WHEC Update - March 2007
|A Newsletter of worldwide activity of Women's Health and Education Center (WHEC)
March 2007; Vol. 2, No. 3
In reality, reproductive health is a union between social sciences and medical sciences. The world has publicly acknowledged that health and well-being, and equality and equality, for women are important ends in themselves. The balance between resources and population, development and sustainability concerns people. This is the beginning of the paradigm shift - from maternal and child health to reproductive health. Many issues can be compressed within reproductive health concern. In our e-learning publication: WomensHealthSection.com, we have provided the diversity and breadth of these issues to achieve proper balance between social sciences and medical sciences. Reproductive health reflects health in childhood and sets the stage for health even beyond reproductive years for both women and men. It affects and is affected by the broader context of people's lives, their economic circumstances, education, employment, living conditions, family-environment, social and gender relationships, and traditional and legal structures within which people live. In WomensHealthSection.com we have focused on five core areas of reproductive health: childbearing; fertility regulation; maintenance of a healthy reproductive system; sexuality and sexual behavior; and the social-cultural context within which reproductive health behavior and ill-health takes place.
The tools of our profession have changed - technology has enabled us to diagnose diseases early and in many cases prevent them that we could not have done before. Computers have liberated us from boxes and have allowed us in many ways to serve our patients. The ease of communication via internet has made it possible to be influenced by cultures in every corner of the world. Fine words, and even legislation, are not enough - implementation is the key. We must work to build momentum for a sustained and multifaceted national and international effort. There are no strangers at Women's Health and Education Center (WHEC) - only the friends you have not met.
A Vision of Hope
In Memory of a Friend, Victoria A. White (1956-2007):
I met Victoria 5 years ago when Women's Health and Education Center (WHEC) undertook the project - e-learning publication, WomensHealthSection.com. To have a friend share this experience provides us with profound wisdom and insights. I have spent many Friday afternoons in her office working with her and her incredible team on this publication. I have laughed and cried many times, her courage and wisdom was an inspiration to me. To be with Victoria was a gift of friendship and insight, courage and generosity. We all have a teacher or a colleague, someone patient and wise, who understood you when you were searching, helped you see the world as a more profound place, gave you sound advice to help you make your way through it. For me, that person was Victoria, a friend. She asked me the first and the only question, when I discussed this e-learning project with her - What would your website like to do? I hope this brings happiness and goodwill in the world; we hope to make a difference. We will miss you.
Rita Luthra, MD
Women's Health and Education Center (WHEC)
Your Questions, Our Reply:
Is contracting-approach to public health and privatization same? Can it improve relations between fund-holders and health service providers, and improve health systems?
Contracting and Public Health: The delivery of healthcare in almost every country involves some form of public-private partnership. Within a health system, large-scale use of contracting almost automatically involves forms of regulations. We believe that by drawing up national policies on contracting, it will be possible to address all its facets and to determine sound guidelines and strategies, which will be taken up by all those involved in healthcare. Contracting is a tool that formalizes the relationships and obligations between the different actors in health system, though it is not clearly limited to health. While contracting has been used to specify the relationships between government and the private sector, its potential uses are much broader. The overall aim is to improve health system performance by clearly specifying the obligations and expectations of different actors in the health systems. There is a huge untapped potential of contracting in public health, as well as the risks and pitfalls. If poorly implemented, contracting may harm health systems performance, but if managed well, the benefits can be immense. Contracting is used more and more to formalize the relationships between different levels of government. The idea of contracting has been gaining increasing attention among both donor agencies and governments, and recognizes the potential value of contracting to improve health system performance.
Contracting is increasingly being used to enhance the performance of health systems in both developed and developing countries. In recent years the way health systems are organized has changed significantly. To remedy the under-performance of their health systems, most countries have undertaken reforms that have resulted in major institutions overhaul, including decentralization of health and administrative services, autonomy for public service providers, separation of funding bodies and service providers, expansion of health financing options and the development of the profit or non-profit private sector. An example of Public-Private partnership: the ministry of health may decide that it will no longer provide certain services and instead will use the funds at its disposal to purchase those services from providers. Several countries in Latin America (Colombia, Costa Rica, Dominican Republic, Guatemala, and Peru) have drawn up contracts with NGOs to extend health coverage or to improve the quality of care. In the countries where health financing passes through autonomous or private insurance systems, contracting is used to define the relations between these insurance bodies and the service providers. These relations cover rates, reimbursement arrangements, customer care and quality of care. Alliances lie at the heart of "working together". The success of agreements requires the active participation of the partners as well as understanding between resources, technology and know-how. Contracting is thus actually much broader and richer than the notion of "contract" in the legal sense of the word. Contracting should not be reduced to a mere management tool used to cut health costs. It is an approach that should lead the various participants to offer to the public health services that are increasingly efficient, effective, superior and fair.
Contracting in health systems is extremely diverse in the terms of types of participants that use it, the types of contractual relationships that are established and the purposes thereof. However, one must never lose sight of the fact that contracting is a tool that should be evaluated on the basis of its impact on the performance of a health system, and ultimately on people's health.
About NGO Association with the UN:
Third Committee: Social, Humanitarian and Cultural - the Third Committee deals with myriad topics related to social development, advancement of women, international drug control and human rights issues. Delegates meet, discuss and debate these issues and work to forge resolutions that enjoy unanimous support, or if this is not possible can be voted upon. Social development is a critical factor in making poverty reduction effective and sustainable. The promotion of social development at the international level implies the total fulfillment of the commitments by the countries in various conferences and summits. Certainly there is relationship between globalization and human rights, but not all human rights are affected by globalization. Globalization could have both positive and negative aspects. Governments are responsible to protect human rights under their jurisdiction, and if they fail to do so, then there is a legitimate concern for the international community to deal with it.
Collaboration with World Health Organization (WHO):
The World Health Organization Quality of Life (WHOQOL) Instruments: WHO defines Quality of Life as individuals' perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment. Strengths of the WHOQOL instruments can be accessed at: http://www.who.int/mental_health/media/68.pdf (pdf)
Collaboration with UN University (UNU):
Proposals for new publications: UNU Press accepts a limited number of proposals for new titles from scholars of international issues facing the United Nations and its member states; UNU Press publishes mostly in the fields of peace and governance, environmental and sustainable development, and economic and technological development. UNU Press books reflect the issues and experiences of a broad number of countries or regions and individual countries. They ideally contain clear learning points or policy recommendations applicable beyond the scope of individual topics or locations. A typical book is 100,000 words. Rights for reprints and translations are available at very generous terms for the reproduction and/or translation of UNU Press titles.
Point of View:
Promoting home-testing for HIV in developing countries: benefits and concerns
The increasing prevalence and incidence of HIV has been a global concern. A bigger concern would be the existing lack of awareness among the people, especially in the developing countries, which may result in errors in HIV reporting. Hence expanding our options that may help in increasing the HIV awareness in the developing countries is the need of the hour and one such option that needs to be explored is promoting the use of home-testing kits for HIV. Two frequently observed reasons for people avoiding the HIV counseling sessions are limited availability of HIV testing services and the social stigma and discrimination that is associated with the disease (1). Home-testing helps in overcoming these barriers by offering advantages such as privacy and ease of use. People living in remote areas do not have to travel far-off places to get tested and people do not have to worry about busy clinics and in some cases, the physician's reluctance to test. It may thus help more and more people in knowing about their HIV status and thus may result in behavior modifications and promoting safer sex practices.
However, to maximize its benefits, it is important to provide pre-test and post-test counseling services. Counseling may help in increasing awareness, may help in discussing the possibilities of false positive/false-negative results and may also provide the much-needed emotional support in cases with a positive test. Also, its proper implementation in developing countries needs some social and political transformations such as laws that prevent the possibility of abuse (sending blood sample of a person without his knowledge). It is possible that women may end up at higher risk of domestic violence and social harassment, and hence more research in this area and better laws for protection of these women will be required. Although home testing may not provide a final solution, a well-designed comprehensive strategy in combination with voluntary counseling and testing may help in increasing awareness, thereby decreasing the prevalence rates.
By Sumesh Kachroo, MS
Doctoral Student, University of Texas School of Public Health
Houston, Texas, USA
- Kachroo S. Promoting self-testing for HIV in developing countries: potential benefits and pitfalls. Bulletin of the World Health Organization. 2006 Dec; 84(12): 999-1000.
Joint United Nations Program on HIV/AIDS (UNAIDS):
Declaration of Commitment on HIV/AIDS "Global Crisis - Global Action": series continues
- Recognizing that poverty, underdevelopment and illiteracy are among the principal contributing factors to the spread of HIV/AIDS and noting with grave concern that HIV/AIDS is compounding poverty and is now reversing or impeding development in many countries and should therefore be addressed in an integrated manner
- Noting that armed conflicts and natural disasters also exacerbate the spread of the epidemic
- Noting further that stigma, silence, discrimination, and denial, as well as lack of confidentiality, undermine prevention, care and treatment efforts and increase the impact of the epidemic on individuals, families, communities and nations and must also be addressed
- Stressing that gender equality and the empowerment of women are fundamental elements in the reduction of the vulnerability of women and girls to HIV/AIDS
- Recognizing that access to medication in the context of pandemics such as HIV/AIDS is one of the fundamental elements to achieve progressively the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Recognizing that the full realization of human rights and fundamental freedoms for all is an essential element in a global response to the HIV/AIDS pandemic, including in the areas of prevention, care, support and treatment, and that it reduces vulnerability to HIV/AIDS and prevents stigma and related discrimination against people living with or at risk of HIV/AIDS
- Acknowledging that prevention of HIV infection must be the mainstay of the national, regional and international response to the epidemic; and that prevention, care, support and treatment for those infected and affected by HIV/AIDS are mutually reinforcing elements of an effective response and must be integrated in a comprehensive approach to combat the epidemic
- Recognizing the need to achieve the prevention goals set out in this Declaration in order to stop the spread of the epidemic and acknowledging that all countries must continue to emphasize widespread and effective prevention, including awareness-raising campaigns through education, nutrition, information and health-care services
- Recognizing that care, support and treatment can contribute to effective prevention through increased acceptance of voluntary and confidential counseling and testing, and by keeping people living with HIV/AIDS and vulnerable groups in close contact with health-care systems and facilitating their access to information, counseling and preventive supplies
- Emphasizing the important role of cultural, family, ethical and religious factors in the prevention of the epidemic, and in treatment, care and support, taking into account the particularities of each country as well as the importance of respecting all human rights and fundamental freedoms
To be continued...
Top Two Articles Accessed in February 2007:
- The Bethesda System - An Overview
Women's Health and Education Center's Contribution
- Quality of life & Gynecological Malignancies
WHEC Publication. Special thanks to World Health Organization project on quality of life (WHOQOL) and Mental Health Department for its assistance and contribution
News, Invitations and Letters:
THE SECRETARY-GENERAL'S REPORT: Strengthening efforts to Eradicate Poverty and Hunger - A report of the Secretary-General on the theme of the 2007 Annual Ministerial Review is being prepared. It is envisaged to consist of two main sections: I. Global Overview and II. Thematic Discussion.
The overview will provide a concise analysis providing an assessment of progress, identifying gaps and obstacles in implementing the UN Development Agenda and making recommendations to overcome those gaps. The global overview will analyze the regional differences (including, where possible and relevant, differences between rural and urban areas) and highlight challenges in implementation. Particular attention may be paid to rural development and food security, financing for development and the role of intellectual property rights. The thematic discussion will approach the 2007 theme from several perspectives. There will be an assessment of the challenges to poverty eradication and hunger, with particular emphasis on successful policies as well as beneficial partnerships. Another section will examine enhancing sustainable fiscal space for countries to achieve the Millennium Development Goals (MDGs). There will also be an analysis of the impact of MDG 8 (Global Governance and Global Partnership), on eradicating poverty and hunger and of the status of implementation of MDG 8 commitments; in particular Official Development Assistance (ODA), debt relief, agricultural support, and technology transfer.
Secretary-General's address to UNIS-UN Conference on Climate Change; New York, 1 March 2007: http://www.un.org/apps/sg/sgstats.asp?nid=2462
The 192nd UN Member State: The people of Montenegro, within just two months, transformed their nation from creating a newly independent republic in a referendum in May 2006 to saluting a reinvented flag and becoming a full-fledged member of the United Nations. The country peacefully separated from the State Union of Serbia and Montenegro on 3 June 2006 and its people, in aspiring for UN membership, have since demonstrated their desire to actively and cooperatively support solving world issues. On 22 June, the UN Security Council, in adopting unanimously resolution 1691 (2006), recommended the admittance of the Republic of Montenegro to the Organization. Six days later, on 28 June, the General Assembly declared and welcomed Montenegro as the 192nd Member State of the United Nations - the newest since Timor Leste's induction on 27 September 2002. The world witnessed a great leap forward for Montenegro in its desire to become an active member of the international community.
UNICEF: The State of World's Children 2007 examines the discrimination and disempowerment women face throughout their lives - and outlines what must be done to eliminate gender discrimination and empower women and girls. It looks at the status of women today, discusses how gender equality will move all the Millennium Development Goals forward, and show investment in women's rights will ultimately produce a double dividend: advancing the rights of both women and children. For details please visit: http://www.unicef.org/sowc07/docs/sowc07.pdf
WHEC thanks Dr. Ian Smith, Advisor to the Director-General, World Health Organization, for his support and assistance in our efforts to improve maternal and child health worldwide. It was indeed a privilege to present this project with him at NGO Briefing, UN Headquarter, on World Health Day 7 April 2005. Thanks for the friendship and World Health Report 2005: Make Every Mother and Child Count.
Thanks again Victoria from all of us at WHEC; your work and contributions to The Board will go on.
Beyond the numbers...
Woods are lonely, dark and deep
But I have promises to keep;
And to go miles before I sleep,
And to go miles before I sleep.
Dedicated to Women's and Children's Well-being and Health Care Worldwide