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Public health is the poor relation in the health system and attracted little additional funding from the 2006 Budget. A modest increase in the allocation to prevention would enable significant advances to be made across a wide range of public health activity and research areas. PHAA should take the lead in developing a planned and sustained advocacy program.

Septicaemia is a major contributor of mortality. Blood culture is the essential investigation for the management of sepsis. Due to lack of resources blood culture is an irregularly used investigation in India. A three-tier level of development is being proposed to develop the blood culture based national programme for early detection of sepsis. The plan envisages the establishment of manual blood culture based elementary system in the health centre and district hospital level (Level 1), direct Gram stain and direct antibiotic sensitivity testing from the "positive" blood culture broths at the medical college hospital level (Level 2) and development of automated methods, enhancement of quality control and safety measures, clinical liaison and re-orientation of microbiology training at the tertiary care centre level (Level 3).

Objective: To describe the documented adherence to quality indicators for the outpatient care of attention-deficit/hyperactivity disorder, conduct disorder, and major depression for children in public mental health clinics and to explore how adherence varies by child and clinic characteristics., Method: A statewide, longitudinal cohort study of 813 children ages 6.0-16.9 years with at least 3 months of outpatient care, drawn from 4,958 patients in 62 mental health clinics in California from August 1, 1998, through May 31, 1999. The main outcome was documented adherence to quality indicators based on scientific evidence and clinical judgment, assessed by explicit medical record review., Results: Relatively high adherence was recorded for clinical assessment (78%-95%), but documented adherence to quality indicators related to service linkage, parental involvement, use of evidence-based psychosocial treatment, and patient protection were moderate to poor (74.1%-8.0%). For children prescribed psychotropic medication, 28.3% of the records documented monitoring of at least one clinically indicated vital sign or laboratory study. Documented adherence to quality indicators varied little by child demographics or clinic factors., Conclusion: Efforts to improve care should be directed broadly across clinics, with documentation of safe practices, particularly for children prescribed psychotropic medication, being of highest priority.

Purpose: Tuberculosis (TB) elimination is an important US public health goal and improving the performance of TB surveillance and action and reducing the costs will help achieve it. But, there exists the need to better evaluate the performance and measure the costs., Methods: We pilot tested an evaluation strategy in Hillsborough County, Florida using a conceptual framework of TB surveillance and action with eight core and four support activities. To evaluate performance, we developed indicators and validated their accuracy, usefulness, and measurability. To measure the costs, we obtained financial information., Results: In 2001, Hillsborough County reported 78 (7%) of the 1145 Florida TB cases. Nineteen (24%) were previously arrested. While 13 (68%) of the 19 were incarcerated during the 2 years prior to being reported, only 1 (5%) of 19 was reported from the jail. From 111 TB suspects, 219 (25%) of 894 sputum specimens were inadequately collected. Of the $1.08 million annual budget, 22% went for surveillance, 29% for support, and 49% for action., Conclusions: This conceptual framework allowed measurement of TB surveillance and action performance and cost. The evaluation performed using it revealed missed opportunities for detection of TB cases and wasted resources. This conceptual framework could serve as a model for evaluation of TB surveillance and action.

Objective: The efficiency of regulation of public health risks has been questioned on the grounds that the costs of regulation may outweigh the benefits. There are strong arguments that risk management is best left to the market place, where individual consumers can make the trade-off between risk and the forgone benefits of reduced consumption of hazardous products. The paper reviews the economic arguments for the regulation of health risks and the use of safety standards., Results: There are five key arguments for regulation of public health risks. Consumers misperceive the hazards of products and therefore take more risks than they would if fully informed. The provision of information has certain public goods characteristics (it is non-rival). There may be economies of scale in collecting, providing and disseminating information that is costly to acquire. The private decision maker may not be the person bearing the whole risk, exposing others to risk e.g. children. If public policy has chosen to provide public finance for health care it may be efficient to discourage risk taking by individuals even if that risk taking is optimal from the individual's perspective., Conclusion: There are arguments for public intervention to reduce private health risks and regulation of risk is a legitimate tool to achieve the socially optimal level of risk in certain circumstances. Private subjective assessment of risk may not capture the full social benefits of risk reduction. Regulation by safety standards however may fail to capture the full range of concerns about risk, including avoiding catastrophe, taking personal control of risk, and a distrust of expert opinion.

The limited resources allocated to Schistosomiasis Control Programme in Kenya are not adequate to implement and sustain all technically efficacious interventions simultaneously. This fact has dawned upon both policy-makers and medical personnel who hitherto advocated a multi-faceted approach to 'eradicate' schistosomiasis. Given that Kenya cannot afford to implement all interventions that might conceivably be of some benefit, it is necessary to establish priorities based on considerations of both costs and benefits. An important part of the benefit of any health intervention is its effect on health (quality and quantity of life) of potential beneficiaries. The objectives of this study were to: identify relevant types of data needed in estimating impacts of schistosomiasis interventions on health status; develop an instrument which can be used to obtain subjective probabilistic impacts of interventions; test its operational feasibility; develop a conceptual framework within which impacts of interventions can be estimated; illustrate how the probabilities could be used in calculating the 'expected quality adjusted life years' (EQALY); and identify obstacles that need to be overcome within a developing country context. In this study, a 'modified Delphi' approach was used to elicit expert subjective judgements on the effectiveness of ten schistosomiasis interventions. The paper compares and contrasts the expected quality adjusted life years estimated using values obtained from two local schistosomiasis experts with those obtained from a foreign expert. The panelists appeared to be consistent in their ranking of the effectiveness of treatment vs. non-treatment options. However, there were large differences in the magnitudes of estimates obtained from the local and the foreign experts. Given that the Delphi technique has been widely and fruitfully used in industry and commerce (among other areas) in developed countries, African countries health policy-makers cannot possibly do worse (than the current practice where decisions to commit resources are based on 'what we did last time' and 'gut feelings') by using systematic decision analyses based on data from such a technique.

The Annual Report of the Director of Public Health for Forth Valley was evaluated in terms of its usefulness as perceived by recipients. Six months after publication, more than half had retained their copy and a similar proportion had made use of it or anticipated using it in the coming year. Its main use was as a reference. The Report had least impact upon Consultants and General Practitioners.

The scarcity of information about program costs in relation to quality care prompted a cost analysis of prenatal nutrition services in two urban settings. This study examined prenatal nutrition services in terms of total costs, per client costs, per visit costs, and cost per successful outcome. Standard cost-accounting principles were used. Outcome measures, based on written quality assurance criteria, were audited using standard procedures. In the studied programs, nutrition services were delivered for a per client cost of $72 in a health department setting and $121 in a hospital-based prenatal care program. Further analysis illustrates that total and per client costs can be misleading and that costs related to successful outcomes are much higher. The three levels of cost analysis reported provide baseline data for quantifying the costs of providing prenatal nutrition services to healthy pregnant women. Cost information from these cost analysis procedures can be used to guide adjustments in service delivery to assure successful outcomes of nutrition care. Accurate cost and outcome data are necessary prerequisites to cost-effectiveness and cost-benefit studies.