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The Bonn Agreement in 2001 determined to end the tragic conflict in Afghanistan and promote national reconciliation muscle relaxant blood pressure purchase 60mg mestinon overnight delivery, lasting peace spasms after eating purchase mestinon with visa, stability and respect for human rights in the country spasms pronunciation discount mestinon 60 mg otc. Two years later a Constitutional Loya Jirga whereby 102 female delegates convened with their male colleagues to debate over a new Constitution culminated in a Constitution which granted afghan women equality with men (article 22) in 2003 muscle relaxant cyclobenzaprine dosage generic mestinon 60 mg with visa. Also in Article 22 Any kind of discrimination and distinction between the citizens of Afghanistan are prohibited. Prisons will have separate facilities for women and juveniles Net primary enrolment for girls will be at least 60 per cent, for boys 75 per cent 150,000 men and women will be trained in marketable skills Female teachers will be increased by 50 per cent University enrolments will be 100,000, with at least 35 per cent female students Basic package of health services will cover at least 90 per cent of the population the number of chronically poor female-headed households will be reduced by 20 per cent and their employment rates will be increased by 20 per cent. Without the equality of women being recognised and implemented across all spheres, there is little chance of the hope of a country like Afghanistan achieving its millennium goals or indeed sustaining peace and the economic stability that it strives for. The sustainable reconstruction and development of Afghanistan definitely requires the full participation of women in political, social, cultural and economic life. Afghanistan must build on its seemingly progressive attitudes and translate its pledges into actions whereby they eliminate the gross discrimination against women that exists, develop their human capital and ensure their leadership in order to guarantee their full and equal participation in all spheres of life. Gender Mainstreaming the Government of Afghanistan has developed a five years strategic benchmark. At present there are very few governmental agencies which have more than 10 per cent of women in the offices. Furthermore, the number of women has gone down in recent years instead of increasing across the spectrum. In spite of the commitment by the Government to aim to have 30 per cent of female workers in the ministries and other governmental offices by 2010, the government needs to look at its own ministries and representatives to encourage this change. Gender mainstreaming must emanate from within, and the government needs to take a first hand stance in this regard. Furthermore, the mandate of helping women directly who are subject to gross violations such as child and forced marriage, is not considered by many in the ministries. Its role of leading and coordinating Government efforts to advance the role of women needs to be more pivotal and supported at all levels of government and it should ensure that policies and programs are reviewed from a gender perspective. The gender focal points which have been appointed to direct and assist mainstreaming efforts within the other ministries should be given full support and provided a mechanism which will ensure the realisation of their goals. Millennium Development Goals the Millennium development goals are key to achieving human development in Afghanistan which lags well behind its neighbours and find itself near the bottom of the chart. This involved extending the time period for attaining the targets to 2020, revising the global targets to make them more relevant to Afghanistan, and adding a ninth goal on enhancing security (see Annex I). Eradicate Proportion of population 24 extreme below minimum level of poverty and dietary energy consumption hunger 2. Ensure Proportion of population 98 environmental using solid fuels (%) sustainability Proportion of population 16 with sustainable access to an improved water source, urban and rural (%) Proportion of population with access to improved 0 sanitation, urban and rural (%) Prop. Develop a global partnership for development secure 28 98 75 94 26 63 31 3 28 7 44 0. As has been discussed throughout this report, the promotion of gender equality and the empowerment of women is key to the future sustainable development of Afghanistan and its ability to afford protection to women against gender based violence in all its forms. One of the major barriers for women to contribute to society is their inability to access economic opportunities. Furthermore, the fact that many afghan women are subject to childbirth at an early age and are not encouraged to delay getting pregnant inhibits their ability to practice a profession which many women are increasingly being trained for. Judicial System One of the main aspects of the Bonn Agreement was to rehabilitate and reform the justice sector. Under the Agreement a new Constitution was written and laws which apparently seemed inconsistent with International Standards and the rule of law were scrutinised. Various Commissions were set up to ensure that laws were in line with international law but at the same time maintained accordance with Islamic principles and afghan legal traditions. Various attempts to monitor and rebuild the sector were enthusiastic at best but were mostly dissolved.

Organisations then signed a memo and submitted to Secretary of Health August 2014 spasms after surgery 60mg mestinon for sale. Currently muscle relaxant pinched nerve buy mestinon 60 mg visa, stakeholders are working through the legal intricacies of getting this move made permanent spasms when urinating safe mestinon 60mg. Use formal and informal meetings with government representatives to push your agenda spasms under left breastbone generic mestinon 60 mg visa, reinforcing the message about the importance of the issues. Develop relationships with government so that they trust you to give them accurate information so you can impact how policy is implemented 5. It can cause your government to take a stronger stance on the issue and even in some contexts, lead to a clampdown on human rights. It allows you to discover information in the process that you may not have known (such as the reasons that the government is not providing services). It establishes a legal precedent for further action and the interpretation of law in other public health and rights cases. In South Africa, the Constitution sees litigation as a means of defining rights and resolving conflicts over the use of public resources. The medication was available to reduce this rate, but the government was hesitant to roll-out a national programme. The court case was needed because of the inaction of the government in the face of a crisis. Build alliances between activists, scientists, and health professionals the judgment and legal papers are available at What is the best practice principle in terms of relative age of consent for sex, marriage and sexual reproductive health? Often, unexpected events present challenges and even opportunities for the process. You are showing that you implemented the plans you said you would to funders and partners. Building and sustaining trust - sharing information for increased transparency and participation. Sensitising for action - building a critical mass of support for a concern/experience. Understanding the context - sensing changes in policy, politics, environment, economics, technology and society related to implementation. Improving operations: Adjusting activities and outputs to achieve more and make better use of resources. Deepening understanding (research): Increasing knowledge on any innovative, experimental or uncertain topics about the intervention, the audience, the policy areas, etc. Hacking Advocacy A hack is any "trick, shortcut, skill, or novelty method that increases productivity and efficiency"("Life hack," 2016). From using templates for sending press releases, to preventing time wastage by making sure that everyone has all the information they need, many things can be made easier and better. What is the difference between monitoring and Monitoring and Evaluation (M&E) is based on the same idea as hacking. It is looking at how you did things, what happened, and how it could have been better. Some reasons for formal evaluation may be when you are applying for funding, reporting on how funding was spent or when reviewing a strategy(Pearson, n. Evaluation is taking different bits of monitoring information to assess how the project is going. M&E involves using the information you have (or can get) to test how well you did in terms of your goal or vision. Indicators are things that give evidence for the inputs, outputs, outcomes and impacts. They can be numbers or they can be things like comments, testimonies or stories about what you are trying to measure. Outcome indicators: this will depend on the output - for instance, it could be the increased attendance at a youth-friendly clinic as a result of a press release.

Medline Peer Reviewed Received: April 4 spasms with fever buy mestinon 60mg line, 2019; Accepted: October 1 spasms colon order mestinon 60mg without prescription, 2019; First Published Online: November 27 muscle relaxant for joint pain buy mestinon 60mg amex, 2019 Cite this article as: Gonik B muscle relaxant quiz order cheapest mestinon and mestinon. This article describes a mixed-method, quasi-experimental study to assess the effectiveness of an Android tablet-based electronic, labor clinical decisionsupport application (ePartogram) in limited-resource settings. Methods: the study, conducted in Kenya from October 2016 to May 2017, allocated 12 hospitals and health centers to an intervention (ePartogram) or comparison (paper partograph) group. The intervention group received an additional 1-day orientation on use and care of the Android-based ePartogram app. We used log binomial regression to analyze the primary outcome of the study, suboptimal fetal outcomes. Conclusion: ePartogram use was associated with improvements in adherence to recommendations for routine labor care and a reduction in adverse fetal outcomes, with providers reporting adoptability without undue effort. Interpreting a single measurement such as fetal heart rate is relatively simple, but evaluating combinations of measurements (e. The exception was outcome of early perinatal mortality before and during ePartogram introduction in intervention sites compared to control sites. Study Setting and Sites the study was conducted from October 2016 to May 2017 in 12 health facilities serving 2 counties, Kisumu in western Kenya and Meru in eastern Kenya. The 2 tertiary care facilities, 1 per county, were allocated to receive the intervention. The Kenyan public health care structure has large central tertiary hospitals, usually 1 per county, and smaller district hospitals and health centers. The larger hospitals usually have a specialist obstetriciangynecologist and many midwives, and health centers often only have 1 or 2 midwives. The usability and functionality of the ePartogram underwent field validation exercises in Kenya and Tanzania and a feasibility study in Zanzibar. The Intervention the ePartogram is an Android tablet-based application developed using human-centered design between 2011 and 2017 to address many challenges of monitoring labor with the paper partograph. The app provides auditory reminders to prompt providers to take measurements when due and provides visual and auditory alerts when clinical rules are triggered that predict complications (via low-level alerts) or detect complications (via high-level alerts) (Figure 1). The app allows for increased data entry efficiency by automatically graphing data and storing all client files within the application. The ePartogram app can handle multiple patients who a provider may be taking care of. Remote supervision off-site with the ePartogram was possible, but we did not activate this function during the study. This training-of-trainers workshop included interactive presentations and case studies, and it facilitated practice using both the paper partograph and ePartogram. Additional topics included respectful maternity care; recognition and management of fetal, maternal, and labor progression abnormalities; fetal distress; pre-eclampsia/eclampsia; and fever. Trainees were also refreshed on when supervisors should be contacted in response to labor abnormalities identified, the standard operating procedures for handing over patients as shifts changed, and how to fill out facility birth and outcome registers. All participating skilled birth attendants and supervisors completed a 2-day labor management update. Global Health: Science and Practice 2019 Volume 7 Number 4 524 Mixed-Method, Quasi-Experimental Study on Electronic Partogram Effectiveness Intervention group participants were also trained in the use of the ePartogram application, maintenance of the tablets, and handover protocols. At all study sites, women in active labor received care according to global and national standards. We only used the partographs and labor records filled out by trained, consenting providers for this study. As the action line has in recent times been increasingly called into question, we abandoned a sample size based on that parameter. Analysis was done on a total sample of 1,884 and on subsets of this sample where some variables were missing. For fetal outcomes, after accounting for missing data, we analyzed a final sample size of 1,405. Outcome Measures Used in the Mixed-Method Quasi-Experimental Study of the Effectiveness an Electronic Partogram Primary Outcome Measure 1. Actions to maintain normal labor include ambulation and encouragement to eat or drink.

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Do women and men and boys and girls under five years old have equal access to malaria bed nets? Do men and women have equal opportunity for employment on indoor residual spray teams? Who pays for treatment and how does this impact the time it takes to seek treatment? Are there beliefs about what it means to be a woman that may deter women who are sick from seeking or receiving care? Do health workers believe that men should receive preferential treatment over women? Are these attitudes and beliefs addressed through district-level supervision and training? Are there times during the malaria season when men or women may be sleeping outdoors? Are nets adequately allocated and distributed in communities where women and men sleep in separate houses at times? Do district plans for net distribution take into consideration who in the household controls financial resources and who might control use of nets? In the case of indoor residual spraying spasms from catheter discount 60 mg mestinon free shipping, do district plans and policies support equal employment opportunities for men and women in all positions on spray teams? Are there gender equitable policies that guide the allocation of malaria resources within the district? Is there research underway or planned to support delivery of home-based and doorstep care? Has the division of labor between men and women been taken into consideration for planning and monitoring to address issues such as exposure risk (times of day when men and women work outside) and biological vulnerability (e yellow muscle relaxant 563 cheap 60mg mestinon with visa. Are women restricted from moving on their own outside of their households or communities that may restrict access to services? Do women or men face time constraints that may limit their ability to get to services when they are open? Are there beliefs about what it means to be a man that may deter men who are sick from seeking or receiving care at health centers? Are data on prevalence disaggregated by sex and analyzed for sex-specific patterns? Are data on utilization of health services disaggregated by sex and analyzed for disparities in utilization of services by men and women according to prevalence rates? Strasbourg muscle relaxant orange pill discount mestinon 60mg on line, France: Directorate General of Human Rights and Legal Affairs spasms just below rib cage quality mestinon 60mg, the Council of Europe. Gender-based Analysis in Government Practices and Those of Local and Regional Decision-Making Bodies. Proportionately, how do health budgets for programs, drugs, supplies, infrastructure, and human resources benefit men vs. Are proposed health reforms and new policies assessed for their potential differential impact on men and women, and on male and female health workers? Does the country have policies on gender equality, and are any of them specific to health? Are statistics on the health workforce disaggregated both by sex and type of professional (e. How is the health system leadership accountable for implementing existing gender equality policies? Do they conduct periodic assessments, issue reports, or measure performance on a regular basis? What percentage of sexual violence cases reported to health facilities has been properly referred?

Table 2 compares the facility characteristics of ePartogram and paper partograph sites spasms hiccups 60mg mestinon, and Table 3 compares the client characteristics skeletal muscle relaxant quizlet order mestinon amex. Although we used partographs only from study-trained providers muscle relaxant hiccups generic 60 mg mestinon with visa, the ePartogram facilities had 94 spasms ms purchase discount mestinon. The ePartogram group consisted of public facilities only, with no faith-based facilities, and also had the 2 largest public facilities; 35. Table 4 compares the proportion of labors in which clinical rules showing abnormalities were triggered. Data collectors were implementing agency staff trained in qualitative research data collection procedures using a data collector training guide26 and study ethics. Interview data saturation was deemed to have been reached, as no new themes emerged in the final interview and all themes were mentioned to some extent in all interviews. The analysis followed the framework analysis process recommended by Ritchie et al. Women cared for using the ePartogram did not have a paper partograph plotted, but on completion of labor, a printout was made for the record and for de-identification before scanning to the study database. Clinical Rules Triggered Based on Recorded Parameters Across Type of Partograph Used Clients Using ePartogram, No. Similarly, selected measures of maternal well-being (maternal pulse, temperature, blood pressure, urine protein) were triggered in 242 (28. However, clinical rules for abnormal labor progress (duration Global Health: Science and Practice 2019 Volume 7 Number 4 and frequency of contractions) were triggered in 565 (54. This difference was statistically significant and has been controlled for in the regression analysis. Clients in the ePartogram group were more likely than those in the paper partograph group to have been fed during labor (71. Interventions to maintain normal labor (any of ambulation, food, fluids, companion, and position of choice combined) occurred in 778 (86. However, this difference was not statistically significant when adjusting for the factors listed above. In Table 8, we present the only before and during study comparison of ePartogram and paper partograph sites for early perinatal mortality estimates based on monthly facility register data during the 6 months before the study compared to facility data during the study period. Table 9 explores compliance to a set standard for frequency of observations as recorded on the ePartogram or paper partograph. Of the 3 measurements to be recorded every 30 minutes (fetal heart rate, contractions, maternal pulse), maternal pulse was more likely to be recorded on the ePartogram than the paper partograph. Global Health: Science and Practice 2019 Volume 7 Number 4 532 Mixed-Method, Quasi-Experimental Study on Electronic Partogram Effectiveness Compliance With Recommended Frequency of Recording of Observations During Labor Instances When Observation Could Be Recorded, % Measure Recommended timing: Fetal heart rate Contractions Maternal pulse Recommended timing: Temperature Recommended timing: Color of amniotic fluid Moulding Cervical dilatation Descent Blood pressure Urine protein Urine acetone Urine volume 43. Like maybe when you are entering the data for a mother who has just come, in regard to the time you are entering Global Health: Science and Practice 2019 Volume 7 Number 4 the fetal heart, the contractions, the dilations so after you are through with the mother and now you want to enter [data], you find there have a difference of 1 minute, 1 minute, 1 minute so assuming you have 3 or 4 mothers then it will reach the due time for entering the next data; that difference for 1 minute for 3 or 4 mothers, it is hectic. In-charges also noted that the ePartogram improved real-time measurement recording and reduced retrospective data entry. Supervisors noted that this feature improved their ability to oversee their subordinates and clients on both a clinical and managerial level. If I am outside the hospital, I am aware [of] what is happening in [the] labor ward and we have kept that continuous conversion. Yes, when we are using ePartogram in our labor ward, the C-section rate goes down, the number of complications goes down because they are doing early interventions and you are able to bring everybody on board so that now, it is a team work approach, the picture is better. To our knowledge, this is the first report on the effectiveness of a digital labor decision-support system in limited-resource settings. For those using the ePartogram, the additional input was entering observations in the tablet device that gave audible alerts if a measurement was not taken on time and visual alerts when a single or a combination of more observations were determined to be abnormal or predicted a potential complication. One explanation is that with an ePartogram, an audible sound alerts the provider and can also be seen by the supervisor, so actions are more likely to be promptly taken to correct the situation.