Rural health care in Mexico?

A very large percentage of Mexico's population living in rural areas lacks resources for health care. Any new effort to provide such care must emphasize the health of the infant population because of the high percentage of infants in the country. Plans made at the national level have not been correlated with the conditions that exist in rural areas. For example, the majority of university programs are oriented toward urban medical practice, and the construction of more schools of medicine to solve the problem of doctors in rural areas is based on a mistaken premise. This problem has not been solved even in developed countries such as the United States where, as in Mexico, graduates in medicine migrate to the cities where optimal conditions are met for practicing the type of medicine for which they have been trained. Furthermore, it is both expensive and illogical to maintain urban doctors in rural areas where they cannot practice their profession for lack of resources; to do so is to deny the purpose of their education (27). Conventional schools of medicine, for reasons of investment and of structure, should teach only very selected groups of students who, on finishing their training, are fully capacitated to practice specialized medicine. A different system is required if we are to provide adequate health care in the rural communities. A system such as that described herein, adapted to the real need of rural communities, would avoid the necessity to create dysfunctional bureaucracies and would not destroy those institutions which have proved useful in the past. This study should be considered as one of the many pilot programs that should be initiated in order to determine the type of program that would best solve the problem of health care in rural Mexico. Other programs already being considered at the National Autonomous University of Mexico include the A36 plan of the Faculty of Medicine, now in operation; the work of C. Biro carried out in Netzahualcoyotl City (both focused on providing medical care to the urban poor); and the Open University program. Unless an efficient program designed to meet the needs of rural communities is quickly put into operation, Mexico will, in the near future, be facing the same problems now confronting Southeast Asia.     

Small area variations in health care delivery

Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health.     

The Population Factor in Africa's Development Dilemma

Despite several decades of international effort, the development problems of sub-Saharan Africa remain acute. By many of the quality of life indexes, the majority of African countries are standing still or moving backward. A rapidly growing population with an adverse dependency ratio places demands on services that present development strategies cannot satisfy. A reorientation of development is necessary to establish realistic population policies and to implement comprehensive family planning programs.     

World Bank, U.S. at odds on population

As the Reagan Administration issued a statement for a U.N. population conference concerning U.S. plans to halt foreign aid to nongovernmental organizations that "perform or actively promote" abortions, several reports appeared about problems which developing nations face in contending with rapid population growth. The World Bank's World Development Report 1984 analyzes population and development trends, argues for providing more aid for population programs, and recounts what has happened in countries where abortion has been outlawed. A National Research Council report documents China's rapid fertility drop since its 1969 antinatalist campaign began. A Population Reports International report advocates housing, education, and incentive-based family planning programs in developing countries.     

Advancing global health research through digital technology and sharing data

The imperative for improving health in the world's poorest regions lies in research, yet there is no question that low participation, a lack of trained staff, and limited opportunities for data sharing in developing countries impede advances in medical practice and public health knowledge. Extensive studies are essential to develop new treatments and to identify better ways to manage healthcare issues. Recent rapid advances in availability and uptake of digital technologies, especially of mobile networks, have the potential to overcome several barriers to collaborative research in remote places with limited access to resources. Many research groups are already taking advantage of these technologies for data sharing and capture, and these initiatives indicate that increasing acceptance and use of digital technology could promote rapid improvements in global medical science.     

Information technology in the Costa Rican dairy sector: A key instrument in extension and on-farm research

Can computer and information technology (IT), widely used in the development of livestock health and production, be of any benefit for Third World farmers and institutions? And if so, how can they be implemented on a large scale? The authors try to answer these and related questions based on experiences with computerized dairy herd health and production programs in Costa Rica. They conclude that IT is becoming a key instrument in the planning and operation of modern extension services and on-farm research for meeting the farmers' increasing needs for information and for enhancing their ability to manage the available resources efficiently. IT enables private sector extension services provided by farmer groups and advisors to give farmers access to information that they previously lacked. These services facilitate bottom-up planning. Where IT does not allow the farmer or extension agent to solve the problem, IT can be used to articulate the problem for researchers or policy makers to address. For low-resource smallholders, access to IT can be provided through local farmer organizations. At the institutional level, IT is giving a strong impulse to the improvement of on-farm research, teaching programs, institutional and disciplinary cooperation, regional networking, and to a better linkage with the productive sector.     

A "prolife" population delegation?

The White House has been circulating drafts of a controversial position paper to be presented at the August 1984 United Nations world population conference in Mexico City. The paper dismisses population growth in developing countries as a cause of unemployment, illegal migration, or famine, and asserts that population programs are no substitute for ending government controls that stifle economic growth. It also contains a strong statement against abortion, states the U.S. position against coercion in family planning, and declares the Reagan administration's resolve not to fund programs advocating abortion. The U.S. stance is expected to antagonize developing countries and isolate the United States at the U.N. conference.     

农业科技档案数字化的几点思考

在农业科技档案数字化建设中,资源数字化建设技术标准,数字资源的长期保存、资源的安全性、人才队伍建设、经费等问题突出.必须制定档案数字化建设的总体规划,加大单位网络建设,加快档案信息资源管理专门人才队伍建设,以推进农业科技档案数字化建设.     

Gender related issues in international development assistance for agriculture and rural life

In this paper, the author points out that although by-passed by international development assistance in many parts of the world, women have been providing skill and labor for agricultural production, as well as subsistence of food, water and firewood for their families. Some of the assumptions which have contributed to the marginal attention to women as agriculturalists in international development assistance programs are reviewed. Factors contributing to these assumptions, examples of achievements in development projects and persistent problems are discussed. Some issues which continue to challenge national policy makers in developing countries as well as donors are identified. The author notes that while various donors and organizations address bits and pieces of the issues intermittently, a systematic, organized and universally shared approach to the issues, within a nation state or on a global basis is lacking. She concludes that just as agricultural production inputs and information need to be modified to fit the unique constraints of any ecological niche, similarly, modifications must be made in development assistance programs to fit the specific needs of women in their agricultural roles and cultural settings.     

推进江苏省城乡公共医疗服务一体化建设的路径探析

针对目前广泛存在的＂看病难、看病贵＂问题,从4个方面提出了推进江苏省城乡公共医疗服务一体化的对策：要树立以人为本的理念,推进改革创新,构建城乡一体的公共医疗服务管理体系;建立健全规章制度形成城乡一体的公共医疗服务长效机制;加大统筹规划力度,完善城乡一体的医疗卫生资源配置体系;推广网络信息技术,建立城乡一体的医疗服务信息共享平台;推进江苏城乡协调发展。     

Intersectoral healthcare delivery

Within a given culture – whether industrialized or more tradition oriented – essentially the same fundamental medical theories, practices, and pharmacopoeia tend to be applied to human and non-human sickness and patients. In modern industrialized societies, however, healthcare services are sharply divided between human and veterinary medicine. There is likewise a sharp division between practitioners in these two health sectors: medical doctors and veterinarians. Yet in non-Western, traditional or indigenous medical systems, the same practitioners often treat both humans and animals. There is a growing body of literature that attests to the efficacy of traditional health practices and herbal medicines for the prevention and treatment of both human and livestock ailments.The authors argue for an intersectoral approach to human and veterinary health services in poor countries, especially those targeted to rural people with LIMITED access to modern health services. Extension of conventional medical and veterinary services is particularly difficult and costly in Third World countries where the necessary infrastructure (roads, clinics, labs, cold chains, etc.) is poorly developed and where much of the populace and their livestock reside in remote, rural areas, or where people may be nomadic or transhumant. Consideration should therefore be given to the joint delivery of human and livestock healthcare and related services, as well as to linking informal, ethnoveterinary practices and practitioners with more formalized systems of veterinary AND medical practice. Several advantages of such an approach are identified and explored.     

六盘水市马铃薯产业发展概况及存在的问题与建议

六盘水市结合市情及气候、土壤等自然资源提出大力发展马铃薯产业,并制定了相关的产业发展规划和发展目标,产业取得一定进展,但也出现了一些问题和不足,从该市马铃薯种植和产业发展概况入手,针对存在的问题进行了分析,并结合基层工作实际提出相关建议。     

Something to be done: treating HIV/AIDS. River Path Associates

Largely because of disparities in access to drug treatment and care, AIDS morbidity and mortality have fallen in the developed world but continue to rise among developing countries. Achieving more equitable access to AIDS drugs is hindered by high drug prices, technical complexities related to the provision of health care, and conflict among stakeholders. Recognition that health is vital to the prospects of the emerging global society must be combined with new mechanisms to help all stakeholders work together cooperatively. Tiered drugs pricing should be coupled with investment in health services. An independent "Global Task Force," able to act as an "active think tank," could build consensus about the way forward.     

Public health. Surveillance and privacy

Surveillance is the radar of public health. It has provided the foundation for public health planning, intervention, and prevention. Important ethical issues regarding privacy--the extent to which name-based reporting violates the trust and assumptions made about how personal medical information will be treated--are raised by public health surveillance. This policy forum looks at the contexts of differing responses from the public health communities and general public to surveillance efforts.     

An assessment of animal health projects: U.S. Agency for international development, 1960–93

What are the more significant broad-based needs of animal health programs in developing countries? Essentially they are: health management programs, delivery systems, disease surveillance and monitoring of livestock movements, and improved technologies that are cost-effective and environmentally sound. Responsible program planning elicits important considerations that strengthen final results if integrated early into project design. Examples of these considerations include

?the potential for intervention;

?producers' requirements for animal health services;

?present and future effect(s) of disease;

?trends in livestock production and marketing;

?affect of improved animal health technology on traditional production practices;

?recurrent costs; and

?affect of government policies on development and application of the technology.

For what reasons do some project activities need to be redirected or continually sustained with donor support? A review of the case studies reveals that five major factors critically impact on project longevity. They are 1) initial expense and recurrent costs, 2) labor required, 3) long-term effectiveness, 4) difficulty in achieving objectives, and 5) government policies or civil strife. The U. S. Agency for International Development (USAID) has funded animal health projects for 30 years. Unlike most other bilateral projects, nearly one-third have continued for at least a decade. Given the nature of the biological cycle of livestock, animal health projects and programs require long-term commitments. USAID's investments in animal health projects continue to pay dividends despite continuously changing global political priorities and the redefining of development issues.     

Genetics and Medicine: an evolving relationship

The rapid expansion of knowledge in human and medical genetics has revealed at least 6 percent average heterozygosity per structural gene locus, in excess of 2300 Mendelian (single gene) variants and several hundred chromosomal variants in man. This means that with the exception of monozygous twins, no two individuals are alike in their phenotype. Therefore, each person has a relative state of health, and genetic factors contribute significantly to disease. The ubiquity of genetic diversity requires the development of services for genetic screening, diagnosis, and counseling to prevent and treat a major portion of disease in modern society. Specific programs in Quebec and Canada illustrate how individuals and populations can be served by such services. Better education of citizens and health professionals in human genetics is essential for the further improvement of genetics services in society.     

Harnessing genomics and biotechnology to improve global health equity

With decisive and timely action, genome-related biotechnology can be harnessed to improve global health equity. In June 2002 in Kananaskis, Canada, leaders of the G8 industrial nations will develop an action plan to support implementation of the New African Initiative. By extending their discussion of health issues raised in the New African Initiative to include genomics, G8 leaders could signal their intention to increase global health equity by preventing a health genomics divide from developing. There are already some early and growing examples of genome-related biotechnology being applied successfully to health problems in developing countries. But how can genomics be systematically harnessed to benefit health in developing countries? We propose a five-point strategy, including research, capacity strengthening, consensus building, public engagement, and an investment fund.     

The birth rate decline in developing countries

Family planning programs historically have played an important role in providing information and counseling and supplying modern methods. Most programs are effective due to socioeconomic development and strong political support. Potential demand for services will be growing. This means that donor agencies must commit additional funding, and users must begin paying or paying more for contraceptives. Services and method choices need to be expanded, and quality of care needs to be improved. Three primary factors will impact on fertility decline: 1) the rate of social development, 2) the speed with which small family norms spread and contraception is adopted, and 3) the facility of private and public suppliers to meet contraceptive demand. Other factors influence reproductive decisions (women's roles and status, economic hardships or opportunities, religion, ethnicity, culture, and tradition). Contraceptive prevalence has increased from under 10% in the 1960s to 38% of all married, reproductive age women in the developing world, excluding China, which has contraceptive prevalence of 72%. Regional differences are wide. In Latin America, contraceptive use averages nearly 60% and ranges from over 50% in 10 countries and below 38% in Bolivia, Guatemala, and Haiti. Contraceptive prevalence is above average in Indonesia (50%), Sri Lanka (62%), and Thailand (68%) and just below average in Bangladesh (40%), India (45%), Philippines (34%), and Vietnam (53%). Sub-Saharan Africa has the lowest prevalence, except for Zimbabwe (45%), Botswana (35%), and Kenya (27%). 80% of current users rely on modern methods. In most surveyed countries, 20-30% of married women have unmet demand. Fertility decline, unmet demand, and contraceptive use have all been affected by the diffusion of ideas about the use of family planning and the small family norm. Innovators are usually high status, educated women, who spread their views to other social groups or geographic areas. The spread can be rapid in countries with few cultural, social or economic barriers. Developing world birth rates have fallen since the 1960s from an average of six children to four in the 1990s, but a replacement level of 2.1 is needed to reach balanced growth.     

农科大学生创新创业能力培养机制研究

加强农科大学生创新创业能力的培养有3个方面的意义,即提高农科大学生的核心发展力,提升农业高等教育的质量,加快我国“三农”科学发展的步伐.研究中发现,目前农科大学生创新创业教育存在着教育主体客体化、教育内容狭隘化等突出问题,据此,要通过“四个结合”,即以个性化教育与通识教育相结合塑造创新素质,以思想政治教育与职业规划教育相结合巩固专业思想,以实践教学与社会实践相结合完善培养机制,以先行先试与稳步推进相结合建立长效工程.     

Computer networks: making the decision to join one

I began this article with the thesis that the director of a university computer center is in a double bind. He is under increasing pressure because of competition with networks and minicomputers at the same time that his funding base is weakening. The breadth of demand for computer services, and the cost of developing new services, are increasing dramatically. The director is pressed by budget officers and internal economics to run more efficiently, but if in so doing he fails to meet new needs or downgrades effectiveness for some existing users he runs the risks of losing demand to the competition and hence worsening his immediate financial problems. The impact of networks on this state of affairs might be, briefly, as follows: 1) The centrally planned computer utility would take these pressures off the individual campus computer center and lodge them in a state, regional, or perhaps even a national network organization. While this might be desirable in some cases (depending on the scale of operations), I believe that economies of scale would tend to be more than offset by diseconomies in planning, management, and control; by a reduction of responsiveness to users' needs; and by a slowing of the rate of innovation in computing. 2) The distributive network substitutes a "market economy" for a centrally planned one. Subject to a certain amount of planning and regulation, which might be undertaken by colleges and universities themselves, individual researchers can tap larger markets for services, and participating institutions can obtain at least part of their computing needs on a variable cost basis at prices determined by competition. 3) Membership in a distributive network with sufficient breadth and depth of resources can emancipate the director of the computer center by widening options and allowing him to serve more effectively the steadily broadening range of legitimate academic and research computing needs without his having to stretch his internal resources too thinly. In other words, he can solve the problem of simultaneously improving the breadth of service and increasing operating efficiency. 4) Involvement in distributive networking will raise a new kind of question for the senior officers of colleges and universities. This is the decision concerning the development of computer services for export to users at other institutions. The effect on the university's own academic program (in the sense of its becoming a "center of excellence" in a particular computerrelated discipline), the risks involved in trying to attract outside users on the network, and the consequent responsibility for providing continuity of service at the peril of suffering in national academic reputation will be key considerations. The worth of, and probably the demand for, such services will be a function of the excellence of the development work, and this in turn will depend on its involvement with the university's academic resources. The "computer services export" question is fundamentally academic, as are decisions on the expansion or contraction of teaching and research programs, and it must be dealt with in the same terms. The next few years will be crucial ones for colleges and universities generally, and for their computing resources in particular. The advent of computer networking raises a host of academic, economic, technological, and organizational problems. In spite of these problems, I believe that distributive networking will have a significant and positive effect on campus computing services.