**3. Conclusion**

254 Health Management – Different Approaches and Solutions

Capacity building is any action that improves the effectiveness of individuals, organizations, networks, or systems—including organizational and financial stability, program service delivery, program quality, and growth. Capacity building is a long-term process that improves the ability of an individual, group, organization, or ecosystem to create positive change and perform better to improve public health results (MSH, 2010). A number of activities which have taken place under the banner of organisational capacity building in relation to the ICDS program have focussed on erecting buildings and providing training

A systems capacity building approach to improving the ICDS looks beyond training, and even the ICDS itself, into structural factors which may impact on child health and development. The starting point for improving child health and development is the Indian nubile female. Poorly nourished women are more likely to give birth to underweight infants, a major risk factor for both child as well as maternal morbidity and mortality (Kelly et al, 1996).A recent maternal nutrition study in Pune found that 33% of Indian women have a BMI less than 17, implying significant underweight, compared with 14% of men (Chorghade et al, 2006). Improving maternal nutrition in India would entail addressing cultural, socio-economic and, knowledgebased and attitudinal impediments, a task beyond the scope of ICDS, but within the scope of India's public health system. Effective systems capacity building comprises optimal interaction

Box 1. Nine component elements of systems capacity building applicable to improving the

*Inadequate systems capacity building input into ICDS* 

of nine components [Box 1 and Figure 3] (Potter & Brough, 2004):

programs to Anganwadi workers.

effectiveness of ICDS programme

The ICDS has not met its objectives, three decades on, due in part to poor health management. A systems capacity building approach is proposed to improve the health and development of mothers and children in India. This approach entails a revitalised India's public health, rather than the ICDS, as a major facilitator of maternal and child health improvements. Issues that need to be addressed include; (1) Revitalising India's public health system, and providing adequate funding to make it more responsive to the needs of the whole population, instead of the over-reliance of vertical programmes such as ICDS; (2) Introducing sustainable poverty reduction programmes, particularly in areas with high maternal and child malnutrition. Improvement in maternal education is also very important in reducing maternal and child health. Remarkably, such improvements are already underway; (3) Expanding the depth and breadth of the training curriculum of Anganwadi workers and professionalising the cadre within India's public service. These workers require adequate remuneration commensurate with their job description, over and above the minimum wage in India's public sector; (4) Devolving the supply of ICDS food from pilfering contractors to local women groups. Employment of dieticians to facilitate adequate quantity (at least 500 calories per meal) and quality (i.e. rich in all food classes) of the meals served at Anganwadi centres. Home visits should be introduced, particularly for malnourished children, to work with the mothers of such children in the provision of nutritious meals at their respective homes; (5) Streamlining the wide array of existing maternal and child health programs, most of which have not demonstrated evidence of effectiveness, to assure quality implementation; (6) Targeting children from 1-3 years, as most of the malnutrition in children develop from this period, and most long term consequences of malnutrition may be minimised if this cohort of children are properly

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**14** 

*USA* 

**Disease Management of** 

*University of Maryland,* 

Muhiuddin Haider and Bethany Applebaum1

 **Avian Influenza H5N1 in Bangladesh –** 

**A Focus on Maintaining Healthy Live Birds** 

Since March 22, 2007 when the Bangladesh Government declared highly pathogenic Avian Influenza H5N1 present, the disease has become a major public health concern throughout Bangladesh. Avian Influenza (AI) affects all poultry, wild and domestic, including poultry at commercial farms, live bird markets, and in backyard farms, putting many people at risk of contracting the disease. Avian Influenza affects both poultry and humans; therefore efforts

This chapter provides an overview of selected2 aspects of H5N1 disease management efforts in Bangladesh, focusing specifically on prevention efforts that decrease the risk involved with live birds transmitting the virus. An analytic model to examine field-level data is used to explore how using behavioral change communication, social mobilization, and the coordination between human and animal health to maintain healthy live-bird facilities can be used to manage H5N1 in Bangladesh. Specifically, this chapter will provide suggestions for continual disease management with a focus on how multi-sector activities, behavioral change communication, logistics management, interventions impacting live birds, and linking research to practice can contribute to successful disease management programs. Current efforts to reduce the prevalence of AI are addressed, as well as gaps in the effort

Highly Pathogenic Avian Influenza (HPAI) is an emerging zoonotic infectious disease, which is caused by the H5N1 subtype of the type A strain of the influenza virus (World Health Organization [WHO], 2006a). The virus is found in, and transmitted through, the feces, saliva, and eye and nasal discharge of infected birds (Centers for Disease Control [CDC], 2008). It is transmitted to healthy birds through contact with infected birds or

1 The authors would like to acknowledge the contributions and assistance provided by Nicole I. Wanty,

2 It is important to note that this chapter does not consider an exhaustive list of all possible aspects of disease management for H5N1. For example, this chapter does not explore the clinical management of H5N1 in Bangladesh. As this chapter will demonstrate, the need for clinical management of AI can be

M.A.A. and Mohammed Zakaria that helped in the completion of this chapter.

decreased, if not completely eliminated, by managing H5N1 in the live birds.

in managing the disease necessitate a multi-sector approach.

and future steps to reduce the prevalence of H5N1.

**2. An overview of AI in Bangladesh** 

**1. Introduction** 


http://southasia.oneworld.net/Files/ICDS.pdf Accessed 29 January 2011.

