WHO World Health Organization

WHO Project to Prevent HIV in the Republic of Karelia

Despite the fact that HIV infections in Karelia are relatively scarce compared with other regions of North-Western Russia, new infections are rapidly increasing. The number of new HIV cases registered during the first ten months this year already exceeded the figure, which occurred during the previous two years. Most HIV cases in Karelia are registered among injecting drug users. The majority of infections occur among young people under 25. The increasing number of injecting drug users and commercial sex workers, practicing unsafe injecting and unprotected sex, respectively, as well as the high level of sexually transmitted infections are preconditions for epidemic spread of HIV in the republic.

The Government of Finland, being concerned about the situation in the neighboring area of the Russian Federation and continuing traditions of good neighborhood, has contributed $300,000 for the implementation of HIV-preventive activities in the Republic of Karelia through WHO, with possible extension of funding. With the Karelian partner WHO has designed activities to alleviate the problem. It will be a pilot project with

The activities will take place in three pilot districts of the Republic of Karelia – Petrozavodsk, Sortavala and Kostomuksha, which are of particular concern. We will strengthen HIV prevention in the high-risk groups, such as injecting drug users and commercial sex workers through establishing low-threshold counseling units and outreach activities. First seminar for project participants was already arranged in November in Petrozavodsk.

Epidemiological surveillance will be improved. An information campaign to promote safe behavior among youth in general will be conducted starting next spring. Sustainability of the activities will be enhanced by improving the capacity of relevant local institutions, and participation of governmental and non-governmental organizations. HIV prevention in the risk groups will lean on local human resources and will be partly financed from local funds.

HIV and AIDS are not only a medical problem. The health sector alone cannot successfully prevent the spread of the infection. Effective cooperation between relevant ministries, institutions and local municipalities is facilitated by the Inter-Sectoral Working Group, which is established under the Deputy Chairman of Government of the Republic of Karelia.

The framework for collaboration between WHO and the Republic of Karelia on HIV prevention was agreed upon in the Memorandum of Understanding, signed during the project launching on December 3, 2001 in Petrozavodsk.

Dr. Nikolai Mashkilleyson

Coordinator on HIV/AIDS

and STI Prevention

and Control Office of the Special Representative of WHO Director-General

in Russia

All WHO Collaborating Centres Meet in Moscow

A meeting for WHO Collaborating Centres in Russia was organized in Moscow 5-6 December 2001 at the Russian Academy of Advanced Medical Studies. The aim of the meeting that collected together about 100 experts was to review the functioning of all presently existing 51 centres, and to look for future prospects of cooperation. Their role in supporting the implementation of Russian health care policies and WHO’s programmes was also discussed. The one-and-a-half day meeting encompassed plenary presentations, poster displays, a panel discussion and interactive group discussions.

Of the Collaborating Centres 18 operate in the field of public health dealing with important disease groups affecting the health of Russian population; 18 on scientific questions of viral, bacterial or protozoic diseases (e.g. as reference laboratories); 8 on non-communicable disease; 3 on health systems and reforms; 3 on medical research and 1 on medical statistics. 39 are located in Moscow, 7 in St Petersburg and 5 in other Russian cities. Many of these institutions have had their collaborating status since the 1960s, but there are also those, which have been designated in the late 1990s for the first time. The collaborating centre status is given for a period of 4 years, after which it can be renewed. It is not automatically connected with any kind of financial support, but for the work the centres do, they can be provided with a fee. Many of the centres provide WHO with expertise and in return WHO links them with the world networks. Ideally it can be a mutually very beneficial arrangement. In practice however, the centres in Russia lack financial support from their own government, expert links to WHO can be weak or non-existent, besides insufficient communication technology and language barriers often make collaboration frustrating or sub-optimal.

This interactive meeting was organized by the Ministry of Health, the Russian Academy of Medical Sciences and the World Health Organization (WHO). The work of each WHO Collaborating Centre in Russia was assessed before the meeting through a questionnaire sent to the directors in October. Responses were received from all. About one third of the centres were additionally visited and directors interviewed.

The Special Representative of WHO Director General in Russia, Dr Mikko Vienonen was the leader of an international team of eight attending the meeting. Experts from WHO Headquarters in Geneva, Regional Office for Europe in Copenhagen, Regional Office from Western Pacific Region in Manila, and representatives from WHO Collaborating Centres in Germany and Italy participated. This strong team shared their technical and administrative knowledge in managing WHO Collaborating Centres, as well as their experience from similar meetings held in Germany and China.

The Ministry of Health expects that the WHO Collaborating Centres in Russia would work more effectively if they focused on the priority areas set by the government, namely mother & child health, control of communicable diseases including HIV/AIDS, non-communicable disease control, and health care reform including general practice. Russian Academy of Medical Sciences expects that the meeting could provide an incentive to the Centres and WHO to work more actively together. Reduction in funding the centres from the side of government and WHO has caused a lot of problems in communication and possibilities to attend conferences. Since funding cutbacks and WHO’s organizational restructuring cooperation has become more difficult.

WHO noted the frustration on the lack of communication and feedback from WHO technical units. WHO is an opinion leader and its feedback is valued. However, only one-third of Centres were satisfied with WHO contacts. The Meeting also provided the opportunity to inform about WHO’s corporate strategy, its core functions and current priorities, which provide the framework for future collaboration.

Experience from Germany showed that new opportunities can follow from being a WHO collaborating centre. International cooperation through WHO, opens the Centres to modern practices in quality and knowledge management. International examples, from the WHO Western Pacific Region illustrated how bilateral links between the centres in different countries could help to strengthen and develop institutions.

One director of a Russian collaborating centre reported on his recent participation in an occupational health network meeting, which had recently taken place in Thailand. It had led the director of another centre to help in organizing a meeting of a European network of collaborating centres in tuberculosis in Russia. Illustrations were given by other directors on how the work of the centres in Russia contributes to WHO’ work, for instance in rapid response to international emergencies, in classification of diseases; in building regional databases on the outcomes of pregnancy, and in the production of national training material on sexually-transmitted disease for general practioners, based on WHO guidelines.

Among the identified shortcomings were that WHO needed to improve the management of the centres. Their monitoring needed to be strengthened nationally. The Centres themselves need to update their annual workplans regularly and to improve their self-evaluation and annual reports.

In networking lies the future of collaborating centres and priority should be given to enhancing communication. This could be done by strengthening the links between the centres in Russia with other collaborating centres in Europe and in the world; linking to WHO and other centres through Internet databases ( a minority of the 51 centres was reported to have internet access).

By definition WHO does not provide direct financial assistance to its collaborating centres. Most of them are therefore totally dependent on state funds. WHO was seen as having a role to play in leverage of funds from donors for small grants to support work that matches the priorities of the Organization and the donor.

In the conclusions of the meeting it was stated that meetings like this are absolutely indispensable and that such meetings must be made into an annual tradition. It became clear that WHO Collaborating Centres in Russia are an under-utilized resource.

Dr Mikko Vienonen

WHO Special Representative

of the Director General

in Russia

Successful Model for Smoking Cessation

Tobacco use is a major public health, social, and economic problem worldwide. It affects over a billion people globally, with the threat of increasing rates in children and women in many parts of the world. Effective policies and interventions exist to counteract this global epidemic. Studies have shown that

75-80% of smokers want to quit, while one third have made at least three serious cessation attempts. As with other addictions, smoking cessation policies require specific strategies to support smokers who want to quit in different stages of their readiness to quit.

The Quit&Win smoking cessation succeed to address most of these stages. For those in the pre-contemplation stage, it stimulates smokers to think about the need to quit through its media approach, awareness and consciousness about quitting as an option. For those in the contemplation stage, it can be necessary step to stimulate the smokers to make the decision to quit. It has proven to be its most successful for smokers in the ready for action stage, delivering messages to the whole community, including health care professionals, support on their decision to stop smoking through their family, peers, health care personnel, and the primary health care system. In the stage it stimulates smokers to try again, thus another benefit of the Quit&Win campaign is to provide one more opportunity to quit.

Originally developed and implemented in Finland, the Quit&Win competition has grown during the last 10 years, reaching over 70 countries and some 420,000 smokers in the year 2000 making the program a true public health campaign that involves people independently of their gender, age group, ethnicity, religion and social class.

Vera Luiza da Costa e Silva, M.D.PhD

Project Manager

Tobacco Free Initiative

World Health Organization

World Health Organization (WHO) works with others to improve the health of populations, by helping Member States. WHO is a specialized agency of the United Nations with 191 Member States. WHO Headquarters are in Geneva, Switzerland, European Regional Bureau is in Copenhagen, Denmark.

WHO has four main functions:

For further information please visit

www.who.int and www.who.dk (European Region)

WHO office in Russia: 28, Ostozhenka 119034 Moscow

Tel: +7 095 787 21 17 Fax: +7 095 787 21 19

e-mail: m.vienonen@who.org.ru.

Special Representative of the Director – General in Russia

Dr. Mikko Vienonen.

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