The World Health Organization (WHO) has been implementing the Healthy Marketplace initiative in the market setting of developing countries since 1997. This initiative forms part of the Healthy Cities strategy and is reinforced through the Ottawa Charter for Health Promotion. The WHO Food Safety Division has indicated that every city in the WHO Healthy City program will eventually also have a Healthy Marketplace program. This is despite the absence of any published guidelines for facilitating program implementation, a clearly articulated Healthy Marketplace concept, and a dearth of meaningful program evaluations. This thesis set out to explore the views and experiences of in-country stakeholders involved in a Vietnamese Healthy Marketplace program. It also set out to examine the roles and perceptions of experts engaged in the design and delivery of programs across the developing world. Through an iterative and post-positivist research methodology, this inquiry collected and analysed data from five key sources: documents, detailed questionnaires, semi-structured interviews, and observations and reflections. The findings revealed that various and even conflicting program concepts and aims existed across and within groups, having significant implications for practice. The settings approach was not the dominant approach to health promotion in the Vietnamese market, but rather a 'top-down' topic-based approach dominated as the mechanism for program delivery. Consequently, numerous challenges have been identified for Healthy Marketplace policy and practice. The challenges are prefaced on the adoption of a settings approach, and include the need for : market communities to set their own agendas; the program target audience to be redefined; increased power sharing across stakeholders; the re-education of professionals; the sharing of knowledge; and the adequate resourcing of Healthy Marketplace programs / Master of Science (Hons)

Antimicrobial resistance (AMR) is a growing problem around the world. To meet the threat of a futurewithout effective treatment of infection, WHO and other authorities have published strategies and actionplans. However, it is unclear to what extent they have been implemented. As the seventh wealthiesteconomy in the world, Brazil could serve as a role model for other fast developing countries in the battleagainst AMR. The objective of this study was to investigate if and how implementation of internationalAMR strategies is addressed in literature, and to describe how such guidelines have been implemented inBrazil. The study was carried out as a literature review of scientific articles and of documents published byBrazilian authorities. In the scientific literature great importance was given to a multidisciplinary approachand to surveillance, with a special emphasis on local data. Brazilian documents showed a focus on healthcare settings and on actions concerning surveillance. Many tools were in place, such as networks and legalframework. Using local data, identifying measures most important for the target group and thenimplementing them, was considered most important. Generally, there was a lack of assessments. Brazil stillhas a long way to go, but has started out well with its focus on surveillance.

A democracia sanitária exige que as normas do direito à saúde sejam derivadas de processos deliberativos que permitam a troca de argumentos que, por sua vez, conduzam à formação da vontade política, sendo que essa vontade deve ser constantemente submetida à confirmação em debates públicos para garantir a responsividade do governo e o controle do exercício do poder político. A partir dessa noção, pretendíamos verificar se, caso fosse aprovado o projeto de Marco para colaboração com os atores não estatais, no seio da reforma da Organização Mundial da Saúde, seriam criadas instituições e processos deliberativos que oportunizassem a participação democrática da sociedade civil internacional. Para tanto, realizamos uma pesquisa qualitativa, e, por meio do método da análise documental, estudamos os documentos básicos e documentos oficiais concernentes à reforma da Organização Mundial da Saúde. A conclusão alcançada foi que, embora o instrumento analisado não promovesse a democracia sanitária em conformidade com o marco teórico adotado no trabalho, ele criaria novas instâncias em que a sociedade civil internacional poderia exercer sua influência. / Health democracy requires that the norms of right to health are derived from deliberative processes that allow the exchange of arguments which, in turn, conduct to the formation of the political will, and this will must be constantly subject to confirmation in public debates to ensure the responsiveness of government and control of the exercise of political power. Based on this notion, we intended to verify whether, if it were approved the draft Framework for engagement with non-state actors, within the reform of the World Health Organization, it would create institutions and decision-making processes that would enable democratic participation of international civil society. To this end, we conducted a qualitative research, and through the method of document analysis, we studied the basic documents and official documents concerning the reform of the World Health Organization. The conclusion reached was that, although the analyzed instrument did not promote health democracy in accordance with the theoretical framework adopted at this work, it would create new instances in which the international civil society could exert their influence.

Magister Public Health - MPH / Background and Rationale The World Health Organization (WHO) has shown that the provision of Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) of many low and middle-income countries is poor. This is compounded by the lack of national plans and consolidated data on WASH in HCFs. This study assessed the availability and adequacy of Water Sanitation and Hygiene (WASH) infrastructure in 13 mission hospitals spanning 13 districts in Zambia. The objectives of this study were to identify the different kinds of WASH infrastructure available, and their adequacy, and factors influencing the status of WASH infrastructure and services in the selected hospitals. Methodology This study had a mixed methods design with semi-quantitative, descriptive and qualitative components. Assessments were conducted of the WASH infrastructure on the hospital property, and specifically in the male medical wards and outpatient facilities as two tracer areas, using a WHO checklist adapted and administered by the researcher. Checklist items were assigned scores (0=absent/bad to 2=on target/good) and total WASH scores for each facility compiled. For the qualitative component, individual semi-structured interviews using an interview guide were conducted, also by the researcher, with the facility managers and the head staff of the male medical wards. Results Overall coverage with an improved water source was reasonably good with 11 of the 13 hospitals reporting availability of improved water sources within the facilities. Hand washing basin coverage was similarly good. In contrast, coverage by well-functioning toilets was not as high, with 5 hospitals reporting toilets that were either broken, blocked, or having no running water and no toilet paper. Facility WASH scores varied from 22 (38%) to 57 (97%) out of a possible total of 58 points. Most of the Facility Managers indicated that the hospital WASH infrastructure was old, and with frequent breakdowns. This was worsened by lack of readily available spares and materials for repairing once there was a fault. Conclusion This study reveals an uneven coverage of WASH across facilities and elements, with poor sanitation a challenge across facilities. This is compounded by ongoing challenges in WASH infrastructure maintenance. Moving forward, there is need for government to develop a clear policy on WASH in HCFs. A national plan with resources and a monitoring framework need to be in place for streamlined support and tracking of progress by all stakeholders.

This research explores the international evolution of the policy of integration (formalisation) of traditional medicine in health care systems. This concept first arose on the policy agenda of the World Health Organisation in the 1970s and then re-emerged in 2002 (with alternative and complementary medicines). The history of this policy at the global level and its transfer to national levels over this period is analysed, via the content, scope and outcomes of policy and programme documents. This analysis emphasises the roles of context and stakeholders (specifically interest groups). The context in terms of the economic, political and social environment surrounding the development of the policy is considered, and held to offer a potential explanation as to how and why the policy agenda on integration was set and the manner in which programmes were formulated and implemented. Interest group interaction (competition for resources) is concluded to play a key role in explaining the development of this policy on an international level, and its problematic transfer to national levels. A case study of Sri Lanka explores national level implementation in greater detail. An analytical framework to analyse the development and implementation of this policy has been created, from a synthesis of anthropological and political science tools. The combination of several theories into an analytical framework allows this policy issue to be understood as an intrinsically political exercise that has been stimulated by global social and economic forces. The analytical framework developed offers another tool for the analysis and consequent understanding of the health policy process and thus may have relevance beyond the health policy issue of integration. / Doctor of Philosophy (PhD)

1950年韓戰爆發，美國因應遠東國際局勢的變遷，為了防堵中國勢力，才轉而提供台灣援助。這些援助多數用於軍事防衛與經濟建設發展，後來才慢慢用於衛生實務上。在瘧疾防治方面，台灣獲得美援充裕資金，奠定穩固的基礎。只是，更不可忽視世界衛生組織專家之專業技能與全球撲瘧計畫在台灣的落實。 1950年，台灣宣布退出世界衛生組織，幸賴該組織沒有嚴格的退會規定，以及劉瑞恆、顏春輝與西太平洋區署署長方頤積的私人情誼，得以於1951年簽下《瘧疾防治協定》，與世界衛生組織開啟四年撲滅瘧蚊的合作。儘管在此之前，世界衛生組織已經在全球許多國家試驗DDT之效能，1952年5月世界衛生組織三位瘧疾專家來到台灣，仍然從瘧疾、昆蟲學、衛生工程的專業知識，予以全盤的考察，終以矮小黑蚊為傳染媒介，掌握矮小瘧蚊習性與活動範圍，從家屋環境歸納DDT噴射效能，以及針對交通狀況、DDT噴射器具、各項人力進行評估等等。這些考察與評估，在7月「先驅計畫」試行，漸次歸納噴射區較未噴射區瘧蚊數量銳減、全部噴射與重點噴射效果相當，噴射隊組織以1-4-2模式能夠發揮最佳效能等。1953年起，瘧疾研究所同仁與國際瘧疾專家共同擴大訓練全島人員DDT噴射技術訓練，以及傳授地方人士瘧疾與瘧蚊知識等，在各界的配合下，大規模DDT家屋噴射作業得以順利啟動。1954年、1955年，台灣大抵也是在這種國際衛生合作的形式上，擴大家屋噴射的規模。其間，瘧疾研究所也適時調整方法，動員全省各界撲瘧人員，加上世界衛生組織專家的協助，撲滅瘧蚊的成果豐碩。1953年，世界衛生組織為了提供一個亞洲瘧疾知識能夠交流的平台，在曼谷召開的首屆亞洲撲瘧會議。台灣派員參加，也讓會員國掌握台灣撲瘧動態。翌年，台灣原本主辦第二屆亞洲瘧疾會議，卻因九三砲戰引發第一次台海危機，致使第二屆亞洲會議改在菲律賓召開。會後，各國瘧疾專家與世界衛生組織顧問也蒞臨台灣實地考察，讚賞台灣撲瘧工作之努力，更欽羨高雄化學廠已能夠生產出符合國際水準的DDT。從此時開始，台灣更成為亞洲地區防瘧作業的前哨站，許多亞洲會員國透過世界衛生組織的協助，紛紛將撲瘧人員送至台灣接受訓練、考察。往後，這些來到台灣的受訓人員，必定將台灣經驗移植本國。 1955年，原本台灣與世界衛生組織之四年防瘧合作將屆，轉因世界衛生組織的全球瘧疾根除計畫，使得兩者間之瘧疾防治工作，得以延續。從1955年起，台灣瘧疾防治工作目標，不再是簡單的將瘧疾壓低至某種程度，而是順應著世界衛生組織的標準範本，必須歷經「準備期」、「攻擊期」、「肅清期」、「保全期」，以完成全球瘧疾根除之目標。1955年，當全球50多個國家接受世界衛生組織的援助，開始準備進行防瘧工作時，台灣在先前的努力與累積的成果上，未從頭執行所謂的「準備期」，而是延展二年DDT家屋噴射工作，進入「攻擊期」的尾段。必須要釐清的是，以往公共衛生專著中所論及之戰後台灣對抗瘧疾奮鬥歷程中，經歷過所謂的「準備期」、「攻擊期」、「肅清期」、「保全期」，其實這是移植世界衛生組織全球瘧疾根除計畫而來的，並非台灣獨有的特徵。換言之，每一個參與瘧疾根除計畫的會員國，必須按照這一套標準作業流程，歷經諸多考驗，根除瘧疾，免於苦痛。只是，當瘧疾防治的目標，從控制走向根除時，在工作層面上似乎更趨複雜了。原本，瘧疾控制只需要將瘧蚊撲滅到最低的程度，切斷傳染途徑，避免大規模感染即可。但是，世界衛生組織掌握瘧蚊是無法全數撲滅的，因此瘧疾根除必須透過「肅清期」將瘧蚊削減至最低程度，接下來必須進行「肅清期」，也就是透過衛生行政機構之監視方法，找尋瘧疾患者，投藥治療，殲滅瘧原蟲。一旦傳染源被消滅了，瘧蚊對人類即無所威脅。 當初，世界衛生組織對這一套放諸四海皆準的瘧疾根除計畫深具信心，只要會員國按照的「準備期」、「攻擊期」、「肅清期」、「保全期」這套標準化流程循序漸進，那麼全球瘧疾根除之目標指日可待。惟會員國社會經濟條件不一，或因DDT噴射工作未完全執行，或缺乏有效領導撲滅瘧疾之工作單位，更甚者，或疏忽了瘧患監視作業，以及瘧蚊出現抗藥性等等，導致許多國家瘧疾復發，日益嚴重。這些情況，迫使世界衛生組織不得不於1969年對外宣告全球瘧疾根除計畫的失敗，修正防治的方法，改以控制瘧疾為主。至今，世界衛生組織仍試圖歸納最佳的防瘧方法，持續為全球瘧疾防治而努力，這種推展國際衛生合作之精神，深值敬佩。 1965年，台灣根除瘧疾的背後，始於全國團結一致與國際力量的援助，得以順利進行DDT噴射作業，可以說，台灣能夠成功對抗瘧疾，實奠基於「攻擊期」的努力。不過，與世界衛生組織合作的許多會員國中，完成DDT噴射作業的國家很多，雖奠定良好的防瘧根基，卻始終無法達到瘧疾根除的境界，錫蘭便是最明顯的例子。錫蘭之所以失敗，便是輕忽「肅清期」的監視作業。其實，台灣在「肅清期」、「保全期」中，也如錫蘭與其他國家般遭遇許多困難與挫折，實非外界想像般的平順。台灣也曾忽視瘧疾的監控，導致爆發小型群體感染病例，掀起瘧疾傳染危機。幸運的是，台灣每逢危機，便能透過世界衛生組織的協助，強化各項監視方法，同時觀察其他國家的經驗而有警覺性，得以化險為夷，成為全球瘧疾根除的模範。 世界衛生組織是聯合國的專門機構之一，除了依照《四年防瘧協定》援助台灣本島開展防瘧實務外，也因應聯合國國際合作的精神，提供台灣獎補金讓瘧疾研究所的同仁們赴外進修學業，前往全球聞名醫學中心研究，以及遠赴各國考察瘧疾流行情況，以茲與台灣比較。世界衛生組織為了提升各國瘧疾知識和防瘧技能，更多次召開亞洲瘧疾會議，讓與會的國家代表透過會議了解各國撲瘧實況，並且進行知識上的交流。更重要的是，台灣出席這些會議的代表回國之後，能將全球最前沿的知識分享國內，提升整體知識水平。世界衛生組織在菲律賓馬尼拉設立國際瘧疾訓練中心，台灣與周邊國家瘧疾人才紛紛前往接受訓練，裨益各國瘧疾防治工作的推展。難能可貴的是，台灣在接受世界衛生組織的援助之餘，協助其他國家訓練撲瘧人力，甚至提供防瘧物資、器材給與他國，另外，台灣在瘧疾防治過程中，並未獨善其身。台灣瘧疾研究所很多專門人員奮鬥有成，前後應邀擔任世界衛生組織的專家顧問，前往世界各地協助很多國家抵禦瘧疾，實質的開拓台灣醫療外交之路。可惜，隨著1971年台灣退出聯合國，與翌年退出世界衛生組織後，也漸漸的中斷台灣瘧疾專家開拓醫療外交實業。直至2000年，曾經服務瘧疾研究所的連日清先生，多次前往聖多美普林西比民主共和國，協助該國防治瘧疾有成，成功為台灣開拓「蚊子外交」，不僅贏得該國的讚賞，更因此獲得聖多美普林西比民主共和國在聯合國大會為台灣發聲，爭取拓展國際關係的機會。

In this project, I am interrogating discourse surrounding the 2008 WHO/UNAIDS controversy, which both preceded and followed the publication of an article in the U.K. newspaper The Independent. The article reported that the head of the World Health Organization’s HIV/AIDS initiative admitted that the threat of an AIDS pandemic among heterosexuals was “officially” over. These texts are particularly important for such an endeavor because, as I will argue below, the controversy enables both “AIDS” and “heterosexuality” to operate as floating signifiers whose meanings are contested in public discourse in ways that ultimately reinforce heterosexual privilege and under-attention to the AIDS crisis. In the end, the destabilization of the meaning of HIV/AIDS does not serve emancipatory ends. Although the destabilization of meaning is the emancipatory gesture ‘par excellence’ for the poststructuralist tradition, my investigation shows that the destabilization of meaning in the WHO controversy actually results in the reification of master narratives. / text

The following paper explores the rise of global biopolitics by focusing on the League of Nations Health Organization (LNHO) and the World Health Organization (WHO) as pivot points around which an international system transitioned into a global system. The central thesis of the paper is that the LNHO served as the first true site of deployment for global discourses on health and hygiene, not as recent scholarship has suggested, the WHO. The purpose of the paper, however, is to provide an overview of the larger transformation of public health in the twentieth century, beginning with the proliferation of nineteenth-­‐century international health organizations and culminating in the WHO. Central to this argument is the belief that population control is the ultimate end of the modern state, firmly placing discourses on health and hygiene at the nexus of modern politics. At its heart, this paper is about the nature of the modern state in relation to an increasingly global world.

Thesis (M.P.H.)--Georgia State University, 2008. / Title from file title page. Frances McCarty, committee chair; Derek G. Shendell, co-chair; Ike S Okosun, committee member. Electronic text (140 p. : col. ill., col. maps) : digital, PDF file. Description based on contents viewed July 15, 2008. Includes bibliographical references (p. 103-108).

Thesis (doctoral)--University College London, 1996. / BLDSC reference no.: DX223936.