Integrating HIV, hepatitis B and syphilis screening and treatment through the Maternal, Newborn and Child Health platform to reach global elimination targets

Every year, an estimated 180 000 babies in the Western Pacific Region are infected by hepatitis B, 13 000 by syphilis and 1400 by HIV through mother-to-child transmission.1 These infections can be largely prevented by antenatal screening, treatment and timely vaccination for newborns. Despite challenges in controlling each disease, major achievements have been made. National immunization programmes have reduced the regional hepatitis B prevalence from over 8% in 1990 to 0.93% among children born in 2012. In addition, HIV testing and treatment have helped keep the regional prevalence of HIV infections at 0.1%. In contrast, the number of maternal syphilis cases is still high in the Western Pacific Region, with an estimated 45 million cases in 2012. Elimination of mother-to-child transmission of these infections cannot be achieved through vertically applied programming and require using and augmenting to the shared Maternal, Newborn and Child Health platform to coordinate, integrate and enable cost efficiencies for these elimination efforts. The Regional Framework for Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018–2030 offers such a coordinated approach towards achieving the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis and provides guidance for decision-makers, managers and health professionals working in programmes addressing maternal, newborn and child health, HIV, hepatitis, sexually transmitted infections and immunization.

How Can Oversea Training Programs Be Effective?Lessons Learned from Training Follow-up / 国際保健医療

<b>Introduction</b><br> Even though many oversea training programs end in developing an action plan from what they learned during the course, follow-up opportunities are quite limited. Group training program on maternal and child health for Francophone African countries are conducted in Japan since 2003, organized by National Center for Global Health and Medicine and funded by Japan International Cooperation Agency. Follow-up activities in Senegal and Benin are reported with lessons learned.<br><b>Methods</b><br> Training organizer team made a semi-structured interview with 11 trainees, 6 superintendents and 4 Japanese advisors, asking “Do trainees implement what they planned at the end of the training course in Japan? If not, what are the difficulties implementing their plans?”Organizer team also provided some interventions to solve the problems they faced.<br><b>Results</b><br> In Senegal, actions were not implemented yet, because plans were shared neither with their superintendents nor with Japanese advisors working with trainees as project counterparts. Organizer team set up a meeting with all stakeholders to clarify the objectives and outcomes of the training course within the concept of the project. This process made the superintendents understand and support the action plans, and facilitated to start implementing them. In Benin, trainees started activities by themselves based on their action plan under a small financial support from a Japanese advisor. It was rather easy, because they were decision makers of a hospital, but they faced difficulties to manage the staff to continue the activities. Organizer team encouraged them to continue the activities during the meeting in the hospital.<br><b>Conclusions</b><br> Appropriate participants can be selected and training could be effective, when cooperation project are well defined and the role of advisors is clear in the follow-up. Involvement of decision makers or superintendents for the selection and follow-up process can be a contributing factor to improve the effectiveness of the training.

For better MCH training on French speaking African countries-Monitoring and evaluation based on daily trainee's voice / 国際保健医療

<b>Purpose</b><br> Every year, a lot of training programs by Japan International Cooperation Agency (JICA) are conducted in Japan. However, the method of monitoring and evaluation of those trainings are not always conducted other than simple questionnaire survey. The purpose of this research is to demonstrate the significance of daily recording and analysis of the trainee’s voice as a way of the improvement of the quality of training.<br> Bureau of International Cooperation in National Center for Global Health and Medicine (NCGM) conducted detailed monitoring and evaluation for “JICA training for Maternal and Child Health in French speaking African countries in 2009” which NCGM itself had planned training curriculum and implemented the training. The key word of this training was “Continuum of care”. At the end of the 5 weeks training, NCGM expected the trainees to obtain comprehensive understanding of continuum of care, especially two different perspectives, which were “the health system” and “the dignity of individual client”.<br><b>Method</b><br> NCGM training team kept recording the trainee’s voice, then analyzed them every day during five weeks’ training. At the end of the training course, the team divided trainee’s voice into several categories, and then analyzed their time-dependent change.<br><b>Results</b><br> The everyday recording and analysis of the trainee’s voice made NCGM training team possible to differentiate the trainee’s fundamental interest and understanding from simple guesses or curiosity. Based on the result of daily analysis, the training team could introduce unscheduled discussion or fine-tuned the contents of lectures for better understanding of trainees. The trainees’ interpretation about “continuum of care” showed obvious change before and after the training. The active learning program by using Laboratory method gave deeper impact on trainees than the expectation of training team. At the end of training course, the trainees formulated concrete and detailed action plans. The purpose of their action plans was to establish the continuum of care from aspects of both “the health system” and “the dignity of individual client” by analyzing the existing stakeholders and institutions, and ensuring a collaborative linkage among them, which were exactly the expected outcome.<br><b>Conclusion</b><br> Daily recording and analysis of the trainee’s voice was effective and useful to monitor the training. The comprehensive analysis at the end of training course revealed the short impact of the training on trainees, which could be used as a self evaluation tool for the training team.<br> NCGM plans to visit the trainees’ workplace in their home countries for middle and long term monitoring and evaluation. The results will be feed backed into the training curriculum of next year.

The Situation of Female Doctors in Iraq / 国際保健医療

This study aimed to analyze roles and status of Iraqi female medical doctors in the society and their homes, their career consciousness, influence of conflicts upon health services in Iraq. As Iraq is an Islamic society in conflicts, this study further aimed to provide a basis to consider the feasibility and problems to train them in neighboring countries, as well as possibilities of future training courses. <br>We conducted face-to-face interviews to 16 Iraqi female medical doctors who participated in a four-week-training course in Egypt under the trilateral medical technical cooperation project. We could not carry out our survey in Iraq because of security concerns.<br>Most of the interviewed Iraqi female medical doctors were engaged in obstetrics and gynecology or pediatrics, and they usually examined female patients. These female medical doctors were highly motivated and rarely felt the gender discrimination in their work sites. They tended to choose husbands who would not hinder their professional career. They were also keen to participate in training courses outside Iraq, if the duration of the courses were within a few months. Their family agreed to send wives or daughters abroad alone for the training. Quality of the training was the most important for those doctors. Therefore, the religion or the distance from Iraq to the training places did not matter much. They expected that training courses of the hospital management systems and nurses'awareness raising should be taken place in future. <br>Female health professionals are preferable to provide female patients with health services in Islamic societies. Although, women and children are especially vulnerable in times of conflicts, the current security situation in Iraq prevents them from receiving direct support. Therefore, this study suggests that inviting female medical doctors to abroad for medical training should be a worthwhile alternative to improve the health status of women and children in Iraq.

The situation of the assistance for the physically disabled people in Cambodia / 国際保健医療

Many people have been killed or physically disabled during twenty-year internal conflict in Cambodia. People still get injured due to remained land mines and unexplosive ordnances, even a decade after the cease-fire. This paper aims to examine the situation of the physically disabled and assistance programs in Cambodia by analyzing published documents and visiting activity sites, and to discuss future challenges. In this paper, the physically disabled mainly implies adults and children with orthopedic impairments.<br>The major causes of physical disability are: land mines; unexplosive ordnances; traffic accidents; occupational accidents such as falling down from palm trees; infectious diseases, etc. Casualties of land mines and unexplosive ordnances were 50,915 (13,686 were dead) between 1979 and 2000. Recently, the number of land mine accidents has been declining, while that of traffic accidents has been increasing. <br>Since 1980s, many international NGOs have assisted land mine victims through providing with artificial limbs, prostheses and rehabilitation services. However, the assistance for the disabled people of other categories has been neglected. The international NGOs provide services based on their own interests, therefore, the participation of the disabled people and their family in the assistance programs has been limited. The government plays only limited roles to endorse the activities of the international NGOs, and has not had any specific strategies to prepare for the future withdrawal of the NGOs.<br>Disabled people require assistance not only for health, but also for education, employment, etc. On the other hand, it is also very important to empower and build capacity of them, so that they can contribute to the development of the Cambodian society. Additionally, means of prevention should be considered as one of the key perspectives. Sustainable supporting systems should be established by the government and domestic NGOs through participation of the disabled themselves.