1-13 December 2018 | Geneva, Switzerland UNAIDS Programme Coordinating Board Issue date: 23 November 2018
UNAIDS/PCB (43)/18.32
Depuis plus de trois décennies, le Bénin a souscrit à l’approche des soins de santé primaires
telle que définie à la conférence d’Alma-Ata (1978) et renforcée par l’Initiative de Bamako
(1987). Le pays a mis en oeuvre diverses expériences de soins de santé au niveau
communautaire ...avec l’appui des Partenaires Techniques et Financiers (PTF) et la
participation des Organisations Non Gouvernementales (ONG) et les Organisations
Communautaires de Base (OCB). Celles-ci ont contribué à l’amélioration de l’offre des
services de santé, malgré l’absence d’une politique coordonnée devant servir de cadre
institutionnel à la santé communautaire.
A l’étape actuelle du processus de mise en oeuvre de diverses expériences pilotes d’actions
communautaires, le Ministère de la Santé s’est engagé dans une réflexion visant l’élaboration
d’une politique nationale de santé communautaire. Celle-ci devra servir à encadrer la mise à
l’échelle des interventions communautaires qui ont démontré leur efficacité et leur impact
sur les populations cibles. Cette réflexion a entraîné la tenue du forum national sur la santé
communautaire en Novembre 2013 à Cotonou.
Le document de Politique de Santé Communautaire s’arrime au Plan National de
Développement Sanitaire à travers lequel le Bénin ambitionne de « disposer en 2025 d’un
système de santé performant basé sur des initiatives publiques et privées, individuelles et
collectives, pour l’offre et la disponibilité permanente de soins de qualité, équitable et
accessible aux populations de toutes catégories, fondées sur les valeurs de solidarité et de
partage du risque pour répondre à l’ensemble des besoins de santé du peuple béninois » Dans
le présent document, il est défini une vision, des priorités et des stratégies pour les dix
prochaines années en santé communautaire. La principale innovation réside dans la
conception et la mise en place au niveau de chaque village et quartier de ville de la
composante locale du système national de santé (CoLoSS) en partenariat avec toutes les
parties prenantes. Le document précise les conditions requises et les mesures
d’accompagnement pour la réussite de la nouvelle politique dans le sens de l’autonomisation
(empowerment) progressive des populations.
more
Recommendations for a Public Health approach and considerations for policy-makers and managers
PLOS ONE | DOI:10.1371/journal.pone.0172392 February 16, 2017
Case Study on Improving HIV Testing and Services for Children Orphaned or made Vulnerable by HIV (OVC)
Expanded IMPACT Program in Zimbabwe
Lea Toto and APHIAplus Nuru ya Bonde programs in Kenya Yekokeb Berhan Program for Highly Vulnerable Children in Ethiopia
Second Edition
Good Policy and Practice in HIV & AIDS and Education
In 1989, the Republic of Benin was facing a great social and
economical crisis. Civil servants of all the sectors in public
administration were on strike. People did not know where to
go for their health care. Salaries were not paid for more than
six months and life for the general population wa...s very dificult.
The country was about to degenerate into civil war as a
result of the civil unrest in the country.
Thanks to the assistance from the French, and Canadian
and American Mennonite missionaries, the Bethesda Health
Centre was started in 1990 with US$ 1,000 granted by theses
partners. Today, the Health Centre of Bethesda has expanded
and has become a large Hospital in Cotonou. It hosts each
year about 100,000 patients and has developed the department
of paediatrics, ophthalmology, stomatology, cardiology,
obstetrical gynaecology, X-rays, etc. The Hospital has also
put in place an AIDS service which has been promoted by the
government to the status of an AIDS Treatment Centre.
In an integrated vision, Bethesda has established other departments.
In 1993, the Sanitation department was established
to implement sanitation and environmentally-friendly
projects aimed at reducing the high incidence of some diseases
frequently treated at the hospital. In 1996, the decision
was made to establish a micro-inance department called
PEBCo. This initiative, which currently has 10,000 clients,
uses community savings to promote income-generating activities.
Since many women were obliged to use the loans for
family needs (health care, children schooling, etc.), they were
unable to reimburse them as planned. Hence the Bethesda
non-government organization (NGO) recently began an initiative
to provide a community-based health insurance option
for the population in 2006. There are now 12,000 members.
This paper focuses on the presentation of Benin and the program,
but also describes how the project could be better improved
and what were its beneits and impacts.
Field Actions Science Reports
The journal of field actions
Vol. 4 | 2010
Vol. 4
more
What at first glance appears to be simple causality – climate change leading to more and more migration – has triggered intense academic debate over the past ten years because the circumstances are complex. There is need for a thorough analysis in the ground between denying the problem and asser...ting immediate causality. In international relations, migration induced by climate change and environmental degradation is increasingly recognized as a problem, whether in the framework of international climate policy, international migration policy, development cooperation, or international crisis management. But considering the dimension of these major challenges, only small steps have been taken so far. The scope of the problem continues to be underestimated. Climate change is jeopardizing the livelihoods of more and more people. It is a risk multiplier. Although understanding of the connection between climate change and migration has increased, many questions have yet to be answered. We need more knowledge to better support the people affected.
more
Der Klimawandel und seine Folgen bedrohen schon heute Millionen von Menschen weltweit. Wissenschaftler/-innen warnen seit Jahren davor, dass ein ungebremster Klimawandel die Welt ins Chaos führen wird. Obwohl der Klimaschutz seit Jahren im Zentrum der öffentlichen Debatte steht und auch weltweit i...n unzähligen Initiativen, Aktionsplänen und konkreter Politik Berücksichtigung findet, steigt der Ausstoß klimaschädlicher Treibhausgase nach wie vor.
more
The devastating impacts of the 2015–16 El Niño will be felt well into 2017. This crisis was predicted, yet overall, the response has been too little too late. The looming La Niña event may further hit communities that are already deeply vulnerable. To end this cycle of failure, there is an urgen...t need for humanitarian action where the situation is already dire, to prepare for La Niña later this year, to commit to comprehensive new measures to build communities’ resilience, and to mobilize global action to address climate change which is creating a ‘new normal’ of higher temperatures, drought and unpredictable growing seasons.
more
Children in Kabwe are especially at risk because they are more likely to ingest lead dust when playing in the soil, their brains and bodies are still developing, and they absorb four to five times as much lead as adults. The consequences for children who are exposed to high levels of lead and are no...t treated include reading and learning barriers or disabilities; behavioral problems; impaired growth; anemia; brain, liver, kidney, nerve, and stomach damage; coma and convulsions; and death. After prolonged exposure, the effects are irreversible. Lead also increases the risk of miscarriage and can be transmitted through both the placenta and breastmilk.
more
نظام مغشوش
سياسات الحكومة السورية لاستغلال المساعدات الإنسانية وتمويل إعادة الإعمار
Des efforts considérables ont été menés pour apporter aux
populations rurales du continent africain des soins de base. Mais
la qualité de ces soins reste aujourd’hui peu satisfaisante car le
médecin généraliste est le plus souvent absent en première
ligne. Cette situation est paradoxa...le en regard du nombre de
médecins formés dans les facultés en Afrique francophone et à
Madagascar. Le déficit en médecin généraliste, exerçant dans les
zones rurales, reste particulièrement préoccupant alors que
les jeunes médecins sans emploi se multiplient dans les villes.
L’ONG Santé Sud, depuis plus de vingt ans, propose un concept
– la médecine générale communautaire – qui, associé à un dispositif
d’accompagnement, a permis l’installation de plus de deux
cents médecins généralistes communautaires au Mali et à
Madagascar. Ce concept a pour intérêt d’associer, dans une même
pratique, la médecine de famille et les Soins de Santé Primaires.
S.F.S.P. | « Santé Publique »
2014/HS S1 | pages 59 à 65
Considerable effort has been made to provide rural African
populations with basic health care, but the quality of this care
remains unsatisfactory due to the absence of first-line GPs. This is
a paradoxical situation in view of the large number of physicians
trained in medical schools in French-speaking Africa and
Madagascar. of the lack of GPs working in rural areas is a real
concern, as many young doctors remain unemployed in cities.
For more than 20 years, the NGO Santé Sud has proposed a
Community General Medicine concept, which, combined with
a support system, has allowed the installation of more than
200 community GPs in Mali and Madagascar. The advantage of
this concept is that it provides family medicine and primary health
care in the same practice.
S.F.S.P. | « Santé Publique »
2014/HS S1 | pages 59 à 65
more
La demencia es una enfermedad gravemente incapacitante para aquellos que la padecen y suele ser devastadora para sus cuidadores y familiares. Se estima que en la actualidad 35.6 millones de personas viven con demencia a nivel mundial. Este número se habrá casi duplicado para el 2030 y más que tri...plicado para el 2050. La alta prevalencia mundial y el impacto económico de la demencia en las familias, los cuidadores y las comunidades, así como el estigma y la exclusión social asociados, presentan un importante reto para la salud pública.
more
In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
more
Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
Monitoring is the on-going collection, management ...and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
more