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<DIV><B>From:</B> <A title=ruglucia@PAHO.ORG
href="mailto:ruglucia@PAHO.ORG">Ruggiero, Mrs. Ana Lucia (WDC)</A> </DIV>
<DIV style="FONT: 10pt arial"> </DIV>
<DIV class=Section1>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=maroon
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: maroon; FONT-FAMILY: Arial">How
can we achieve and maintain high-quality performance of health workers in
low-resource settings?<o:p></o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN
style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial">Alexander K
Rowe , <SPAN class=ja50-ce-textfn7>Malaria Branch, Division of Parasitic
Diseases, <st1:PlaceName w:st="on">National</st1:PlaceName> <st1:PlaceType
w:st="on">Center</st1:PlaceType> for Infectious Diseases, Centers for Disease
Control and Prevention, <st1:country-region w:st="on"><st1:place
w:st="on">USA</SPAN></st1:place></st1:country-region></SPAN><BR><SPAN
id=aff2>Don de Savigny<SPAN class=ja50-ce-affiliation-sec> </SPAN><SPAN
class=ja50-ce-textfn7>Swiss Tropical Institute, <st1:City
w:st="on">Basel</st1:City>, <st1:country-region
w:st="on">Switzerland</SPAN></st1:country-region>, and Tanzania Essential Health
Interventions Project, Tanzania Ministry of Health, <st1:country-region
w:st="on"><st1:place
w:st="on">Tanzania</SPAN></st1:place></st1:country-region></SPAN><BR><SPAN
id=aff4>Claudio F Lanata, <SPAN class=ja50-ce-textfn7>Instituto de Investigacion
Nutricional, <st1:place w:st="on"><st1:City w:st="on">Lima</st1:City>,
<st1:country-region
w:st="on">Peru</SPAN></st1:country-region></st1:place></SPAN><BR><SPAN
id=aff5>Cesar G Victora, <SPAN class=ja50-ce-textfn7>Universidade Federal de
Pelotas, <st1:place w:st="on"><st1:City w:st="on">Pelotas</st1:City>,
<st1:country-region
w:st="on">Brazil</SPAN></st1:country-region></st1:place></SPAN><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><B><FONT face=Arial color=#333399 size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">
The Lancet, 9 August 2005 - </SPAN></FONT></B><FONT
face=Arial color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">DOI:10.1016/S0140-6736(05)67028-6</SPAN></FONT>
<FONT face=Arial color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> -(Registration
is FREE)<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Website: <A
href="http://www.thelancet.com/journals/lancet/article/PIIS0140673605670286/fulltext?isEOP=true"><FONT
color=#333399><SPAN
style="COLOR: #333399">http://www.thelancet.com/journals/lancet/article/PIIS0140673605670286/fulltext?isEOP=true</SPAN></FONT></A>
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">“…..In
low and middle income countries, health workers are essential for the delivery
of health interventions. However, inadequate health-worker performance is a very
widespread problem. We present an overview of issues and evidence about the
determinants of performance and strategies for improving it. Health-worker
practices are complex behaviours that have many potential influences. Reviews of
intervention studies in low and middle income countries suggest that the simple
dissemination of written guidelines is often ineffective, that supervision and
audit with feedback is generally effective, and that multifaceted interventions
might be more effective than single interventions.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Few
interventions have been evaluated with rigorous cost-effectiveness trials, and
such studies are urgently needed to guide policy. We propose an international
collaborative research agenda to generate knowledge about the true determinants
of performance and about the effectiveness of strategies to improve performance.
Furthermore, we recommend that ministries of health and international
organisations should actively help translate research findings into action to
improve health-worker performance, and thereby improve health….[au]
…..”<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><o:p></o:p></SPAN></FONT> </P></DIV></BODY></HTML>