WHEC Update - May 2008
|A Newsletter of worldwide activity of Women's Health and Education Center (WHEC)|
May 2008; Vol. 3, No. 5
Don't ever give up on what you believe in. Not once. Not ever. As a longtime admirer of the work of the United Nations and World Health Organization; I was thrilled to participate in the development of e-learning publication: WomensHealthSection.com. What a great way to introduce the next generation about the possibilities and opportunities. And to think it all began...with an idea. This is the age of Internet and this new media has fascinated young and old; rich and poor; men and women. Our spotlight is on: Internet Classrooms to Improve Women's Health Worldwide. Enjoy your passion for knowledge on the web. This is a timely initiative, and it is very encouraging to see international community with government officials and representatives of the private sector and civil society, are supportive of these efforts. We care about the details. Could it be farther you travel the closer you become! When life feels perfect.....Where to next? In only a few years, the Internet has revolutionized trade, health, education and, indeed, the very fabric of human communication and exchange. Moreover, its potential is far greater than what we have seen in the relatively short time since its creation. In managing, promoting and protecting its presence in our lives, we need to be no less creative than those who invented it. Clearly, there is a need for governance, but that does not necessarily mean that it has to be done in the traditional way, for something that is so very different. Health promotion reaches out to people where they live, work and play. It is essential for health education campaigns to be rooted in the needs of local communities.
The issues are numerous, and complex. Even the definition of what we mean by Internet Governance is a subject of debate. But the world has a common interest in ensuring the security and dependability of this new medium. The vision of constructing Internet governance arrangements that are multilateral, transparent and democratic with the full involvement of all stakeholders is a noble challenge. This will require goodwill among all parties, as well as good information on which to base decision.
Equally important, we need to develop inclusive and participatory models of governance. The medium must be made accessible and responsive to the needs of all the world's people. Keep in mind the paramount goal of helping people everywhere, build free and decent lives, is of utmost importance. Whatever you do must contribute to the cause of human development. Governments in the developing world cannot afford to implement expensive, lengthy academic programs. Rather, what is needed are practical courses that give healthcare providers working in underserved areas the competencies they need to enable them to provide skilled health services. Let me assure you the Women's Health and Education Center's (WHEC's) commitment to this effort. Important as it is to address the issues of governance and funding, let us not forget the larger task: implementing the plan of action to benefit both industrialized and developing countries. As the Internet becomes part of the fabric of our lives and as its spread becomes increasingly global, harnessing its full potential may require a re-thinking of how it is should be governed. It is becoming increasingly important to think of inclusive, collaborative approaches that will enhance the Internet's impact on the achievement of our development goals, and thus improve lives of people everywhere.
I wish you every success.
Reviewing the Past and Defining the Future
Rita Luthra, MD
Your Questions, Our Reply:
Are we wasting our health resources? What is wastage?
Under - or Over - utilization of health systems: Efficient health systems provide a maximum of quality healthcare at a minimum cost. Few countries, if any, reach this standard of economic efficiency. Very frequently either expenditure is higher than it should be or the amount and quality of healthcare are lower than they could be for the costs incurred. Inefficiency occurs when the resources used to produce a given result are greater than necessary. Wastage is the careless use or squandering of resources, often in connection with excessive or particularly conspicuous inefficiency. Allocative inefficiency occurs when funds are allocated to urban areas instead of the underserved rural populations, or to tertiary care despite greater needs in primary care. It is seen where the healthcare system does not provide enough for priority diseases or when health facilities are located beyond the reach of the people who need them. Technical inefficiency is found where the costs of providing specific services or goods are higher than necessary. For example, if a health center has been designed and staffed to handle 20,000 visits a year but in fact is only handling 10,000; the cost of each visit is clearly higher than necessary.
Wastage by under- or over-utilization of facilities, people, and health inputs is an inadequately studied issue. The small number of careful assessments of the value of "wasted" resources, however, puts them as very large in the health systems of rich and poor countries alike. Spiraling health care costs are causing world wide concerns, and a key component of health sector reform efforts in many countries has to do with making the best use of existing resources. Governments and the public are concerned about waste and inefficiency in the health sector. Although there are likely to be various underlying causes, wastage often results from limited information and from limited accountability for decisions about the use of resources. Corruption and fraud occur where there are conflicting interests in combination with limited accountability. Policy-makers, managers, healthcare providers and service users should feel responsible for ensuring that scarce health resources are used efficiently. They should actively combat wastage by identifying the causes, and then make corresponding changes in policy, management and technical procedures.
About NGO Association with the UN:
The Millennium Declaration, signed by world's leaders of 189 countries in 2000, established 2015 as the deadline for achieving most of the Millennium Development Goals (MDGs). The majority of MDG targets has a baseline of 1990, and is set to monitor achievements over the period 1990-2015.
Millennium Development Goal (MDG) 5: Improve Maternal Health
TARGET: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Half a million women continue to die each year during pregnancy or childbirth, almost all of them in sub-Saharan Africa and Asia. A number of middle-income countries have made rapid progress in reducing maternal deaths. Nevertheless, maternal mortality levels remain unacceptably high across the developing world, particularly in sub-Saharan Africa and Southern Asia. Each year, more than 500,000 women die from treatable or preventable complications of pregnancy and childbirth. In sub-Saharan Africa, a woman's risk of dying from such complications over the course of her lifetime is 1 in 16, compared to 1 in 3,800 in the developed world. Health-care interventions can reduce maternal deaths, but need to be made more widely available: Proportion of deliveries attended by skilled health care personnel, 1990 and 2005 (Percentage). Efforts to reduce maternal mortality need to be tailored to local conditions, since the causes of death vary across developing regions and countries. In Africa and Asia, hemorrhage is the leading cause of maternal death, while in Latin America and the Caribbean; hypertensive disorders during pregnancy and childbirth pose the greatest threat. Obstructed labor and abortion account for 13 and 12 per cent, respectively, of maternal mortality in Latin America and the Caribbean. In Asia, anemia is a major contributor to maternal deaths, but is a less important cause in Africa and a negligible factor in Latin America. In Africa, particularly parts of Southern Africa, HIV and AIDS are frequently involved in deaths during pregnancy and childbirth. Preventing unplanned pregnancies alone could avert around one quarter of maternal deaths, including those that result from unsafe abortion. Still, an estimated 137 million women have an unmet need for family planning. An additional 64 million women are using traditional methods of contraception with high failure rates. Contraceptive prevalence increased slowly from 55 per cent in 1990 to 64 per cent in 2005, but remains very low in sub-Saharan Africa, at 21 per cent. In addition, in regions where the adolescent birth rate remains high, a large number of young women, particularly very young women, and their children face increased risk of death and disability. In sub-Saharan Africa, Southern Asia and Latin America and the Caribbean, the high adolescent birth rates prevailing in 1990 have not declined significantly, despite continued reductions in total fertility in those regions. No single intervention can address the multiple causes of maternal deaths.
The vast majority of maternal deaths and disabilities could be prevented through appropriate reproductive health services before, during and after pregnancy, and through life-saving interventions should complications arise. Attendance at delivery by skilled health personnel (doctors, nurses, midwives) who are trained to detect problems early and can effectively provide or refer women to emergency obstetric care when needed is essential. The regions with the lowest proportions of skilled health attendants at birth are Southern Asia and sub-Saharan Africa, which also have the highest numbers of maternal deaths. Disparities in the support available to women during pregnancy and childbirth are evident both among countries and within them. According to surveys conducted between 1996 and 2005 in 57 developing countries, 81 per cent of urban women deliver with the help of a skilled attendant, versus only 49 per cent of their rural counterparts. Similarly, 84 per cent of women who have completed secondary or higher education is attended by skilled personnel during childbirth, more than twice the rate of mothers with no formal education. Antenatal care has long been recognized as a core component of maternal health services. It can help women identify potential risks and plan for a safe delivery. It also can serve as an entry point into the wider health-care system. Since 1990, every region has made progress in ensuring that women receive antenatal care at least once during their pregnancy. Even in sub-Saharan Africa, where the least progress has occurred, more than two thirds of women receive antenatal care at least one time during pregnancy. For antenatal care to be effective, international experts recommend at least four visits to a trained health-care practitioner during pregnancy. However, in many countries, particularly in Africa, there is a large gap between the proportions of women who receive antenatal care at least once compared to those who receive care four or more times. In Kenya, for example, in 2003, 87 per cent of women received antenatal care at least once, while only 51 per cent received care the recommended four times. Similarly, women in Madagascar were twice as likely to receive antenatal care at least once rather than four or more times.
Collaboration with World Health Organization (WHO):
Governance of the World Health Organization
The World Health Assembly is the supreme decision-making body for WHO. It generally meets in Geneva in May each year, and is attended by delegations from all 193 Member States. Its main function is to determine the policies of the Organization. The Health Assembly appoints the Director-General, supervises the financial policies of the Organization, and reviews and approves the Proposed programme budget. It similarly considers reports of the Executive Board, which it instructs in regard to matters upon which further action, study, investigation or report may be required. The Executive Board is composed of 34 members technically qualified in the field of health. Members are elected for three-year terms. The main Board meeting, at which the agenda for the forthcoming Health Assembly is agreed upon and resolutions for forwarding to the Health Assembly are adopted, is held in January, with a second shorter meeting in May, immediately after the Health Assembly, for more administrative matters. The main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work. The Secretariat of WHO is staffed by some 8000 health and other experts and support staff on fixed-term appointments, working at headquarters, in the six regional offices, and in countries. The Organization is headed by the Director-General, who is appointed by the Health Assembly on the nomination of the Executive Board. WHO Governance: http://www.who.int/governance/en/
Bulletin of the World Health Organization; Volume 86, Number 5, May 2008, 321-416 Table of contents
Collaboration with UN University (UNU):
UNU-WIDER (World Institute for Development Economics Research) Expert Series on Health Economics
Entrepreneurial Ventures and the Developmental State: Lessons from the Advanced Economies (Discussion Paper)
A basic intellectual challenge for those concerned with the poverty of nations is to come to grips with the nature and causes of the wealth of the world's wealthier nations. One might then be in a position to inform the poorer nations how they might achieve similar outcomes. This paper is organized around what I call 'the theory of innovative enterprise', a perspective derived from the historical and comparative study of the development of the advanced economies. The theory of innovative enterprise provides the essential analytical link between entrepreneurship and development. Section 2 offers, as a point of departure, a contrast between entrepreneurship in rich and poor nations. Section 3 outlines the theory of the innovating firm in which entrepreneurship has a role to play. Section 4 identifies the roles of entrepreneurship in new firm formation in terms of the types of strategy, organization, and finance that innovation requires, and emphasizes the 'disappearance' of entrepreneurship with the growth of the firm. In Section 5 I argue that, in the advanced economies, successful entrepreneurship in knowledge intensive industries has depended heavily upon a combination of business allocation of resources to innovative investment strategies, and government investment in the knowledge base, state sponsored protection of markets and intellectual property rights, and state subsidies to support these business strategies. One cannot understand national economic development without understanding the role of the developmental state. At the same time, the specific agenda and ultimate success of the developmental state cannot be understood in abstraction from the dynamics of innovative enterprise. It is through the interaction of the innovative enterprise and the developmental state that entrepreneurial activity inserts itself into the economic system to contribute to the process of economic development. Publisher: UNU-WIDER; Volume: 2008/01. Authors: William Lazonick;
Key words: entrepreneurship, innovative enterprise, developmental state
(Details of the paper can be accessed from the link of UNU-WIDER on CME Page of WomensHealthSection.com)
United Nations Charter:
We the Peoples of the United Nations .... United for a Better World
PACIFIC SETTLEMENT OF DISPUTES
- The parties to any dispute, the continuance of which is likely to endanger the maintenance of international peace and security, shall, first of all, seek a solution by negotiation, enquiry, mediation, conciliation, arbitration, judicial settlement, resort to regional agencies or arrangements, or other peaceful means of their own choice.
- The Security Council shall, when it deems necessary, call upon the parties to settle their dispute by such means.
The Security Council may investigate any dispute, or any situation which might lead to international friction or give rise to a dispute, in order to determine whether the continuance of the dispute or situation is likely to endanger the maintenance of international peace and security.
- Any Member of the United Nations may bring any dispute, or any situation of the nature referred to in Article 34, to the attention of the Security Council or of the General Assembly.
- A state which is not a Member of the United Nations may bring to the attention of the Security Council or of the General Assembly any dispute to which it is a party if it accepts in advance, for the purposes of the dispute, the obligations of pacific settlement provided in the present Charter.
- The proceedings of the General Assembly in respect of matters brought to its attention under this Article will be subject to the provisions of Articles 11 and 12.
- The Security Council may, at any stage of a dispute of the nature referred to in Article 33 or of a situation of like nature, recommend appropriate procedures or methods of adjustment.
- The Security Council should take into consideration any procedures for the settlement of the dispute which have already been adopted by the parties.
In making recommendations under this Article the Security Council should also take into consideration that legal disputes should as a general rule be referred by the parties to the International Court of Justice in accordance with the provisions of the Statute of the Court.
Should the parties to a dispute of the nature referred to in Article 33 fail to settle it by the means indicated in that Article, they shall refer it to the Security Council.
If the Security Council deems that the continuance of the dispute is in fact likely to endanger the maintenance of international peace and security, it shall decide whether to take action under Article 36 or to recommend such terms of settlement as it may consider appropriate.
Without prejudice to the provisions of Articles 33 to 37, the Security Council may, if all the parties to any dispute so request, make recommendations to the parties with a view to a pacific settlement of the dispute.
ACTION WITH RESPECT TO THREATS TO THE PEACE, BREACHES OF THE PEACE, AND ACTS OF AGGRESSION
The Security Council shall determine the existence of any threat to the peace, breach of the peace, or act of aggression and shall make recommendations, or decide what measures shall be taken in accordance with Articles 41 and 42, to maintain or restore international peace and security.
In order to prevent an aggravation of the situation, the Security Council may, before making the recommendations or deciding upon the measures provided for in Article 39, call upon the parties concerned to comply with such provisional measures as it deems necessary or desirable. Such provisional measures shall be without prejudice to the rights, claims, or position of the parties concerned. The Security Council shall duly take account of failure to comply with such provisional measures.
The Security Council may decide what measures not involving the use of armed force are to be employed to give effect to its decisions, and it may call upon the Members of the United Nations to apply such measures. These may include complete or partial interruption of economic relations and of rail, sea, air, postal, telegraphic, radio, and other means of communication, and the severance of diplomatic relations.
Should the Security Council consider that measures provided for in Article 41 would be inadequate or have proved to be inadequate, it may take such action by air, sea, or land forces as may be necessary to maintain or restore international peace and security. Such action may include demonstrations, blockade, and other operations by air, sea, or land forces of Members of the United Nations.
- All Members of the United Nations, in order to contribute to the maintenance of international peace and security, undertake to make available to the Security Council, on its call and in accordance with a special agreement or agreements, armed forces, assistance, and facilities, including rights of passage, necessary for the purpose of maintaining international peace and security.
- Such agreement or agreements shall govern the numbers and types of forces, their degree of readiness and general location, and the nature of the facilities and assistance to be provided.
- The agreement or agreements shall be negotiated as soon as possible on the initiative of the Security Council. They shall be concluded between the Security Council and Members or between the Security Council and groups of Members and shall be subject to ratification by the signatory states in accordance with their respective constitutional processes.
When the Security Council has decided to use force it shall, before calling upon a Member not represented on it to provide armed forces in fulfillment of the obligations assumed under Article 43, invite that Member, if the Member so desires, to participate in the decisions of the Security Council concerning the employment of contingents of that Member's armed forces.
In order to enable the United Nations to take urgent military measures, Members shall hold immediately available national air-force contingents for combined international enforcement action. The strength and degree of readiness of these contingents and plans for their combined action shall be determined within the limits laid down in the special agreement or agreements referred to in Article 43, by the Security Council with the assistance of the Military Staff Committee.
Plans for the application of armed force shall be made by the Security Council with the assistance of the Military Staff Committee.
- There shall be established a Military Staff Committee to advise and assist the Security Council on all questions relating to the Security Council's military requirements for the maintenance of international peace and security, the employment and command of forces placed at its disposal, the regulation of armaments, and possible disarmament.
- The Military Staff Committee shall consist of the Chiefs of Staff of the permanent members of the Security Council or their representatives. Any Member of the United Nations not permanently represented on the Committee shall be invited by the Committee to be associated with it when the efficient discharge of the Committee's responsibilities requires the participation of that Member in its work.
- The Military Staff Committee shall be responsible under the Security Council for the strategic direction of any armed forces placed at the disposal of the Security Council. Questions relating to the command of such forces shall be worked out subsequently.
- The Military Staff Committee, with the authorization of the Security Council and after consultation with appropriate regional agencies, may establish regional sub-committees.
- The action required to carry out the decisions of the Security Council for the maintenance of international peace and security shall be taken by all the Members of the United Nations or by some of them, as the Security Council may determine.
- Such decisions shall be carried out by the Members of the United Nations directly and through their action in the appropriate international agencies of which they are members.
The Members of the United Nations shall join in affording mutual assistance in carrying out the measures decided upon by the Security Council.
If preventive or enforcement measures against any state are taken by the Security Council, any other state, whether a Member of the United Nations or not, which finds itself confronted with special economic problems arising from the carrying out of those measures shall have the right to consult the Security Council with regard to a solution of those problems.
Nothing in the present Charter shall impair the inherent right of individual or collective self-defense if an armed attack occurs against a Member of the United Nations, until the Security Council has taken measures necessary to maintain international peace and security. Measures taken by Members in the exercise of this right of self-defense shall be immediately reported to the Security Council and shall not in any way affect the authority and responsibility of the Security Council under the present Charter to take at any time such action as it deems necessary in order to maintain or restore international peace and security.
To be continued...
Top Two Articles Accessed in April 2008:
- Urodynamic Assessment: Patient Evaluation & Equipment;
WHEC Publications. Special thanks to the writers/editors/physicians for their contributions in preparing the series on urodynamic assessment.
- Urodynamic Assessment: Cystometry;
WHEC Publications. Special thanks to the writers/editors/physicians for their contributions in preparing the series on urodynamic assessment.
News, Invitations and Letters:
The Nobel Peace Prize
The United Nations: Formally Recognized and Recognized by Association
The Nobel prizes, awarded in five different areas, one of which is peace, came into existence upon the death in 1896 of Alfred Nobel, whose trust fund called for bestowing prizes each year on those who have "conferred the greatest benefit on mankind". First awarded in 1901, the prizes are closely linked to the history of modern science, the arts and political development. The Norwegian Nobel Committee, in its 107 years of existence has awarded the Nobel Peace Prize to United Nations agencies and staff ten times. Before 1914, the Nobel Committee credited, in particular, efforts at legislation and arbitration leading to peace, especially in connection with the Hague Peace Conferences of 1899 and 1907, and it awarded the Prize to a number of representatives of popular peace movements and international legal tradition, such as Frederic Passy of France (1901), one of the principal founders of the Inter-Parliamentary Union, and former Belgian Prime Minister August Beernaert (1909), a member of the Permanent Court of Arbitration at The Hague.
1945: Former United States Secretary of State Cordell Hull received the Nobel Peace Prize in recognition of his prominent role as a senior member of the American delegation in the creation of the United Nations.
1949: Lord Boyd Orr, a British scientist and founding Director-General of the Food and Agriculture Organization of the UN, was honored with Nobel Prize for his efforts to employ scientific discoveries to "promote cooperation between nations".
11 December 1950: Ralph Bunche becomes the first United Nations Nobel Peace Laureate.
1951: The Nobel Prize went to Leon Jouhaux of France, a leader in the International Confederation of Free Trade Unions who had helped found the International Labor Organization in 1919.
1957: Former Canadian Secretary of State Lester Bowles Pearson, who served as the President of the seventh session of the UN General Assembly, received the Nobel Peace Prize in 1957, primarily for his efforts to end the Suez conflict and resolve the Middle East question through the United Nations.
1963: On the 100th anniversary of the founding of the Red Cross, the Prize was awarded jointly to two major arms of the Red Cross movement: the Swiss International Committee of the Red Cross and the International League of Red Cross Societies.
1965: The United Nations was honored in 1965—for the fourth time—when the Nobel Peace Prize was awarded to the United Nations Children's Fund (UNICEF) for playing a vital role in fostering "the brotherhood among nations and the furtherance of peace". This award was a recognition of the vital role UNICEF has carved for itself in the pursuit of basic human needs and rights of all children.
1968: The Peace Prize went to René Cassin, President of the European Court for Human Rights and, as one of the foremost legal scholars, a principal drafter of the Universal Declaration of Human Rights, which was adopted by the UN General Assembly in 1948.
1974: The Nobel Peace Prize went to Sean MacBride of Ireland, who founded in 1961 the non-governmental human rights organization Amnesty International, which also received the Prize in 1977. Elected to the Office of United Nations Commissioner for Namibia by the UN General Assembly, MacBride served as Commissioner, with rank of Assistant Secretary-General, from 1973 to 1977.
1982: The Nobel Peace Prize went jointly to Alva Myrdal of Sweden and Alfonso Garcia Robles of Mexico for their efforts in disarmament, much of which was done under various UN negotiations.
12 October 2001: Norwegian Nobel Committee decides to award the Nobel Peace Prize for 2001, in two equal portions, to the United Nations and its Secretary-General, Kofi Annan, for their work for a better, organized and more peaceful world. It is the eighth Peace Prize awarded to the UN system.
7 October 2005: Nobel Peace Prizes awarded for the ninth time to the UN system. The International Atomic Energy Agency (IAEA) and its Director-General, Mohamed ElBaradei, are cited for their efforts to ensure that nuclear energy is used for peaceful purposes.
12 October 2007: The Intergovernmental Panel on Climate Change (IPCC) won the Nobel Peace Prize, jointly with former United States Vice-President Al Gore. The IPCC was established in 1988 by the World Meteorological Organization (WMO) and the United Nations Environment Program (UNEP) to recognize the problem of the increasing global warming.
With the 2007 Nobel Peace Prize, the IPCC joins the following UN officials and bodies as Nobel laureates: UN mediator Ralph Bunche in 1950; the Office of the UN High Commissioner for Refugees (UNHCR) in 1954 and again in 1981; UN Secretary-General Dag Hammarskjöld in 1961; the United Nations Children's Fund (UNICEF) in 1965; the International Labor Organization (ILO) in 1969; the UN Peacekeeping Forces in 1988; the United Nations and UN Secretary-General Kofi Annan in 2001; and the International Atomic Energy Agency (IAEA) in 2005. http://www.un.org/Pubs/chronicle/2007/webArticles/101907_nobel_prize_ipcc.html
WHEC thanks Dr. Frank A. Chervenak, Given Foundation Professor and Chairman, Department of Obstetrics and Gynecology, New York Weill Cornell Medical Center for his priceless support, friendship and contributions. It is indeed a pleasure and privilege for everyone at Women's Health and Education Center (WHEC) to work with your group. We all are looking forward to plan and develop many useful projects/programs in women's health. Thanks again for everything.
Beyond the numbers...
He who sees things grow from the beginning will have the finest view of them.
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