases (NCDs). It outlines policies such as the Integrated NCD Prevention and Control Policy, the Multi-Sectoral Action Plan for NCD Prevention and Control (2014-2020), and the National Policy and Plan for NCD Prevention and Control (2013-2017). It also discusses the Health Education, Information and Communication Program and policies within the Second Long Term Health Plan, Nepal Health Sector Strategy, and other documents. The document analyzes some of the systematic challenges facing NCD prevention in Nepal, such as limited funding for primary prevention and a lack of coordination between sectors.
This presentation provides an overview of family planning, including its history and definition. It discusses global trends in contraceptive use and unmet need for family planning. Specific data on South Asia and Nepal is presented regarding population growth trends, total fertility rates, and contraceptive prevalence over time. The major activities of Nepal's family planning program are outlined. The presentation concludes with an overview of various contraceptive methods and a discussion of a potential new reversible male contraceptive method called RISUG.
The National Diabetes Prevention Program (National DPP) encourages collaboration among federal agencies, community-based organizations, employers, insurers, health care professionals, academia, and other stakeholders to prevent or delay the onset of type 2 diabetes among people with prediabetes in the United States.
1) The document discusses adolescent health in Nigeria from 1990-2015, focusing on matching health policy with practice. It describes Nigeria's adolescent health policy and its goals of meeting special needs of adolescents.
2) Key health issues affecting Nigerian adolescents are discussed, including high rates of HIV, early pregnancy, unsafe abortion, and lack of access to health services. Over 30 million Nigerians are between 10-19 years old.
3) The document outlines Nigeria's adolescent health policy framework and strategic trusts, which include improving access to health services, health promotion, and capacity building for healthcare workers on adolescent health issues. Implementation of the policy has faced challenges with poor funding and evaluation.
The National Health Mission aims to improve health outcomes in rural and urban India through various programs and initiatives. It encompasses the National Rural Health Mission and the National Urban Health Mission. The NRHM focuses on improving access to primary healthcare in rural areas by strengthening infrastructure like subcenters and PHCs and promoting community health through Accredited Social Health Activists. The NUHM similarly focuses on improving access for urban poor populations, particularly in slums, through urban primary health centers and community health workers. Both missions aim to reduce infant and maternal mortality and improve health indicators.
Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Morta...DerejeBayissa2
This systematic review and meta-analysis assessed the effectiveness of linking pre-pregnancy and pregnancy care in reducing neonatal and perinatal mortality in low- and middle-income countries. The analysis included 5 randomized controlled trials with outcomes of neonatal, perinatal, and maternal mortality. The meta-analysis found that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality by 21% and perinatal mortality by 16%, but did not find an effect on maternal mortality. The review concluded that neonatal and perinatal mortality can be reduced by linking pre-pregnancy and pregnancy care as part of a continuum of care approach.
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) aims to prevent and control non-communicable diseases in India through strategies like health promotion, early diagnosis, treatment, and capacity building. Key objectives include preventing and managing common NCDs, providing early diagnosis and affordable treatment, and establishing surveillance systems. The program focuses on lifestyle changes, screening and management of conditions like diabetes, hypertension, cancer and cardiovascular disease at primary health centers, community health centers, and tertiary cancer centers. Achievements include establishing over 290 district NCD clinics and 100 cardiac care units nationwide.
India faces several major health issues that affect its entire population. Communicable diseases like malaria, tuberculosis, diarrheal diseases, acute respiratory infections, leprosy, and filariasis remain significant problems. Non-communicable diseases such as cancer, cardiovascular disease, and diabetes are also increasing. Nutritional deficiencies including anemia, low birth weight, and iodine deficiency disorders are widespread public health issues. Environmental sanitation problems related to water supply and waste disposal are compounded by rapid urbanization and industrialization. There is an inequitable distribution of healthcare resources between urban and rural areas. Population growth further exacerbates these health challenges.
Family planning, Poverty and Economic developmentShikha Basnet
The document discusses family planning and its relationship to poverty reduction and economic development. It provides definitions of family planning and outlines its benefits, including improved health outcomes for mothers and children as well as empowerment of women. Family planning is characterized as a cost-effective intervention. The document then discusses global trends in contraceptive use and unmet need for family planning. It also provides regional overviews of family planning for South and Southeast Asia as well as scenarios specifically for Nepal. Major family planning activities and challenges to uptake are outlined. Poverty is then defined and its multidimensional causes and measurement approaches are briefly explained, followed by the global scenario of poverty.
Healthy People 2010 aims to improve national health through two overarching goals: increasing quality and years of healthy life, and eliminating health disparities. It monitors progress through 467 objectives across 28 focus areas. Achieving its goals requires recognizing that health is determined by interactions between individual behaviors, environments, and policies targeting factors like access to healthcare. Two successful programs that exemplify this systematic approach are Action for Healthy Kids, which promotes healthy school environments, and the 100 Black Men Health Challenge, which empowers communities through lifestyle modeling and education.
This document outlines a presentation on Nepal's National Health Policy 2071, which was approved in July 2014. It provides background on Nepal's past health experiences, current health context, and key problems and challenges in the health system. The presentation describes the need for a new health policy to address these issues. The policy's vision, mission, goals, and 14 policy areas with 120 total strategies are summarized. The presentation also discusses organizational management, financial sources, monitoring, risks, and new areas addressed by the new health policy.
Sexual and reproductive health and rights Shikha Basnet
1) Sexual and reproductive health services are essential in humanitarian and fragile settings to reduce unintended pregnancies, unsafe abortions, and maternal deaths. However, these services often face barriers to access during crises.
2) The Minimum Initial Service Package (MISP) for sexual and reproductive health aims to immediately implement lifesaving services at the onset of emergencies. It includes preventing sexual violence, reducing HIV transmission, and providing contraceptives and maternal/newborn healthcare.
3) Following the 2015 Nepal earthquake, the MISP was activated and services like clean delivery kits, medical camps, and outreach clinics helped address the sexual and reproductive health needs of those affected. Challenges to implementation included
Factors Associated with Anemia among Pregnant Women of Underprivileged Ethnic...Prabesh Ghimire
Abstract
Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education
Evolution of National Family Planning Programme (NFPP) and National Populatio...Dr Kumaravel
This presentation discuss the evolution of India's National Family Planning Program and National Population Policy 2000, significant impact of 1994 Cairo conference on country's Reproductive health approach.
An Expert Committee (1971) of the WHO defined family planning as "a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country“.
Basic Human Rights
Scope of family planning services
Health aspects of family planning:
1. Women's health: Unwanted pregnancies, Limiting the number of births and proper spacing, Timing of births
2. Foetal health
3. Child health: Child mortality, Child growth, development and nutrition, Infectious diseases
The welfare concept
Small-family norm
Eligible couples
Target couples
Couple protection rate (CPR)
This document summarizes the child health program in Nepal. It discusses the main medical causes of infant mortality and morbidity, including low birth weight, respiratory infections, diarrhea, and malnutrition. It then outlines Nepal's national immunization program, which aims to increase vaccination coverage and prevent diseases like polio, measles, and tetanus. The program is guided by national health strategies and goals to reduce child mortality and morbidity from vaccine-preventable illnesses. Key activities discussed include vaccinator training, polio campaigns, and integrated disease surveillance.
This document provides information on family planning in Nepal, including:
1. Definitions of family planning, its aims to improve health and contribute to national development.
2. A history of family planning initiatives in Nepal beginning in 1959 with NGO programs and the government adopting policies in the 1960s-1970s.
3. How family planning can help achieve the Millennium Development Goals by reducing poverty, improving education and gender equality, and decreasing disease and mortality. Meeting family planning needs can prevent maternal and child deaths.
The MDGs originated from the United Nations Millennium Declaration in 2000 where 189 countries agreed to help reduce extreme poverty. The MDGs established 8 goals and 18 targets to improve health, education, and living standards globally by 2015. In India, various policies and programs were implemented to achieve the MDGs. For example, poverty reduction programs helped reduce India's poverty headcount ratio from 47.8% in 1990 to 21.9% in 2012. However, India fell short of fully achieving some targets like reducing hunger and child mortality by 2015. Overall, the MDGs helped focus global efforts on improving living standards for the world's poorest people.
National health programs and policies for prevention and control of ncds in n...Pawan Dhami
This document summarizes several national health programs and policies in Nepal related to the prevention and control of non-communicable diseases (NCDs). It outlines policies such as the Integrated NCD Prevention and Control Policy, the Multi-Sectoral Action Plan for NCD Prevention and Control (2014-2020), and the National Policy and Plan for NCD Prevention and Control (2013-2017). It also discusses the Health Education, Information and Communication Program and policies within the Second Long Term Health Plan, Nepal Health Sector Strategy, and other documents. The document analyzes some of the systematic challenges facing NCD prevention in Nepal, such as limited funding for primary prevention and a lack of coordination between sectors.
This presentation provides an overview of family planning, including its history and definition. It discusses global trends in contraceptive use and unmet need for family planning. Specific data on South Asia and Nepal is presented regarding population growth trends, total fertility rates, and contraceptive prevalence over time. The major activities of Nepal's family planning program are outlined. The presentation concludes with an overview of various contraceptive methods and a discussion of a potential new reversible male contraceptive method called RISUG.
The National Diabetes Prevention Program (National DPP) encourages collaboration among federal agencies, community-based organizations, employers, insurers, health care professionals, academia, and other stakeholders to prevent or delay the onset of type 2 diabetes among people with prediabetes in the United States.
1) The document discusses adolescent health in Nigeria from 1990-2015, focusing on matching health policy with practice. It describes Nigeria's adolescent health policy and its goals of meeting special needs of adolescents.
2) Key health issues affecting Nigerian adolescents are discussed, including high rates of HIV, early pregnancy, unsafe abortion, and lack of access to health services. Over 30 million Nigerians are between 10-19 years old.
3) The document outlines Nigeria's adolescent health policy framework and strategic trusts, which include improving access to health services, health promotion, and capacity building for healthcare workers on adolescent health issues. Implementation of the policy has faced challenges with poor funding and evaluation.
The National Health Mission aims to improve health outcomes in rural and urban India through various programs and initiatives. It encompasses the National Rural Health Mission and the National Urban Health Mission. The NRHM focuses on improving access to primary healthcare in rural areas by strengthening infrastructure like subcenters and PHCs and promoting community health through Accredited Social Health Activists. The NUHM similarly focuses on improving access for urban poor populations, particularly in slums, through urban primary health centers and community health workers. Both missions aim to reduce infant and maternal mortality and improve health indicators.
Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Morta...DerejeBayissa2
This systematic review and meta-analysis assessed the effectiveness of linking pre-pregnancy and pregnancy care in reducing neonatal and perinatal mortality in low- and middle-income countries. The analysis included 5 randomized controlled trials with outcomes of neonatal, perinatal, and maternal mortality. The meta-analysis found that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality by 21% and perinatal mortality by 16%, but did not find an effect on maternal mortality. The review concluded that neonatal and perinatal mortality can be reduced by linking pre-pregnancy and pregnancy care as part of a continuum of care approach.
This presentation covers the USAID Office of Maternal, Child Health and Nutrition; the Office of Health Systems; Office of Population and Reproductive Health; and the Center for Innovation and Impact.
This document outlines a unit on international public health. It discusses the need for a global perspective on health and defines key concepts like international health, public health, and global health. Important forces affecting international health are noncommunicable diseases, communicable diseases, food security and nutrition, environmental health, and health inequity. Current issues requiring global action include long COVID, mental health, climate change impacts, and strengthening health systems. International public health actions involve health promotion, disease prevention, health protection like immunization, and pandemic control. Globalization can impact health through issues like nutrition, emerging diseases, pharmaceutical industries, and effects on underdeveloped nations.
The document summarizes the World Health Organization (WHO) and Canada's support and collaboration with WHO. It discusses that WHO was established in 1948 and is responsible for international public health. Canada works closely with WHO to reduce global diseases like polio, HIV/AIDS, tuberculosis, and malaria. Canada also contributes funding to WHO and supports initiatives like the development of an Ebola vaccine. The document outlines several areas of collaboration between Canada and WHO, including on health emergencies, maternal and child health, and improving health systems.
Lecture 1 Public health administration in the Pacific Islands.pptxLencyMuna1
Public health in Pacific Island Countries faces challenges of a rising non-communicable disease burden as well as communicable outbreaks. In Fiji, priorities include addressing non-communicable diseases through prevention and treatment programs, reducing maternal and child mortality, and controlling communicable diseases. Community health networks require strengthening to improve primary care access and health outcomes.
This document discusses the relationship between nutrition, health, and economic development. It states that malnutrition negatively impacts economic development by increasing mortality and morbidity, especially in children and women. Poor nutrition lowers educational performance and cognitive ability due to issues like iodine and iron deficiencies. However, improved nutrition can boost economic growth by increasing labor productivity and utilization of resources. Overall, better health and nutrition are closely tied to individual and national well-being and prosperity.
Childhood obesity has been described as the main health-related problem in developed countries, due to its link with physical, social and psychological consequences with an increased risk for developing metabolic and cardiovascular diseases in adulthood.
All the pupils of both sexes attending the second year of all the primary schools in Pavia, Northern Italy, were recruited (n=470) for this study. Measurements of weight, height and waist circumference (WC) were taken under standard conditions. Body Mass Index (BMI) and waist-to-height-ratio (W/HtR) were computed and sex specific percentile values for BMI, WC and W/HtR were calculated and compared with the same percentiles available for different countries.
The results show that according to Cole’s cut-off point reference standards, 12.5% and 9.0% of boys and girls respectively are overweight, 4.7% and 5.2% respectively are obese. The WC mean value is equal to 60.0 ± 6.0 cm in boys and 59.0 ± 6.7 cm in girls. Using different 90th reference worldwide standard percentiles for WC as a comparison, the prevalence of our children with WC > 90th percentile is very different. The W/HtR mean value of the total sample is 0.46 ± 0.03. Assuming a cutoff of 0.5, 87.6% of the pupils have a W/HtR value ≤ 0.5, while 12.4% of the subjects have a value > 0.5, showing abdominal obesity among 55 children at an early age.
Our results point out the need for specific preventive and treatment interventions by identifying and implementing effective strategies, policies, and nutritional education programs in order to decrease the prevalence rate of obesity as well as the risk of metabolic disorders.
Global health is an important new term, and an important new concept. The Institute of Medicine refers to global health as "health problems, issues and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions."
OBJECTIVES OF GLOBAL HEALTH CARE
Why should medical students learn about global health
CONTINUE…
Public health, medicine, and nursing: parts of the same puzzle
CHALLENGES IN GLOBAL HEALTH CARE
THE KEY CONCEPTS IN RELATION TO GLOBAL HEALTH
. THE DETERMINANTS OF HEALTH
CONTINUE..
CONTINUE..
Continue…
2. The Measurement of Health Status
CONTINUE..
CULTURE AND HEALTH
CONTINUE..
4. The global burden of disease
5. Key Risk Factors for Various Health Conditions
CONTINUE..
Trends in Global Deaths 2002-30
HEALTH PATTERNS IN RESOURCE POOR COUNTRIES
HEALTH PATTERNS IN RESOURCE RICH COUNTRIES
Sharing the information.Network formation
REFERENCES
THANK YOU
The document provides an overview of the first five years of the Public Health Surveillance Unit (PHSU) within Vancouver Coastal Health from 2007-2012. It describes the PHSU's core functions of disease surveillance, health assessment, epidemiological investigations, and knowledge transfer to support public health in the region. The PHSU monitors trends in communicable diseases, conducts health profiling of communities, leads investigations into disease outbreaks, and works to build public health capacity.
Global health initiatives aim to improve health and healthcare equity worldwide through both medical and non-medical efforts. They rose alongside globalization and increased public awareness of shared global health challenges. Major initiatives work towards the UN's 8 Millennium Development Goals, including eradicating poverty and hunger, improving education, gender equality, child and maternal health, and combating diseases. Key organizations coordinating global efforts include the WHO, World Bank, Global Fund, GAVI, and others working in areas like immunization, tuberculosis, malaria, non-communicable diseases, and more. Overall, global health initiatives are needed for nations to work together towards the important goal of saving lives and improving health outcomes globally.
The document discusses several international health agencies including WHO and UNICEF. It provides details on their establishment, goals, activities, and collaboration with Indian agencies. WHO works to promote health and prevent disease worldwide. It aims to achieve 'Health for All'. UNICEF was established in 1946 to help children in need and works to support child survival, development, protection, education, and HIV/AIDS prevention. Its GOBI campaign promotes growth monitoring, oral rehydration, breastfeeding, and immunization.
Forty years ago, the Region of the Americas played a critical JeanmarieColbert3
Forty years ago, the Region of the Americas played a critical role in the develop-
ment and negotiation of the Alma-Ata Declaration, which identified primary health
care as a central strategy to the goal of health for all and a comprehensive approach to
the organization of health systems. Since then, the values and principles of primary
health care, which include the right to health, equity, solidarity, social justice and par-
ticipation, and multisectoral action, among others, have formed the basis of many
PAHO mandates and have guided health systems transformation in the Region. The
positive impact of primary health care on the reduction of mortality, morbidity, and
inequities in health is well known. (1) What’s more, primary health care consumes less
financial resources than curative approaches and promotes a chain of positive results
from improved health to increased economic output, growth and productivity. (2)
In 2007, PAHO’s position paper on Renewing Primary Health Care in the Americas
included the definition of elements and functions of a primary healthcare-based
health system with the intention of providing guidance to countries as they worked
to transform their systems. (3) In 2014, the 53rd PAHO Directing Council’s resolution
on Universal Access to Health and Universal Health Coverage (4) recognized the
values and principles of Alma-Ata. The resolution urged PAHO Member States to
promote intersectoral action to address social determinants of health and move
toward health systems where all people and communities have access, without any
discrimination, to comprehensive, appropriate and timely, quality health services, as
well as access to safe, effective, and affordable quality medicines, while ensuring that
the use of such services does not expose users to financial difficulties. (4) The Sustai-
nable Health Agenda for the Americas 2018–2030, which represents the commitment
of Member States to the 2030 Agenda for Sustainable Development and unfinished
business from previous engagements, established areas of action that reinforce and
complement the recommendations of the Alma-Ata Declaration. These include stren-
gthening the national health authority; tackling health determinants; increasing so-
cial protection and access to quality health services; diminishing health inequalities
among countries and inequities within them; reducing the risk and burden of disease;
strengthening the management and development of health workers; harnessing
knowledge, science, and technology; and strengthening health security. (5)
In the Region, the lessons that have been learned about the primary health care
approach since Alma-Ata have been overwhelmingly positive. We have seen that
countries that have implemented policies and programs based on primary health
care have registered the lowest levels of infant and maternal mortality. Other achie-
vements include improvement in public spending, increase in primary care s ...
This document provides an overview of oral health promotion. It defines oral health promotion as public health actions to protect or improve oral health through behavioral, educational, socioeconomic, legal, environmental and social measures. The document discusses the origins and concepts of health promotion, as well as methods, strategies and approaches to oral health promotion. It also examines barriers to oral health promotion and provides examples of oral health promotion in action through various international conferences and charters.
The document summarizes the Disease Control Priorities, Third Edition (DCP3) project. It is producing 9 volumes that systematically review the cost-effectiveness of health interventions for low and middle income countries. The volumes cover a range of health topics, from essential surgery to child development. The goal is to influence priority setting and resource allocation for health programs globally and within countries. The first volumes will be published electronically and in print in 2015-2016. DCP3 builds on two previous editions to provide updated evidence on intervention efficacy, effectiveness, and comprehensive economic evaluations.
Strategic Review: Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes a strategic review of options for improving integrated management of newborn and childhood illness (IMNCI) going forward. The review draws on data from over 90 countries and hundreds of experts. Key findings are: 1) While IMNCI has helped transform child health services, interest and funding have declined and scale-up was rarely achieved; 2) To achieve ambitious new child mortality targets, health systems must be strengthened and universal health coverage ensured; 3) The review proposes renewing focus and action on IMNCI through a "Grand Convergence" to end preventable child deaths, supported by domestic and international financing. The goal is high quality care across home, community and health facilities as part of reproductive, maternal
This document discusses challenges in managing diabetes among the world's poorest populations. It notes that while type 2 diabetes is increasing globally due to obesity and lifestyle changes, the poorest billion people face a different challenge as they have higher rates of type 1 diabetes and atypical forms. Treatment for these complex forms of diabetes is often unavailable in these resource-poor settings. The document outlines two initiatives aimed at improving access to insulin and establishing integrated care for chronic diseases like diabetes in Rwanda and Haiti over three years. It emphasizes the need to address disparities in diabetes management and outcomes between rich and poor populations worldwide.
Knowledge and practice on oral health among diabetic patients NAAR Journal
- The study assessed the knowledge and oral health practices of 120 diabetic patients in Bangladesh through interviews.
- It found that 65% of patients had good knowledge of oral health risks but only 7.5% had good oral health practices.
- Factors like education level, occupation, and income were associated with both better knowledge and practices.
This document provides an overview of pharmacy education and training in a global and national context. Globally, organizations like FIP and academic pharmacy sections are working to promote harmonization of pharmacy education worldwide. Nationally, the document discusses Zambia's health system and the development of the country's pharmacy education program. It was established through collaboration between the University of Zambia, Ministry of Health, and professional bodies to train registrable pharmacists through academic and practice-based components. The goals of pharmacy education are also outlined, including developing skills in various areas and providing scientific, academic, and professional knowledge bases.
This report provides a suggested roadmap for a multi-sectoral approach to addressing the noncommunicable disease (NCD) crisis in the Pacific Islands. NCDs like cardiovascular disease and diabetes impose large health, economic, and social costs. The roadmap calls for strategic priority setting and actions across government agencies, as well as partnerships with development partners, the private sector, civil society, and regional organizations. These collaborative efforts aim to reduce NCD risk factors through strategies like tobacco control, alcohol reduction, taxes on unhealthy foods/drinks, and health promotion. The roadmap also emphasizes the importance of implementation and applying economic principles to ensure responses are affordable, effective, and financially sustainable.
This document provides an acknowledgements and contents section for the Kingdom of Tonga NCD Risk Factors STEPS Report from 2014. It acknowledges the many individuals and organizations that contributed to compiling the report. These include staff from the Ministry of Health of Tonga, the World Health Organization regional and country offices, as well as statistical and administrative support. The contents section provides an overview of the report's structure, which includes an executive summary, introduction, methodology, results, comparisons with a previous 2004 STEPS survey, discussion and conclusions, and recommendations. The report examines risk factors for noncommunicable diseases in Tonga through the WHO STEPwise approach, analyzing data on tobacco use, alcohol consumption, diet, physical activity, obesity, blood
This document provides an acknowledgements and contents section for the Kingdom of Tonga NCD Risk Factors STEPS Report from 2014. It acknowledges the many individuals and organizations that contributed to compiling the report. These include staff from the Ministry of Health of Tonga, the World Health Organization regional and country offices, as well as statistical and administrative support. The contents section provides an overview of the report's structure, which includes an executive summary, introduction, methodology, results, comparisons with a previous 2004 STEPS survey, discussion and conclusions, and recommendations. The report examines risk factors for noncommunicable diseases in Tonga through the WHO STEPwise approach, analyzing data on tobacco use, alcohol consumption, diet, physical activity, obesity, blood
The STEPS survey of chronic disease risk factors was conducted in Tonga from August to October 2004. It collected socio-demographic, behavioral, physical, and biochemical data from 958 adults aged 15-64 through questionnaires, physical measurements, and blood samples. Key findings included that over half of participants had at least 3 risk factors for chronic diseases, such as smoking, low fruit/vegetable consumption, physical inactivity, overweight/obesity, or high blood pressure. Males generally had higher risk factors than females. The survey aims to monitor non-communicable disease risks to help guide public health strategies in Tonga.
The document provides a review of Tonga's health system. It summarizes that Tonga has a decentralized health system managed through 4 districts, with the majority of primary care and 90% of hospital services provided by the public sector. Key achievements include control of infectious diseases, high immunization coverage, and prioritization of non-communicable diseases. However, challenges remain such as high rates of non-communicable diseases and their risk factors. The health workforce faces issues of limited education opportunities and brain drain overseas. Infrastructure and medical equipment also require significant upgrades.
This document discusses global updates on noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory disease. It notes that NCDs account for over 80% of deaths in the Western Pacific region. The main risk factors for NCDs, such as tobacco use, unhealthy diet, and physical inactivity, are increasingly behavioral and promoted by unsupportive environments. Initiatives discussed include implementing sin taxes on tobacco and alcohol in the Philippines, using mHealth to combat NCDs, developing an urban health framework for the Western Pacific, and promoting healthier families. The document advocates addressing NCDs through a continuum of prevention and management strategies.
This document summarizes a research paper on designing characteristics for a human resource information system (HRIS). The paper proposes a framework to help design HRIS characteristics for future improvement strategies. It uses several models and theories to validate its findings, including the Technology Acceptance Model, DeLone and McLean Model of IS Success, case study approach, experiment and survey approach, and combinatorial approach. The paper contributes to research on HRIS design by developing a general framework that combines different approaches to study characteristics.
This document summarizes an environmental impact assessment and cost-benefit analysis for a proposed port development project in Savusavu, Fiji. The objectives of the project are to support regional development goals and address transportation issues facing the outer islands. The presentation outlines the project site and goals, analyzes environmental impacts and mitigation measures, discusses economic and financial feasibility studies, and concludes that the project is viable if proper safeguards are implemented.
This document outlines measures taken in Tonga to address high rates of non-communicable diseases (NCDs) through taxation. It discusses Tonga implementing taxes on unhealthy foods like mutton flaps and subsidies for healthy foods. The results were mixed - consumption of some taxed foods like mutton flaps decreased significantly while demand for others like sugary drinks was less responsive. Overall, the taxes increased government revenue as consumption declined. However, consumers also shifted to cheaper unhealthy substitutes. The document recommends stronger policies to promote affordable healthy foods and engage community leaders to support behavior change initiatives.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
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VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
1. Pacific island health inequities forecast to grow unless
profound changes are made to health systems in the region
Don Matheson1,4
FAFPHM, MBChB, BSc, Professor
Kunhee Park2
MD, PhD, Doctor
Taniela Sunia Soakai3
Diploma Business (Health Service Management), MBA, Deputy Director,
Public Health Division
1
Griffith University School of Medicine, 170 Kessels Road, Nathan, Qld 4111, Australia.
2
World Health Organization, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji.
Email: parkku@who.int
3
Pacific Community BP D5, 98848, Noumea, New Caledonia. Email: sunia@spc
4
Corresponding author. Email: donmathes@gmail.com
Abstract
Objective. Twenty years ago the Pacific’s health ministers developed a ‘Healthy Islands’ vision to lead health
development in the subregion. This paper reports on a review of health development over this period and discusses the
implications for the attainmentof the health related Sustainable Development Goals.
Methods. The review used qualitative and quantitative methods. The qualitative review included conducting semi-
structured interviews with Pacific Island Government Ministers and officials, regional agencies, health workers and
communitymembers.A documentreview was also conducted.The quantitativereview consisted of examining secondary
data from regional and global data collections.
Results. The review foundimprovementin healthindicators,butincreasinghealthinequality between the Pacific and
the rest of the world. Many of the larger island populations were unable to reach the health Millennium Development
Goals. The ‘Healthy Islands’ vision remainedan inspirationto healthministersandseniorofficials in the region. However,
implementationof the ‘Healthy Islands’ approach was patchy, under-resourcedand un-sustained. Communicable and
Maternal and Child Health challenges persist alongside unprecedentedlevels of non-communicablediseases, inadequate
levels of health finance and few skilled health workers as the major impedimentsto health development for many of the
Pacific’s countries.
Conclusions. The currenttrajectoryfor healthin the Pacific will lead to increasing health inequity with the rest of the
world. The challenges to health in the region include persisting communicable disease and maternal and child health
threats,unprecedentedlevels of NCDs, climate change andinstability, as well as low economicgrowth. In orderto change
the fortunes of this region in the age of the SDGs, a substantial investment in health is required, including in the health
workforce, by countries and donors alike. That investment requires a nuanced response that takes into account the
contextual differences between and within Pacific islands, adherence to aid effectiveness principles and interventions
designed to strengthenlocal health systems.
What is known about the topic? It is well established that the Pacific island countries are experiencing the double
disease burden, and that the non-communicabledisease epidemic is more advanced.
What does this paper add? This paper discusses the review of 20 years of health developmentin the Pacific. It reveals
that although progress is being made, health development in the region is falling behind that of the rest of the world.
It also describes the progress made by the Pacific countries in pursuitof the ‘Healthy Islands’ concept.
What are the implications for practitioners? This paper has significant implications for Pacific countries, donor
partners and development partners operating across and within Pacific countries. It calls for a substantial increase in
health resourcing and the way development assistance is organised to arrest the increasing inequities in health outcomes
between Pacific people and those of the rest of the world.
Additional keywords: health promotion,health system evaluation, health system strengthening,Healthy Islands, Pacific
island health development, settings approach, sustainable development goals.
Received 9 May 2016, accepted 23 August 2016, published online 20 February 2017
Journal compilation AHHA 2017/World Health Organization www.publish.csiro.au/journals/ahr
CSIRO PUBLISHING
Australian Health Review, 2017, 41, 590–598
http://dx.doi.org/10.1071/AH16065
INTERNATIONAL
Open Access CC BY-NC-ND
2. Introduction
The Pacific island countries have a population of 10 million
people living in 22 nationsand territoriesspread over morethan
25 000 islands and islets occupying an ocean covering one-third
of the Earth’s surface. These countries vary considerably in
population size, growth and density, the non-communicable
disease (NCD) burden, the wider burden of disease, resource
availability for health and local capacity. Rates of obesity and
diabetes in many Pacific countriesare higherthananywhere else
intheworldandcontinuetoincrease.1
AlthoughNCDsdominate
the disease burden in many Polynesian and Micronesian coun-
tries, the disease burden in most of Melanesia is shared with
communicablediseases and maternaland child health issues, as
evidenced by outbreaksof cholera, high maternaldeathratesand
low levels of child nutrition;this is the only region in the world
where the number of underweight children increased over the
past25 years.2
Thematernalandchild health-relatedMillennium
DevelopmentGoals (MDGs)4 and5 (http://www.unmillennium-
project.org/goals/gti.htm,verified 13 October16) have not been
reachedinthePacific’s mostpopulouscountries;basic necessities
of life, such as clean water supplies, are accessible to only half
the population and only one-third of people use any type of
improvedsanitationfacility.3
The recentEl Niñoweatherpattern
exposed the fragility of food security for many Pacific commu-
nities, where stunting rates were already high. Added to this is
the effect of climate change, starkly demonstrated by high-
intensity cyclones hitting the region, costing lives, devastating
dwellings and crops and further damaging weak economies.
As sea levels rise, the very existence of some Pacific states and
cultures is threatened because, in many countries, the entire
populationlives at 5 m above sea level.
Twenty years ago, Pacific health ministers declared their
vision for ‘Healthy Islands’ in the Yanuca Island Declaration.4
They envisioned Healthy Islands as places where children are
nurturedin body and mind, environments invite learning and
leisure, people work and age with dignity, ecological balance is
a source of pride and the ocean which sustains us is protected.5
The health ministersreturnedto Yanuca Island, Fiji, in April
2015 and reviewed the progress made over the past 20 years.
They reaffirmed their commitmentto Healthy Islands as their
vision forhealthdevelopmentforthe21st century.6
InSeptember
2015, the world’s political leaders confirmed their commitment
to 17 Sustainable Development Goals (SDGs),7
with health
featuring directly in Goal 3: ‘Ensure healthy lives and promote
well-being for all at all ages’.
The purpose of this paper is to report on the findings of a
review of the past 20 years of health development in the Pacific
across 22 countries and territories,8
and to discuss the implica-
tions of these findings for future health development in the
subregion if the health-relatedSDGs are to be achieved.
Methods
The review used qualitative and quantitative methods. The
qualitative review included conducting semi-structured inter-
views and a document review. The interview questions were
derived fromthe five elements describing a ‘Healthy Island’ and
explored its strength as a vision, a catalyst for change and its
effects. Therecruitmentprocess forinterviewees was purposeful,
initially involved identifying key informants through contacts
in the respective Pacific island governmentsand regional health
agencies (World Health Organization (WHO), the Secretariat
of the Pacific Community,Pacific Island Health Officers Asso-
ciation). Snowballing was then used to identify further key
informantsto be interviewed. Participants were interviewed in
person at a regional meeting of health ministers held in Manila
from 13–17 Oct 2014 during country visits to Fiji, Samoa and
Vanuatu or by telephone. In all, 79 people were interviewed,
including six ministers of health, 20 senior health officials,
development partners at national and regional levels and other
national and sub-nationalhealth workers in the three countries
visited. Interviews were recorded manually and then entered
into NVivo software (QSR International), where data were
coded according to the initial questionnaire,then furthercoded
to capture emerging themes and concepts. Participantsincluded
people from all three Pacific groupings: Melanesia, Polynesia
and Micronesia.
The quantitative review consisted of examining secondary
data from regional and global data collections. Indicators were
sought according to the following criteria: data available to
assess trends over a 20-year time frame; data covering both the
subregion and individual countries; and data reflecting progress
ononeof theoriginalHealthyIslanddescriptors.Nationalreports
from specific countries were used to fill the gaps in global data
collections.
Results
Child survival
Measurable outcome indicators, such as life expectancy and
child survival, show health improvementin the Pacific over the
20-year period. However, the progress is slower than the world
average.
Figure 1 shows thedeathrateinchildrenunder5 years of age.
Overall, this death rate is decreasing for the Pacific. However,
comparisons show that the mortality rate for children under
5 years of age was lower in the Pacific thanthe rest of the world
in 1995, but is now higher. Differences between the Pacific
countries and the rest of the world are increasing and, if the
current trends continue, the inequality in child mortality will
intensify. MDG4 was not met for Pacific Children.
The child mortality rate in Melanesia is much higher than
that in Polynesia or Micronesia (Fig. 2). (Melanesia includes
Fiji, Papua New Guinea (PNG), Solomon Islands and Vanuatu.
Micronesia includes Kiribati, Marshall Islands, Federated
States of Micronesia, Nauru and Palau. Polynesia includes
Cook Islands, Niue, Samoa, Tonga andTuvalu.) Whenthe three
major groupings in the Pacific are examined, there are very
marked differences between them. The mortality rate for
children under 5 years of age is highest in Melanesia, largely
influenced by PNG, with its under-5 population of 1 million
children.
Water and sanitation
Figure 3 shows the proportion of the population using
improved water sources. This is lower for the Pacific than the
rest of the world, and the gap is not closing. A similar pattern
is seen for the proportion of the population with improved
Pacific island health inequities Australian Health Review 591
3. sanitationfacilities, with theworld at 64% andthePacific at 36%
at 2012 and the gap increasing. There is a strong correlation
between the state of water and sanitationand the mortality rate
for childrenunder5 years of age. Melanesia again has the lowest
level of coverage (data not shown).
Non-communicable diseases
The differences between the Pacific and the rest of the world are
most marked when it comes to NCDs. Figure 4 shows that the
rates of obesity for adults over 18 years of age for many Pacific
Countries far exceeds the world average. Obesity reduces life
expectancy, as it is a major risk factor for NCDs such as
diabetes, heart disease and some cancers. The negative effects
on families of losing parents at a young age are considerable.
The negative economic effect is also large, not only throughthe
cost of health care, but also throughloss of labour productivity.
Almost half of all deaths (48%) in Tonga occur below the age
of 64 years as a resultof cardiovasculardisease, resultinginlarge
losses of labour productivity among the country’s most skilled
workers.9
The WHO STEPwise approach to Surveillance (STEPS)
surveys (WHO Office, Suva, pers. comm) and other studies
show that the NCD epidemic in the Pacific has not yet reached
its peak. Living with diabetes is now becoming the norm for
adults in some Pacific communities.
Health resourcing
Health in the Pacific, as elsewhere, is strongly affected by the
wider determinants of health, as well as the health system
0
1
9
9
5
1
9
9
6
1
9
9
7
30
60
90
Pacific
Year
Deaths
per
1000
live
births
World
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
M
D
G
t
a
r
g
e
t
(
2
0
1
5
)
Fig. 1. Mortalityratefor childrenaged 5 years in the Pacific comparedwith the world from1995 to 2014.
Note: “Pacific” in this figure includes data from14 countriesand areas. Data was notavailable for American
Samoa, Guam, the Commonwealth of the NorthernMariana Islands, Pitcairn, Tokelau, Wallis and Futuna,
New Caledonia, French Polynesia.8
0
20
Year
Child
mortality
40
60
80
100
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
2
0
1
1
2
0
1
2
2
0
1
3
M
D
G
t
a
r
g
e
t
(
2
0
1
5
)
Polynesia Melanesia
Micronesia World
Fig. 2. Mortality rate for children aged 5 years in Melanesia, Polynesia and Micronesia from 1995 to
2014. MDG, Millennium Development Goal. Note: Melanesia includes Fiji, Papua New Guinea, Solomon
Islands and Vanuatu. Micronesia includes Kiribati, Marshall Islands, Federated States of Micronesia, Nauru
and Palau. Polynesia includes Cook Islands, Niue, Samoa, Tonga and Tuvalu.8
592 Australian Health Review D. Matheson et al.
4. response. Gross domestic product (GDP) growth per capita
from 1992 to 201210
has been slow in the Pacific, and negative
in some periods. Only PNG is showing significant growth, due
to the effect of the extraction industry, but recent predictionsof
high growth in this economy have not materialised because of
the currentlow price for oil and gas. Pacific economies have a
narrow economic base, are geographically isolated from global
markets, rely on few commodities for export (agriculture, for-
estry, fishing, minerals and gas) and are prone to interruption
because of the frequency of naturaldisasters.
Investment in health per head of population in the Pacific
began at one-fifth of the global spend in 1995, but by 2012 this
proportion had decreased, with Pacific health spending now
one-sixth of the world average, reflecting increased inequality
in health resourcing (Fig. 5).
There is wide variation in the expenditure on health service
provision per capita and the efficiency of the health spend
between different Pacific countries. PNG (with 75% of the
region’s population) spends USD100 per person per year,
whereas New Caledonia spends US$2600 (data not shown).
Figure 6 shows the relationshipbetween health expenditureand
themortalityrateof childrenunder5 years of age, with improved
mortality associated with increased expenditure. Many Pacific
states (Cook Islands, Tonga, Vanuatu, Fiji, Solomon Islands)
have achieved lower levels of child mortality than the world
trend line (Fig. 6), despite their geographic and demographic
challenges. Other countries (Federated States of Micronesia,
Marshal Islands, Kiribati, Palau) have expenditures above the
trend line (Fig. 6). A full examination of the drivers of these
differences has not been conducted.
The health workforce profile in Pacific countries (Fig. 7)
shows that although many of the countries have at least the
critical threshold11
required to meet the MDGs, the exceptions
(PNG, Vanuatu, Solomon Islands and Samoa) involve some of
the biggest populations. In PNG, it is estimated that 3.5 million
people do nothave access to a doctorwithin theirdistrict.12
The
countryrequires17 600 additionalskilled healthworkers.13
The
global critical threshold of 2.3 skilled health workers per 1000
population12
does not take into account the workforce required
to meet the overwhelming NCD challenge or the workforce
required for isolated island populations. The critical thresholds
for a health workforce in the Pacific to meet global goals has yet
to be determined.
Qualitative findings
The interviewees strongly supported ‘Healthy Islands’ as
the overarching vision for Pacific health development. The
meaning associated with Healthy Islands was the articulation
0
10
Year
20
30
40
50
60
70
80
90
100
1995
1997
Pacific World
1999
2001
2003
2005
2007
2009
2011
%
Population
using
improved
drinking
water
source
Fig. 3. Proportionof thepopulationusing improveddrinkingwatersources
in the Pacific comparedwith the world from 1995 to 2011.4
51%
36%
41%
37%
46%
43%
28%
43%
28%
43%
40%
35%
13%
C
o
o
k
I
s
l
a
n
d
s
F
i
j
i
N
a
u
r
u
0
10
20
30
40
50
60
Premature
NCD-related
deaths
(%)
K
i
r
i
b
a
t
i
F
S
M
N
i
u
e
P
a
p
u
a
N
e
w
G
u
i
n
e
a
S
a
m
o
a
S
o
l
o
m
o
n
I
s
l
a
n
d
T
o
n
g
a
T
u
v
a
l
u
V
a
n
u
a
t
u
W
o
r
l
d
Fig. 4. Percentageof theadultpopulation with obesity in selected Pacific Countriescompared
to the world average (dashed line). Available from: http://app
s.who.int/gho/data/view.
main.2450A?lang=en [verified 4 November 2016].
Pacific island health inequities Australian Health Review 593
5. of a high-level vision steeped in Pacific understandingof health
and the environment. This view was consistently articulated
by ministers and senior health officials. Interviewees reported
a heartfelt message arising from Healthy Islands, using words
such as ‘utopia’, ‘unifying’, ‘spiritual’, ‘freedom’, ‘wisdom’ and
‘heart’ to describe its meaning. Healthy Islands was used in
0
200
Total
health
expenditure
per
head
of
population
US$
(purchasing
power
parity)
400
600
800
Year
1000
1200
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Pacific World
Fig. 5. Total health expenditure per head of population in the Pacific compared with the world from 1995 to 2012.
Note: “Pacific” in this figure includes data from Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the
Marshall Islands, Nauru, New Caledonia, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu
and Vanuatu.8
CI
FJ
KB
MI
FSM
NR
NU
PL
PNG
SM
SI
TA
TV
VN
NC
0
20
40
60
80
100
120
140
160
180
200
0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000
Total health expenditure per head of population
Mortality
rate
for
children
aged
5
years
Health expenditure in US$ (purchasing power parity) per capita in 2014
Fig. 6. Relationship between health expenditure and mortality rate of children under 5 years
of age in 2014. PNG, Papua New Guinea; KB, Kiribati, FSM, Federated States of Micronesia;
MI, MarshallIslands; NR, Nauru;SI, SolomonIslands; TV, Tuvalu; NU,Niue; NC, New Caledonia;
FJ, Fiji; SM, Samoa; PL, Palau; VN, Vanuatu; TA, Tonga; CI, Cook Islands.8
594 Australian Health Review D. Matheson et al.
6. practicetorefertoa settingsapproach,primaryhealthcare, health
promotionandworkingacross sectors. Recent evidence suggests
that Pacific youth also share this holistic view of health.14
Healthy Islands played a significant role in the advocacy by
Pacific ministers to address NCDs globally, and the adoption
of inter-sectoral approaches at the national level. The vision
framedtheapproachPacific healthleaders have taken toengage
with other sectors, and continues to inspire health ministers
and senior health officials across the Pacific. As one official
noted, ‘Healthy Islands was ahead of its time, and its time
has now come’. A joint agreement has been forged15
between
Pacific health and economic ministers on the approach to
NCDs, including an agreement to increase excise duties on
tobacco products and to consider an increase in taxation of
alcohol products, as well as introducing policies that reduce the
consumption of local and imported food and drink products
high in sugar, salt and fat. Several Pacific countries have
already developed this approach for tobacco control16
and it
could be extended furtheracross the region to include alcohol,
gambling and some foods.
There was a broad consensus that although the vision was
strong, more could have been achieved had greater attention
been paid to the implementation barriers over the 20-year
period. These barriers included the fragmented approach taken
by development partners. Interviewees commented that even
existing funds, such as Global Alliance for Vaccines and
Immunization(GAVI), the Global Fund to Fight AIDS, Tuber-
culosis andMalaria,andtheGates Foundationaretoofrequently
off plan, off budget and have separate reporting arrangements,
severely limiting their futuresustainability and the opportunity
to strengthen local systems. In addition, barriers identified
by participants included political upheaval, vertical programs
driving system inefficiencies, lack of sustained momentum in
programs, lack of sub-national health system development
and local managementfailures, including the lack of adequate
information systems and reporting.
Discussion
The review of the past 20 years of health developmentin Pacific
island countries has found that despite improvements,gaps are
increasing between health outcomes in the Pacific and those in
the rest of the world. The region has a well-supported vision,
Healthy Islands, butimplementationhas fallen short.Inadequate
finances, workforce and fragmented implementation are the
main implementationbarriers identified.
Fromthe perspective of Pacific ministersandseniorofficials,
the problemhas not been the lack of a clear vision, or the cross-
sectoral approaches required,but the challenges of implementa-
tion. Resourcing for health has been low for most countries,
reflecting weak economic growth. Efficiency of health service
provision does not differ markedly from global trends,although
there is considerable variation within the region. The strategic
frameworks developed by the Pacific and global leaders are
unlikely to reverse the currenttrajectoryfor health in the Pacific
unless the implementationmechanism,including resourcingthe
health systems in the region, is strengthenedconsiderably.
The prospects of economic growth closing the gap in health
development between the Pacific and the rest of the world are
slim. Economic growth is attracted to scale and concentration,
and deterred by isolation and dispersal.17
The Pacific reality is
small populations,isolated frommarketsandreliantonfiniteand
diminishingcommodities,such as forests, fish, mineralsandgas.
The island nationshave experienced considerable downsides to
globalisation to date. Pacific food supplies have seen nutritious
local food consumptionreplaced by low-quality importedfood,
high in fat, salt and sugar. The numberof underweightchildren
is increasing18
and water and sanitation coverage lags behind
0
2
4
6
8
10
12
14
Cook
Islands
Fiji
French
Polynesia
Kiribati
Marshalls
FSM
Nauru
New
Caledonia
Niue
Northern
Marianas
Palau
PNG
Samoa
Solomon
Islands
Tokelau
Tonga
Tuvalu
Vanuatu
Wallis
Futuna
Health
worker
ratio
per
1000
Midwives Nurses Physicians
Fig. 7. Pacific health workforce (doctors, nurses, midwives) per 1000 population in 2011.
The dashedline indicatesthe WorldHealthOrganization(WHO)thresholdof healthworkers
to meet MillenniumDevelopment Goals.8
Pacific island health inequities Australian Health Review 595
7. therestof theworld. Deterioratingfood security remainsa major
health challenge.19
The by-product of the rest of the world’s
global economic growth, climate change, now threatens the
existence of some Pacific island nations, and associated climate
instability furthercurbs economic growth.
What needs to change over the next 15 years?
The global SDGs have now been set for 2030. These goals have
madestronglinks between differentdimensionsof development.
Health benefits are likely to accrue from attainmentof most of
the goals. Of special significance to the Pacific is Goal 13: ‘Take
urgent action to combat climate change and its impacts’.7
The Pacific ministers, 20 years earlier, had envisaged health as
being intrinsically connectedto work, the learningenvironment,
ecological balance and the protection of oceans. The SDGs
also affirm a strong focus on equity. ‘No one left behind’ and
‘Universal Health Coverage’ (http://www.who.int/dg/speeches/
2015/universal-health-coverage/en/, verified 13 October 2016)
imply that there needs to be a system response that delivers on
equity.
Both Healthy Islands and the SDGs call for an integrated
view of health development. The past has seen a disconnection
between economic, environmental and social progress in the
Pacific (as they have elsewhere). For example, tradeagreements
have been largely negotiated without assessing their health and
environmental effects on the Pacific peoples.20
An integrated
view of healthdevelopmentneeds to be putintopracticeby both
the countries themselves and the development partners.
For much of the past 20 years, the bulk of the Pacific
population’s health services had insufficient levels of financing
and human resources to achieve global health goals. Island
governments’ contributions to health have increased over the
period and, for most countries, health is now predominantly
governmentfunded.Given theeconomicheadwindsbeing faced,
it is unlikely there will be sufficient growth in these economies
to fund health services in the Pacific to the level that is required
to meet the health SDGs, as happenedwith the MDGs.
Ontheirown, many Pacific countriescannotafford universal
health coverage. Given the global origins of many of the chal-
lenges faced (NCDs, global warming), developed countries
should take more responsibility in addressing health challenges
in the Pacific.
As indicated in Fig. 8, the level of overseas development
assistance for most of the region’s largest donors21
(Australia,
USA, New Zealand, Japan, Korea) is currentlybelow the Orga-
nization for Economic Cooperationand Development (OECD)
average of 0.29% of gross nationalincome,21
and well less than
half of the 1970 UnitedNations commitmentto 0.7%. France is
the only major Pacific island donor country that contributes
above theOECD average. The commitmentto 0.7% has recently
been refreshed at a meeting of small island developing states22
and as a central tool for meeting global development goals.23
Any move that major donors in the Pacific make towards 0.7%
could substantially address the financingdeficit for health in the
region.
The numberof actors providing supportfor Pacific countries
is increasing rapidly. There is a strong likelihood of further
fragmentation, and resulting frustration,24
with the potential
addition to the development architecture of the Green Climate
Fund (www.greenclimate.fund, verified 15 February 2016),
Asian InfrastructureInvestment Bank (www.aiib.org, verified
15 February 2016), the Global InfrastructureHub (www.globa-
linfrastructurehub.org, verified 15 February 2016) , the New
Development Bank (www.ndbbrics.org, verified 15 February
2016), the Asia Pacific Project PreparationFacility (www.adb.
0
Sweden
Luxembourg
Norway
Denmark
United Kindom
Netherlands
Finland
Switzerland
Belgium
Cermany
Ireland
France
DAC total
New Zealand
Australia
Austria
Canada
Iceland
Japan
United States
Portugal
Italy
Spain
Korea
Slovenia
Czech Republic
Creece
Slovak Republic
Poland
ODA as percentage of GNI (2014)
0.2 0.4 0.6 0.8 1.0
Fig. 8. Overseas development assistance (ODA) as a percentage of gross national income (GNI).
The dashedline indicatesthe 1970 UnitedNationscommitmentto 0.7% of developed countries’ gross
national income to Official Development Assistance (Internationa
l Development Strategy for the
Second United Nations Development Decade”, UN General Assembly Resolution 2626 (XXV),
24 October 1970, paragraph43).22
596 Australian Health Review D. Matheson et al.
8. org/documents/asia-paci
fic-project-preparation-facility,verified
15 February 2016), the World Bank Group’s Global Infrastruc-
ture Facility (www.worldbank.org/en/programs/global-Infra-
structure-facility, verified 15 February 2016), Global Financing
Facility in supportof Every Woman,Every Child (www.global-
financingfacility.org, verified 15 February 2016), a Technology
Facilitation Mechanism (www.sustainabledevelopment.un.org/
topics/technology/facilitationmechanism,verified 15 February
2016) and the Technology Bank for Least Developed Countries
(www.unohrlls.org/technologybank,verified 15 February2016).
This list is not exhaustive, because it omits the global growth
of private philanthropicefforts. Pacific health leaders have iden-
tified fragmentationof development efforts as a major impedi-
ment to implementation over the past 20 years, so this latest
wave of development modalities risks furtherexacerbating this
problem, overwhelming local capacity and consequently failing
to achieve health development goals. What is required is better
coordination, and a focus on how development assistance in
the Pacific can best meet the developmentneeds of these unique
populations in this unique setting. This renewed interest in
financing modalities is welcomed, but its effect will be limited
unless aid effectiveness principles25
and cognizance of the
Pacific context are applied from the start.
The response to the health care worker deficit also requires a
nuancedresponse to the different island contexts. PNG’s deficit
requires a substantial boost to its local health training capacity.
Currently,45 doctorsaretrainedinthecountryperyear (G. Mola,
pers. comm.),andthisneeds toincrease to300 peryear if thereis
to be any chance of meeting universal health coverage require-
ments. Effective deployment of these doctors will also require
resources for salaries, infrastructureand supplies. Other coun-
tries, such as the Solomon Islands, will double their doctor
numbers in the next 5 years by increasing the number trained
outside the country, such as in Cuba.26
Their challenge is to
build the necessary districtinfrastructureso thatthey can deploy
these new graduates to areas where their skills are most needed.
The NCD epidemic also calls for a response commensurate
with the size of the disease threat, and the state of knowledge
of effective interventions. The Pacific is already pioneering
public health responses to NCDs27
that will have important
lessons for therestof theworld. The currentpackage of essential
NCD interventions for primary health care approach is an im-
portant start, but much more is required in adapting chronic
disease managementapproaches for Pacific island contexts.
Conclusion
The current trajectory for health in the Pacific will lead to
increasing inequity with the rest of the world. The challenges to
health in the region include persisting communicable disease
and maternal and child health threats, unprecedentedlevels of
NCDs, climate change and instability, as well as low economic
growth.
In orderto change the fortunesof this region in the age of the
SDGs, a substantial investment in health is required, including
in the health workforce, by countries and donors alike. That
investment requires a nuanced response that takes into account
the contextual differences between and within Pacific islands,
adherence to aid effectiveness principles and interventions
designed to strengthenlocal health systems.
Competing interests
The lead authoris a healthsystems consultantandtheco-authors
work for the World Health Organisation and the Pacific Com-
munity respectively.
Acknowledgements
This article uses some of the findings of The First 20 Years of the Journey
towards the Vision of Healthy Islands in the Pacific, which was supported
financiallyby theWorldHealthOrganization(WHO)andis available athttp://
iris.wpro.who.int/bitstrea
m/10665.1/10928/3/9789290617150_eng.pdf, ver-
ified 14 October2016], andThe State of HumanDevelopmentin the Pacific;
A Report on Vulnerability and Exclusion in a Time of Rapid Change’,
available at: http://www.unescap.org/resources/state-human-deve
lopment-
pacific-report-vulnerability-and-exclusion-time-rapid-change [verified 2 May
2015]. The authors thank Vivian Lin, who provided valuable commentar
y
at the drafting stage, and Junsoo Ro, who assisted with the compilation
of indicators. The views expressed in this paper are those of the authorsand
do not necessarily reflect the official policy or position of the World Health
Organization or Pacific Community.
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