The failure of environmental health programmes in Nigeria: A concern for health planners in the developing nations

Although many extraneous variables such as different countries, levels of economic development, technologies, and politics are as important in determining the success of a project as its budgeting and finance, this report is solely from the finance and budgeting perspective. It is shown that projects in the United States have a systemic budgeting process, based on sound concepts of planning and control. In contrast, financial and budgeting planning is underdeveloped in the two projects examined in Nigeria. It is desirable that the least developed countries seek expert advice before embarking on any environmental health services programmes which may lead to the waste of resources if not properly planned and managed.     

Water, sanitation and hygiene for the health of developing nations

The water and sanitation needs of the poor in developing countries are huge. To meet the target of water and sanitation for all by the end of 2025, some 2.9 billion people will have to receive improved water supplies, and 4.2 billion improved sanitation. The technologies used must be appropriate and, in particular, simple, affordable and sustainable.     

Occupational health in China

China has been experiencing rapid industrialization and economic growth, resulting in a transformed industrial structure and expansion of the labor force. Occupational health and safety services, nonexistent before 1949, have made remarkable advances over the past decades. However, these services face greater challenges, consisting of both traditional and new occupational health problems. Poorly regulated work environments often lacking health services in recently developed and thriving small-scale industries and joint venture enterprises have created increasing risks for occupational diseases and work-related injuries. A special strategy based on cooperation among and contributions from the legal, administrative, social, economic, and scientific communities is critical to achieving the ultimate goal of control and prevention of these occupational health problems.     

Occupational health in developing countries: review of research needs

Over the past two decades, industrial activity has increased rapidly in developing nations. Industrial growth has also increased the health risks facing workers in these countries both by intensifying existing health problems and by introducing new hazards. Inadequate information about occupational hazards creates major obstacles to effective prevention of occupational diseases in many developing countries. This brief report reviews the occupational health determinants of developing nations and suggests current research needs and objectives. Our purpose is to stimulate discussion and initiate debate among health professionals worldwide who confront growing problems in occupational health.     

Urban sanitation and health in the developing world: reminiscing the nineteenth century industrial nations

The dichotomy in development trajectories of urbanisation, industrialization and economic change, and the associated environmental health challenges, between the industrialised nations and the developing world, could offer useful lessons, especially for the latter. This paper examines points of convergence in the underlying factors and theories, underpinning urbanisation, sanitation and health in the 19th century industrialised nations and the developing world and explores the major reasons why many low income countries have not managed to redress their urban sanitation and health problems. It concludes that any meaningful developments in low income countries may require strategies, policies and actions, which emphasise local realities over and above global concerns and priorities.     

Teaching health economics to medical personnel from developing nations

Outlines the author's experiences and the lessons learnt from work in the field of management training for doctors and other medical personnel. Explains the policy of using a dual approach: economic concepts and ideas in practical situations. States that by adopting this participative, problem-solving approach and involving the discipline of economics in tandem with other skills and subjects, it addresses some of the issues which medical personnel face in their places of work.     

A community based approach in developing health policies: implications for Asia-Pacific nations

Only a few state in the US have followed up on the Nation's 1990 health objectives and almost all used professional experts and planners to do so. Hawaii has taken the extra step and involved the community in studying and preparing its health objectives. Hawaii used the US Public Health Service's framework which included preventive health services, health protection, and health promotion. Some of the priority areas under preventive health services included family planning, pregnancy and infant health, and sexually transmitted diseases. In 1985, the State organized 15 groups each studying a different health priority area with 8-20 members each from the community and various organizations. Members consisted of public health professionals (31%), health professionals from private voluntary organizations (15%), practicing physicians (13%), voluntary health associations members (11%), university faculty (8%) and the remaining members represented the military, health care institutions, business, labor, State Department of Education, and special interest groups. The study groups met monthly and arrived at 92 high, 82 medium, and 27 low priority areas. At each of 3 public forums, 5 different study groups presented their findings. Prior to the Governor's Conference on Health Promotion and Disease Prevention, each participant received a preconference report consisting of detailed summaries of each study group's findings. After the conference, the study groups met again to incorporate conference feedback into their final working papers. In December 1988, the Department of Health hosted a conference to evaluate progress and developments relating to achieving the state's health objectives. Broad based community involvement and intersectorial cooperation and political commitment in health planning are essential to meeting health objectives, policies, and actions.     

Health care facility vulnerability in developing nations: strengthening health care policy-making and implementation

Background

In developing countries such as India, inadequate importance and consideration given to assessment of health care facilities negatively affects progress towards achieving health targets. India has focused on developing Primary Health Centres (PHCs) for rural basic laboratory and curative services. The local decision-makers do not have any national-level framework to evaluate the vulnerability of PHCs which are not meeting national PHC standards, nor do they have resources to meet national PHC standards.

Aim

The study proposed a framework to assess the public health care facilities for vulnerability.

Methods

A cross-sectional questionnaire survey was performed. The study used PHC laboratory services of 42 PHCs of Osmanabad District, India as a case study for proposed framework. The data assessment was carried out at district level, block level, PHC cluster level, and PHC level to provide flexibility to local decision-makers in taking remedial measures.

Results

Staff workload (73.17%), physician’s need (51.22%), and organization structure (36.59%) are the most prevalent challenges across PHCs. Multiple challenges are prevalent in the PHCs across districts. The PHCs with poor medical doctor (MD) capability or many challenges have shown poor laboratory performance.

Conclusion

Governance need to be strengthened in PHCs, followed by sustained support in resources and financing. Poor health status in developing nations necessitates a public health response based on health systems. Therefore, an assessment of health facility vulnerability in the form of laboratory services is essential in primary health care facilities.

     

Occupational health research in developing countries: a partner for social justice

Occupational health remains neglected in developing countries because of competing social, economic, and political challenges. Occupational health research in developing countries should recognize the social and political context of work relations, especially the fact that the majority of developing countries lack the political mechanisms to translate scientific findings into effective policies.Researchers in the developing world can achieve tangible progress in promoting occupational health only if they end their professional isolation and examine occupational health in the broader context of social justice and national development in alliance with researchers from other disciplines. An occupational health research paradigm in developing countries should focus less on the workplace and more on the worker in his or her social context.     

Financing reforms of public health services in China: lessons for other nations

Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.     

Occupational health in the People's Republic of China.

China's drive to modernize its economy will produce new occupational health problems even as it resolves earlier ones. Well aware of this, Chinese occupational health experts are intensifying efforts to improve workers' health and establish a modern occupational health program. Occupational lung disease, occupational cancer, heavy metal poisoning, industrial chemical poisoning, and physical factor-induced diseases (noise and heat) have all been targeted for expanded research which will serve as a basis for standard setting. Hazard control efforts include engineering controls, particularly in new construction, limited use of personal protective equipment, and expansion of environmental and medical monitoring. Worker education and professional activities have been expanded. International exchanges have been initiated and will prove occupational health a promising area of scientific cooperation.