Jon Rohde - Academia.edu (original) (raw)
Papers by Jon Rohde
Lancet, 2008
We assessed progress for primary health care in countries since Alma-Ata. First we analysed life ... more We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (eg, immunisation, family planning), and 14 have progressed to comprehensive primary health care, marked by high coverage of skilled attendance at birth. Good governance and progress in non-health sectors are seen in almost all of the 14 countries identifi ed with a comprehensive primary health care system. However, these 30 countries include those that are making progress despite very low income per person, political instability, and high HIV/AIDS prevalence. Thailand has the highest average yearly reduction in mortality among children less than 5 years of age (8·5%) and has achieved universal coverage of immunisation and skilled birth attendance, with low inequity. Lessons learned from all these countries include the need for a nationally agreed package of prioritised and phased primary health care that all stakeholders are committed to implementing, attention to district management systems, and consistent investment in primary health-care extension workers linked to the health system. More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the Millennium Development Goals and "health for all".
Lancet, 2008
In this paper, we revisit the revolutionary principles-equity, social justice, and health for all... more In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.
Health Policy and Planning, 1987
ABSTRACT This paper considers the impact of recent efforts to integrate the national family plann... more ABSTRACT This paper considers the impact of recent efforts to integrate the national family planning programme in Haiti into the Ministry of Public Health and Population as part of a broad-scale effort to improve rural health delivery. In spite of major investment over the last 5 years, there has been a decline in family planning activities, extremely low contraceptive prevalence and a lack of direction in the programme. The family planning management information system did not allow programme leaders and policy-makers to monitor programme results and take corrective action. Too rapid integration, based on little more than conventional wisdom, led to the disintegration of a family planning programme that had shown slow but steady growth and progress for 10 years. Steps needed to improve the situation are discussed.
Bulletin of The World Health Organization, 2006
Indian Journal of Pediatrics, 1989
In this paper, we revisit the revolutionary principles-equity, social justice, and health for all... more In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.
It is unclear whether a substantial decline in malnutrition among infants in developing countries... more It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions. The study was designed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age. In a controlled trial, 418 infants 4 mo of age were individually randomized to one of the four groups and followed until 12 mo of age. The first group received a milk-based cereal and nutritional counseling; the second group monthly nutritional counseling alone. To control for the effect of twice-weekly home visits for morbidity ascertainment, similar visits were made in one of the control groups (visitation group); the fourth group received no intervention. The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk (P Ͻ 0.001), 1739 kJ at 38 wk (P Ͻ 0.001) and 2257 kJ at 52 wk (P Ͻ 0.001). The food supplementation infants gained 250 g (95% confidence interval: 20 -480 g) more weight than did the visitation group. The difference in the mean increment in length during the study was 0.4 cm (95% confidence interval: Ϫ0.1-0.9 cm). The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages (P Ͻ 0.05 at all ages) but no significant benefit on weight and length increments. Methods to enhance the impact of these interventions need to be identified.
It is necessary to differentiate between complications of pregnancy and population risk groups fo... more It is necessary to differentiate between complications of pregnancy and population risk groups for those complications. The latter have limited use as most complications occur in the low risk groups. Complications of pregnancy need to be treated in health facilities that can provide blood transfusions, cesarean section, removal of placenta and induction of labor. A plan must exist for each pregnant woman to be moved to such a facility, since it is not possible to predict who will have thecomplication. Early detection andeffective treatment of complications and family planning services to prevent unwanted pregnancies is the way to lower maternal mortality.
The immediate and long-term health effects of war have been explicated elsewhere, 24---28 to an e... more The immediate and long-term health effects of war have been explicated elsewhere, 24---28 to an extent beyond the scope of this article. Descriptions of military programs that address the physical and psychological effects of military service, 29---34 albeit with insufficient resources, 31,35 are also beyond the scope of this article. Only selected physical and psychosocial effects are noted herein to introduce the FRAMING HEALTH MATTERS e34 | Framing Health Matters | Peer Reviewed | Wiist et al.
Lancet, 2008
We assessed progress for primary health care in countries since Alma-Ata. First we analysed life ... more We assessed progress for primary health care in countries since Alma-Ata. First we analysed life expectancy relative to national income and HIV prevalence to identify overachieving and underachieving countries. Then we focused on the 30 low-income and middle-income countries with the highest average yearly reduction of mortality among children less than 5 years of age, describing coverage and equity of primary health care as well as non-health sector actions. These 30 countries have scaled up selective primary health care (eg, immunisation, family planning), and 14 have progressed to comprehensive primary health care, marked by high coverage of skilled attendance at birth. Good governance and progress in non-health sectors are seen in almost all of the 14 countries identifi ed with a comprehensive primary health care system. However, these 30 countries include those that are making progress despite very low income per person, political instability, and high HIV/AIDS prevalence. Thailand has the highest average yearly reduction in mortality among children less than 5 years of age (8·5%) and has achieved universal coverage of immunisation and skilled birth attendance, with low inequity. Lessons learned from all these countries include the need for a nationally agreed package of prioritised and phased primary health care that all stakeholders are committed to implementing, attention to district management systems, and consistent investment in primary health-care extension workers linked to the health system. More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the Millennium Development Goals and "health for all".
Lancet, 2008
In this paper, we revisit the revolutionary principles-equity, social justice, and health for all... more In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.
Health Policy and Planning, 1987
ABSTRACT This paper considers the impact of recent efforts to integrate the national family plann... more ABSTRACT This paper considers the impact of recent efforts to integrate the national family planning programme in Haiti into the Ministry of Public Health and Population as part of a broad-scale effort to improve rural health delivery. In spite of major investment over the last 5 years, there has been a decline in family planning activities, extremely low contraceptive prevalence and a lack of direction in the programme. The family planning management information system did not allow programme leaders and policy-makers to monitor programme results and take corrective action. Too rapid integration, based on little more than conventional wisdom, led to the disintegration of a family planning programme that had shown slow but steady growth and progress for 10 years. Steps needed to improve the situation are discussed.
Bulletin of The World Health Organization, 2006
Indian Journal of Pediatrics, 1989
In this paper, we revisit the revolutionary principles-equity, social justice, and health for all... more In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.
It is unclear whether a substantial decline in malnutrition among infants in developing countries... more It is unclear whether a substantial decline in malnutrition among infants in developing countries can be achieved by increasing food availability and nutrition counseling without concurrent morbidity-reducing interventions. The study was designed to determine whether provision of generous amounts of a micronutrient-fortified food supplement supported by counseling or nutritional counseling alone would significantly improve physical growth between 4 and 12 mo of age. In a controlled trial, 418 infants 4 mo of age were individually randomized to one of the four groups and followed until 12 mo of age. The first group received a milk-based cereal and nutritional counseling; the second group monthly nutritional counseling alone. To control for the effect of twice-weekly home visits for morbidity ascertainment, similar visits were made in one of the control groups (visitation group); the fourth group received no intervention. The median energy intake from nonbreast milk sources was higher in the food supplementation group than in the visitation group by 1212 kJ at 26 wk (P Ͻ 0.001), 1739 kJ at 38 wk (P Ͻ 0.001) and 2257 kJ at 52 wk (P Ͻ 0.001). The food supplementation infants gained 250 g (95% confidence interval: 20 -480 g) more weight than did the visitation group. The difference in the mean increment in length during the study was 0.4 cm (95% confidence interval: Ϫ0.1-0.9 cm). The nutritional counseling group had higher energy intakes ranging from 280 to 752 kJ at different ages (P Ͻ 0.05 at all ages) but no significant benefit on weight and length increments. Methods to enhance the impact of these interventions need to be identified.
It is necessary to differentiate between complications of pregnancy and population risk groups fo... more It is necessary to differentiate between complications of pregnancy and population risk groups for those complications. The latter have limited use as most complications occur in the low risk groups. Complications of pregnancy need to be treated in health facilities that can provide blood transfusions, cesarean section, removal of placenta and induction of labor. A plan must exist for each pregnant woman to be moved to such a facility, since it is not possible to predict who will have thecomplication. Early detection andeffective treatment of complications and family planning services to prevent unwanted pregnancies is the way to lower maternal mortality.
The immediate and long-term health effects of war have been explicated elsewhere, 24---28 to an e... more The immediate and long-term health effects of war have been explicated elsewhere, 24---28 to an extent beyond the scope of this article. Descriptions of military programs that address the physical and psychological effects of military service, 29---34 albeit with insufficient resources, 31,35 are also beyond the scope of this article. Only selected physical and psychosocial effects are noted herein to introduce the FRAMING HEALTH MATTERS e34 | Framing Health Matters | Peer Reviewed | Wiist et al.