https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61406-3.pdf

Community participation: lessons for maternal, newborn, and child health

Assessing health system performance in developing countries: A review of the literature

The World Health Organization welcomes requests for permission to reproduce or translate its publications , in part or in full. Applications and enquiries should be addressed to the Office of Publications , World Health Organization, Geneva, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The editors alone are responsible for the views expressed in this publication.

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Design and Implementation of Health Information Systems

Consanguineous marriages are strongly preferred in much of West and South Asia This paper examines the prevalence and sociodemographic correlates of consanguineous unions in Pakistan using local and national data Information from 1011 ever-married women living in four multi-ethnic and multi-lingual squatter settlements of Karachi, the main commercial centre of the country, are compared with data from the national 1990/91 Pakistan Demographic and Health Survey (PDHS), based on information provided by 6611 women Both sets of results indicate that approximately 60% of marriages were consanguineous, over 80% of which were between first cousins The mean coefficients of inbreeding (F) in the present generation were 00316 and 00331 for the Karachi and PDHS data respectively In both surveys the prevalence of consanguineous unions appeared to be unchanged over the past three to four decades Consanguineous unions were more common among women who were illiterate or had only primary level education, were first or second generation migrants from rural areas of Pakistan or, in the PDHS, lived in rural areas, and whose parents were also consanguineously married

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0021932098002612

The prevalence and demographic characteristics of consanguineous marriages in Pakistan

considerations. Biomedical Research Involving Animals is a report of the proceedings of the 1983 conference which discussed a draft of the Guiding Principles for Research using Animals presented at the conference and which it was hoped would provide widely applicable criteria for establishing codes of practice or legislation concerning the use of laboratory animals for scientific purposes. Whilst no one could fault the intention, the list of participants emphasises the rather one-sided nature of the proceedings. Of some 200 participants, scientists outnumbered animal welfarists by more than 20 to 1. The sooner those involved in any of the scientific disciplines accept that responsible lay opinion in all areas where the welfare of man or animal is at stake must be given equal weight with scientific opinion, the better. The attitude expressed by one scientist at the round table conference that those who are not in favour of experiments with animals simply do not understand what basic scientific method is about, is no longer true or acceptable. Nevertheless, Biomedical Research InvolvingAnimals is a useful selection of papers and discussions on this controversial and contentious issue. The conference was divided into three sessions, each of which included three or four papers followed by discussion: Scientific Progress and Research Involving Animals; Determinants of Future Policy Regarding Research Involving Animals, and Care and Protection of Laboratory Animals. The book ends with reports and summaries by the session chairmen. I found the most interesting and useful paper was that of Dr Zimmermann, of the International Association for the Study of Pain, on Ethical Considerations in Relation to Pain in Animal Experimentation. In discussion, Dr Zimmermann makes the point which should give pause for thought to all those involved in experimental research:

https://jme.bmj.com/content/medethics/12/1/50.full.pdf

Just Health Care.

Building the infrastructure for primary health care: An overview of vertical and integrated approaches

Developing a primary health care management information system that supports the pursuit of equity effectiveness and affordability.

OBJECTIVES. The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS. Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS. The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, c...

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.83.11.1537

A developing country's university oriented toward strengthening health systems: challenges and results.

The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation aboutwhich aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put Collaboration across sites can yield a catalogue of indicators that will facilitate further work

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An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries

In 1996 the World Health Organization (WHO) identified the following issues for consideration as it designed its new strategy to achieve "health for all" in the 21st century: the determinants of health health patterns in the future intersectoral action essential public health functions partnerships in health human resources for health and the role of the WHO. Because ethical considerations play a vital role in developing the strategy the WHO sought the input of the Council for International Organizations of Medical Sciences in this regard. As understanding of the role and nature of medical ethics has deepened in the past decades new ethical questions are continually being raised by changing patterns of disease and health care and by technological advances. The new health-for-all strategy must therefore give prominence to the consideration of equity utility equality and human rights. In order to attain justice the equilibrium between equity and equality should be maintained. Cultural diversity will also inform notions of equity. The principles of primary health care contained in the WHOs Alma-Ata Declaration also need to be strengthened to place proper emphasis on the need for information systems decision-making mechanisms and support systems. The most important activities the WHO is applying to its effort to renew its "health for all" strategy are 1) clarifying the concepts; 2) strengthening links to related fields; 3) working in partnership with countries regions and organizations; and 4) promoting the dissemination of information and ideas. The WHOs renewed strategy must bring clarity practicality and effectiveness to global health activities while fostering an understanding of the moral issues that contribute to human well-being.

John H. Bryant

Papers

Building the infrastructure for primary health care: An overview of vertical and integrated approaches

Developing a primary health care management information system that supports the pursuit of equity effectiveness and affordability.

A developing country's university oriented toward strengthening health systems: challenges and results.

An evidence-based approach to benchmarking the fairness of health-sector reform in developing countries

Ethics, equity and renewal of WHO's health-for-all strategy