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(1996). Medical education: Finishing the unfinished business of the 20th century. Teaching and Learning in Medicine: Vol. 8, No. 3, pp. 132-136.

Bangladesh has many success stories in health, including its on-track progress in achieving the millennium development goals (MDGs).1,2 Yet, the country is suffering a huge shortage of workforce in the health sector, particularly doctors, nurses and midwives.3,4 the Alma Ata Declaration in 1978 reiterated the importance of primary Health Care (pHC)5 and the role of community health workers (CHWs) in responding to the healthcare needs of the people.6 in addressing this human resource gap, an innovative CHW initiative has shown promising results, including recruitment and retention of staff, health system performance and health outcomes.Development of ChwsCollaborative working between government and non-government organizations (NGos) has enabled better utilization of human resources, particularly in the use of front-line health workers. it is estimated that out of 219,000 CHWs in Bangladesh, 56,000 are government workers and 163,000 are from NGos, of which 105,631 are employed by the largest NGo in Bangladesh, 'BrAC' (formerly known as Bangladesh rural Advancement Committee).7,8 this means a collective resource of 13.7 CHWs per 10,000 populations, much higher than neighboring countries, such as, india, pakistan and Nepal.7recognizing the need for human resources in pHC, BrAC, an indigenous NGo, has pioneered the introduction of trained female CHWs to support disadvantaged populations.8 With knowledge of local context and needs, BrAC adapted the role of the CHW creating two new types known as Shasthya Shebika (SS) and Shasthya Kormi (SK). these workers promote good health, encourage community mobilization for health improvement, provide basic health services and link the community with the formal health system in rural areas and slums of cities and municipalities. the SSs, as the first front-line workers, are recruited from the community to serve 150-250 houses and are trained on basic preventive, health promotion and curative essential health care, which is backed up by regular monthly refresher training. the SKs are the second front-line CHWs trained by BrAC as paramedics, mostly offering basic antenatal and postnatal care, and who support, reinforce and supervise the activities of SSs. Going from house to house, the SKs and SSs explain family planning, provide antenatal and postnatal education and basic care, attend childbirth, offer newborn care, facilitate immunization, treat simple diarrheal diseases, counsel on nutritional behavior and practices and promote safe water, sanitation and hygiene.progress anD refleCtionsthe involvement of BrAC's CHWs in public health programs has shown positive results. tuberculosis case detection and treatment success rates are better where CHWs have been involved in communities.8 Health system management has improved where delays in seeking and accessing emergency obstetric care have reduced due to CHWs' involvement.9 Community empowerment is influenced by CHWs themselves being empowered, while also providing the bridge between the community and formal health systems.10the motivation and retention of CHWs has always been a challenge. in the late 1990s, the drop-out of SSs was 42%,11 improving to 12% in 2008,12 and recently is claimed to be as low as 5%-6%. introduction of incentives, continuous interactions through monthly refresher training and meetings, supportive field supervision and gaining a respectful position in the community have all boosted the motivation and retention of SSs. …

The survival and well-being of children is identified as the primary frontier of international health. In this regard, 1990 is identified as the most historic year ever in world history for children, and the achievements of the Universal Child Immunization program in immunizing 80% of children of the Third World under one year of age by December 1990 and the Convention on the Rights of the Child and the World Summit for Children are cited. The importance of the world community exercising its capacity to act on a common problem together, of the health services taking on a much stronger social purpose, and of the tireless and dedicated spirits in these efforts is stressed as essential for making a much better world for children in the centuries to come.

Resume: Pour mettre en œuvre le consensus actuel sur le developpement, des changements plus profonds sont necessaires. Il faut en particulier s’attaquer aux problemes de la discrimination, des paysans sans terres et du chomage par des reformes agraires, des investissements en faveur des petits agriculteurs, la restructuration des depenses publiques et des programmes d’aide au profit des plus pauvres, la reduction des depenses militaires et une majoration sensible des ressources allouees a un developpement ecologiquement durable. Mais la voie du progres est bloquee, par les groupes d’interets politiques et economiques et par la nature politiquement peu attrayante d’un grand nombre des mesures necessaires dont la devise pourrait etre: «peiner aujourd’hui pour un avenir meilleur».

EI aspecto mas important del progreso alcanzado en favor de los ninos y nihas del inundo en desarrollo es el gradual dominio que se esta eonsiguiendo contra las principalis enfermedades infantilis.

L’aspect le plus important des progries realises en faveur des enfants du monde en developpement est la maitrise progressivement acquise sur les principales maladies de l’enfance.

El derrumbe de la antigua Union Sovietica y la extincion del orden mundial bipolar han marcado claramente el fin de una era historica. Pero la conviccion de que la guerra fria ha acabado entre debiles estertores sin un gran estallido final y que uno de los bandos ha logrado imponerse sin que mediara casi ningun disparo se ha convertido en el primer y mas peligroso placebo de una nueva era. En efecto, la guerra fria ha tenido efectos mas destructivos que ninguna otra a lo largo de la historia humana; ha sido una guerra sin vencidores y cuyas mas graves cosecuencias aun no se han manifestado.

Avec l’effondrement de l’ex-Union sovietique et la disparition de l’ordre mondial bipolaire, c’est de toute evidence une periode de l’histoire qui a pris fin. Pourtant, croire que la guerre froide s’est achevee sur un soupir et non une explosion, quo l’une des deux parties a rempotre la bataille presque sans coup ferir, est la premiere et la plus dangereuse des illusions de l’ere nouvelle. De tous les conflits de l’histoire humaine, la guerre froide a ete le plus destructeur. Ce fut une guerre sans vainqueurs, une guerre dont les effets les plus pernicieux pourraient bien etre encore a venir.

Apres avoir presente une synthese des progres realises et des perspectives ouvertes dans plusieurs grands secteurs d’une importance particuliere pour le bien-etre des enfants, la premiere partie de ce rapport parvient a la conclusion que nous possedons maintenant assez de connaissances, de technologies et de moyens d’application pour apporter a un prix raisonnable a toutes les familles, dans pratiquement tous les familles, dans pratiquement tous les pays, les bienfaits essentiels du progres, Les dirigeants nationaux et la communaute internationale sont notamment en mesure aujourd’hui, pour peu qu’ils le veuillent, d’ameliorer de maniere significative et durable la survie, la sante, l’education et la nutrition de plusieurs millions d’enfants de par le monde. Les dirigeants politiques de la plupart des nations ont adopte des objectifs specifiques qui sont le reflet de ce pouvoir potentiel.

The collapse of the former Soviet Union and the ending of the bipolar world order have clearly brought an era of history to an end. But the view that the cold war has gone out with a whimper rather than a bang, and that one side has won with hardly a shot being fired, is the first and most dangerous placebo of the new age. The cold war has been more destructive than any war in human history; it has been a war in which there have been no winners, and a war of which the severest consequences may yet be to come.