BP2001. Reproductive health conference report, October 15-22, 1997, Savannah, Georgia.
Cooperative Assistance Relief Everywhere conducted a 1-week conference during October 15-22, 1998, on best practices in reproductive health entitled "BP 2001," which brought together 52 CARE reproductive health field staff, 4 collaborating partners with major donor organizations and technical resource persons in Savannah, Georgia. The conference aims to position the programs of CARE to meet best practices in reproductive health by the year 2001. Specifically, the conference objectives were to 1) discuss the findings of six issue-focused task forces; namely, community participation and mobilization, sexually transmitted diseases and HIV/AIDS, maternal mortality, IEC (information, education, and communication), service delivery/quality improvement, and management information systems; 2) establish preliminary best practices for HIV, maternal health, and family planning components; 3) strengthen networks between field staffs, donors, and headquarters; and 4) share diverse field-based experiences. The conference held special events, which included a reproductive health project fair, a partner panel and donor panel sessions, and evening presentations on breastfeeding and HIV/AIDS transmission, and adolescents and reproductive health programming. The conference was successful as reflected in the post-conference evaluations. Field staff particularly valued their experience working on task forces and encouraged the continuation of such formats for addressing technical programming areas as issues unfold. Lastly, the BP 2001 conference helped build networks between projects across regions around the world.
INOPAL III final technical report: Marketing Reproductive Health Services, CI95.83A.
This paper presents the final technical report of the Latin America and the Caribbean Operations Research and Technical Assistance in Family Planning and Reproductive Health (INOPAL III) on the marketing reproductive health services of MEXFAM, the largest private family planning organization in Mexico. INOPAL conducted technical assistance in three phases to achieve its objective of increasing the profitability of the medical service centers (MSCs) of MEXFAM. These phases are as follows: 1) help MEXFAM estimate reliable financial information, including number of services provided, revenues and income generated per service and per service provider; 2) estimate costs, cost composition per service, break-even points and use of the installed capacity; and 3) train clinic administrators and service providers to understand and use financial information. Overall, MEXFAM improved its report generation capacity. Furthermore, analyses conducted under the project enabled MEXFAM to determine that some clinics were largely dependent upon open single service. Results also showed a significant underutilization of medical offices, operating rooms, and personnel time. In addition, analyses of the financial situation of MSCs helped MEXFAM administrators to 1) be more aware of their excessive reliance on one or two services, 2) identify market opportunities that could be exploited to expand the range of services offered to clients, 3) identify ways to promote services through referrals and client recommendations, and 4) establish cost reduction strategies.
Feasibility Study for the Introduction of Manual Vacuum Aspiration (MVA). Final report.
The aim of this study was to assess the feasibility of introducing manual vacuum aspiration (MVA) in Bolivia's public health facilities, with the understanding that this would contribute to higher-quality and lower-cost treatment of complications resulting from incomplete abortion. The study employed an in-depth, semi-structured instrument, and was conducted in four major cities located in diverse geographic and ethnic regions of the country, namely, La Paz, Santa Cruz, Cochabamba, and Sucre. It assessed a total of 64 clinical health care professionals and policy-makers on their knowledge of postabortion care (PAC) services; their familiarity with new reproductive health technologies; their perceptions of barriers to provision of PAC services; and the likelihood that he/she would participate in a pilot study of PAC with MVA at some future date. Overall, health care professionals were favorably disposed towards introducing MVA into public sector hospitals, and supported a proposal to carry out a pilot MVA project, preferably within 6 months. Their positive responses also indicates a high level of political support for introducing MVA, a critical element in incorporating PAC into the national public health system. The next stage in introducing MVA as part of PAC services should take the form of a pilot study of PAC in select hospitals with accompanying training in MVA use for public health providers.
The Mayan population, which represents 40% of the total population in Guatemala, is the most underserved in terms of all kinds of health care. Its access to reproductive health services and information is very limited. In response to this problem, Asociacion Guatemalteca de Educacion Sexual y Desarrollo Humano (AGES) designed and tested a strategy for providing reproductive health education to indigenous audiences in Guatemala. The strategy involved using teachers of the National Bilingual Education Program (PRONEBI) to teach reproductive health courses in indigenous communities. The following activities were also part of the strategy: 1) AGES developed three 10-hour courses that PRONEBI teachers could teach in their communities; 2) PRONEBI teachers had to pass a written exam based on a list of readings and attend a 12-hour training course for each module in order to participate in the Reproductive Health Education System; and 3) certified teachers assembled groups and taught the courses in their communities. A total of 55 teachers completed the full process of examination, training, and giving at least one course. In addition, a total of 496 courses for 11,171 students were taught in a 7-month period. The contraceptive prevalence rate of married participants increased by at least 3% points after the course (equivalent to an increase of 18% in the use of all methods and of 40% in the use of modern methods). 65% of those not married or in union not yet using methods reported that they expected to use a family planning method in the near future. The cost per course was US$56.40; per student, US$2.50.
This final report summarizes the findings of a study entitled "Strengthening of the postpartum and postabortion program in family planning in the Hospital Escuela" in Tegucigalpa, Honduras. The purpose of the study were to obtain information on the conditions and variations within the implementation of referral and counter-referral system; and identify aspects of the development of the system of referral and counter-referral. Several intervention strategies were used. Two of these were training of institutional staff and strengthening of the referral and counter-referral system for pregnant and post-childbirth patients. Results of the supervisory visit confirmed the training received in family planning counseling, presence and availability of the stamp, prevalent and correct use of stamp, appropriate registry of referral patients and failure to receive counter referrals. Likewise, recommendations were presented for both the health centers of the Metropolitan Health Regions and the maternal infant block.
This project tested the efficacy of different strategies for disseminating information about emergency contraception among service providers and audience of potential users in Mexico. In order to inform physicians and pharmacists, brochures were distributed through mails; direct distribution in eight public health centers; and publishing of articles in three professional courtesy journals for physicians and pharmacists. Then, phone interviews and simulated client visits were conducted. Phone surveys revealed that emergency contraception awareness increased among physicians from 38% to 61% and among pharmacists from 5% to 26%. On the other hand, simulated client visits confirmed a significant increase in awareness and knowledge of emergency contraception on both types of providers. Likewise, strategies to inform potential users through direct brochure distribution to students and placement of posters showed an increase of emergency contraception awareness from 37% to 50%. Furthermore, efforts to include emergency contraception during public relation campaigns, particularly through magazines, television and radio programs resulted in reaching and informing 12,773,190 people. The cost per person informed was less than 7% the costs that would have been incurred by purchasing the time or space at commercial centers.
HIV / AIDS surveillance data base. AIDS literature review.
This document presents, in table form, the HIV seroprevalence information, categorized by country. These data were presented at three AIDS conferences in 1997: 1) the Fourth International Congress on AIDS in Asia and the Pacific on October 25-29, 1997; 2) the Latin American Congress on Sexually Transmitted Diseases (STDs) on December 3-6, 1997; and 3) the 10th International Conference on AIDS and STDs in Africa on December 7-11, 1997. The document also includes additional materials compiled over the past several months since the last database was released on January 1998. This updated document contains 3458 data items from 317 separate sources. With these data files, duplication will be eliminated and the most complete information will be selected to ensure accurate and up-to-date database.
Harmful traditional practices affecting the health of women and children in Ethiopia.
This exploratory survey on female circumcision (FC) and other traditional practices within their socioeconomic context in Ethiopia aimed to find out how deeply rooted such practices were, and to measure its impact on women and female children. In general, it is noted that in all the areas covered, conservative influences were very strong. Considerable pressure seemed to be exerted by the older members of society to ensure that the younger groups conform to tradition. In particular, prevalence of FC in areas covered by the survey is high. The types of FC practiced seem to be influenced by ethnic group, the status of women within the group, religion and the way of life. Medical complications observed among the circumcised include clitoral cyst, urethral infections, extensive scarring, keloid formations, and an increased incidence of tearing during delivery, causing fistula and excessive blood loss. More importantly, the study has shown that there is a strong correlation between the practice of FC and the advocacy for it. In view of this, initiatives aiming to change attitudes towards FC are recommended.
Ivory Coast tackles female circumcision.
In the Ivory Coast, female circumcision is a widely practiced tradition, in which girls who reach puberty were forced to undergo the ritual. According to Minister for Women and Family Affairs Albertine Herpie Gnanazan, at least 4 million Ivorian women have been circumcised. The practice has been carried out in unsanitary conditions in the bush, and complications--sometimes leading to death--include tetanus or later problems with childbirth. Coming of age ceremonies abound in traditional African societies. Supporters say female circumcision, often laden with spiritual significance is necessary for hygiene and to curb promiscuity by denying a woman sexual pleasure. In addition, it has been observed that circumcision has traditional values and beliefs among all the tribes who practice it. Considering such strong traditions, the Ivorian Association for the Defense of Women's Rights have planned to convince those who believe in the practice to use an animal instead.
Research on female genital mutilation in Cameroun.
This study determined the magnitude of the practice of female genital mutilation (FGM) in Cameroon. Specifically, this study outlined the social, religious, and traditional attitudes towards the practice of FGM; identify health problems encountered as a result of this practice; and suggest possible ways of dealing with the issue leading to the eradication of the practice. A qualitative/quantitative study was carried out with focus group discussions and interviews, and also a written questionnaire among 468 women, young girls, students, traditional rulers and legislators. In general, findings showed that prevalence of FGM is high among the people in both the South-West and Extreme North provinces. The age when this practice is performed differs from village to village and from tribe to tribe. Eradication of the practice is greatly advocated by young girls; however, older women feel it is a practice that has existed for a very long time and do not see the reason why it should be abolished now. Based on these findings, sensitization campaigns, training activities and refresher courses are recommended.
Adolescent fertility: "Who chooses abortion"? Final report.
This final report presents the findings of the research which ascertained the decision-making process involved in choosing abortion and determined specific informational needs that are not being met. The study mainly focused on circumstances surrounding and leading to abortion as an option in dealing with an unwanted pregnancy. A total of 77 young Kenyan women who had or were at the time of the study expectant were identified as key respondents. In summary, factors encouraging or discouraging abortion include initial acceptance or non-acceptance by the "father", family support or lack of support, and financial stability of the young woman's family. In addition, lack of knowledge about their bodies and contraception has increased the number of abortions as the only option. It is noted that teachers are the most appropriate community members to share information with young adults on their bodies, contraception, and pregnancy. In view of the findings, it is recommended that a package of combined interventions need to be developed for use by teachers, parents, community leaders and young adults themselves.
This Institutional Analysis aimed to identify and analyze existing institutions, agencies, organizations and media resources in Uttar Pradesh, and their capabilities regarding information, education and communication (IEC) activities. In addition, this was undertaken as input to the IEC strategy and to make optimum use of limited communication resources. The institutions reviewed include Training Institutions, IEC Institutions, Mass Media, Nongovernmental Organizations IEC Capabilities, Institutions that use Models of Communication, and Political Advocacy. Overall, it is noted that there is need to strengthen IEC inputs substantially by organizing training of trainers in the institutes and upgrading and modernizing the production facilities. Also, IEC networks need to be strengthened in terms of their capabilities to conceptualize, plan, design, manage, produce and evaluate IEC interventions in a concerted and coordinated manner. Moreover, with proper interfacing of mass media and interpersonal channels of communication through communication networks and youth clubs, the eligible couples in rural areas could effectively be approached for education, motivation and adoption of family planning measures.
Report of the WHO Working Group on Quality Assurance, Geneva, 18-20 May 1994.
The WHO Working Group on Quality Assurance in Developing Countries convened on May 18-20, 1995, in Geneva to discuss quality assurance (QA) concepts for developing countries and to explore areas for collaboration and joint follow-up action. One of the activities during the convention was the discussion on quality assurance which resulted to an agreement of a guiding principle that QA is based on a sound system design followed by continuing performance evaluation leading to appropriate educational-motivational activities and readjustments in system design. The Working Group discussed a number of characteristics common to traditional QA, total quality management, and other quality management methods. Several countries like Egypt, Malaysia, USA and Zambia presented their experiences to the Working Group, outlining the efforts to promote and apply QA in developing countries. After learning from their experiences, the Working Group suggested future cooperative activities.
The American College of Obstetricians and Gynecologists (ACOG), New York State supports the legislation that authorize and direct the Department of Health in conjunction with the department of social services to conduct a study of the risks, traumas and danger associated with female genital mutilation. ACOG joins many other major health organizations in opposing all forms of medically unnecessary surgical modification of the female genitalia. In fact, the committee of ACOG on Gynecologic Practice and International Affairs issued a joint opinion reminding physicians that although there is no scientific basis for female genital mutilation procedure, patients who have undergone the procedure should be treated with sensitivity and compassion. Furthermore, the opinion recommends that the issue be addressed by promoting awareness among the public and health care workers and by developing methods for educating physicians regarding the gynecologic and obstetric care of women who have undergone this procedure.
New York state prohibition of female genital mutilation act [Bill].
This paper presents the provisions of the "New York State Prohibition of Female Genital Mutilation Act". The penal law is amended by adding a new section, 130.75, to the old law. Among the added section were the two conditions upon which a person, parent, guardian or other person will be held legally responsible and charged guilty for the offense of female genital mutilation. This section also provides the conditions as to when the person performing a surgical operation does not violate this section. Moreover, this section provides permission for the department of social services and the department of health to establish and implement appropriate education, preventive and outreach activities in communities practicing female circumcision once the study of the health risks, emotional trauma and danger associated with female genital mutilation is finish. Finally, the section specifies the date in which the Act would be implemented.
This paper presents the suggested alterations to the "Justification" section of the memorandum in support of the legislation on female genital mutilation (FGM) in New York State. It also discusses the reasons why the legislation on FGM in New York State needs changes. It is noted that FGM is traditionally practiced in 28 African countries and among small minorities in Asia. It is assumed that if the practice were allowed in the US, it would not be done with a razor blade and with no anesthesia as part of a group circumcision ceremony. However, will most likely be performed by licensed physicians in hospitals and clinics equipped with anesthesia and the state of the art sterile equipment. According to WHO, there are three major types of FGM: type I, partial or total excision of the clitoris; type II, partial or total removal of the clitoris and labia minora; type III, partial or total removal of clitoris and labia minora, with stitching of labia majora over the urethra and vagina. Furthermore, WHO reported that FGM remains a major violation of the right of a nonconsenting child to preserve her bodily integrity. Included in this paper are the countries that have legislated against the practice of FGM.
Summary of federal and state legislation on FGM.
This paper summarizes the status of federal and state legislation on female genital mutilation (FGM) in the US. The Federal Prohibition of Female Genital Mutilation Act was sponsored by Representative Pat Schroeder. The act criminalizes FGM for minor girls and requires the Department of Health and Human Service to identify and educate communities concerning FGM. This act was referred to Judiciary Subcommittee on Crime and Commerce Subcommittee on Health and Environment but no hearing was planned. On June 7, 1995, the House passed a sense of Congress resolution on FGM as part of a Gilman en bloc amendment to H.R. 1561, the American Overseas Interest Act (foreign operations authorization). The President is expected to veto this bill. Moreover, Schroeder offered an amendment in the House Judiciary Committee to H.R. 2202, the Immigration in the National Interest Act, to require the Immigration and Naturalization Service to provide immigrants and visitors from countries where FGM is commonly practiced with information about the legal and health consequences of FGM, upon their arrival in this country. This amendment was approved by the committee. Likewise, the North Dakota law was enacted to be effective on August 1, 1995, while in New York, Rhode Island, and Tennessee the bills were pending. The H.R. 2442 bill in Texas becomes inactive in the 1995 session but will be reintroduced in the next session in 1997.
This paper presents the conclusions and recommendations of the Regional Seminar on Traditional Practices, held in Burkina Faso April 29 to May 3, 1991. From the documents circulated to participants and from the detailed discussion which followed, it was observed that despite the seriousness of the problem and the numerous resolutions adopted at the international, regional and national levels, the question of traditional practices affecting the health of women and children, especially female circumcision, has not received the attention it deserves. Since 1979, female circumcision and other harmful traditional practices identified by the organization within the system of the UN as presenting risks to physical and mental health and involving suffering for women and young girls been vigorously condemned. Accordingly, a number of recommendations regarding measures for the total elimination of such practices have been made to the States concerned. However, the participants view that these practices persist because of the lack of political will of many States and the failure to inform and educate the public. In light of the foregoing and in view of the scale of the phenomenon, which give rise to lengthy discussion, the participants have adopted the following recommendations for the elimination of all forms of traditional practices affecting the health of women and children, particularly female circumcision. These recommendations are enumerated.
Children's nutritional status.
This report describes the nutritional status of 19 developing countries, as well as differentials in the levels of undernutrition by selected demographic, socioeconomic, and health-related characteristics. It presents only findings based on anthropometric indices derived from the measurement of children's height and weight. Three main patterns of undernutrition, roughly corresponding to different regions of the world, were identified from the surveys. First, children in some countries are shorter than expected but not thin. The data show levels of stunting that are much higher than levels of underweight. This pattern is typically seen in Latin American and North African countries, as well as in Uganda and Zimbabwe. Second, there are countries where children are both shorter and thinner than expected. The data show high levels of stunting accompanied by even higher levels of underweight, and findings from Mali and Sri Lanka conform to this pattern. Third, most of the remaining countries, including most sub-Saharan countries, display an intermediate pattern where children are shorter and somewhat thinner than expected. The data show high and roughly equal levels of stunting and underweight, and wasting is also more common than expected. A major finding in all countries is the pronounced deterioration in nutritional status during the first year of life. Undernutrition is also more prevalent in rural than urban areas in all the countries surveyed.
This paper describes the innovative strategies adapted by the Instituto Mexicano del Seguro Social (IMSS) to improve the availability and use of vasectomy in Mexico. IMSS, Mexico's largest provider of health and family planning services, had launched a long-range strategy to increase the number of vasectomies performed in Mexico. The immediate results were that within 2 years the number of vasectomies performed in IMSS facilities more than doubled, and the number has continued to increase. IMSS now provides more vasectomies than any other institution in Latin America. The success of the IMSS program lies in its strategies. These strategies include: introducing and adopting no-scalpel vasectomy as the program's standard technique; conducting training at the service sites for all personnel involved with vasectomy services using a novel "site training" approach; removing barriers by providing access to vasectomy at the primary-care level; and providing ongoing supervision and technical support to the local service delivery sites. The continuation of these strategies within IMSS and the adaptation of the IMSS strategy by other institutions will further increase vasectomy use in Mexico.
This paper critically examines how the international perspective on population and development has viewed the health dimension. It begins by reviewing the context within which population policy has addressed issues related to fertility, mortality and age structure that forms the core of the population-health intersection. It then presents a systematic look at the response of population policy to these developments as articulated in the international plans of action. This paper traces the emphasis given to the health dimension through a consideration of three documents that reflects the response of population policy to forces that have shaped this context. These documents are 1) the World Population Plan of Action at the Bucharest Conference in 1974, 2) the Recommendations for the Further Implementation of the World Population Plan of Action at the Mexico Conference in 1984, and 3) the Draft Programme of Action of the International Conference on Population and Development held in Cairo in September 1994.
Population and economic development. A report to the Government of the Commonwealth of Australia.
Written by nine independent, internationally recognized authorities on population-related issues, this Inquiry report presents a detailed study of the relationships between population growth and the economic development and well-being of developing countries--in particular, the effects on education, health, food supply, housing, poverty, and the environment. It also examines the impacts of family planning on fertility, and the human rights implications of family planning. This report finds that undue pressure in individual men and women to modify their reproductive behavior is unacceptable, and it correctly emphasizes that adequate protection of human rights should be built into all family planning programs. It states that well-designed family planning programs, which have as their goal the health and empowerment of women, are central to promoting basic human rights.
Healthy people 2000. National health promotion and disease prevention objectives.
This document, entitled Healthy People 2000: National Promotion and Disease Prevention Objectives, contains a national strategy for significantly improving the health of the US nation for the year 2000. It is the product of a national effort, involving individuals, private organizations, and public agencies from every part of the country. It addresses the prevention of major chronic illnesses, injuries, and infectious disease. It offers a vision for the new century, characterized by significant reductions in preventable death and disability, enhanced quality of life, and greatly reduced disparities in the health status of populations within the American society. It is comprehensive in addressing health promotion and disease prevention opportunities in order to allow local communities and States to choose from among its recommendations in addressing their own highest priority needs.
Rinderpest is a deadly disease that killed 80-90% of all cattle and wild ruminants across Africa 100 years ago and has been a recurrent problem ever since. It not only kills animals but also destroy the livelihood of rural people dependent on those animals. In response to this problem, the Pan African Rinderpest Campaign (PARC) aims to eradicate rinderpest from Africa through vaccination campaigns and other control measures. This booklet presents discussion tools for the campaign that are considered as key components of the PARC communication strategy. The discussion tools include flipchart, poster, leaflet, literacy booklet, sticker, postage stamp, and banner. This booklet describes how to produce and use a kit of these printed materials, using local resources, facilities and personnel. It can be use by national project coordinators, communication officers, and media producers. It contains the types of discussion tools and materials, an illustration guide, and a technical guide.
The unit cost of family planning.
The cost of family planning has received increased attention in recent years because of the substantial increase in contraceptive users in developing countries, from 192 million in 1980 to 365 million in 1990. This rapid increase has occurred at the same time that some donors are finding it more difficult to support expansion of funding. Estimating the unit cost of family planning is essential for understanding how the costs compare with probable benefits, for projecting program resource requirements, and for assessing the most cost-effective service delivery methods. But computing these costs is complicated since family planning is delivered in both an integrated and vertical fashion. It can be quite daunting to disentangle joint costs and to collect costs from all suppliers; yet a number of attempts have been made to determine the cost per user, and the cost per year of couple protection from pregnancy. Differences in the unit costs of family planning were noted and at least five major factors were relevant to explain these differences: level of demand; population density; contraceptive methods being used; quality of services offered; and efficiency of these services.
The determinants of breastfeeding practices in Ghana.
This paper examines relationships between breast-feeding and women's work in Ghana, specifically by investigating patterns of breast-feeding durations for different groups of women using life table estimates for and multivariate hazards models of both the duration of unsupplemented breast-feeding and the total duration of breast-feeding. Findings show that breast-feeding in Ghana is virtually universal and lengthy, with the median duration of breast-feeding being about 21 months. Moreover, dietary supplementation is initiated relatively early, with half of the children receiving solid supplements at 5-6 months of age. Liquid supplements, most commonly water, are introduced even earlier. In addition, the types of work women do and characteristics of their work have significant bivariate associations with the duration of both unsupplemented breast-feeding and the total duration of breast-feeding. The compatibility of women's jobs and earnings are also associated with the breast-feeding durations, with more compatible jobs and jobs closer to the home being associated with longer breast-feeding and earnings inversely associated with breast-feeding durations. However, the effects of the work variables are not as marked in the multivariate models estimated, and individual characteristics, level of education, and contextual factors, urban residence relative to rural residence, have more consistent effects on breast-feeding durations.
This paper presents the final draft report of the operations research project "Four Approaches to Emergency Contraception in Ecuador," which was undertaken by the International Center for Research on Women in collaboration with four Ecuadorian institutions: 1) Centro Medico de Orientacion y Planificacion Familiar, 2) Centro Obstetrico Familiar, 3) Centro Ecuatoriano para la Promocion y Accion de la Mujer, and 4) Direccion de Higiene Promocion de la Salud del Distrito Metropolitano de Quito. The research aimed to test the effectiveness of a gender and emergency contraception (EC) training intervention on providers' perception, knowledge and attitudes of EC. The primary intervention was a 1-day training followed with technical assistance that consisted of site visits to the participating clinics. A single-group pre- and post-test design was used in this project and a combination of systematic interviewing techniques was employed in data collection. Findings showed that there was a substantial improvement in the providers' level of acceptance of EC and in their belief of the importance of gender to EC provision. In addition, the training increased awareness among providers of the need to better understand the sexual realities of women that result in the need for EC which include having unprotected sex and casual sexual relations, and the reality of rape and violence against women. Finally, this study recommended that 1) EC training and dissemination be promoted on a wider scale and 2) accurate and systematic information on EC be given to providers and women.
Improving quality and lowering costs in an integrated postabortion care model in Peru. Final report.
This paper presents the findings of an operations research project that assessed the effects of integration of treatment of abortion complications with postabortion family planning counseling and services in Lima, Peru. The study focused on clinical treatment services, postabortion family planning, information provided to patients, women's pain perceptions, service delivery organization, costs to both the hospital and patient, and potential for long-term sustainability of the integrated model. It used a quasi-experimental, pre-post intervention design and was conducted at National Hospital "Daniel Alcides Carrion. The information sources for the study include the following: patient exit interview; clinical history form; cost and resource use component; logbook review; and in-depth interviews with patients, providers, and policy-makers. Findings showed that in most hospitals in the region, family planning offered to postabortion patients was virtually nonexistent prior to the implementation of the integrated model. Improvements in postabortion family planning were facilitated by the presence of a strong family planning clinic in the hospital. Sustainability should be a major goal of any postabortion care (PAC) model. Incorporation of manual vacuum aspiration and other PAC content into routine obstetrics-gynecology training for residents and other staff was a landmark for sustainability. Hospital officials rated the prospects for sustainability of the integrated PAC services as high.
This paper reports on the Financial Self-Sustainability of Reproductive Health Services Conference, held at Ixtapa-Zihuatanejo, Mexico, on December 1-4, 1997, and sponsored by the Latin America and Caribbean Operations Research and Technical Assistance in Family Planning and Reproductive Health (INOPAL III) project. The conference aimed of bringing together representatives of local public and private reproductive health organizations, and cooperating agencies to present and discuss lessons learned from operations research projects conducted under INOPAL III on the financial self-sustainability of reproductive health service delivery organizations. The themes of the conference included prices, costs, marketing and income generation strategies, and financial problems of reproductive health service delivery. Specific services that were discussed include medical consultations, lab analyses, ultrasound services, pharmacies, post-abortion services, and clinic and community-based services. Appendices 1, 2, and 3 of this paper contain the conference agenda, conference proceedings in Spanish language, and translation of the presentation and introduction of the proceedings, respectively.
This paper presents the final report of an operations research study that was conducted in Lima, Peru, to explore a simple, low-cost way of estimating the nature and prevalence of sexually transmitted diseases (STDs) and high-risk sexual behavior in order to determine the cost effectiveness of providing new or expanded services. The study hypothesized that self-administered questionnaires could be an ideal alternative, as a low cost methodology that avoided respondents' hesitancy to provide information about high-risk sexual behavior. The self-administered questionnaires were evaluated with regard to acceptability and instrument validity. Instrument validity refers to the ability and willingness of respondents of different socioeconomic backgrounds to provide accurate responses to personal questions without the assistance of an interviewer. Findings of the study suggest that self-administered questionnaires are a feasible, low cost way to collect data on sensitive issues such as STDs and sexual behavior across different populations. Since the highest proportion of inconsistent responses came from those with primary education or less, the results further suggest that self-administered questionnaires are best suited for data collection among populations with at least some secondary schooling.
This study assessed the cost and quality implications of a new service model for women seeking care for incomplete abortion with an explicit aim of quantifying the savings resulting from the use of the manual vacuum aspiration (MVA) procedure. It examines the complete costs of a postabortion service model while simultaneously addressing the issue of patient quality care. The service delivery model was implemented by the Aurelio Valdivieso General Hospital in Oaxaca, with support from the Population Council and the European Union. The objective of this model was to improve the postabortion quality of care while conserving resources by 1) modifying hospital procedures to reduce wasting time, to improve pain management, and to ensure patient privacy; 2) using the MVA technique when indicated; and 3) providing postabortion contraceptive counseling and providing educational material and contraceptives to patients. Findings showed that the improved service delivery model achieved significant cost savings and simultaneously improved quality of care for patients undergoing postabortion treatment. A 32% cost reduction in treating patients was achieved with the introduction of the service delivery model. Assuming an annual case load of 600 postabortion cases, the potential cost savings could reach US$50,550 per year. Moreover, significant improvements were noted in patient-physician interaction and information exchange. This nurtures trust between the provider and the patient, leading to increased compliance with provider recommendations and advice.
This paper presents the final report of a diagnostic study that focused on the Mexican Institute of Social Security (IMSS) family planning/post-obstetric event program to identify factors such as provision of family planning without informed choice, limited range of contraceptive choice, and inadequacy of information and counseling, which reduce the clients' decision-making power. The study also assessed the degree to which requests for a postpartum method are met. Data were collected through interviews with service providers and women in 13 outpatient clinics and 13 hospitals in 12 states. Findings showed that more than one-third of the women did not receive information and counseling on contraceptive methods during prenatal care. About 70% of the women who had a recent delivery, cesarean section or abortion received a contraceptive method at the hospital, mainly an IUD or female sterilization. Of these women, 4.5% stated that they had received a method they had not wanted and had not accepted. Concerning the informed consent program started by the IMSS, over two-thirds of the providers interviewed had received training, knew the program materials, and over one-half were using the new form. These findings emphasize the need to strengthen training and supervision on informed consent procedures, not only because one third of the providers have not received training, but also because a large proportion of women reported having received methods without signing the form and signing it after the method had been delivered.
A private-public sector partnership between a pharmaceutical company, the Mexican National Population Council, and two family planning nongovernmental organizations is working to increase financial and physical access to oral contraceptives in Mexico by socially marketing the low-dose oral contraceptive Microgynon. This research estimated the extent to which individuals in these target areas have ready access to the reduced price of the Microgynon product. The two components of this research project were 1) mapping of distribution points and client intercept survey and 2) distribution check and population interviews. A total of 90 pharmacies were selected for the client intercept survey. Interviews with intercepted client were conducted in 3 consecutive days while provider interviews were conducted with all pharmacists in the target pharmacies. Household-based interviews were also conducted with married women and "madres solteras" aged 18-34. Results indicate that larger pharmacies were more likely to draw in clients who did not live in the surrounding locality, and more likely to draw in clients who live more than 1 hour or 30 km away. However, there was no difference between the proportion of male and female clients who live more than 1 hour or 30 km away. It was further found that the addition of Microgynon-10 had the greatest potential impact on the very smallest pharmacies as compared with larger pharmacies. The findings indicate that the effective coverage of pharmacies extend beyond the communities in which they are physically located.
This report summarizes the results of a study on linking reproductive health services conducted by the General Direction for Reproductive Health of the Ministry of Health of Mexico. The purpose of the study was to provide information for decision making in the implementation process of the 1995-2000 Reproductive Health and Family Planning Program and of the Mexican Official Norms for the different reproductive health services. About 25 health centers in eight Mexican states were visited. In each health center, service delivery staff was interviewed, exit interviews with women of reproductive age were conducted, client-provider interactions were observed and the organization and resources of the facilities were assessed. Overall results indicated that there was a need to increase the distribution of the norms for the delivery of the different reproductive health and, more importantly, to establish mechanisms that allows the staff to study them in their own units. It was further observed that compliance with norms have deficiencies which could be associated to low provider competence and to the lack of supervision system focused on the compliance with norms. The weakest point in the implementation of the new service delivery perspectives requested by the Family Planning and Reproductive Health Program has been the scarce diffusion, explanation and subsequent understanding of the new concepts included in the program. Finally, this report enumerated recommendation to improve the use of norms among service delivery staff.
The Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) provides health services to approximately 9 million beneficiaries and about 4.5% of current contraceptive users in Mexico. As part of the Service Delivery Expansion Project, the ISSSTE started receiving international funds to strengthen its reproductive health program in 1992. Within this context, the ISSSTE thought that an operations research program could help test strategies for scaling up in a second phase. To implement the operations research program, ISSSTE circulated a call for operations research proposals among clinics and hospitals in nine Mexican states. About 14 proposals were received, but only four were selected for funding of approximately US$5000 each. Two proposals intended to study the effects of systematically offering reproductive health services in outpatient clinics; one proposal tested strategies to establish services for adolescents; and the fourth proposal sought to decrease the high incidence of cesarean sections and increase the use of postcesarean family planning. The results of these studies were presented in this final report.
The National Institute of Public Health (INSP) started offering a distance education masters degree in public health for mid-level managers in 1991. This program resulted in 86 chiefs of local health systems receiving the degree. Also, the program has been replicated by the PAHO in other Latin American countries. Given this experience, the INSP thought of the possibility of using the same approach to remedy the training needs in reproductive health management. Thus, INSP conducted a market study to examine the potential demand of an in-service graduate degree program in management of reproductive health programs. The purpose of the study was 1) to identify the profile of the Ministry of Health state- and jurisdictional-level reproductive health program managers; 2) to assess the acceptability of an in-service graduate degree in Management of Reproductive Health Programs; and 3) to obtain information to design the curricula of the educational program. These objectives were achieved by a survey conducted among 203 state and local health system managers. In addition, 18 state-level top decision-makers were personally interviewed. Results of the study showed that there was a high potential demand for an in-service graduate degree program, but the program would have to meet several requirements in terms of funding, location of activities, availability of time and capability with present work requirements. The degree should emphasize reproductive health, program operations and functioning, management, and methodology, evaluation and operations research as main subject areas.
Several innovative communication interventions have contributed to the rising contraceptive acceptance in Anambra State, Nigeria. Among these is a radio drama series entitled Ezi Na Uno (Our Family) for rural audiences. The program was produced and broadcasted by the Anambra Broadcasting Corporation, which provided listeners with information on family planning benefits, methods and availability of services. The impact of the program was evaluated by using a multi-faceted approach, which included a recall survey and source of referral data from new acceptors at selected clinics. Survey findings suggested that Ezi Na Uno program attracted a respectable size of the targeted audience from the rural areas. The results also demonstrated the ability of the program to entertain and educate the audiences. In addition, the source of referral data from new acceptors suggested a link between clinic attendance or family planning acceptance and the Ezi Na Uno series. Based on the findings, researchers concluded that proper combination of mass media, entertainment, and education could be a powerful tool for health educators in influencing audience knowledge and behavior. Valuable lessons gained from the project that were applied in subsequent projects are summarized.
Contagion is central to the study of network models of the diffusion of innovations. Contagion via cohesion occurs when individuals adopt an innovation by imitating the behavior of other individuals with whom they have direct contact. On the other hand, contagion via structural equivalence occurs when individuals adopt an innovation by imitating the behavior of other individuals who occupy the same position in the social structure. The study presented a new technique for comparing cohesion and structural equivalence and determined whether evidence for diffusion via structural equivalence existed in other diffusion research. The study measured the degree of contagion that occurred for the diffusion of innovations and presented a theoretical framework for understanding contagion via cohesion and structural equivalence. Contagion was measured via cohesion and structural equivalence across 3 different data sets in 40 communities, and was compared based on the personal network diffusion model. Thresholds were computed for a range of cohesion and structural equivalence models and these measures were compared against each other. Correlation, regression, and analysis of variance tests indicated that diffusion more likely occurred via structural equivalence than by cohesion. In addition, the strong association between structural equivalence thresholds and innovation indicated that individuals are more strongly influenced by their near-peers (structurally equivalent others) than their cohesive peers (direct contacts).
A study presents the results of a computer simulation of opinion and behavioral change regarding the practice of family planning, and discusses the implications for social impact theory and communication theory. The theory that was simulated through a computer program is a derivative of the dynamic theory of social impact (Nowak, Szamrej, and Latane, 1990) modified by the convergence theory of communication (Kincaid, 1987; Rogers and Kincaid, 1981). Empirical data was gathered in a Bangladesh village to create the initial values for the simulation. The geodesic distance among village women as measures of communication distance was calculated using the actual communication network data. Persuasiveness was weighted by frequency of communication to determine the degree of social impact among each link in the network. After running the simulation for 20 iterations (simulating a 20-month period), approval of family planning and contraceptive prevalence increased from 58% to 83% and from 15% to 45%, respectively. An examination of where the adoption occurred in the network revealed a division of the network into 2 factions: 1 with almost 100% adoption and the other with almost 100% nonadoption with oscillation among women located at the boundary between each faction. The various strategies for program intervention are discussed. Among the strategies is changing the initial communication network structure so that satisfied family planning adopters on one side of the village can provide direct support to isolated adopters on the other side.
The Zimbabwe male motivation project.
This project concerns the Zimbabwe Male Motivation Program, the first ever information, education and communication project addressed exclusively to men in sub-Saharan Africa. The program aimed to increase the knowledge of family planning methods in men of reproductive age, promote more favorable attitudes among men towards family planning, increase the use of modern family planning methods among men and their sexual partners, and promote joint decision-making between men and their sexual partners. The three program interventions consisted of the radio serial drama ( Akarumwa Nechekuchera ), motivational talks, and family planning leaflets. The methods that were used to evaluate the effectiveness of the program included: a male motivation impact evaluation survey (MMIES), focus group discussions with radio listeners, omnibus survey questions, exit interviews with participants, and a acceptors survey. MMIES was conducted in 1989 and included a total of 892 men aged 18-55 years. Data were analyzed from three angles: 1) a comparison of findings of the MMIES to those of the Male Fertility Survey, 2) the effect on men of exposure to the campaign, and 3) the differential impact of the campaign media. In general, the Male Motivation Program brought significant changes in men s' attitude and behavior toward family planning. A comparison of the three campaign media showed that the radio was most effective in reaching men and teaching them about family planning. Motivational talks, on the other hand, were most effective in getting men to discuss family planning with partners and encouraging couples to begin contraception.
Report of the Working Group on Traditional Practices Affecting the Health of Women and Children.
The results of the working group on traditional practices affecting the health of women and children as presented during the 42nd session of the UN Commission on Human Rights are reported. Among the various traditional practices identified was the problem of female circumcision. Several aspects of female circumcision were explored; namely, the definition of female circumcision, forms of female circumcision and the age at which it is carried out, origins and scope of the phenomenon, evolution of the problem, countries practicing female circumcision and reasons for the practice, effects on physical and mental health of women and children, and measures undertaken for the eradication of female circumcision at the regional, national and international levels. Conclusions that were drawn from available data and the recommended actions to abolish female circumcision are presented.
Health and family planning services in Lesotho: the people's perspective.
The fundamental goal of Lesotho's Ministry of Health (MOH) is to expand the provision of modern health services to the country's population. The World Bank realized the enormity of the MOH s commitment and undertook a study to assist the Ministry in achieving health for all by the year 2000. The study was conducted in three selected communities: Linareng, Ha Rankhelepe, and Lithoteng, which provided an in-depth qualitative analysis of individual and household attitudes, behavior, and practices regarding health. The study showed that the participants chose from at least nine different health options in attempting to alleviate their pains, which included patent medicine, traditional remedies, traditional practitioners, private doctors, clinics, hospitals, faith healers, and home nurses. The factors involved including past experiences, rumors, hearsay, beliefs, culture, and the nature of the perceived complaint that influenced people's choice of health options. Furthermore, attitudes and perceptions of people towards the health services differed from level to level. It was further found that many people went to private doctors and hospitals when their first action failed to produce satisfactory results. In addition, old interviewees reported a deterioration of health services and lack of sensibility on the part of the public health system towards the intended beneficiaries. Continuous research and evaluation is necessary that should form the basis of planning for the future.
Impact of population growth on the environment.
This article contains presentation notes from the APHA annual meeting on the impact of population growth on the environment. The main topics of the meeting were presented by using slides, which focused on the relationship between population and the environment; the impact of environmental problems to health; and population as an environmental intervention. Overall, the lessons that were learned from the presentation indicated that population was an easier intervention than many of the others, but it was insufficient. Timing is noted as being critical and the next decade may determine whether the human species, as well as many others will become extinct like the dinosaurs. In view of this, a need to promote positive benefits is highlighted. It was noted that population and environmental specialists need to support each other and to stay focused on the key changes needed. In addition, more research would help in understanding the dimensions of the problem. Finally, it was noted that the ways to limit the destruction and make ecosystems sustainable should be introduced.
AIDS, sexually transmitted diseases (STDs) and teen pregnancies are the prevalent problems affecting the adolescent population in the Dominican Republic. In response to these problems, INSAPEC (National Institute of Sexual Education) attempted to address this problem through sexual education in some low-income neighborhoods in the city of Santo Domingo. The Health Messenger Peer to Peer Project evaluated a pilot project conducted by INSAPEC in Guachupita, to build upon its experiences. The peer to peer sexuality education program focused on skill-building techniques for teens aged 11-19 years. In addition, it created activities and developed a coalition of related health and community organizations to integrate the community into the program. The project was implemented in Villa Juana, a heavily populated, low-income neighborhood, which integrated community-based sex education, counseling and information programs that promoted adolescent health by reducing pregnancies and STD/HIV infections. Approximately 1500 adolescents and young adults were trained through the program. The total request for the 3-year program was US$300,000.
Introduction: definitions, assumptions, themes, and issues.
This article provides a unique and innovative perspective on the complex problem of wife beating, which has generated a public concern in Euro-American society. Wife beating was defined as a man intentionally inflicting pain on a woman, within a nontransient, male-female relationship, whether or not the partners were officially married. The subject was further restricted to physical aggression. A full explanation of aggression against wives included not only sociocultural but also psychological variables. This article presents an overview of customs in a variety of cultures supplemented by evidence for analogous behavior among nonhuman primates. Furthermore, descriptive information is presented, which was drawn from societies located in widely scattered geographic areas; and from societies that ranged in complexity from hunter-gatherers, to horticulturists (with special emphasis on Melanesia, a culture area in which wife-beating has been widely reported), to industrializing complex societies. The information and enlarged perspective called attention to the worldwide plight of battered wives, promoted their cause, and furthered the efforts of those working to eliminate the abuse of women. Also, the article provides definitions and assumptions that were shared by contributors. A brief review of previous cross-cultural studies is presented and other promising areas of research are suggested.
Guidebook on domestic violence in Uganda.
This guidebook on domestic violence, which was published by the National Association of Women Judges, provides educational information to the victims of and the public about domestic violence. The book highlights the prevailing social attitudes toward the problem. Part 1 deals with the nature and forms of domestic violence that exists in Uganda. Illustrative case studies and cases handled by members of the association and other organizations identifying the causes of the problem are also presented in part 1. Part 2 outlines the international instruments relating to domestic violence, which further attempts to give a critical analysis of the existing laws in Uganda. Illustrated are aspects of the legislation, which are effective and which are not along with its strengths and weaknesses. Part 3 describes the duties of the law enforcement organs, including the Resistance Council officials, the police and courts. It also gives guidelines to victims who would wish to seek assistance and the constraints involved. Part 4 presents and examines the possible remedies that are available to victims. The guidebook also provides recommendations for reform and an enactment of progressive, effective but practicable legislation with legislative support for services to victims.
This article focuses on women's struggles for health and examines the complex mosaic of women's health politics. It explores women's responses to the economic, social, and cultural obstacles that prevent many women from meeting their physical and psychological health needs. Millions of women are involved individually and collectively in the fight for better health. The women have formulated goals, created strategies, and devised methods appropriate for their own circumstances. Many groups of women are now working under the broad banner of reproductive rights and are fighting for a wide variety of reproductive rights, from the demand for women's right to greater sexual autonomy to birth control. Campaigns have been conducted from bottom up to top down and interventions have been made at local, regional, and international levels. Women have worked for change both inside and outside of medical institutions and formal organizations, and have organized themselves in mixed, as well as single sex groups. No single movement has emerged, but all share a common belief in women's right to health.
This paper contains the conclusions of the Conference on Traffic in Persons that was held from November 15-19, 1994, in Utrecht and Maastricht. It discusses the national and international measures that should be taken to address the problem of traffic in persons. Traffic in persons constitutes a violation of human rights as stated among others in the Vienna Declaration of Program of Action, adopted by the World Conference on Human Rights, and in the Declaration on the Elimination of Violence Against Women. Various international legal human rights instruments provided points of reference to fight the traffic in persons. Such instruments included the Convention on the Elimination of All Forms of Discrimination Against Women; the International Covenant on Civil and Political Rights; the International Covenant on Economic, Social, and Cultural Rights; and other relevant International Labor Organization conventions. One national measure recommended is to raise the public awareness of the problem of traffic in persons with particular attention to the human rights dimensions. Moreover, both countries of destination and of origin should develop policies for supporting persons who are trafficked. It was noted that both countries of destination and origin should examine sociocultural structures that make the continuing supply and demand for trafficking possible, and that they should take steps to rectify such structures wherever necessary.
This study evaluates the implementation and effectiveness of a new domestic violence protocol as a component of child abuse/neglect investigations by New York City Child Welfare Administration caseworkers. The study also seeks to identify the beneficial outcomes and obstacles to the implementation of the protocol. In-depth interviews were conducted with a voluntary sample of 15 caseworkers, supervisors, and administrators to gather opinions and attitudes regarding the implementation and utilization of the domestic violence protocol. Additional qualitative information was gathered from case record data that was routinely collected by caseworkers as they carried out child protective service investigations. 724 cases were received during the 6 months that the protocol was being implemented. Results of the interview revealed a range of feelings and opinions which were grouped into six categories: workload, characteristic of families in which battering occurs, the protocol document, training, service delivery, and roles and responsibilities. Although there was resistance to the implementation of the protocol, the interviewees generally conveyed a willingness to comply and complete the protocol, as well as a sense of responsibility to provide services to combat domestic violence. Many of those interviewed tried to convey how difficult the job of child protective work is. Most respondents believed that their number one mandate was to protect the child and question the role of identifying domestic violence in protecting the children. The questions of how child protective workers should assess and intervene with domestic violence are complex and lead to an examination of the mission of child protective service agencies.
Action for change: creating a co-ordinated response to violence against women.
This document presents a multi-agency strategy that addressed the problem of domestic violence in Scotland. Meeting women's needs and preferences was the main priority of the strategy, which involved the coordination and collaboration of a range of health, social, legal, and financial resources. The proposals for a comprehensive approach were based on the understanding that male violence to women is rooted in broader issues of social inequality within the wider society. The strategy emphasized the need to support women in making and carrying out decisions about their lives. The proposals for action contained in the strategy were set in the context of a policy framework for domestic violence. The actions included proposals for overcoming the barriers to service provision, drawing attention to the process of enabling and achieving change relevant to domestic violence, and for making recommendations about challenging the acceptance of male violence to women. The proposals are supplemented by four policy papers, which are central to implementation of the strategy. The policy papers are on 1) principles and values, 2) best practice guidance, 3) training program, and 4) participation by women in planning and development of services.
Family violence, sex and reproductive health behavior among men in Uttar Pradesh, India.
This paper presents the preliminary findings of a survey on attitudes of men towards women, family violence, pre- and post-marital sex, and reproductive tract infections among men in five districts in Uttar Pradesh. The findings revealed that the men in general strongly believed that their wives should always respect them and obey the elders in the family. Although persuasion was the main measure suggested to change the behavior of wives if they disobeyed their husbands, a significant number of men thought that physical force should be used. In addition, fathers mistreating mothers was very high in all districts. The proportion of currently married men mistreating their wives was also very high. The findings demonstrated the unchanging status of women. Moreover, men used physical force to have sex with unwilling wives. Almost all of them did not use condoms or any other contraceptive method at the time of forced sex, which resulted to a large number of unwanted pregnancies. A significant proportion of men had sexual contacts with women before marriage. The same proportion had also reported symptoms of reproductive tract infections, and only a small proportion of them contacted qualified medical professionals for treatment. Almost all of them claimed that they were cured of symptoms at the time of marriage. The findings indicated that reproductive health programs should not only address issues related to service delivery but also look into broader areas such as status of women, family violence, and sexual activities of men.
This preliminary discussion paper on The Effects of Armed Conflict on Girls undertaken within the context of the UN Study on the Impact of Armed Conflict on Children, aimed to determine whether girls suffer more, less, or at least differently from boys. In conducting the study it was attempted to pull together the experiences of various World Vision programs working with girls in the following areas: 1) their active participation in armed conflicts; 2) the particular vulnerabilities they face due to displacement; 3) their health and nutrition; 4) their traditional roles; and 5) the targeting of girls for violence and abuse. The evidence that was collected indicated that while there was commonality in the experiences of boys and girls, girls were affected in different ways to boys by armed conflict. The most significant differences were the targeting of girls for sexual abuse and rape, with the psychological and physical needs this induces, and the lack of reproductive health services to meet even the most basic needs of girls and women. The paper helps to raise awareness of some of the particular vulnerabilities of girls in armed conflicts, and highlights some possible research hypotheses for more comprehensive study.
WAO. Women's Aid Organisation. Pertubuhan Pertolongan Wanita. 1995: annual review.
This article reports on the 1995 annual review of the Women's Aid Organization (WAO) in Malaysia. The paper begins with the presentation of the organization's philosophy, history and objectives. It then mentioned the services offered by WAO which included a refuge center for battered women and their children, face-to-face counseling, and telephone service/counseling that dealt with crisis situations and basic legal queries. WAO also supported the Anak Angkat Program and Child Care Center, which are programs for children. In 1995, many achievements were made by the organization; namely, a seminar was conducted by WAO National Research on Battered Women; a fund-raising dinner--Majlis Malam Amal WAO 1995; and networking activities like the International Women's Day 1995, Joint Action Group evaluation workshop on strategies to combat domestic violence, and the 4th World conference on women and the nongovernmental organization forum on women.
Most discussions on private sector participation and public-private partnerships focus on the contribution of the formal enterprises and not informal forms of participation, such as different forms of community-based, public-private partnerships. This kind of partnership is rarely included in the planning for privatization and public-private partnerships that are organized by national or local authorities or by water utilities. Yet, these community-based public-private partnerships can be most responsive to the demands and needs of the civil society and may very well complement the formal enterprise-based, public-private partnerships. Drawing upon the experiences of several countries including Nigeria, Mozambique, and India, this paper examined the areas where community action could help achieve greater equity and efficiency in the water sector and facilitate new investments in partnerships with the public and private sectors. It discusses the role of community as a consumer and as a service provider.
The CBD and the biological diversity of inland waters.
Given its wide acceptance and binding force as an international legal instrument, the Convention on Biological Diversity (CBD) can greatly contribute for a new paradigm for freshwater management, for which the world's momentum has been built. Within the context of the CBD, inland water biological diversity is a matter of concern since it depends on ecosystems and habitats containing high diversity and large numbers of endemic and threatened species. Furthermore, inland water ecosystems perform valuable ecological functions and inland water species, genomes and genes are of social, scientific and economic importance. In accordance with the CBD, inland water biological diversity should be maintained through in situ and ex situ conservation, the sustainable use of its components and the fair and equitable sharing of the benefits arising out of the utilization of its genetic resources.
Optimization of water resources management through maintaining the functioning of ecosystems.
Water is critical for all life on earth and constitutes a vital resource for humans and the environment. Water management infrastructure has been constructed worldwide to facilitate the intensive use of water resources. These developments, however, have caused serious damage and degradation of many ecosystems, which in turn has led to a loss of valuable goods and services that these ecosystems provide to human society. To ensure the availability and sustainability of the existing water resources, it is important that the role of the ecosystem as the provider of goods and services be recognized. This paper presents the Ecosystem Approach, which involves the maintenance ecosystem functions and the sustainable management of resources for meeting human needs. Its implementation is based on the following: 1) adopting ecosystem management at the most appropriate level; 2) improving assessments of water resources and ecosystems; 3) strengthening capacities to manage water resources; 4) improving communication through establishing partnerships; and 5) adapting policy and planning to include development costs and benefits and promote wise use practices. The paper concludes with a series of recommendations focusing on the implementation of the Ecosystem Approach.
Planet Earth 2025. A look into a future world of 8 billion humans.
Population projections for the next quarter century are reasonably predictable, and related resource challenges are quite visible. The world's population is expected to grow to around 8 billion by 2025. According to the International Food Policy Research Institute, if current levels of investments in agriculture and social welfare continue, food grain production will increase by about 1.5% and livestock production by 2.7% a year over the next 2 decades. These levels are much lower now compared to previous decades, and population could outstrip supply unless there is a big increase in developing country imports. The continued destruction of the earth's forest mantle as a result of human activities is another desperate concern. By 2025, some 3 billion people will live in land-short countries and another 2 billion will be living in urban areas with high levels of air pollution. In addition, coastal ecosystems, which are already exposed to unbridled coastal development and mounting pollution loads, will experience more pressures as the number of people living near them increases in the next 25 years. One final challenge is the unprecedented rate of habitat loss and species extinction. Ecosystem destruction is so severe that as many as 60,000 plant species could be lost by the year 2025.
Millennium hopes. Fighting taboos.
The author's first wish is for International Planned Parenthood Federation (IPPF) to be tenacious in its continuous, unstinting support of family planning in its original sense. Secondly, the author would like to see wider recognition of the urgency with which IPPF must move into the sexual and reproductive health arena, including fighting for the rights of women, men and young people in the many areas of the world still suffering from societal taboos. Thirdly, the author wants IPPF to be visionary in recognizing that young people, women and men need supportive social and economic environments to help them plan and space the children that they would like to have. Current educational and economic requirements and circumstances have become very child unfriendly, as the low birth-rate countries illustrate. Finally, the author hopes to see a much better understanding of intergenerational communication and support as IPPF steps up its efforts to support society in its sexual and reproductive needs. (full text)
Millennium hopes. The search for harmony.
The Executive Director of the UN Population Fund, Dr. Nafis Sadik, appealed to all people to support the goals of the International Conference on Population and Development in 1994. She encouraged changes in the attitudes and values of men, in particular, to bring about partnership for the realization of qualitative changes in life for all people. She stressed the importance of protecting the reproductive health and rights of the billion young people who are beginning their reproductive life. According to Sadik, much progress has been accomplished in the last 5 years; however, many challenges remain. Lastly, she hoped that the new millennium will find a world that defines progress not just in narrow economic terms but in social, ethical and human dimensions, with safety nets and minimum needs met for the most vulnerable, and where people and planet can be in harmony.
This article reports on the crisis facing reefs throughout the world and the struggle to save them. Coral reefs, one of the biological wonders of the world, are among the largest and oldest living communities of plants and animals on earth, having been evolved between 200 and 450 million years ago. Located mostly in the Pacific region, most established coral reefs are now dead and only the upper layer is covered by a thin changeable skin of living coral. Reefs, over the years, have been the main source of animal protein for over 1 billion people in Asia. Countries near the coastlines, which relied on the seas, have resorted to dynamite fishing, poisoning and other illegal and dangerous techniques. Overpopulation and pollution has caused the deteriorating conditions of the 600,000 sq. km of coral reefs worldwide. Despite these conditions, the government has ignored this problem as they struggle to develop their economies at the expense of common resources. In addition, this article narrates the efforts that are exerted by governments in promoting coral reef protection and management of these coastal resources, setting the Apo Island in the Philippines as an example of good management and sustainability.
This article reports on responsible action that must be taken to stop the decline of coral reefs locally, regionally and globally. It examined the causes of degradation and the global pressures that directly affect the reefs. It presented the concept of coastal management, which offers a philosophy and techniques for dealing with the problem. Coastal management holds the promise of being a stepping stone towards effectively governing the behavior of human societies as this relates to the qualities of coastal ecosystems. The central idea is to analyze human societies and define public policy as one of the many interlinked processes in which coastal ecosystems, function and change. One benefit of the ecosystem-based approaches to management is that they demand a long-term perspective, but the key lies in bolstering the societal values that can lead to changes in human behavior on all levels. Furthermore, the need for stewardship to successfully promote coastal management initiatives require a profound, detailed and accurate knowledge of nature and society, as well as careful attention and clarity in articulating the objectives of the management.
Protecting a marine wonderland.
This article reports on the condition of the Belize reef system and how the government takes the initiative to protect its wondrous beauty. The Belize reef system is located along the coast between Belize City and Punta Gorda, which is considered to be the largest barrier reef in the Western Hemisphere. Despite the appearance of a remarkably empty coastline, a glance to the Maya Mountains in the west will show that most of the development is taking place in the coastal areas. The earliest attempts to protect Belize s reefs focused on the establishment of protected areas and from this resulted in a remarkably ambitious marine protection program. Based on an integrated coastal zone management, a Coastal Zone Management Unit was established in 1990. This program encouraged the sharing of information, contribution to the creation of feasible government policies, plans and programs, identification of technical problems and provision of advice on a variety of issues. In addition, a steering committee was established in 1993, which is responsible for overseeing the implementation of the program and ensuring inter-ministerial coordination. Furthermore, public participation is also taking place in more direct ways, particularly with fishermen and dive operators. In order to achieve self-sufficiency, the program requires financial sustainability, a sufficient national capacity for management and political will, and public support.
This article reports on the crisis facing the Philippine s coral reefs and their effort to reclaim its previous grandeur on a local and regional level. Faced with growing destruction of the coral reefs, the Philippine government agencies and nongovernmental organizations have taken steps to solve the problem. But even more significant is the growing trend among local communities in taking the initiative to restore and conserve their natural resources. This local effort all started from a much-admired initiative of the Silliman University, which is based in Negros Oriental's capital city of Dumaguete, in getting people to recognize and act on the need to protect and preserve their coral reefs and marine resources. The major achievement made by the University was the formation of the community-based Marine Conservation and Development Program in 1985, which sparked a series of initiatives among local communities in protecting the Philippine coastlines.
Silencing the dynamite fishers.
Dynamite fishing in the villages near Tanga is not a widespread practice but a highly damaging one. This and other destructive methods of fishing, coupled with too many people fishing, are viewed as the most critical environmental issues in Tanga. In response, the regional government sought help from the World Conservation Union for technical assistance and program development. After 2 years of program implementation, significant changes were observed. These changes were attributed to participatory appraisals of used coastal resources and the problems and methods of solving them. In addition, villagers also helped in the collection of information for the appraisal and review of the results. A number of actions were undertaken to increase income without compromising the coral reefs. Furthermore, the committees worked closely with marine police and fishery officers to patrol and inspect gears and catch dynamite fishers. Despite the chronic shortage of finances in resource management, the village committees are very committed to forging new ways of working with government officials to achieve better management and enforcement, and perceive each other as allies to meet the challenges of resource sustainability.
Coral reefs and the World Bank.
The World Bank s involvement in coral reef conservation is part of a larger effort to promote the sound management of coastal and marine resources. This involves three major thrusts: partnerships, investments, networks and knowledge. As an initial partner and early supporter of the International Coral Reef Initiative (ICRI), the Bank serves as the executive planning committee of ICRI. In partnership with the World Conservation Union and the Great Barrier Reef Marine Park Authority, the Bank promotes the efforts towards the establishment and maintenance of a globally representative system of marine protected areas. In addition, the Bank invested over $120 million in coral reef rehabilitation and protection programs in several countries. Furthermore, the Bank developed a Knowledge Bank that would market ideas and knowledge to its clients along with investment projects. This aimed to put the best global knowledge on environmentally sustainable development in the hands of its staff and clients. During the celebration of 1997, as the International Year of the Reef, the Bank planned to cosponsor an associated event that would highlight the significance of coral reefs and encourage immediate action to halt their degradation to conserve this unique ecosystem.
China's fickle rivers: dry farms, needy industry bring a water crisis.
This paper concerns a water crisis and the impact it had on the lives of Chinese village peasants, who depended on the Yellow River for agriculture and industry. The crisis occurred when the government restricted the peasants from using the water from the Yellow River and only allowed the oil industry access to the water supply. This scenario was another indication of China's developing water crisis. The government favored the oil industry by declaring a state of emergency that forced farmers and factories to close sluice gates so that the water would reach Dongying, where the oil company was located. This bias was just one of the many problems that caused the water shortage. Chinese government scientists had predicted that the demand for Yellow River water would outstrip available supplies by 250 billion cu. feet in the year 2000, while the World Bank s assessment went beyond that of the scientists predicted value. Although China ranks 6th in the world in total water resources, at that time the abundant water resources were often found in the wrong places at the wrong time, so a shortage still occurred. Since the Yellow River is key to the people s survival in that region, the government planned a series of new dams to be built, which would control the flow of river water.
The freshwater biodiversity crisis.
This article concerns the threat on freshwater ecosystems, which harbor a disproportionate amount of the world's biodiversity. In many parts of the world, freshwater ecosystems are already degraded from a range of human activities, including water extraction, pollution and physical alteration. The data that showed a biodiversity crisis in ecosystems included species loss and breakdown of the ecological processes and resources. Furthermore, several case studies were cited to illustrate the status of freshwater diversity. Numerous reasons for freshwater biodiversity loss were mentioned, which included pollution from pesticides and agricultural and mine run-off, and physical alteration through channelization and impoundments that affected the hydrology and benthic habitat. Despite the successful establishment of institutions to conserve water birds and wetland habitats, there was a lower priority for conservation of freshwater biodiversity in terms of species and habitats. This bias has had important and serious implications for allocation of resources to increase the knowledge and understanding of freshwater ecosystems, as well as for the adequacy of impact assessments for development projects affecting them.
Dead zone hits record in the Gulf.
This article concerns the worsening condition of the Gulf of Mexico due to pollutants from the Mississippi River. Termed as the Dead Zone , this area is considered too overrun to support marine life and is at its worst in hot weather. The polluted area covers an estimated 7728 sq. miles. The phenomenon was first reported in 1974 by Dr. R. Eugene Turner, who discovered the deadly depletion of oxygen at the bottom of the gulf that is brought about by the flow of pollution in the form of excess nitrogen, which comes from agricultural runoff. These discharges promote an overgrowth of algae, which often leads to the utilization of oxygen upon decomposition. Furthermore, continuous flow of freshwater forms a separate layer on top of the thicker salty gulf waters, which prevents air from reaching the floor of the gulf. The measurement of the Dead Zone is based on water samples and instrument readings that were conducted by a federal task force charged with drafting a management plan for nutrient issues in the Mississippi River basin. Though it was clear that levels of nitrogen should be reduced, researchers debated on effective ways to reduce the levels of nitrogen.
Population: the critical decade.
This paper concerns the urgent need to address the world s environmental problems as a result of the increasing population. The human population is growing by 1 billion every 11 years and requires immediate action, since this will be the last chance to stabilize human population through humane and voluntary measures in this decade. The population problem requires a massive and immediate international effort and political will to implement family planning and development programs that are known to rapidly reduce birth rates. The implication of the current population trend also calls for efforts that will alleviate widespread poverty and promote peaceful democratic changes. The implications of population trends are based on the close link among poverty, population growth, and environmental degradation, which cause many of the environmental problems. Measures like quality reproductive health care, greater educational and economic opportunities for women and reduction in infant and child mortality rates must be developed to change this scenario. Population growth can be addressed by ensuring wider availability of birth control methods and family planning programs. The US stressed the need to prioritize population stabilization without deterring its assistance towards the developing countries. The paper suggests an efficient method in protecting global development initiatives to make a clear distinction between development assistance and foreign policy objectives requiring aid.
This article concerns the Organization of the Petroleum Exporting Countries (OPEC) crisis and its impact on energy efficiency measures in the US. In 1985, when the OPEC collapsed, the US government had avoided the need to construct 350 gigawatts of new electric capacity. The most successful efficiency improvements, especially in household appliances and equipment, lighting and tightened energy efficiency standards in new buildings, resulted from the OPEC event. The real innovation of that time was the change in profit rules for utilities. This revolution and the way some US utilities view energy have not caught on elsewhere. Despite the initiative toward improving energy efficiency in homes, offices and industries, the change has been slow. Partly to blame are the big development banks, which pointed out that short-term conservation and efficiency measures could save at least 15% of the total energy demand without the need for major investment. The benefits of energy conservation was shown during the oil shock when per capita energy consumption fell by 5% in the member states of the Organization of Economic Cooperation and Development, while the per capita gross domestic product grew by a third. There has been a decrease in energy expenditure worldwide, and the scope for further energy savings is enormous, but governments need to recognize and seize the opportunity.
Salvation from sewage in Calcutta marshes. Sustainable success stories: 1.
This article concerns the benefits of Calcutta's system of sewage and refuse disposal. In Calcutta, one of India's most beautiful cities, every day 20,000 people living and working in the East Calcutta Marshes transform a third of the city s sewage and nearly all of its domestic refuse into 20 tons of fish and 150 tons of vegetables. Developed by Dr. Ghosh, the ingenious system of maximizing waste products is low cost and uses a self-help sanitation scheme. Although the system is complex, its long-term benefit is wondrous. Calcutta s fish catch has risen and polluted water from sewage and industry is filtered and almost drinkable. Furthermore, several fishermen, who are reformed criminals, now fish for a living. Calcutta s sewage and refuse, once useless, has now become a valuable resource.
Why the Pope can't change the Church's position on birth control: implications for Americans.
The principle of papal infallibility pertains to the Catholic dogma that the pope is God's representative on earth and God guides him as he cares for his flock. When the pope formulates a doctrine, he is simply transmitting this dogma on God's behalf; the teaching cannot possibly be in error. Although this principle worked at first, Catholic intelligentsia recognized that at some point in the future, this principle would lead to self-destruction of the institution. The principle of infallibility became the fundamental principle of the Church upon which all other dogma would rest. Thoughtful Catholics understood that if this principle were destroyed, all Church teachings would eventually collapse. This paper discusses how the principle of infallibility is linked to the stance of the Church on the issue of birth control, contraception and abortion. Humanae Vitae ruled out any change of the Church's position on birth control for all time. This paper further elaborates on how the papacy is threatened by legalized birth control and abortion; the commitment of the Vatican to block legal abortion; the bishops' Pastoral Plan for Pro-life Activities; and the outcomes of the Catholic bishops' Pastoral Plan.
A brief concept paper for Honduras: communicating reproductive health.
The US Agency for International Development, along with their counterparts has developed a strategy in Honduras that 1) expands the availability of reproductive health services for the less economically well-off and 2) embraces program sustainability issues for the largest nongovernmental organization, ASHONPLAFA, through the initiation of a new line of services tailored to the upper middle class market. The Mission requested technical assistance from the PCS project to assist them and their local counterparts in designing, producing and evaluating reproductive health communication strategies and campaigns which meet the Mission's overall strategic objectives. Over the last 6 months, a series of discussions with the key players in Honduras have led the PCS team to propose a series of interrelated campaigns, which should be carried out over 18 months. These campaigns included the ASHONPLAFA internal campaign, ASHONPLAFA image campaign and the third is generic reproductive health for all key players. The activities included in this campaign are discussed.
Consumer perceptions of quality of family planning services in Egypt. [Draft].
This paper presents the results from a study designed to explore consumers' expectations for quality of family planning (FP) services and how it may influence demand in Egypt. The first section of the paper presents findings on women's and men's knowledge of reproductive health issues, including their definition of FP, the various FP methods, rumors and misinformation about these methods, attitudes and decision-making processes about FP practice and sources of information on FP. The findings provide a context for the types of services that Egyptian women and men may want or need. The second section covers the elements of quality that participants consider critical to good services and how the participants ranked these elements. The elements of quality are illustrated by descriptions of women's experiences with FP services as either positive or negative examples of each element. Finally, the third section presents results on the respondents' willingness to pay for high-quality services.
The use of international human rights norms to combat violence against women.
Violence against women encompasses far more than the paradigm instances of battery or murder within the home and rape by acquaintances and strangers. Different types of violence against women implicate a surprisingly diverse array of international law sources and international institutions. The paper addressed seven areas of violence committed against women; namely, 1) domestic violence; 2) genital mutilation; 3) violence by police and security forces, including torture of detained women; 4) violence against women during armed conflict; 5) violence against women refugees and asylum-seekers; 6) violence associated with prostitution and pornography; and 7) violence in the workplace, including sexual harassment. Each of these forms of violence remains pervasive, yet each has been the subject of treaty provisions, resolutions of intergovernmental organizations, studies, or debate at the international level. In order to form effective strategies to combat violence, three theoretical challenges must be confronted and resolved, these theoretical strategies are discussed.
The intimate enemy: gender violence and reproductive health.
This document presents a brief on gender violence and reproductive health. It is stated that gender violence causes more death than cancer, malaria, traffic accidents or war and disability among women aged 15-44 years. The WHO estimated that at least 1 in 5 women has been physically or sexually abused by a man at some time in her life. Despite this, violence against women in the home was not explicitly declared a breach of women's human rights until the 1993 UN World Conference on Human Rights. The negative impact of gender violence on women's reproductive health is only just beginning to be recognized. Domestic violence and sexual violence are considered to be reproductive health problems because they are intertwined with sexuality, fidelity, pregnancy and childbearing. International consensus against gender violence and national laws that criminalize such abuse are important. This document is divided into eight sections: Uncovering a Global Tragedy; Recognition, Change and Resistance; Understanding Gender Violence; An Encyclopedia of Gender Violence; The Health Consequences of Gender Violence; What Can Be Done; Act Locally; and Community Action.
State responses to domestic violence: current status and needed improvements.
This paper reports on state responses to domestic violence, which endeavors to contribute to the process of reforming the legal treatment of such violence. A review of the literature revealed that most states continue to address domestic violence through their constitutional provisions and their penal and civil codes. Analysis of the study, which surveyed 146 women's rights advocates, including lawyers, academics and service providers from 94 states, is also presented. Chapter 1 provides a broader context placing legal form as one among many strategies designed to eradicate gender violence. Chapter 2 identifies international legal instruments and standards relevant to domestic violence. It demonstrates that many norms and provisions implicate the subject of domestic violence and may be interpreted to require states to both prohibit and prevent domestic violence. Chapter 3 reviews selected laws that states have employed to address the issue. Chapter 4 presents the survey respondents' evaluation of the legal treatment of domestic violence and their recommendations for its improvement. The last chapter incorporates the conclusions of the research into a model for drafting domestic violence legislation.
The reach of the "SIDA dans la Cite" AIDS prevention television series in Cote d'Ivoire.
This paper examined target group coverage and targeting efficiency through the utilization of a survey from 2171 individuals for SIDA dans la Cite (SDLC), a popular television soap opera on AIDS in Cote d'Ivoire. The key target groups for the program are those with an elevated risk of contracting the HIV virus and those with low socioeconomic status who are very likely to have limited access to health information and services. The majority of people living in electrified locations have access to a television set and have been exposed to AIDS information broadcasts on radio and TV, these findings show that SDLC exposure is very high. Very good coverage has been noted among elevated-risk groups, and moderate to good coverage among the low socioeconomic status groups. The finding that rural populations obtain AIDS information overwhelmingly from radio and television implies that televised HIV prevention information can play a crucial role in electrified rural regions. In view of this, it is important to recognize that television, like radio, can play an important role in providing information about HIV/AIDS prevention, especially when there are few alternatives.
In response to the significant changes that took place in the Philippine Population Program, the Commission on Population (POPCOM) and The Johns Hopkins University developed the project entitled Organizing for Population Advocacy and Mobilization in Local Government Structures. The goals of the project were to 1) create a favorable policy and program environment for the Philippine Population Management Program at the national and sub-national levels; 2) upgrade the advocacy skills of POPCOM staff; and 3) build the capabilities of the local government units in the local population policy formulation and program promotion. Project activities were directed through local government mobilization, legislative liaison, youth involvement, community participation, and mass media outreach. Problems in implementation were encountered, which included delays in project start-up, too much central office control, and low turnout of local chief executives. Two lessons were learned from the implementation experience; namely, that participation of regional leaders and influential people are relevant and that project success can be achieved through intensive preparation and participation.
The final report of the AIDS Communication Campaign conducted nationwide in the Philippines reports on the 10-month informative-motivational mass media and public relations campaign. The campaign aimed toward preventing the transmission of HIV/AIDS through various modes among Filipinos to reduce the impact of the disease on individual, family, and society. The campaign was conducted in four waves, from July 1995 to February 1996, its activities included a review of available research data; revision of media materials from the previous AIDS campaign; a series of mass and small media materials; and a mass media/public relations campaign. Overall, the follow-up survey indicated an increased awareness of the AIDS disease among Filipinos. Misinformation in transmission and risk-reduction issues, however, remained even after the campaign had ended. Lessons learned and problems encountered are specified in the article.
Sex on TV: content and context. A biennial report to the Henry J. Kaiser Family Foundation.
In general, the influence of television on social beliefs, attitudes, and behaviors tend to occur by a gradual, cumulative process that is most likely to develop with repeated exposure over time to common patterns of behavior. This study provided a complete and comprehensive examination of sexual messages found across the overall television environment in the US. A large, representative sample of programming that totaled 1351 shows was gathered using a composite week design complemented by an over-sample of prime-time programming. Findings are organized into sections that look into the presence of sexual messages, types of talk about sex, types of sexual behaviors, messages involving sexual risks or responsibilities, contextual elements in scenes with sexual intercourse, comparing patterns of sexual content across program genres, sexual messages involving teenagers, sexual messages in prime-time network programming and sexual messages in children's programming. Overall, this study confirmed that sexual messages are a frequent part of the television landscape, but it also emphasized that such messages follow a pattern that pose some concern.
USAID / Jordan: 2000 results review and resource request.
This document concerns the progress and the problems that were encountered by the US Agency for International Development (USAID) in implementing its programs in Jordan. A Mission was posed that would create a strategic agenda, supported by almost US$750 million in program resources in the coming 5 years, that would respond to Jordan's most pressing development constraints, yet remain achievable given staffing and operating expense limitations. This Mission was successfully met. The USAID/Jordan remains well prepared to continue to deliver critical development results that support USAID and the Government of Jordan development priorities, as well as respond to important US foreign policy objectives. Three Mission strategic objectives were formulated in 1997: 1) direct support to the US Embassy/Amman's effort to foster political stability, support economic prosperity and address important global issues in population and the environment; 2) improvement in water resource management; and 3) increasing practice of family planning with an emphasis on modern methods. Although the assistance arrived late in the fiscal year, the Mission achieved measurable development results in 1997 and is expected to make significant progress under the Mission's three strategic objectives by September 2000.
USAID / Nigeria results review and resource request (R4), FY 1997-2000.
This document describes the progress and the problems encountered by the US Agency for International Development (USAID) in implementing their programs in Nigeria. From being confronted with Nigeria's political and social problems, the USAID/Nigeria formulated strategic and special objectives that corresponded directly to the Mission Performance Plan (MPP) prepared by the US Embassy in Lagos. The MPP listed 19 objectives, and out of these 19, 6 are directly and strongly supported by the USAID/Nigeria's program. Based on these objectives, program activities were conducted to meet them. The activities were directed to meet the objectives for family planning, child survival, HIV/AIDS, and democracy/governance. The performance rating for fiscal year 1997 either exceeded or met expectations in nongovernmental areas.
USAID / Ecuador results review, FY 1997 and resource request, FY 1999 - FY 2000.
This document describes both the progress and the problems encountered by the US Agency for International Development (USAID) in implementing their programs in Ecuador. The document is organized into four parts. Part I presents the overview and factors affecting program performance. Part II discusses the realignment of USAID/Ecuador portfolio, focusing on three Strategic Objectives (SOs) and three Special Objectives (SpOs) as part of the new Strategic Plan for fiscal year 1998-2002. These SOs are Biodiversity Conservation, Family Planning/Health, and Civil Society, while the SpOs include Pollution Prevention, Microenterprise, and Good Governance. The evaluation was able to find that all SOs and SpOs were met. Part III focuses on the status of the management contract, and part IV discusses the resource request.
USAID / Ghana: results review and resource request (R4), FY 2000.
This document describes the progress and the problems encountered by the US Agency for International Development in implementing its programs in Ghana. This document is organized in four parts. Part I presents an overview and findings of the factors affecting program performance, while the performance analyses of four strategic objectives were discussed in part II. These four strategic objectives are 1) increasing economic growth; 2) increasing the effectiveness of the primary education system; 3) improving family health; and 4) enhancing civic participation and accountable governance. Under each discussion, the expected progress through fiscal year 2000 and management actions were indicated. Part III focuses on the status of the management contract. Part IV discusses the resource request for fiscal year 2000.
USAID / Tanzania: FY 2000 results review / resources request.
This document describes the progress and the problems encountered by the US Agency for International Development (USAID) in implementing its programs in Tanzania. Changes in the broader development context were insignificant despite economic and political problems encountered due to El Nino. The USAID/Tanzania had five strategic objectives (SOs) to obtain. SO 1 aimed to increase the use of family planning, maternal and child health and HIV/AIDS preventive measures. SO 2 established the foundation for the adoption of environmentally sustainable Natural Resource Management practices. SO 3 established the foundation for the transition to democratic governance. SO 4 aimed to increase micro and small enterprise participation in the economy, and SO 5 aimed to improve the rural road in a sustainable manner. Of the five SOs, only SO 4 fell short of the expectation, while the remainder met the expectation. Likewise, the factors affecting the level of program performance to meet these SOs are discussed.
USAID / Senegal results review and resource request, (R4), FY 1997-2000.
This paper presents the evaluation results of the US Agency for International Development/Senegal (USAID/Senegal) program for the fiscal year 1997-2000. The paper primarily discusses the progress of the program towards its strategic objectives (SOs); namely, 1) decreased family size, 2) increased crop productivity through improved natural resources management (NRM), and 3) increased liberalization of the markets for agricultural resources-based product. A special objective of USAID/Senegal is to improve democracy and governance. The evaluation findings of SO 1 indicated that the program had met targets in most areas. As to SO 2, a January 1998 impact assessment reported that significant impacts are evident from the 5 years of investment in promoting NRM in Senegal. The achievements during the 5-year investment period included completion and validation of the National Environment Action Plan; increased adoption and spread of key NRM practices; improved income generation and quality of life from natural resources-based enterprises; continued high credit repayment rates; success of the empowerment-ownership-sustainability triad; enhanced capacity of government organizations and nongovernment institution related to natural resources sector. The evaluation findings relating to SO 3 showed that most of the required reforms were completed ahead of schedule. The monitoring of markets exceeded expectations. Its special objective was also achieved.
Madagascar: FY 2000 results review.
This paper presents the results review of the US Agency for International Development (USAID)/Madagascar program for the fiscal year 2000. The USAID/Madagascar program has three strategic objectives (SOs); namely, 1) foster an environment in which private action can flourish, 2) smaller, healthier families, and 3) biologically diverse ecosystems conserved in priority conservation zones. The first part of the paper presents an overview of the program and factors affecting program performance. The results of the performance analysis are presented based on achievements of prestated outcomes of each of the three SOs. Tables are used to summarize program achievements and indicators. The management contract of USAID/Madagascar is discussed at the end of the paper.
USAID / Guinea FY 2000 results review and resource request (R4).
The Republic of Guinea has been distinguished as a leader in improving regional security, undertaking economic restructuring, implementing law enforcement against drug trafficking, and curbing illegal immigration to the US. This paper presents the results review and resource request of the US Agency for International Development/Guinea program for the fiscal year 2000. The program is designed to meet the following strategic objectives: 1) growth in agricultural markets; 2) increased use of essential family planning, maternal and child health, and sexually transmitted disease/AIDS-preventive services and practices; and 3) provision of quality primary education to a larger percentage of Guinean children, with emphasis on girls and rural children. The program also aimed to foster civil society development and good governance. Part I of the report presents an overview of the USAID/Guinea partnership and the factors affecting program performance. Results of the program analysis are presented in detail in part II. Parts III and IV focus on the status of the USAID/Guinea management contract and resource request.
USAID / Dominican Republic results review, resource request, FY 1997-2000.
This paper presents the results review of the US Agency for International Development (USAID)/Dominican Republic program for the fiscal year 1997-2000. The USAID/Dominican Republic program has the following strategic objectives: 1) institutions which contribute to increased economic opportunities for poor Dominicans; 2) increased use of effective preventive health services and practices; 3) more participatory, representative and better functioning democracy; and 4) increased national capacity to produce environmentally sound energy. Part I offers an overview of the USAID/Dominican Republic partnership and the factors affecting program performance. Results of the program evaluation are presented in detail in part II. Parts III and IV describe the status of the USAID/Dominican Republic management contract and resource request.
Results review and resource request, R4, Brazil.
This paper reports on the progress of Brazil's program for sustainable development in cooperation with the US Agency for International Development (USAID). The USAID/Brazil initiative has four strategic objectives: 1) adoption of environmentally and socioeconomically sustainable alternatives for sound land use adopted beyond target areas; 2) increased adoption by key actors of concepts, methods, and technologies for clean and efficient energy production and use; 3) increased sustainable and effective programs to prevent sexual transmission of HIV among target areas; and 4) increased access to contraceptive methods and integrated family planning services to improve women's reproductive health. In addition, the program has two special objectives; namely, 1) improved quality of life for at-risk youth in target and 2) improved capacity of prosecutors and police to fight organized crime. Part I offers an overview of the USAID/Brazil partnership and factors affecting program performance. The results of the program analysis and expected progress are presented in detail in part II. Part III describes the status of the Brazil/USAID management contract, and part IV presents the resource requirements.
USAID / Malawi results review and resource request, FY 2000. Part 1 - Results review.
This report presents the evaluation findings of the US Agency for International Development (USAID) program in Malawi. The USAID/Malawi program is designed to meet the following strategic objectives: 1) increased agricultural incomes on per capita basis; 2) increased sustainable use, conservation and management of natural resources; 3) increased adoption of measures that reduce fertility and risk of HIV transmission, including improved child health practices; 4) increased access to and quality and efficiency of basic education, especially for girls; and 5) a strengthened and broadened institutional base for democratic participation. Part I offers an overview of the USAID/Malawi partnership and the factors affecting the program performance. The progress of the program is highlighted in part II. The final section discusses the status of the USAID/Malawi management contract.
Consensus guidance for updating practices: hormonal methods and IUDs. Draft.
This consensus document serves as a reference for service providers on procedural steps for administration of hormonal methods and IUDs. It also contributes to the reduction in the number of barriers to family planning services that result from outdated or unnecessarily restrictive medical practices. In addition, this document contains tables that summarize the expert opinion of the Working Group members on selected procedural questions in the delivery of combined oral contraceptives, progestin-only injectables, NORPLANT Implants and IUDs. Furthermore, two major assumptions behind the guidance given in this consensus document were highlighted, while four classes were established to differentiate procedures. The last section, on the other hand, reflects the conviction of the Medical Barriers Guidelines Working Group that aimed to reduce medical barriers and increase access to quality family planning services. Lastly, the appendices contain information on the applicability, precautions and contraindications, promotion, reduction of medical barriers and organizations and agencies affiliated with the distribution of contraceptive methods.
A three-phase pilot project was developed in Tanzania in response to the lack of information, and the demand and expressed need for the training of health attendants. Phase 1 consists of the Needs Assessment Study, which contains the findings and recommendations used in the development of a valuable training strategy and the pretesting of the training strategy. The later phases include the training of health attendants using the developed materials (phase 2) and the evaluation of training effectiveness (phase 3). This report presents Part 1, Phase 1 and the study s findings on the potential of health attendants for family planning and reproductive health expansion in Tanzania. The Needs Assessment Study explored the potential of health attendants in providing family planning and reproductive health (FP/RH) services. Furthermore, it assessed the ability of health attendants in obtaining data used as a guide in the expansion of services. Positive results of the study included the presence of a stable and dependable workforce, sustainable training efforts, delivery of FP/RH services by male and female health attendants, acquisition of rudiment FP/RH knowledge and skills, integration of FP into other services, ability of health attendants as potential community motivators and educators and FP providers, and existence of FP/RH infrastructure. Shortcomings on supplies, management, essential commodities, and transportation were noted.
Communications and development: a practical guide.
This document provides a practical guide to communications in the Department for International Development (DFID) programs by emphasizing the information needs and rights of the poor and marginalized population. Furthermore, it aids in defining an emphasis on rights and on strengthening civil society and encouraging program ideas and improving existing initiatives. The guide is divided into three sections, where section 1 presents an overview on development communication. In section 1, communication issues are merged with main social development principles presented within the context of the DFID agenda. In addition, section 1 discusses communication as a means of exchanging information between stakeholders. Section 2 concerns communication strategies by covering key issues and presenting case materials. Section 2 describes how communication issues stretch across many project outputs and across all parts of the project cycle. Section 3 describes the different kinds of media, which included drama (theater and video), broadcast media (television and radio) and other forms of media covering information and communication technology, advocacy and public relations, and networks.
This 1998 World Population Profile series of the Census Bureau provides a comprehensive assessment of world demographic prospects for the end of the 20th century. Major demographic trends, roles of less developed and more developed nations, and factors and uncertainties underlying global population change are presented. The report includes the demographic information of 227 countries and territories, as well as the methods and assumptions that was used for estimating population and projections. The special focus section, on the other hand, provides an update on one of the key international health and demographic events and the source of the uncertainty associated with demographic change in the coming decades--the worldwide HIV/AIDS pandemic. Further highlighted in the report is the continuous increase in population growth despite the decline in fertility rates and the HIV/AIDS pandemic. Projections of the Census Bureau in the early part of the 21st century indicated an enormous increase in death rates, exceeding the birth rates of the more developed countries. Figures on population size and growth and the components of change, population composition and distribution, contraceptive prevalence, and prevalence of HIV/AIDS in the developing world are included.
Focus on HIV / AIDS in the developing world.
This US Census Bureau Report focuses on the impact of HIV/AIDS pandemic on populations and the status of the HIV/AIDS epidemic in selected countries. The major demographic impacts on population of AIDS mortality resulted to high crude death rates, setbacks in improving infant and child mortality, slowed population growth and decline in life expectancies. Perhaps the largest demographic impact of AIDS mortality will be on life expectancies. The HIV/AIDS epidemic continues to develop in sub-Saharan Africa. Many can be described as generalized with high (over 5%) HIV prevalence in general adult population and increasing urban to rural equalization of HIV prevalence. In Asia, on the other hand, is extremely diverse ranging from countries with no evidence of an epidemic (Mongolia, South Korea) to countries with high HIV prevalence among population exhibiting high-risk behaviors, as well as evidence of HIV prevalence in the general population (Cambodia, Burma, and Thailand). HIV/AIDS is well established in the Caribbean and Latin America region but information is scarce. Levels of HIV prevalence and subsequent AIDS mortality are having impacts on population in Guyana, Haiti, Honduras, and Brazil. By the end of 1997, the UN Joint Program of HIV/AIDS estimated that over 40 million people had become infected since the beginning of the pandemic in the late 1970s with majority of the infection occurring in sub-Saharan Africa.
Proceedings of the expert meeting on female genital mutilation, Ghent, Belgium, November 5-7, 1998.
This document presents the proceedings of the expert meeting on female genital mutilation (FGM), which took place in Ghent, Belgium, on November 5-7, 1998. The goal of this meeting was to discuss a number of recommendations for the European Commission, concerning strategies to combat FGM in Europe. Experts from Africa, Europe and the US were brought together in order to exchange ideas and to help formulate these recommendations. Three working groups were created to discuss FGM in Europe, focusing on its medical, sociocultural and legal aspects. Discussions and findings of the workshops are presented in detail. African experts provided valuable input in making the recommendations realistic and compatible with the fight against FGM in Africa, as well as among the immigrant population of other continents. The American participants contributed their long-standing experience with regard to implementation of anti-FGM legislation among immigrant populations.
Strengthening Egypt's population program.
This presentation discusses an analysis of the costs and benefits of slowing the growth rate of the Egyptian population. Data for this presentation come from Egypt, the 1988 Demographic and Health Survey and the 1990 Pan Arab Child Survey. Overall, it is stated that it would be highly beneficial to the people and Government of Egypt to strengthen and accelerate its national population program beyond what has been planned. Findings showed that essentially every couple know where family planning can be obtained, and more and more couples are coming to recognize the material advantages of smaller families and having only those children whom they can properly nourish, educate, and supervise. A proposal for setting a new national goal of a two-child family is presented. Such measures emphasize the fundamental importance of strengthening the current family planning program, which include stepping up motivational activities to encourage smaller family size, increasing the availability of contraceptives and increasing the participation of both the private and public sectors in Egypt's national family planning program.
How to listen, how to speak: a model information campaign on the prevention of HIV and AIDS.
In Brazil, most of the efforts to shed light on AIDS and its prevention have been campaigns based on the guidelines pinpointed by technicians and authorities in the health and social communication fields; however, it was noted that such an approach almost never had very satisfactory follow-up efforts. Hence, the Program for the Production of Educational Material for Specific Groups for HIV/AIDS Prevention has put forth efforts in fundamentally diverse ways. Based on a strategy involving certain target groups, the concern has been to elaborate a methodology to allow for quick evaluation of results as well as eventual corrections in the direction the course was taking. Its general objective has been to strengthen and increase informative and educational efforts for HIV/AIDS prevention for the risk-behavior population of Rio de Janeiro. The project report is presented in 4 chapters. Chapter I is about the work done on the Vila Mimoza prostitutes. Chapter II discusses the approach used in addressing street kids. Chapter III presents the projects targeting homosexuals, such as the Dial AIDS hotline and the distribution of posters and cards. Chapter IV discusses the failures and triumphs, as well as the losses and gains in the project.
This paper presents an annual quarterly report for the period (January to March 1989) and a summary of activities for the period (April 1988 to March 1989) of the information, education, and communication component of the Nigeria Family Health Services (FHS) Project. The main focus of the activities was the coordination and strengthening of national level programs best exemplified by the Federal Ministry of Health's development of a national family planning logo. In addition, there was a selection, pretesting and recording of two songs and music videos by King Sunny Ade and Onyeka Onwenu. This enter-educate project promoted family planning and sexual responsibility through music. The overall strategy for statewide mobilization campaigns included orchestrated mass media, training and materials production activities for priority audiences. Research and evaluation activities were emphasized in the lessons learned from past experiences to improve future communication projects in Nigeria. It was hoped that FHS would continue to meet the challenge of expanding and strengthening family planning programs nationwide.
In 1992, The Asia Foundation (TAF) and The Johns Hopkins University Population Communication Services decided to replicate information, education and communication (IEC) interventions in two areas of TAF-supported projects. The first project site, Promoda Sundari Sen (PSS), had contraceptive prevalence rate (CPR) of 61%, with very good management, while the other site, Bandhan, located in the Noakhali district had a CPR of 45%. The replication of IEC interventions in PSS is discussed. The implementation started with the orientation of the PSS project staff on IEC interventions. Field workers and supervisors then selected the Jiggashas by using predetermined criteria. The field workers developed a routine visitation system to visit the Jiggashas to provide services to clients of the Jiggasha catchment area. In general, the interventions have brought knowledge and awareness among the clients about family planning, particularly regarding the use of contraceptives.
Statement on quality of care. [Summary of key points].
This paper presents a summary of the key points of a statement on quality of care that was developed jointly by the International Planned Parenthood Federation (IPPF) technical expert panels. Quality of care is an essential element of the IPPF Strategic Plan, called Vision 2000, which places the following challenge before the IPPF: successfully addressing the need for quality of care is the key to the future viability and continued credibility of IPPF and family planning associations (FPAs) as the conscience of the family planning movement. In order to provide quality of care, the clients' rights and the providers' needs have to be addressed. Following this framework recognizes the rights of clients to information, access, choice, safety, privacy, confidentiality, dignity, comfort, continuity, and self-expression. Providers, for their part, should have the following needs met: training, up-to-date information, adequate physical infrastructure and family planning supplies. Quality of care at the strategic level should involve aspects of advocacy, access to education and services, as well as monitoring. The role of IPPF and FPAs in demonstrating quality of care is discussed. In brief, it is the responsibility of FPAs to ensure that quality of care is provided within whatever is available, and to devise an effective, permeating and sustained environment and system for improved quality of care.
The purpose of this report was to provide information to the Family Planning Services Division of the Office of Population, Agency for International Development on approaches to the quality of care of eight of its cooperating agencies (CAs); namely, Association for Voluntary Surgical Contraception, Cooperative Assistance Relief Everywhere, Center for Development and Population Activities, Enterprise, International Planned Parenthood Federation/Western Hemisphere Region, Pathfinder, Family Planning Services Expansion and Technical Support project, and Social Marketing for Change project. The report addresses questions on the following areas: CA definition of quality of care, approaches to assessing quality, success stories, constraints to quality of care, future activities, and their recommendations regarding quality of care. The overall approaches of quality assurance fall into four categories: grass roots, medical/management monitoring, information and training, and method/stage of program approach. The approaches to assessing quality of care that are developed by each CA are often complementary. Some of the major constraints to quality of care include lack of understanding of client-oriented services, provider bias, and restrictive government policies. Estimated resources devoted for quality of care was between 5 and 30%. In terms of the future of the quality of care, all CAs would like to increase levels and approaches, and try new approaches and activities in the area of quality of care.
Institutionalizing continuous quality improvement (CQI): MEXFAM's experience.
In 1991, the Fundacion Mexicana para la Planeacion Familiar (MEXFAM), a nonprofit, private family planning organization that provides family planning and reproductive health services in Mexico, started to introduce continuous quality improvement (CQI) management techniques into the organization within an operations research context. The project aimed to improve the quality of services offered thereby increasing the acceptability of family planning and continuation rates of contraception as well as the cost-effectiveness of the organization. In essence, the core of the CQI strategy was to establish quality work teams and interfunctional teams. During the first year of activities, MEXFAM developed appropriate training materials, prepared a core team of facilitators to guide quality improvement team meetings, and provided quality-related training to employees in its headquarters and 7 logistic regions. During the second year, MEXFAM began quality improvement team activities. The paper presents the structure and development of CQI in MEXFAM, and shows basic process statistics and illustrative examples of projects conducted by quality improvement teams. Discussed in the final section are the achievements and difficulties in conducting quality improvement activities in decentralized, nonprofit organizations with a large number of volunteers.
This report contains the proceedings and recommendations of the Pathfinder-sponsored workshop on Family Planning Quality of Care in Asia held on April 3-8, 1993. The purpose of the workshop was to catalyze efforts to improve quality of care (QOC) in the family planning programs in the region. The objectives for the workshop included 1) addressing the role of QOC in family planning services, 2) analyzing QOC concepts, 3) agreeing on a working definition of QOC, 4) developing an implementation plan for QOC baseline studies, and 5) agreeing on QOC indicators and the methods to measure them. A total of 13 papers were presented as background to the various views and approaches to QOC in family planning. The workshop enabled the participants to develop a definition of QOC within the Bangladesh context and determine the elements and indicators of process, outcome, and impact. Family planning QOC refers to the degree to which the services provided were able to meet the needs and preferences of clients and prospective clients. It also refers to a set of minimum standards, considers available resources, and addresses the following 8 elements of quality: service access and convenience, provider technical competence, interaction between service provider and donors, choice methods, provider-client information exchange and interaction, appropriateness and acceptability of services, mechanism to ensure continuity and service site conditions. Indicators of each QOC element are presented.
Report on EPI Message Development Workshop, 26-30 October 1991.
This report briefly describes the activities of the Expanded Program on Immunization (EPI) message development workshop held at Rajendrapur, Bangladesh, on October 26-30, 1991. The purpose of the workshop was to 1) expose participants to suitable methods of identifying EPI issues and problems and to define the target groups for specific messages; 2) transfer useful skills to the participants so that they can develop appropriate messages; and 3) demonstrate message testing techniques and provide field based exercises so that participants could get first hand experience. The workshop was participated by 16 participants drawn from 11 government and nongovernmental organizations who were involved with maternal and child health/EPI message development, dissemination and evaluation. The content of the workshop included issues relevant to message development based on conceptual clarity, exploration of past experiences and skill development. The outcomes of the workshop were 1) identification of 25 message needs; 2) development of 35 message concepts, which may be further developed for future use; 3) development and pre-testing of 10 materials with messages; 4) exposure of participants to systematic message development and testing process; and 5) establishment of scope/mechanisms for involving organizations and persons for developing/reviewing program communication messages/materials including EPI.
"Sexual responsibility" message in songs and soap operas: Phyllis T. Piotrow and Patrick L. Coleman.
Mass-media entertainment campaigns focusing on reproductive health have been reaching millions of young adults in 40 countries worldwide. Among the themes addressed in the campaigns were sexual responsibility, family planning, teenage pregnancy, AIDS, and other reproductive health issues. According to public health experts, extensive documentation of the impact of the campaigns, their focus on sexual responsibility, and their strong commercial appeal make them distinctive in public health communication. Grounded on the enter-educate approach of learning new behavior, this approach uses entertainers and artists to draw attention to new behavior, simultaneously entertaining and educating the audience. A number of innovative avenues have been used by countries to convey messages concerning reproductive health; namely, live concerts, television dramas, and radio spots. Increases in calls to telephone counseling centers, visits to family planning clinics, and adoption of contraceptive methods are indicators that the enter-educate campaigns pioneered by Phyllis T. Piotrow and Patrick L. Coleman are effective ways to reach young adults and change their behaviors.
NCIH poster session: JHU / PCS evaluation of Nepali family planning booklets.
In June 1986, consultant Scott Wittet, in collaboration with Ann Jimerson of The Johns Hopkins University Population Communication Services (JHU/PCS) prepared a poster session for the National Council for International Health Conference in the District of Columbia. The attractive display described the evaluation of two family planning booklets developed by the Nepal Maternal and Child Health/Family Planning (MCH/FP) Project with the support of JHU/PCS. The MCH/FP-JHU/PCS display showed the stages in the formative evaluation of the booklets and final evaluation survey results. Approximately 40 conference participants viewed the display and discussed the project with Mr. Wittet. A handout, which described the survey in greater detail, was also distributed. The full text of the display is presented in the paper.
This paper provides a detailed assessment of the quality of service providers family planning (FP) counseling skills; quality of information provided during FP counseling sessions; and the availability and use of FP/information, education, communication (IEC) materials at service delivery points in Kenya. The study was carried out using observations of interactions between family planning providers and clients and subsequent interviews with these same providers and their clients at 25 service points throughout Kenya. A total of 105 providers, 155 new family planning clients, and 200 continuing clients participated in the study. The counseling skills of providers were assessed based on the key elements of FC counseling: greet, ask, tell, help, explain, and return. Overall, the providers displayed encouraging counseling skills. Significant differences, however, exist between community-based distribution (CBD) agents and non-CBD providers in terms of counseling skills. IEC materials were not widely available in the 25 service points observed, and were rarely used during counseling sessions. The situation analysis also highlights the strengths and weaknesses of the family planning program in Kenya. Knowledge of both counseling and utilization of IEC materials will help Kenyan family planning organizations improve their services.
Coached client evaluation of family planning counseling training in Zimbabwe.
In April and May 1992, the Zimbabwe National Family Planning Council (ZNFPC) conducted 2 training courses, one for community-based distributors (CBDs) and the other for nurses and doctors in family planning counseling and interpersonal communication. Curricula were based on extensive training needs assessments that revealed several weaknesses in counseling skills. To correct these weaknesses, ZNFPC designed skills-oriented training in counseling skills, conducted group talks, motivated maternal child health clients to use family planning methods, and used visual aids effectively. The paper reports the findings of a coached client evaluation methodology used to measure the impact of these training workshops on service providers counseling skills. The changes in counseling behavior of nurses and CBDs were measured by randomly selecting trainees to perform mock counseling sessions before and after training. These sessions were videotaped and were viewed by a team of trainers. The checklist included the same counseling skills that were required during training that should be applied during each counseling situation. Verbal and nonverbal interpersonal communication skills were also rated. Counseling observation scores for nurses increased from 13 to 20 post-training. CBDs showed much less improvement, reaching an average post-training score of 15. In conclusion, the coached client methodology proved to be a useful tool for evaluating immediate post-training impact on a service provider's counseling behavior.
Cameroonian nurses' perceptions of family planning: implications for nursing practice.
Perceptions of family planning service providers of modern contraceptive methods can determine their counseling practices. In particular, perceptions can affect the types of modern methods providers assist clients to choose. Nurses and midwives who provide 75% of the health services of Cameroon, and who are trained to work with communities are the most appropriate health providers to provide family planning services. A total of 67 family planning providers from 17 maternal and child health care centers were asked about their perceptions of modern contraceptive methods. Of the 67, 88% said modern methods should be available to all Cameroonians and 11% thought that modern family planning was a foreigner's plot to reduce African population. Service providers were likely to choose contraceptive methods for their clients. Of the modern methods stocked in the centers, providers said the pill was the most available (68%), the most recommended (69%), and the most effective (52%). In contrast, the IUD was the least available method (2%), the least recommended (2%), and perceived as the most harmful (24%). The condom was perceived as the least harmful and the least effective.
Family planning knowledge, attitudes and practices in Cameroon: baseline survey.
Cameroon is one of the African countries with strong pronatalist political and cultural systems that have joined the ranks of countries seeking to control population growth. The extent that population programs increase contraceptive rates depend partially on how carefully family planning projects utilize research data to plan, implement, monitor, and evaluate project activities. This paper presents the results of a baseline family planning survey conducted in 5 towns of Cameroon with diverse geographic, religious, and cultural characteristics and active family planning services. The towns were selected by using a purposive cluster sampling. A total of 500 men and women were interviewed. The respondents had characteristics favorable to contraception: urban residence, high education, Christianity, and access to family planning services. Family planning knowledge and use was high compared to national surveys. Project strategies, activities, materials, and services that resulted in increased use of modern methods will be adapted in other towns and villages. The success of project activities, including the use of research data for project monitoring and evaluation, is crucial for the expansion of family planning in Cameroon.
[National Nutrition Survey, 1996. Anthropometry]
The sample for Costa Rica s 1996 National Nutrition Survey included 1008 children aged 1-6 years, 582 children aged 7-12 years, 69 women aged 15-19 years, 865 women aged 20-44 years, and 120 women aged 45-59 years. 22.4% of the preschool aged children showed inadequate weight and 21.4% inadequate height for age. The proportion with deficient weight for age declined from 30.9% in 1982. 6.1% showed moderate or severe growth retardation and 5.1% moderate or severe malnutrition indicated by weight for age. 4.2% were overweight. 78.7% were of normal height or tall, compared to 70.7% in 1982. According to Waterlow s classification, 92% were of normal height, 2% were acutely malnourished, 5.7% were chronically malnourished, and 0.3% were acutely and chronically malnourished. School aged children and women were evaluated using the body mass index. 16.5% of school aged children showed nutritional deficiencies and 14.9% were overweight. 16.3% of girls and 13.6% of boys were overweight, but the proportions with nutritional deficits did not differ significantly. 75.4% of the women aged 15-19 were of normal nutritional status, 23.2% were overweight, and 1.4% were underweight. 45.1% of women aged 20-44 had normal nutritional status, 49.5% showed some degree of obesity, and 9% were malnourished. 50.6% in rural areas, 42.2% in metropolitan areas, and 44.8% in other urban areas were obese. No significant rural-urban differences were observed in nutritional deficits. Among women aged 45-59, 22.5% showed a normal nutritional status, 75% some degree of obesity, and 2.5% nutritional deficit.
[National Nutrition Survey, 1996. Micronutrients: iron, folates, Vitamin A, iodine, fluoride]
Costa Rica s 1996 National Nutrition Survey was conducted on a sample of 961 children aged 1-6 years, 538 children aged 7-12 years, 901 women aged 15-44 years, 68 pregnant women, 96 breast-feeding women, and 1108 households. The prevalence of anemia was 27.9% in pregnant women, 26% in preschool children, and 18.9% in women aged 15-44. 32.7% of preschool children in rural areas, 27.9% in other urban areas, and 16.6% in metropolitan areas were anemic. 56.3% of preschool children and 58.5% of pregnant women had deficient iron reserves measured in ferritin, with severe deficiencies in 44.5% of the women and 24.2% of the children. The prevalence of anemia was nearly unchanged since 1982. 24.7% of fertile-aged women and 11.4% of preschool children had deficient serum folate levels. Among the women and preschool children, respectively, 19.1% and 5.3% in metropolitan areas, 23.3% and 14.4% in other urban areas, and 31.4% and 14.2% in rural areas had folate deficiency. 8.7% of all preschool children, 9.1% in rural areas, and 8.5% in urban areas had vitamin A deficiencies. 31.4% of preschool children had marginal deficiencies (20-30 mcg/dl). 1% of breast-feeding women had vitamin A deficiencies. Iodine and fluoride deficiencies were assessed through urinary excretion in school aged children. 91.1% of children had adequate urinary excretion of iodine, and the proportion of households consuming salt fortified with iodine increased from 87.3% in 1989 to 97% in 1996. 91.6% of the fortified salt showed adequate iodine levels. The median urinary excretion of fluoride was 1.1 mcg/ml, considered normal. 97% of households consumed salt fortified with fluoride, and the level of fluoride was adequate in 90.5%.
[National Nutrition Survey, 1996. Intestinal helminths]
Results of the intestinal parasite study in the 1996 National Nutrition Survey show that Costa Rica has become the first Latin American country to achieve a high level of efficacy in control of intestinal helminthes. 508 preschool children aged 1-6 years, 268 schoolchildren aged 7-12 years, and 503 women aged 15-44 years were evaluated. The study showed a significant reduction in prevalence among preschool children between 1982 and 1996, from 6.9% to 1.6% for Ascaris, from 6.9% to 3.7% for T. trichiura, and from 0.4% to 0.2% for Ancylostomas or Uncinarias. In school children the prevalence of Ascaris declined from 6% to 3.4% and that of T. trichiura from 14.9% to 5.6%. The prevalence of Uncinarias increased from 1.5% in 1982 to 1.9% in 1996. Among the women, prevalence of Ascaris declined from 4.3% to 1.6%, that of T. trichiura from 12.4% to 2.7%, and that of Uncinarias from 2.7% to 0.4%. The data imply a reduction of prevalence of 58% for Ascaris, 77% for T. trichiura, and 85% for Uncinarias. The general prevalence of intestinal helminthes was 5.4%, and only 1% were infected with two or more types. The most frequent type in the total sample was T. trichiura (3.6%), followed by Ascaris (2%), and Uncinaria (0.6%). The declines reflect progress in Costa Rica in control of sewage, nearly universal access to potable water, and great advances since the 1970s in the primary health care strategy which includes diagnosis and treatment of parasites.
[National Nutrition Survey, 1996. Tooth decay]
A study of fluoride levels and dental caries was part of Costa Rica's 1996 National Nutrition Survey. Fortification of table salt with fluoride began in 1987. The fluoride level was determined through urinary excretion in a sample of 538 school children aged 7-12 years, and fluoride in salt was assessed in samples of salt from 1108 households. The median urinary excretion of fluoride was 1.1 mcg/ml, considered normal, in contrast to the 0.34 mcg/ml in 1985. The levels were 1.1 mcg/ml in the metropolitan and other urban areas and 1.2 in rural areas. 92.4% of rural households, 100% of metropolitan area households, 99.1% of other urban households, and 97% of Costa Rican households overall consume salt fortified with fluoride. 90.5% of the fortified salt had adequate levels of fluoride. 1014 preschool children aged 3-6 and 585 school children aged 7-12 were evaluated in the study of dental caries. 39% of preschool children overall had no caries and 29% had 1-4 teeth with a history of caries, extraction, or fillings. In rural areas, 40.7% of preschool children had 5 or more teeth with a history of caries. The average number of teeth with caries or extracted among preschool children was 3.8 nationally, 3.0 in the metropolitan area, 2.7 in other urban areas, and 4.0 in rural areas. Nationally, 23.7% of school age children had no caries, 21.7% had 1 or 2, 28.2% had 3 or 4, and 26.4% had 5 or more. The average number of teeth with caries, extracted, or filled was 2.6 in the metropolitan area, 3.4 in other urban areas, 3.2 in rural areas, and 3.2 nationally. The average number with caries, extracted, or filled was 5.24 in 1984.
[Work manual for the "nutritional collaborator"]
This work manual for nutrition collaborators in El Salvador is intended for use as a guide to activities with groups of mothers. Nutrition collaborators are community volunteers who receive training in nutrition and hold meetings and other activities to help mothers improve food and nutrition. The work begins with suggestions for encouraging the mothers to arrive promptly, share their ideas, and listen attentively. The necessary materials for each meeting are listed, beginning with an adequate meeting place. The nutrition collaborator s activities are then outlined. They form groups of 8-10 mothers with the help of the health clinic nurse, meet weekly to develop a theme and practical demonstration, and visit the homes of members to ascertain whether the new knowledge has been put into practice. Instructions for meeting preparations and conducting the meeting are then presented. Greeting the group, introducing new members, taking attendance, discussing actions since the prior meeting, leading discussion and development of the current theme, and planning the next meeting are the major responsibilities. The collaborators are expected to submit monthly reports of their activities to the clinic. They obtain free clinic care and other benefits in addition to the satisfaction of helping the community.
[Nutrition and AIDS: nutritional guide for AIDS patients and personnel caring for them]
This brief guide for AIDS patients and their caregivers presents recommendations for simple and readily available foods to provide adequate nutrition and defense against collateral diseases. The importance of nutrition in maintaining immune system function, the need to consume sufficient food to replace weight lost during episodes of illness, and the importance of a balanced diet are explained. Alcohol and smoking should be avoided. Alcohol interferes with absorption of nutrients and of most medications. Basic information on nutrition is then presented in terms of three basic food categories: 1) cereals, tubers, and legumes, which usually form the basis of the diet and furnish the majority of calories and protein and many of the B vitamins; 2) products of animal origin, which provide protein, vitamins B2, B6, B12, A, D, and minerals; 3) vegetables and fruits, which provide vitamins A and C and minerals. The functions of each of the three basic groups are described. Consumption of a wide variety of foods each day is recommended to assure that the body receives all the nutrients needed. At least 5 portions of grains, tubers, and legumes and 4 each of animal products and fruits and vegetables should be consumed. Simple menus balancing foods in the 3 groups are presented, along with suggestions for sanitary food preparation. Practical suggestions follow for special problems including increasing the protein or energy it the diet, too tired to eat, becoming satiated very soon, no appetite, pain in the mouth and throat, changes in the sense of taste, nausea, diarrhea, constipation, and reactions to medications.
In 1985, when El Salvador s Ministry of Public Health and Social Assistance presented the Child Survival Plan based on maternal and child health care, the Nutrition Institute of Central America and Panama (INCAP) became involved in providing technical and financial assistance with training of health personnel. This retrospective analysis of activities in 1985-89 was conducted to provide information on the strengths and weaknesses of plan implementation and INCAP assistance. Interviews were held to study activities carried out with the Integrated Child Survival Module and the three oral rehydration units in Santa Ana, San Miguel, and San Salvador. The investigation in June-August 1991 revealed that work with the Integrated Child Survival Module began with training of personnel in related areas in 1986. Two workshops were held in educational methodology and work teams developed the contents of the modules with INCAP technical assistance. In 1987, INCAP prepared the revised version and began distribution. In June 1988 the process of diffusion and utilization of the Integrated Child Survival Module was evaluated, but the report was not acted upon. Interviews with 17 persons involved in child survival activities revealed that 5 had no experience with the module because of their recent employment, and the other 12 had experience. Two groups of studies involving diarrhea and components of child survival were identified. Two of the three oral rehydration programs whose personnel received INCAP assistance were not longer functioning regularly because of personnel changes. The 17 interview subjects suggested projects for future INCAP assistance.
[Educational guide for the nutritional collaborator]
This guide for nutrition collaborators in El Salvador contains information about food and nutrition and suggestions for developing the themes with groups of mothers. The guide is intended as a reminder of material studied in the training course, and should be reviewed before meetings. Each topic is developed in two sections, the first containing material for the collaborator and the second containing suggestions for presenting the material at the meetings. The topics covered include good nutrition; nutrition for infants under one year; nutrition for children aged 1-5; growth monitoring in children; care of malnourished children; care of children with diarrhea, cough, or cold; personal hygiene; household hygiene; food hygiene; food storage; and increasing the quantity and variety of foods in the household.
[Study on seroprevalence and risk factors of maternal and congenital syphilis in Bolivia]
A study was conducted to obtain information for a national program to prevent congenital syphilis in Bolivia. 1428 women who delivered live infants and 43 with stillbirths at 7 hospitals in La Paz, El Alto, and Cochabamba in 1996 were tested with the rapid plasma test (RPR) for syphilis to determine its prevalence and risk factors. The sample amounted to 63% of mothers giving birth in the 7 hospitals during the study period. Mothers with reactive RPR and their newborns were treated before discharge. Maternal syphilis was diagnosed in 61 (4.3%) of the mothers with live births. Prevalence ranged from 2.7% to 6.4% in the 7 hospitals. 66% of the women with syphilis had at least one prenatal visit. 5% of women with syphilis and 3% without had signs suggestive of syphilis. Women with less than secondary education and those with a history of syphilis had the greatest likelihood of syphilis in multivariate analysis. 16% of mothers with syphilis and 7% without had low birth weight infants, but no significant difference was observed in prematurity rates. The 43 stillbirths were among 95 that occurred in the 7 hospitals during the study period. 26% of the mothers with stillbirths had syphilis. Women who had stillbirths were significantly more likely to have syphilis than mothers with live births, and were slightly less likely to have had prenatal care. There were very few false positive results with the RPR, and the same result was obtained in 96% of the 847 samples analyzed in both hospital laboratories and reference laboratories.
A brief survey is presented of advances in Mexico s family planning program according to data from surveys conducted over the past 20 years. The proportion of fertile-aged women in union who used a contraceptive method increased from 30.2% in 1976 to 66.5% in 1995. All 9 states surveyed in the 1995 National Family Planning Survey except Hidalgo showed increases in contraceptive usage during 1992-95, but the percentage of users was still low in Oaxaca (48.3%), Chiapas (51.1%), and Guerrero (54.1%). Between 1987 and 1995 prevalence increased from 61.5% to 71.3% in urban areas and from 32.5% to 52.7% in rural areas. It is probable that family planning goals for the year 2000 of 75% use in urban areas, 57% in rural areas, and 70.2% nationally will be met. Educational differentials have been declining. During 1987-95 the proportion of illiterate women using a method increased from 23.7% to 48.4%, while the increase was from 69.9% to 73.5% among women with secondary or higher education. Only 36.1% of women aged 15-19 who were in union used a method, and only 17.5% of childless women in union used a method. The most used method in 1995 was tubal occlusion (41.3%), followed by the IUD (21.9%), traditional methods (13.4%), oral contraceptives (12.7%), injectables (4.6%), vasectomy (0.9%), and local methods (5.1%). Unsatisfied demand for family planning declined from 25.1% in 1987 to 14.1% in 1995. It was 11.3% in urban and 21.9% in rural areas. Mexico s total fertility rate declined from 6.6 in 1970 to 2.8 in 1995.
God's last offer: negotiating for a sustainable future.
Over the past years the earth has endured hurricanes, floods, wildfires, and droughts of unprecedented dimensions, as well as outbreaks of terrifying diseases, that have struck every continent afflicting millions of people. On the other hand, the economic situation across all countries is turning from bad to worse. This book, entitled God's Last Offer , presents the relationship between these events and their impact on the population. The author further identifies four phenomena that have altered and destroyed the life on earth that include the rate of carbon gas emission, rate of biological extinction, the unsustainable consumption, and the exploding human population. In addition, the book tries to sort through a jumble of rumor, hyperbole and indolence in the face of sophisticated techniques used by corporations, institutions and governments to perpetuate public indifference. Furthermore, the author emphasizes that the population creates these problems. The book offers hope and possibility to a sustainable future for the Earth that must be embraced immediately before it expires.
Getting the signals right: tax reform to protect the environment and the economy.
This book discusses the importance of tax reform in order to protect the environment and the economy. Environmental degradation is so obvious nowadays that it made policy-makers think about solutions to end this problem. The results are the formation of environmental tax theory. By putting environmental tax theory into practice, it will not only benefit the environment but also industrial companies. The reason is that by imposing taxes on pollution, resource depletion and ecosystem degradation among industrial companies, in the same way, it enforces ideas among companies to create technologies that conserve resources and slash pollution rates, often at surprisingly low cost. If these taxes would be fully exploited, these could raise US$1 trillion annually in the coming decades, which allows approximately a 20% cut in conventional taxes on work and investment. Since total taxation could stay the same, the government could continuously protect the environment without compromising the economic stability. Lastly, the supporters of this change need to consider its effect on pensioners, workers and investors.
Biodiversity: a key to food security.
This document reports on the programs of the International Center for Agriculture Research in the Dry Areas (ICARDA) in achieving food security through biodiversity. The ICARDA mission is to meet the challenge posed by a harsh, stressful, and variable environment in which the productivity of winter rain-fed agricultural systems must be increased, but in a manner that is sustainable and within the constraints of the natural-resource base. To achieve food security, the ICARDA breeding program stressed the importance of using farmer's own varieties, called landraces, which have the characteristics of local adaptation. Furthermore, ICARDA have acknowledged the importance of plant biodiversity for human survival. That is why, ICARDA and its partners, particularly farmers and national scientists working for collection of germplasm and for in-situ conservation, are determined to ensure that genetic diversity is preserved and used for the benefit of future generations.
How much is enough? The consumer society and the future of the earth.
This book, entitled How Much is Enough? , explains the need to break the vicious cycle of material consumption, which brings more destruction to the earth. The author argues that the consumer society can only be a passing phase in the world's history for its own sake and that of the future habitability of the planet. He also stressed the need for consumer society to change ways in order for the future generations to enjoy abundance of food, better education, fulfilling work, shelter, and good health. This can only be achieved through a culture of permanence, a society that lives within its means; that draws on the interest provided by the earth's resources, not its principal; that seeks fulfillment in a web of friendship, family and meaningful work. Finally, the author points out the linked fates of humanity and the natural realm, which depends on consumers.
Factor four: doubling wealth -- halving resource use. The new report to the Club of Rome.
This book describes technologies representing a quadrupling of resource productivity by offering a rough quantitative formula. The first part of the book (chapters 1-3) highlights 50 examples of quadrupling resource productivity by presenting 20 examples of revolutionizing energy productivity, 20 examples of revolutionizing material productivity, and 10 examples of revolutionizing transport productivity. Part 2 (chapters 4-7) presents several strategies to overcome obstacles in revolutionizing productivity. These include rewards for saving resources, procedures for choosing the best buys and competition in saving resources. Part 3 (chapters 8-11) focuses on previous programs addressing these problems, particularly on the issues raised during various conferences. Part 4 (chapters 12-14) presents a discussion on how to harness resource efficiency as a human and worthy goal in meeting global needs. In addition, it considers a brighter civilization in language that goes beyond technology and quantitative targets. Furthermore, the informal sector still plays an important role in many developing countries, while simplistic views of the benefits of free trade will also need some thoughtful reconsideration.
The greening of Africa: breaking through in the battle for land and food.
This book entitled, The Greening of Africa , written by Paul Harrison, provides a lively and authoritative survey of the roots of the problems in Africa, from chronic debt and food deficits to land degradation and deforestation. The author surveyed the groundbreaking ventures that mobilized the peasants to boost food production, conserve soil, water and forest and reduce vulnerability to drought. In part one, it provides an overview on the dimensions of the crisis, the harshness of habitat and the record of failure in Africa. Part two presents the response of the government in the light of the problems, which are the tapping of the potential, boosting of food production, the implementation of green revolution, success in soil conservation, land reclamation, water conservation, forestry protection, significance of agroforestry, solving of the fuelwood crisis, importance of livestock production, solving of runaway population problems, the emphasis on human resource, and the mobilization for change. Lastly, the third part presents the lessons learned during the implementation of programs, particularly the secrets of success and the prospects for a quantum leap.
China's coastal cities: catalysts for modernization.
The coastal region of China has undergone remarkable physical and social transformation upon the implementation of the open policy of the government in 1978. This book ( China's Coastal Cities ) is the culmination of a lengthy collaborative research project among scholars in China, Hong Kong, Canada, and other countries, and attempts to assess the impact of coastal zone development policies in China's modernization. The chapters present a historical background of the city by emphasizing the economic and urban development through development of infrastructures, administrative support and other conveniences to attract domestic and foreign investors. In addition, an overall conceptual framework for the study and clarification of trends, policies and issues was also presented. Among the topics mentioned in the following chapters include port facilities, industrial and urban development in North China; data and insights of modern Tianjin, Yantai, Quingdao, Lianyungang, Shanghai, Ningbo, Wenzhou, Fuzhou, Xiamen, Guangzhou, Shenzhen, Taizhong and the Special Economic Zone. The final chapter examines the link between various cities.
China's coastal cities as development and modernization agents: an overview.
This book chapter presents an overview of the problem concerning China's coastal cities, which have been identified as catalysts of development. It discusses the implementation of the open policy in 1978, which prompted more areas of China into the reform experiment and marked the radical departure from adherence to self-reliance, as well as spatial redistribution of development efforts from the interior to the coast. Furthermore, it provides an overview of coastal cities being studies and how the open policy affected their industrial and urban growth. Despite the common characteristics of these coastal cities, their specific geographical factors, natural endowments, and different hinterlands have given rise to many differences.
Dalian: its industrial development and urban growth.
This book chapter studies Dalian port facilities, industrial development and urban growth. Dalian is an old port and industrial center in North China, first developed under Russian and Japanese influences. Its harbors can be classified into 3 types according to their functions. The first type is the military harbor at Lushun; the second comprises the fishing harbors on the northern shores; and the third type is the commercial harbor on the western shore of Dalian Bay. After the introduction of the open policy in 1978, Dalian's government started to expand its port facilities but it was not enough to spark changes both in Dalian's industry and urban development. Because of the backwardness in production and technology, the city government has actively supported industrial modernization through technical education and imported technology. The chapter also highlights the function of urban districts, especially the Dalian ETDZ. Finally, the problems faced by the city in mounting its development and modernization programs, including transport bottlenecks and shortage of electricity are mentioned.
Tianjin: north China's reviving metropolis.
This book chapter provides a comprehensive and structured account of modern Tianjin by giving full data and insights. Despite its strategic location as the leading port city in the Bo Hai-Yellow Sea Rim, Tianjin stagnated during the first 30 years after founding of the People's Republic under the long shadow of Beijing. With its exceptionally well-endowed natural resources in the form of oil, salt, and land for industrial and urban development, Tianjin is well on its way to recapturing its former status as the leading port in North China. Furthermore, the city has developed rapidly under the open city policy, registering outstanding success in restructuring its urban economy and improvement in urban infrastructure. Innovation has been exhibited in its approach to urban renewal and housing construction. Lastly, the chapter examines Tianjin's development in the broader framework of economic cooperation regions, such as the Beijing-Tianjin-Tangshan Region and the Bo Hai-Yellow Sea Rim Economic Region.
Yantai: a geographical appraisal of its potential.
The port of Yantai, one of the 14 coastal cities opened during the initiation of the open policy in China, has been one of the oldest foreign trade outlets. This chapter examines the geographical advantages that have led to the economic development of Yantai. The benefits of Yantai under the open policy were expected to generate economic impulses that would lead to the development of its hinterland. Situated in the northern part of Jiaodong Peninsula in the northeastern portion of Shandong province, Yantai served as a port for trade between China, Japan and Korea. In terms of population size, Yantai is an intermediate city by Chinese standards and belongs to the second highest category. As a city, Yantai is endowed with rich natural resources, which served to provide sources of income for the populace and attract tourists. Industrial locations, on the other hand, experienced great changes throughout history, which now caters to both light and machinery manufacturing. Yantai possesses advantages that prepare it for more intense interaction with the outside world, although it is stressed that modernized facilities are needed to further improve its services and attract more investors. The establishment of the trade liaison offices between China and Korea serves to raise the hopes for Yantai, particularly in the areas of agriculture, communications, transportation and nuclear energy.
Qingdao: from colonial port to export base.
This book chapter reviews the historical development, economic structure of Qingdao. It surveys the major issues of its urban development in order to assess its prospects as one of China's key open coastal cities. Qingdao is renowned for its port facilities, mild climate and scenic setting and its development and colonial history have endowed it with advantages. Several problems on the facilitation of its transformation into one of the key coastal cities charged with the dual tasks of attracting more foreign investment and developing export trades were identified. Qingdao started as a fishing village thousand of years ago, although changes have taken place over the years. Establishment of open port and development of commerce and trade has developed the city. Events prior and after the World War I have enlarged and encouraged commercial and industrial activities under Japanese occupation. Intense industrial development has led to urban expansion, particularly of harbor, railways and water plants. Port of Qingdao is considered as a significant contributor towards economic development and the promotion of foreign investment and trade. However, its future development depends on the successful fulfillment of three roles: 1) it is expected to remain a tourist mecca for both international and domestic visitors; 2) its role as an export base for energy resources to both domestic and foreign destinations; and 3) expectations of attracting foreign trade.
Lianyungang: from coastal development to interior development.
Lianyungang, which is strategically located in the northern part of Jiangsu, is well endowed with natural resources. It has an excellent supply of water for both industrial and domestic use, with more than 50 kinds of minerals and rocks. Historically, seaport development dates back to the Qin dynasty; during the early part of the century, railway, port facility, and industrial/commercial towns were developed. Changes have taken place, and in 1983 there was a 930 million yuan total industrial output, with 1250 enterprises in industries specializing in fields such as textiles, electronics, food processing, and paper-making. Due to its geographical position, it has been the major producer of grain, cotton, and edible oil and has been an important base for animal husbandry, mining, and energy production. Despite this, economic development was slow because of much silting in the harbor, a weak economic base in surrounding areas, and reliance of heavy transport on railways, with underdeveloped coastal and road transport. This book chapter makes four major recommendations regarding the development of Lianyungang: 1) the construction of a modern port with multiple and functions; 2) the development of a new industrial base; 3) building of a financial center and base of entrepot trade; and 4) building of unique tourist resorts. The chapter underscores the considerable potential of Lianyungang as a large city by developing a plan to control the growth of the city proper and develop small towns within the boundary of the municipality.
Shanghai was designated an open city in 1984 to serve as a recipient for foreign investment and technology transfer from developed nations. This book chapter presents a general survey of the leading factors contributing to the ascendance of the city from a county town to a world metropolis within several decades. The first section of the chapter presents an overview on the location and physical environment of Shanghai. Section 2 briefly discusses the history of the city by tracing human habitation 4000 years ago. The transformation of Shanghai as a paradise for adventurism into the most important industrial base in China is highlighted in section 3. In addition, the role of Shanghai as the largest commercial center and a center for advanced science, technology, and education in China is also discussed. Data on the transformation and development of urban spatial structures are presented. Several major impediments that affect the development including high concentration of population and industry in the central city and inadequate transport and communication services are also discussed. Measures have been suggested that are vital to the rapid economic growth of Shanghai in the year 2000, which include the establishment of Special Economic Zones, industrial transformation and development, development and tertiary industry, and urban renewal and construction.
Ningbo: east China's rising industrial port.
This book chapter discusses Ningbo as a gateway of external economic links, as well as the political, economic, cultural and communication center for Zhejiang region, located on the south shore of Hangzhou Bay. The history of Ningbo's development has been characterized by the role of its port in stimulating the growth of the city. Indeed, the rise and fall of the port have markedly affected the development of Ningbo. Ningbo's port development dates back during the Qin dynasty. In its modern development it has focused on a deep-sea port (Beilun) and heavy industries related to oil refining, electricity generating, and chemical fertilizer manufacturing. Another focus of its development stemming from implementation of the open policy has been the establishment of the Economic Trade and Development Zone to attract foreign investment and technology, which can make use of the port's new facilities. Ningbo's people are famous for their commercial ingenuity, and the city has excellent overseas connections that help boost its export-oriented economy. New infrastructural facilities are also being installed, and a wider hinterland of agricultural products is being tapped by new railroad connections. The future role of Ningbo will complement two major cities in the region--Shanghai, the international port of the region, and Hangzhou, the scenic spot of the region.
Wenzhou: development in regional and historical contexts.
This book chapter explores the development of Wenzhou City in its geographical, historical, and political context. Located in southeastern Zhejiang province in China, Wenzhou City was the most densely populated administrative unit in Wenzhou region. Owing to the combined effects of several interrelated factors including the political chaos prior to 1949, rugged terrain, inadequate land transport, and the closed-door economic policy of China between 1950s and 1970s, the progress in Wenzhou's development remained slow. Although by now the region has grown into a territory with a population of over 6 million, its built-up area remains small; the majority of its people that live in rural areas are involved in agricultural activities. In Wenzhou City, infrastructure and other social amenities are old and inadequate, resulting in low productivity. In addition, the foundation for economic growth, which the city has inherited from the past, is unable to support immediate gains from the open and reform policies, which have created opportunities for people in Wenzhou region to interact with the outside world. Given the present condition in Wenzhou, the people will have to face enormous difficulties in a rapidly developing city. Nevertheless, the city and the region at large, through the open policy, do possess great potential for future progress, especially in the use of its natural resources and the development of trade, commerce, and tourism. Its development process, however, will depend on the success of the open policy and on the conviction of the people that such policy will succeed.
Fuzhou: capital of a frontier province.
This book chapter analyzes the urban development of Fuzhou, the capital city of Fujian province in the framework of the frontier movement so as to shed light concerning the open policy and Special Economic Zones of China. Examination of the development of Fuzhou and Fujian reveals ample evidences that an open policy is not new, at least to the region of southeastern China around Fuzhou. Throughout Chinese history, this area represents one of the most open, especially in its overseas trade. Fuzhou City exhibits a great continuity of its traditional role and function to serve an administrative center for the development of a frontier province. Reasons for choosing Fuzhou to undertake this special role were explored. In order to develop Fuzhou into one of the 14 open coastal cities, four plans for major improvement were developed by the Fujian government. Essentially, these plans address the issues of port development, the Fuzhou Economic and Technological Development Zone, its transport and communication network, and the reliability of the energy supply of the city. To conclude, the southeastern frontier has been a very active frontier in China since the Ming dynasty, apart from episodic acts of war, maritime prohibitions, and total stoppages of trade. It is perhaps the time for Fuzhou's government to recognize that its heyday as a port in Fujian, monopolizing the trade of China, is long gone. What Fujian could do is to build on its special geographic and socioeconomic advantages in dealing with Taiwan.
Xiamen: regional center and hometown of overseas Chinese.
This book chapter focuses on Xiamen, the regional center and hometown of overseas Chinese situated on the southeast coast of Fujian, China. Section 1 of the chapter discusses the two periods of the history of Xiamen: the early history, which can be traced back to the Shang Dynasty (about 1000 years BC) and the period 1842-1949. The rise and continual development of Xiamen was closely linked to foreign trade and efforts of overseas Chinese and the its designation as a treaty port in 1842. Section 2 looks at the situation of Xiamen under the People's Republic, the first 30 years and specific development after 1978. The spatial structure of the city, particularly the urbanized area and its immediate vicinity, is described in section 3. Section 4 highlights the development potential of Xiamen. Stemming from its geography, history, external links, and economic structures, a variety of locational advantages greatly assist the city in realizing its development potential. These include favorable environmental conditions, a long history of external trade, the hometown of overseas Chinese and Taiwanese, numerous tourist attractions, a sizable pool of educated workers, and a well-developed industrial and commercial base. However, its further development is constrained by certain geographical, economic, and political factors such as limited hinterland, lack of energy and water resources, limited capacity for external transport, and confrontation between Taiwan and the mainland. Finally, section 5 offers a prospective look at the economic progress of Xiamen.
Guangzhou: the southern metropolis in transformation.
Enhanced under China's recent open policy, Guangzhou, the largest port and city in South China, has always been the unrivaled southern metropolis. This book chapter examines the economic development of the ancient Chinese city within the context of its historical and geographical setting, as well as the open policy for which the city has witnessed rapid and momentous changes, functionally and physically. More specifically, the chapter describes the urban structure of Guangzhou and the role of the Huangpu Economic and Technical Development Zone in the economic progress of the city. Emphasis is placed on the situation of the city under the open policy, and the problems related to both urban system and management which emerged and exacerbated as a result of its rapid transformation including conflicting land use, housing, and transport. Moreover, the chapter examines the rural/urban relations of Guangzhou from three perspectives: development of rural counties, development of satellite towns, and development of an economic region. Finally, Guangzhou must seek a role that will enhance its centrality and leadership position in a system of urban places. Efforts should be made to foster a development that proceed along the lines of a division of labor among different urban places so that they will grow economically or otherwise in concert, rather than in competition. In this way, the city's traditional position as the southern metropolis will be further consolidated and expanded.
Shenzhen: special experience in development and innovation.
The phenomenal growth of Shenzhen from small frontier town to the largest Special Economic Zone in China is unprecedented and is very much the product of planned development under the open policy and the drive for modernization. Its experience is significant in both urban and economic growth and in its being a test case for a number of reforms and innovative measures quite foreign to a socialist country. This book chapter looks at the transformation of Shenzhen within the last decade, as witnessed by its phenomenal growth in population and the expansion of various economic sectors. Section 1 of the chapter focuses on Shenzhen's environment for development, its geographical location, land resources, natural resources, and investment environment. Section 2 summarizes the two conceptual models on which Shenzhen based its development and growth; namely, free zones and experiments in modernization. Section 3 discusses the population growth and characteristics in Shenzhen within the last decade. Economic development, as discussed in section 4, is explained in relation to the city's economic structure, manufacturing development, and achievements in economic development. The final section looks at the problems faced by Shenzhen in the course of its development, as well as prospects to address these problems. The chapter concludes that the rapid growth of Shenzhen is very much the result of the open policy and the establishment of the special economic zone.
Taizhong: a geographical and developmental appraisal.
This book chapter presents a geographical and developmental appraisal of Taizhong, the third largest city in Taiwan located in the heart of the developed region of the western part of the country. The chapter begins by giving a picture of the geographical environment of Taizhong. It then describes the trends in population growth, land use and major structural changes in Taizhong in the course of its rapid economic growth. These include the construction of Taizhong Harbor, one of the 10 largest construction projects in Taiwan started in 1970s, and the Taizhong export-processing zone. In addition, the locational principles, which governed the development of Taizhong Harbor and the Taizhong export-processing zone, are explained. In general, Taizhong shi does not have favorable geographic conditions. Its development can be traced back to the decision of the Taiwan government to establish another economic center in the region in order to ameliorate regional imbalance. For Taiwan as a whole, the development of Taizhong has already contributed much to a change in the regional balance of population and economic growth, and now possesses the basic economic conditions for more rapid economic growth. However, its administrative framework must be modified if the region is to play a greater role in promoting economic development in the future.
This book chapter ties together the various studies of China's coastal cities presented in the previous chapters. This task is essential by the fact that not all the coastal open cities are included in this volume and only two cities in the Special Economic Zones have been subjects of inquiry. It presents some comparative statistics among the major coastal cities. Given the political events of June 1989, the chapter assesses recent developments in these areas. Now that the dust has almost settled, the modernization and development roles to which Chinese coastal cities have been assigned can be duly weighed in the context of broad policies and development.
[Report on second year, September 1992 - August 1993]
This study documents activities from September 1992 to August 1993, the second year of the family planning project in the commercial sector carried out by the Peruvian nonprofit agency Apoyo a Programas de Poblacion (APROFE). Execution in the second year showed achievements within acceptable levels, but some difficulties requiring adjustments were also identified. Financial execution was generally in line with proposed budgets. The contraceptive social marketing program maintained four name-brand products on the market. Low prices make the products accessible to the target market of lower middle and upper lower level consumers. The commercial sector became increasingly involved in advertising and promoting the methods. Distribution was efficient at the national level, and the products were available in over 90% of Peru s pharmacies. Sales and income were lower than anticipated, with the oral contraceptives meeting 88% of the goal, Depo-Provera 82.5%, and vaginal tablets 72%. An intense promotional effort to incorporate potential clients involved informing 2167 enterprises and contacting 1072. Even with promotion, the different plans designed for firms were not offered to workers. Reasons for the failure included competition, prices, the economic reality of Peruvian firms, and perhaps the complexity of the product design. The mass communication activities generated demand for family planning services, reflected in high levels of telephone counseling. The difficulty of incorporating social marketing of contraceptives in the street theater, the Catholic Church s attacks on modern contraception, and security worries were among the principal problems. Technical assistance was hampered by travel restrictions to Peru for reasons of security.
[Panama National Food Consumption Survey, 1992]
The 24-hour recall method was used to determine the consumption of food and nutrients at the national level, in rural and urban areas, and in metropolitan and nonmetropolitan areas of Panama. 1156 households were studied, 32.8% urban and 67.2% rural. The report describes nutritional problems in Panama and the survey methodology, and presents results in terms of the principal nutrients and foods. Per capita calorie consumption was 2255 at the national level and 2336 in the metropolitan area (Panama City and Colon). Rice is the single most important source of energy, contributing 42% of calories in rural areas and 30% in urban. 24% of families surveyed consumed less than 70% of the daily requirement and 18% consumed over 130%. Average protein consumption was 136% of the requirement at the national level, but 12% of families ingested less than 70% of the requirement and 37% of families ingested over 150%. The two most deficient nutrients were iron and calcium, with 29% and 63% of families reporting consumption of less than 50% of the recommended level. Foods consumed daily by over 30% of families included sugar, rice, coffee, cooking oil, peppers, evaporated milk, plantains, bread, and oranges. 91% of families reported consumption of some type of milk, but per capita consumption was only 5 g/day, insufficient to satisfy calcium needs. Per capita meat consumption was 6 ounces in urban and 4 ounces in rural areas. Average vegetable consumption per day was 1 ounce at the national level and 2.5 ounces in the metropolitan area.
[Quantification and occupational profile of the El Salvador nutritionist]
A descriptive study of 150 nutritionists working in the public and private sectors and graduates in nutrition not employed in the field was conducted in 1991 to develop a directory of nutritionists in El Salvador, identify their general characteristics and work situation, and determine continuing education and professional needs. The report begins by describing food and nutrition problems and policies and the evolution of the career of nutritionist in El Salvador. The survey results are then presented in terms of general characteristics, work situation, and occupational profile of nutritionists, followed by recommendations for increasing employment and training opportunities and professional status. 17 of the 150 identified nutritionists were abroad and 127 were successfully interviewed. 92% were women, 82% were under 40 years old, and slightly over half were married. 76% were trained in universities in El Salvador, with over half entering the field within the past 5 years. 78% reported receiving in-service training. Only 86 of the 127 nutritionists identified were employed as nutritionists. 38 worked in food services, 16 in clinical nutrition, 19 in applied nutrition, and 13 in nutrition education. The greatest number was employed in health sector institutions. The unemployment rate was estimated at 32% and the underemployment rate at 16%. The areas in which the nutritionists perceived deficiencies in their training were research, public health, food services, and clinical nutrition, and they expressed interest in training in these areas. The nutritionists played little role in formulating policy or planning programs to confront the country s food and nutrition problems.
The database on technologies in health, food, and nutrition generated, identified, or evaluated by the Nutrition Institute of Central America and Panama (INCAP) during 1982-92 is intended as a tool to systematize transfer of knowledge and technology developed by INCAP. The technologies included in the database are characterized by name, objectives, development achieved, place of application and users, supporting bibliography, source of financing, future actions to complete development, basic requirements or conditions of application, and observations. The database is expected to contribute to technical assistance, research, training, and IEC functions. The principal users are expected to be INCAP personnel and their national counterparts, and workers in international organizations involved in generation or transfer of technology. 155 technologies or methodologies were identified, of which 136 were inventoried. 21.3% were in the programmatic area of food technology, 19.1% in human nutrition, 14.7% in integrated agriculture, food, nutrition, and health systems, 12.5% in food socioeconomics, 12.5% in infectious diseases affecting nutritional status, 8.1% in human resource training and health education, 6.6% in food protection and consumer orientation, and 5.25 in micronutrients. 63.9% of the technologies have been validated at the applied level and 32.4% at the experimental level, and 3.7% have not been validated. 60.3% have been evaluated regarding application or uses. The programmatic areas and countries of application of the technologies are specified in annexes.
[Control of iodine deficiency disorders in Central America]
This study of control of iodine deficiency disorders in Central America contains three self-contained sections that examine prevalence of goiter, legislation regarding iodizing of salt, and production and marketing of iodized salt. The situation in Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica and Panama is separately examined in each section using the same format, in order to identify similarities as bases for regional corrective action. Goiter is endemic in Central America, and iodine ingestion is deficient. Only 12% of the salt consumed in the region meets international standards for iodizing. The average prevalence of goiter in Central America is 14.3% overall, 16% in urban areas, and 13.2% in rural areas, and is tending to increase. The six countries have a sufficient legal-juridical apparatus to assure effective iodizing of salt, defined as over 30 parts per million in regions of high endemicity. Consumption of iodized salt is limited because regulation is lacking, and because human, technical, and economic resources are limited. Lack of knowledge about iodine deficiency disorders on the part of the consumers and the desire to cut costs of producing salt are other factors. The six countries should share experiences to systematize legislation and make it operational through adequate regulation and creation of National Programs of Salt Iodization within health ministries. Governments should provide economic assistance to salt producers and establish laboratories to monitor the iodization and quality of salt. Most salt production in Central America is inefficient and unhygienic, based on evaporation of seawater through action of the sun, but production is relatively sufficient. Most producers, processors, and distributors are unaware of the vital importance of iodizing salt, and should be informed about it.
The use of family vegetable gardens as sources of iron and vitamin A in two communities in the department of Totonicapan, Guatemala, is evaluated in this work. A literature review regarding the dietary requirements and sources of vitamin A and iron, and family and community vegetable gardens as resources for providing micronutrients precede the study. Existing cultivation systems in 34 family gardens in San Antonio Buenabaj and Pacoj were studied, and integrated systems including spinach, carrots, chard, and other sources of vitamin A and iron were designed and validated. Changes in the nutritional values of the vegetables throughout the period of harvest were assessed, and preparation techniques for the foods were observed and recommendations made for conserving nutrients. The experimental design was applied in 12 randomly selected gardens. Vegetables were selected to provide vitamin A and iron and to be compatible with climatic conditions in the area. The results indicated that establishment of systems of cultivation based on family gardens that provide sources of micronutrients is feasible. The population was receptive to the changes despite difficulties of obtaining seed and changing habits. The traditional system of preparing the products was based on use of large quantities of water and prolonged cooking, resulting in loss of nutrients.
A study was conducted among schoolchildren in the province of Cocle, Panama, to compare the efficacy of four different iron supplementation interventions and to assess knowledge of anemia. Hemoglobin was measured in June 1996 and again in December 1996. 804 children tested on both days constituted the sample. 176 students received a daily supplement of 60 mg iron for 3 months and cream containing 2.65 mg iron daily for 6 months; 210 received the daily cream only, 223 received a weekly supplement of 60 mg iron and daily cream, and 195 received milk and crackers containing 10.7 mg of iron daily and a weekly supplement of folic acid. 42.4% of the students were anemic at the outset of the study, with hemoglobin levels of 9-11 g/dl. 70% of the anemic children were aged 6-9 years. At the second assessment, 40% of the 341 children anemic at the first measurement had adequate hemoglobin levels. The prevalence of anemia declined from 42.4% to 27.4% overall, from 51% to 32% among students aged 6-9 years, and from 30% to 20% among those aged 10-13 years. The greatest effect was observed in children receiving the cream and the weekly iron supplement; the proportion with normal hemoglobin levels increased by 52.5%. The increase amounted to 15.2% for the group receiving the cream only and 20% for the other two groups. 8 focus groups with 5th and 6th grade students and four each with teachers and parents revealed that the students had little understanding of anemia and the parents and teachers had incomplete knowledge.
[Profile of the Costa Rican educator for nutrition education]
The Food and Nutrition Education Program in the Costa Rican Educational Sector (PEANSEC), as part of an effort to promote and improve food and nutrition education, conducted a study of the theoretical and practical knowledge that food and nutrition educators should have and defined a profile of such educators in Costa Rica. A workshop on the profile attended by educators from throughout the country and meetings with regional nutrition advisers in the Ministry of Public Education were the main sources of information. Food and nutrition education was defined as a continuous process in which elements of educational science and nutrition science interact in order to provide learning situations for health prevention and promotion throughout life. The work outlines goals of food and nutrition education in Costa Rican schools, and defines criteria for operationalization of the goals. The disciplines or subject units that currently address food and nutrition topics are identified. The advantages of concentrating food and nutrition study are detailed. The academic characteristics that a food and nutrition educator should have are then outlined, based on deliberations at the national meetings. The knowledge that the educator should have is specified in regard to nutrients, foods, food availability, food technology, hygiene, diet, nutritional status, and diet therapy. Skills that should be developed, activities that should be promoted, teaching resources, and attitudes that should be encouraged are also outlined.
[Analysis of iodine deficiency status in Latin America: its trends and action strategies]
The Pan American Health Organization, in close collaboration with UNICEF and the International Council for Control of Iodine Deficiency Diseases, conducted a review of the literature and recent reports to provide current information on the status and trends of iodine deficiency disorders and control programs and their effectiveness. The study was conducted to assess the magnitude and gravity of the endemic, bottlenecks impeding elimination, and lessons learned in successful programs. Interagency coordination to aid in control efforts was also examined. The different sections of the report provide background on the prevalence of goiter and other iodine deficiency diseases, previous efforts at control, and related research. Epidemiological criteria for estimating the severity of iodine deficiency disorders as a public health problem are then described. The results are presented in terms of the prevalence of goiter, urinary excretion of iodine, iodization of salt, national legislation regarding the obligation to fortify salt with iodine, action strategies for elimination of iodine deficiency disorders in 17 countries, and interagency coordination. Reports from 20 individual countries are also presented, with information on recent studies of goiter and urinary excretion of iodine, availability of iodized salt and iodine compounds, and action strategies in each country. Other sections present overall conclusions and suggestions for future action.
[Research outline: prevalence of breast feeding in three regions of Nicaragua]
This research protocol for determining the prevalence of breast-feeding in three regions of Nicaragua describes a study intended to provide current information for use as a baseline for evaluating the National Plan for Promotion and Maintenance of Breast Feeding, orienting resource allocation, and guiding contents of IEC programs. The report begins with a review of the benefits of breast-feeding, the actions of previous campaigns to promote breast-feeding, and results of the few available recent studies of breast-feeding in Nicaragua. The objectives of the study are to determine the prevalence of breast-feeding in infants under 1 year in regions 2, 3, and 4, which contain around 60% of the national population. The prevalence of exclusive breast-feeding in infants under 4 months and of mixed breast-feeding in children under 1 year and their relation to rural or urban residence; maternal age, occupation, and education; and place of birth (home or institution) will be assessed. The study is to have a descriptive cross-sectional character, with a sample size of 3807. The information is to be collected on previously designed and validated questionnaires by regional health personnel. Procedures for data processing, training, the pilot study, and logistics are outlined. Data collection is projected to occur in October 1990.
The nutritional status of 180 male and 115 female athletes representing Antioquia was assessed prior to the 1996 Colombian National Games on the basis of information in their clinical records, and a pilot study with 50 athletes of different sports was conducted for the dietary evaluation. 10.5% of the male and 6.9% of the female athletes were found to be malnourished, while 3.8% of the males and 6.1% of the females were obese. The athletes were 21 years old on average, indicating that their greatest growth had been achieved. The males had an unexpectedly low average height, around the thirtieth percentile of height for age. The average height for age of the women was around the fiftieth percentile. Body mass index, somatotypes, and weight for height indicated that the majority of athletes lacked muscle mass. Average percentages of muscle were 47% for males and 46% for females. The average body mass index was 22.8 for males and 21.7 for females. According to the methods of Faulkner and Juhasz, the average fat proportions were 13.2% and 9.0% for males and 15.4% and 18.0% for females respectively. Women in a few sports had high percentages of fat. The dietary profiles of the athletes indicated a 30% deficit of energy and a 50% deficit of protein. Only 70% of the calcium requirement was met. The average diet contained more fat and less carbohydrate than recommended. Women consumed only 67% of the recommended dietary level of iron. Vitamin A consumption was adequate. The majority of athletes had optimum levels of hemoglobin and hematocrits.
[Evaluation of the Panama Ministry of Education's school afternoon snack program]
This report of the evaluation of the Panamanian Ministry of Education s school snack program begins with a brief history of school feeding programs in Panama. A 1995 law established the program for distribution of a glass of milk, nutritional cracker, or enriched cream in preschool and primary schools throughout Panama. Milk and the nutritional cracker are distributed in urban schools with larger enrollments, and enriched cream is provided elsewhere. The evaluation was conducted to assess functioning and acceptance of the program at the national and local levels, assess the nutritional status of students receiving the snack, and propose solutions to any weaknesses observed in the program. Students were studied in 14 schools receiving milk and crackers and 38 schools receiving cream. A set of forms was designed with open and closed questions, room for observations, and height and weight information. Fieldwork was conducted in the last quarter of 1997. The selected 20 students along with 6 teachers and 6 parents were interviewed in each school, and preparation and distribution of the snack were observed. The results are presented in seven sections that provide general information on the schools, discuss program operation, management and storage of foods, preparation and distribution of the snack, nutritional status and acceptance of the snack by students, school stores and gardens, and perceptions of the snack program. It was concluded that the school snack arrived consistently to about 70% of the programmed population and irregularly to the other 30%, generally schools in inaccessible rural areas.
[Toward integral and humanized care of women]
The nine chapters of this manual are intended to provide auxiliary nurses in Bolivia with the information they need to provide competent, warm, and respectful reproductive health care to women. The work attempts to promote analysis, reflection, and critical examination of Bolivia s social and cultural context so that the auxiliary will assume a commitment to participate in the search for solutions to health problems. The content was developed to conform to the political and normative dispositions of the National Health Secretary, and the work is also intended for students and supervisors in health services. Each chapter begins with a statement of objectives. Questions for reflection are scattered throughout, and illustrations and diagrams are plentiful. The chapters cover the social and cultural context of reproductive health; process of reproductive life; interpersonal communication, counseling, and method of problem resolution; animation of health education events; process of maternal health care; process of reproduction and family planning; management of sexually transmitted diseases and AIDS; cervical and breast cancer; and biosafety in reproductive health.
[Technical documents. 45th anniversary edition]
Ten working documents in five different areas of food and nutrition are compiled in this publication. Two articles concern increasing the availability of foods at the local level. The first concerns diagnosis of rural agroindustry and analysis of the technical system of small coffee plantations in Guatemala, while the second examines development of a feminine rural agroindustry in the region of Totonicapan, Guatemala. In the area of food, nutrition, and health of preschool and school age children, papers discuss food and nutrition in children under 6 years old, and physical activity and energy needs of school children with different nutritional and social histories. Three papers concern infectious diseases that affect nutritional status. The first assesses the quality of health services within the diarrheal disease control program, the second examines recurrent Campylobacter jejuni infections in children of Santa Maria de Jesus, and the third discusses how to speak with mothers about pneumonia, with a summary of popular perceptions of acute respiratory infections in Ciudad Vieja, Sacatepequez. Papers on food supplement programs discuss characteristics of the supplemental feeding programs for the maternal-child health population of Guatemala and the focus on potential benefits in the selection of beneficiaries for supplemental feeding programs. A paper in the area of maternal education and child growth discusses the importance of maternal education in child health, growth and survival
[Diet and health in Latin America and the Caribbean]
Results of the multicenter project Diet and Health in Latin America and the Caribbean regarding the nature, magnitude, distribution, and determinants of nontransmissible chronic diseases are presented. The methodology involved compilation, systematization, analysis and interpretation of data and secondary information available in existing national information systems in the health sector and other national and international institutions. Four working meetings were held between October 1992 and November 1994 to coordinate the work. The introductory section describes the theoretical framework, objectives, methodology, and limitations of the study. The following chapters discuss trends in mortality and morbidity from chronic diseases related to diet and life style, causal factors, implications for policy and programs, and research needs. Information on the nature and magnitude of morbidity and mortality, the nutritional status of the population, and underlying causes was limited in most of the countries by problems of coverage, quality, and timeliness. It appears evident despite data limitations that most problems of nutritional deficiency are declining, while those associated with imbalances and excess are increasing. In the majority of countries both types coexist. Available information suggests that eating habits are becoming less healthy while traditional native diets with excessive consumption of fats, sugar, and refined products are persisting. Consumption of fruits, vegetables, and legumes is declining. Lack of political will for implementation of legislation or programs that would protect the population at greatest risk is evident in most countries.
[Inventory of technologies in health, food, and nutrition (1982-1993)]
This inventory of information on technologies in health, food, and nutrition generated or studied by the Nutrition Institution of Central America and Panama (INCAP) during the period 1982-93 is intended to facilitate transference of knowledge and technologies developed by the Institute. The principal users are expected to be INCAP personnel at the headquarters or country level, their national counterparts, and personnel in international agencies involved in generation or transfer of technologies. This document contains information on 136 technologies or methodologies. The inventory provides the name; objectives; description; information on application including names of organizations that have used the technology and INCAP publication or bibliographic citation; and basic requirements or conditions of operation such as type of equipment or educational level of human resources. All technologies or methodologies are ready for validation at the experimental or applied level or have been validated, applied, or evaluated. All originated in applied research carried out by INCAP. An annex lists technologies according to 1993 INCAP programmatic components. 17 concerned food socioeconomics; 7, micronutrients; 9, protection of food and consumer information; 20, integrated agriculture, food, nutrition, and health systems; 11, human resource training and health education; 17, infectious diseases affecting nutritional status; 26, human nutrition; and 29, food technology.
[National Nutrition Survey. Volume 1. Anthropometry]
Results are presented of Costa Rica s National Nutrition Survey carried out in mid-1996. The sample included 1008 preschool children aged 1-6 years, 582 school children, 934 women aged 15-44, and 120 women aged 45-59 belonging to 1197 households. The results indicate that the proportion of preschool children with moderate or severe malnutrition as indicated by weight for age declined from 6.3% in the 1982 National Nutrition Survey to 5.1%, while the proportion with growth retardation declined from 7.6% in 1982 to 6.1%. The proportion with acute malnutrition, measured by weight for height, increased from 1.9 to 2.3%. 16.5% of school age children were underweight and 14.9% were overweight according to the body mass index. According to World Health Organization criteria, the proportion underweight in the school age population was much higher than the expected 5% and constitutes a public health problem. Malnutrition in school aged children was concentrated in rural areas (19.4%), while obesity was more prevalent in metropolitan areas (20%). 1.4% of women aged 15-19 were underweight and 23.2% were overweight. 45.9% of women aged 20-44 and 75% aged 45-59 presented some degree of obesity. The proportion underweight declined from 16.6% to 8.2% between 1982 and 1996. Obesity should be considered the priority public health problem for women aged 20-59.
619 students aged 14-22 years, who were in the final year of secondary school in 26 public or private, rural or urban schools in the Province of Chiriqui, Panama, participated in this study of their knowledge of nutrition during adolescence, pregnancy, breast-feeding, and infancy. The students responded to self-administered questionnaires and participated in focus groups. The study objectives were to determine degree and sources of knowledge, assess differences by sex and type of school, and develop a plan of action for nutrition communication with adolescents. The preferred learning style of respondents was group discussion. Weight loss diets and nutrition of adolescents and adults were identified as topics the respondents would like to study. The adolescents did not know how to create a balanced menu, although they considered a balanced diet important for health reasons. Errors included believing bananas to be a source of iron, and inheritance to be a factor in obesity. Respondents recognized the importance of maternal malnutrition in low birth weight, but did not relate low birth weight to adolescent pregnancy or understand the nutritional consequences of adolescent pregnancy. Respondents had no knowledge of maternal nutritional needs during breast-feeding. In the area of infant nutrition, respondents considered milk the best food for newborns, but they believed that the only risk of bottle-feeding was unhygienic handling. 90.6% of the students had deficient knowledge, especially students in urban public schools. Male students had less knowledge than female students. Gender was a more important determinant of knowledge than type of school.
Issues involved in design of reproductive health interventions directed at adolescents in Peru are discussed. Separate sections discuss conceptual framework, programs and policies, the proposal, focus, objectives, and lines of action. The conceptual framework defines adolescence in general terms and according to criteria in Peruvian legal documents, assesses demographic trends as reflected in changing adolescent population size and incidence of adolescent pregnancy and other reproductive health problems, and makes recommendations for reproductive health and family planning services based on the specific characteristics of the age group. The section on programs and policies describes the type of programs that could be developed for adolescents, government and private institutions currently involved in providing services for adolescents, and the legal framework of adolescent reproductive health programs. The third section contains a proposal for adolescent integrated health programs that are harmonious with current US Agency for International Development program objectives. The strategy, principles, and areas of action of proposed interventions are discussed. A section on the focus of the proposed intervention recommends that adolescent services integrate promotional with preventive and curative services, promote youth development and social participation, be oriented to protective factors, and be intersectorial, decentralized, and sustainable. The intervention objectives are described as contributing to the nation s goals for improving health and welfare of the adolescent population through technical assistance to sectors involved in service delivery to adolescents. The final section proposes lines of action for the programs.
[Family and sex education guide for magisterial training]
This sex and family life education training guide is intended for use in teachers colleges. The curriculum is oriented toward promoting healthy experiences of sexuality in the context of family and social life in future teachers, emphasizing formation of attitudes with a philosophical and ethical dimension. The guide is structured in two main sections, the first covering family and the second sexuality and reproductive health. The guide proposes concepts, procedures, and attitudes on various themes. It begins with a general discussion of the processes of learning and methodological orientations for teaching. The section on the family discusses family structure and function and forms of family organization in Peru, satisfaction of the basic needs of children, the family and society, marriage and its legal framework, mistreatment and family violence, children in situations of risk, the relationships between the family and population and quality of life and between family and health and the environment. The section on sexuality and reproductive health discusses culture and sexual behavior, sexuality, self-esteem and assertiveness, development of sexuality, sex roles and stereotypes, gender equity and women s empowerment, sexual and reproductive health, pregnancy and birth, reproductive risk factors, sexually transmitted diseases and AIDS, abortion, sexual relations and adolescent mothers, and responsible parenthood and family planning.
The Mexican Institute of Social Security (IMSS) instituted a project to strengthen informed choice procedures in postpartum and postabortal family planning programs in IMSS hospitals and clinics. An intensive training program to promote use of the informed consent form before delivery of contraceptive methods was begun in January 1997. This document reports results of an INOPAL III-funded evaluation based on interviews and surveys of users and service providers. A qualitative study was conducted in four states in May and June 1997 to develop the questionnaire. The quantitative diagnostic study was conducted in July and August 1997 in 13 hospitals and 13 IMSS clinics in 13 Mexican states. 453 hospital service providers and 202 out patient clinic service providers were interviewed. 730 pregnant women and 202 women in the first 3 months postpartum were interviewed at outpatient clinics, and 967 women were interviewed in hospitals prior to discharge after an obstetric event. 66% of service providers at hospitals and 80% in outpatient clinics reported receiving a training course on informed consent procedures. 89% of service providers in hospitals and 80% at outpatient clinics said the consent form and guidelines were being implemented at their facilities. 59% or more of women interviewed reported receiving information on family planning during prenatal care. 90% stated they wanted to use a method after delivery, and 70% were offered a postpartum method during prenatal care. 70% of women interviewed at the hospital received a contraceptive method during their stay, primarily IUDs. 80% of women interviewed at the hospital reported being asked to sign an informed consent form, and 90% reported signing.
The 98 tables presented in this document constitute a statistical annex to the report of an operations research project examining implementation of informed choice procedures following obstetric events in Mexican Institute of Social Security (IMSS) hospitals and clinics. Volume I of the study appears as PIP document 146463. The Informed Choice Among Acceptors of Contraceptive Method After an Obstetric Event project was implemented by the IMSS between November 1996 and August 1998 to strengthen informed choice procedures in postpartum and postabortal family planning. The 98 tables in this document present results of a quantitative diagnostic study conducted in July and August 1997 in 13 hospitals and 13 clinics in 13 Mexican states. The tables provide data on the characteristics and perceptions of 730 pregnant women, 202 women in the first 3 months postpartum, 967 women interviewed in hospitals following an obstetric event, 453 hospital service providers, and 202 outpatient clinic family planning service providers.
This document presents results of two separate but similar operations research studies conducted in CEMOPLAF facilities with INOPAL III assistance. The first study evaluated measures to improve the image of CEMOPLAF in the Ventanas and Quininde centers. The research involved two phases, a baseline survey to provide a basis for implementing actions to improve CEMOLAF image and competitive position, and a second survey one year after implementation of the improvements to observe image changes. The actions implemented included changes of locale and personnel, implementation of a mass media IEC program, and scheduling adjustments. The second study assessed the image of CEMOPLAF in the Riobamba and Cajabamba centers in order to determine whether specific factors could explain the slow growth of the centers. The research was conducted in two phases, a preliminary qualitative study and the quantitative phase whose results are presented. Both reports describe the study objectives, samples, and methodology, present results regarding characteristics of the women, aspects related to fertility, knowledge and use of contraception, community demand for services, and aspects related to family planning communication. Both reports also analyze aspects related to the image of CEMOPLAF, including perceptions of services received, relations with personnel, and relative importance of different factors in the women s perceptions.
In line with the orientation of its new masters degree program, which seeks to promote an integrated approach to food and nutrition problems, the Nutrition Institute of Central America and Panama developed this self-administered course on basic aspects of food and nutrition. The course is designed to assure that students from diverse disciplinary backgrounds share a basic knowledge of food and nutrition, and passage of the course is a requirement for admission to the masters program. The introduction to this document explains the steps in the process of completing and submitting the materials. The two major sections contain statements of general and specific objectives. Specific objectives of the first section, in the area of chemical and biological sciences, are to learn general aspects related to composition of materials, cellular components and functions, protein synthesis, nutrients, the digestive and endocrine systems and metabolism. The student should be able after completing the course to identify similarities and differences between vegetal and animal cells, describe plant physiology in relation to photosynthesis and respiration, and relate plant physiology and post harvest conditions to factors in decomposition of foods. The second section presents basic concepts of food and nutrition. Topics examined include conditioning factors of nutritional status and basic concepts of human food and nutrition. The student should be able to describe the functions of different nutrients, the nutritional contribution of different food groups, and the characteristics of a balanced diet.
Focus on Young Adults, a program funded by the US Agency for International Development, is providing technical assistance to pubic and private sector organizations in Peru. The Ministry of Health began developing the School and Adolescent Health Program (PSEA) in 1992 to improve health and living conditions of the population aged 5-19. The PSEA program, with Focus assistance, is training service providers in communication skills for providing sexual and reproductive health services to adolescents. A study was conducted to evaluate the effects of training on the quality and coverage of adolescent services in three health subregions of Peru where service providers and some secondary school teachers were trained by PSEA in interpersonal communication skills for orientation of adolescents in sexual and reproductive health. 110 service providers trained by FOCUS at least two months before the evaluation and who were actively involved in offering sexual and reproductive health services to adolescents were interviewed using a structured questionnaire and a test of knowledge. 22 were also directly observed interacting with adolescents. Four hospitals, 15 health centers, and 20 health posts were visited. 36 adolescent clients were also interviewed. In general it was concluded that the training improved the skills of the providers in communicating with adolescents. The adolescent clients were also satisfied with the attention received. The 22 providers were observed using a 35-step list; they followed 67% of the steps, indicating that adolescent services meet acceptable standards of quality.
[Manual of the little stars: participative method for teaching nutrition]
A nutrition education program based on the use of symbols to represent quantities of calories, proteins, and other nutrients was designed as an easy to understand method of communicating basic nutritional concepts and assisting in diet evaluation. Food and nutrition education constitutes a useful tool for achieving dietary modifications in families with malnourished members and the ability to acquire the necessary food. This publication was designed for health professionals and especially nutritionists, and the technique of symbol use is intended to be used in educational activities adapted to the needs of specific groups. The technique consists of using recommendations of the principal nutrients for age groups related to the composition of different foods, expressed through a simplified scheme. Development began with determination of the most frequently consumed foods in the area of Darien, Panama, based on data from a subsample of 18 indigenous families from a 1991 national food consumption survey. A list of foods was developed with portions defined for preschool children. A star was assigned for each 80-120 calories and a circle for each 1.5-2.5 g of protein in a portion. Another table showed caloric and protein recommendations for different age groups. The technique was tested with a group of community leaders in Darien. After simple explanations of nutritional needs, the participants designed three daily menus for different age groups. A group analysis allowed participants to recognize their own dietary patterns and possible improvements.
[National women's plan, 1998-2003]
The National Women s Plan 1998-2003 diagnoses the status and condition of women in Venezuela from a gender perspective and proposes integral objectives in a variety of areas to promote empowerment. New management models characterized by decentralization, intersectoriality, and participation of the civil society are promoted as key elements in coordination of economic, political, and social actions. The document defines the conceptual framework of the Plan and examines the political and legal framework and the mission and structure of the National Women s Council (CONAMU). Background is then presented on the national and international agreements entered into by Venezuela related to women s empowerment. Areas of concern and programs and projects carried out by CONAMU are examined. A long diagnostic section discusses geographic and other aspects of Venezuela and then examines female inequality and the status of women in relation to education; health; decision making; culture and communications media; legislation, juridical security, and violence; areas of special attention; inequality in conditions of access and participation of rural women; and current status of statistical studies related to women s status. Institutional mechanisms for follow-up and evaluation of the Plan are outlined in the form of 18 specific actions to achieve 4 objectives. The final section identifies lines of action, programs or projects, and responsible agencies in the strategic areas examined in the diagnosis.
[Support for the decentralization of the policy of spatial distribution of the population]
This document contains an exercise in microregional planning in the states of Queretaro and Sonora, suggests methodologies for formulating policies of population distribution for both microregions, and provides guidelines for their application. Four microregions were selected for study in order to analyze contrasting levels of development, resources, and population dynamics. Cadereyta de Montes in Queretaro is predominantly rural and manifests significant socioeconomic and demographic backwardness. Only small-scale agriculture and livestock raising are feasible. Industry is incipient, but with marketing, technological and financial aid some types of manufacturing may be possible. The microregion of Sonora has shown sustained development and high productivity, with superior levels of living and sufficient regional infrastructure to support economic and population growth. Microregions and their central places constitute the basic territorial units for promoting population retention and attraction. The National Population Council used 1990 data to identify 44 priority microregions for design of strategies to influence population distribution. The strategies require coordinated federal, state, and municipal action. The case studies begin with a diagnosis of demographic dynamics, the settlement pattern, social context, infrastructure and equipment, principal environmental characteristics, evolution of the economy and the state context, and employment. The objectives, population and employment goals, and lines of action proposed for the microregions are then detailed.
To respond to planning needs in the area of population distribution, Mexico s National Population Council (CONAPO) developed the Environmental Conditions of Strategic Microregions for Modifying the Spatial Distribution of Population in Mexico project. The various project goals include defining a national framework for population distribution, regional development, and sustainable development; and analyzing environmental conditions and development potential for attracting or retaining population in 44 priority microregions. Chapter 1 of the report indicates the principal conceptual bases of the study and the plan of analysis. The treatment is considered somewhat exploratory in the absence of consensus over a paradigm for analysis of relations between the population and environment. Chapter 2 examines the national context, with attention to the natural physical environment, economic activities, and relations between population, natural resources, and regional development. Chapter 3 looks at the same phenomena at the level of microregions. An exploratory classification of the 44 priority microregions is presented based on their potential for attracting or retaining population and whether or not their central places are state capitals. The final chapter presents the case study of the Obregon microregion, with analysis of geographic, sociodemographic, and economic characteristics and the principal environmental problems. A proposal for strategies oriented to retaining or attracting population with a focus on environmental sustainability is presented.
In September of 1998, a developmental workshop was held in Washington, District of Colombia which led to the establishment of national AIDS/sexually transmitted disease (STD) hotlines in two Caribbean nations, Jamaica and Trinidad and Tobago. The AIDS Information Hotlines is considered as one of the major AIDSCOM efforts in the area of communication, one that contributes to the understanding and development of a Public Health Communication Strategy for AIDS prevention. This article presents a study that determined the public acceptability and use of AIDS information hotlines in the Caribbean. Data from the first 6 months of operation was collected and analyzed. It was noted that a total of 795 calls related to AIDS/HIV occurred during the specified period; 74 calls related to STDs and basic needs. Overall, results indicated that the AIDS hotline in Trinidad and Tobago has been accepted by the public, meeting a need for specific information and confidential counseling.
Patterns of condom use of male bisexual injection drug users: a brief report.
This paper describes the behavior of bisexual injection drug users (IDUs), who constitute a singular bridge for spread of HIV across the homosexual, injecting, and heterosexual populations in the US. Information reported in this paper was collected through interviews of 804 sexually active male IDUs with multiple partners. Among the respondents, 84% were heterosexuals, 7% were homosexuals, and 9% were bisexuals. Overall, results indicate that bisexuals did not use condoms any more with women than did heterosexual men, which was very little. It was also observed that bisexual IDUs were more likely to use condoms with men than they were with women, but in a pattern different than that of their gay counterparts. The kind of sex they were having with men influenced their use of condoms. However, condom usage was noted to be more prevalent for gay men. Based on these findings, it is clearly shown that bisexual IDUs are running great risks of contracting HIV from multiple groups, including the high seroprevalence groups of gay men and gay injectors. Moreover, they are also putting partners from several low-prevalence groups in great risk of acquiring HIV through needle use and sexual behaviors. Thus, any risk reduction program designed for men should take into consideration that the respondent has sex with men and with women.
Male IEC needs in family planning: some evidence from Nyamira district, Kenya.
This article presents a research project set up to study the information, communication, and education (IEC) needs in family planning (FP) of a group of men in Nyamira District. Utilizing a focus group format, the study was conducted with a total of 179 men from Mangia, Kijauri and Nyamira township specified into three age groups. Discussions focused on understanding of the term "family planning", reasons why some men resist FP, preference for male children, oral contraceptives, IUDs, injectables, vasectomy, condoms, AIDS and FP, understanding the menstrual cycle, and adolescents and contraceptive use. Overall, it was noted that the appreciation of the need for and benefits of a long birth-spacing interval have been apparent to most men. Given such attitudes to birth interval, it is clear that majority of the participants were in favor of family planning. Hence, family planning role models within the community may be necessary to convince those with unreformed positions. Moreover, it is indicated that there is a clear need for an effective communication strategy through an IEC program specifically targeting the main areas of misunderstanding.
Population policy review: the Gambia.
This population policy review contains statements and information, referred to as "indicators", of the explicit and implicit position of the Government of The Gambia on selected population matters. It also includes the latest information available from public sources and identifies the population issues of greatest concern to the country and how the government is responding to those issues. Overall, it is noted that The Gambia is concerned with nearly all aspects of population change. Rates of growth, fertility, mortality and immigration are considered to be too high, while emigration is considered satisfactory and spatial distribution and internal migration appropriate. Policies designed to reduce population growth, mortality, and fertility include the integration of family planning into government maternal-child health services. Contraceptives, available through government health services and nongovernmental sources can be imported duty-free. While the law is not specific on sterilization, abortion is permitted on grounds of life and health.
AIDS in Bangladesh: a regional crisis in "South East Asia".
It is estimated that 2 million people in Southeast Asia are affected by AIDS. Most of these afflicted patients are citizens of India, Nepal, Thailand, Malaysia, Indonesia and Bangladesh. In these parts of the world, particularly in Bangladesh, it is noted that proper care and nursing should be ensured to save the patients from a fatal outcome, which is death. Hence, an AIDS resolution to eradicate its fatality through a medico-legal approach is proposed. To this end, vaccine trial should be implemented among all suffering patients with AIDS by the year 2000. In addition, a program with a project proposal governed by the academic society for the disease would have to be implemented among the people to create awareness and proper consciousness with the guidance of institutional attitude, as well as efficient knowledge and clinical experience. Moreover, academic manipulation will be most essential to create more awareness among staff fighting against AIDS by skill and power around the world.
In 1993, Mr. William Glass, Program Assistant, and Mrs. Hannah Dankwa-Smith, consultant for the Johns Hopkins University Population Communication Services, visited Uganda at the request of the Family Planning Association of Uganda and the US Agency for International Development in Kampala. The main aim of their visit was to develop and facilitate a radio scriptwriters workshop concerned of promoting modern family planning. The workshop, called Radio Imagination: creative approaches to family planning radio production, was attended by 25 participants from different organizations related to family planning and communications. Both visitors were resource persons for the 2-week radio workshop. The workshop exposed the participants to: other family planning radio experience throughout Africa; implications of family planning research for radio production; key messages to be included in the dramas and spots; principles of good scriptwriting and recording; and the process of radio presenting. Several recommendations for communication organizations and family planning agencies are cited.
In response at the request of the US Agency for International Development (USAID) Office of Population, Mr. Gary Saffitz of Saffitz, Alpert and Associates, Inc. made a technical assistance visit to Minia, Egypt, from July 6 to 24, 1992. The purpose of the trip was to assist USAID and the National Population Council Minia in developing activities supporting the Minia Initiative Project. During the technical assistance visit, positioning activities related to the workshop were developed and conducted. In addition, two intensive information, education, and communication group meetings were held with all the agencies to discuss options and opportunities for future collaborative efforts. Numerous ideas were developed and discussed, however, there was insufficient time to reach full consensus and create detailed follow-up plans. To this end, arrangements were made to facilitate additional follow-up with staff who will be remaining in Minia for the July week activities. A major recommendation cites that future technical assistance may be needed to help in finalizing the plans and activities supporting future collaborative efforts.
This content analysis documents and discusses adolescent reproductive health issues reported in local newspapers and magazines in Kenya. It also gauges the extent to which various adolescent reproductive health issues are discussed. To this end, various local newspapers and magazines were reviewed and documented. Overall, the analysis indicates that some issues, such as sex education/family life education, female education, pregnancy and related school drop-out, and sexually transmitted diseases/AIDS, have received serious discussions and relatively plenty of articles in terms of coverage. In the context of the issue of rape, it is noted that it has received a lot of coverage statistically but discussions have been low keyed. In addition, further analysis indicated that the pattern, trend, level of discussion and the tempo of discussion are determined by several factors. Such factors include power of personalities involved, nature of the constituency, extent of media coverage, and the topicality of the issue. Based on these findings, recommendations for media, government, and youth advocates are cited.
This case study aims to obtain a perspective of potentials and barriers to women's use of family planning services and elucidates areas of conflict for their use of services, as well as reasons regarding their high fertility. Situated within the framework of women's health in Kissi, a rural area in Kenya, focus was on the various dimensions of women's position at the household level, the changes that position have been submitted to during colonial and post-colonial times, and how these changes have affected women's health and fertility patterns. It is noted that over time, gender roles and relations have been submitted to tremendous changes. Such changes have profoundly affected the position of women within the household, both regressive, as well as progressive. In terms of the impact of changing gender roles and relations on women's use of antenatal services, no immediate relationship can be seen. However, in terms of family planning use, women's position at the household level seems to interact much more intimately with their use patterns. In view of this, government should provide economic security and increased investment in the social sector; and provide efficient family planning measures to be carried out within an ethical framework where the greatest concern should be the women.
A new beginning for Egypt's youth.
In 1981, the Egyptian Government invited the US Agency for International Development (USAID) to participate in its plan to reform the country's educational system. A partnership between the Ministry of Education and USAID was established, subsequently promoting the Basic Education program that addresses several constraints, including overcrowded classrooms, unequal access, curriculum deficiencies, ineffective teaching, and an inefficient administrative school system. A key element in the effort to increase access has been the construction of school buildings at locations which are not considered to be too far away from the homes of the children. Other efforts emphasized the improvement of the quality of education focusing on integrating technical and research capabilities, improving learning delivery systems, strengthening assessment and evaluation programs, and making decisions based on research data. In addition, the Ministry created information- and research-based agencies that would lay the foundation for the development of new patterns of education. Overall, it is observed that such reforms are enhancing the quality and relevance of education for the Egyptian youth.
This document presents the address of Dr. Haryono Suyono, chairman of the Indonesian National Family Planning Coordinating Board, which was presented during the meeting of the Population Association of America on May 5, 1994. Dr. Suyono shared some of Indonesia's experiences in implementing family planning programs, particularly on the issue of quality in the development of family planning programs. He stressed that reaching a stationary population size is an important goal for Indonesia. The country is presently developing two complementary national policies, family planning and prosperous family development, as part of its total development programs. The two policies of Demand Fulfillment and Demand Creation are both needed in designing the most effective and efficient family planning system, and to ensure priority investments in development. The Indonesian Family Planning Demand Fulfillment Policy is an approach to designing family planning services and information campaigns to enable every couple to achieve their desired number and timing of births effectively and healthfully. The Family Planning Demand Creation Policy, on the other hand, is an approach to prioritizing development efforts based on an understanding of how the context of families' lives affects their desire for children. Together, these policies assure that individual and family needs for healthy family planning, and national needs for a stationary population are being met.
A review of research in adolescent fertility in Kenya.
This document is a compendium of information on adolescent fertility in Kenya that was compiled by the Center for the Study of Adolescence (CSA). The objectives of this activity were 1) to prepare a document of past and current research, so as to enable the members of CSA, and other interested persons to know what has or is being done in the area of adolescent fertility in Kenya; 2) to monitor on-going research in the area and regularly update the document. The document is presented in two parts. The first part summarizes research studies on the definition of adolescents; levels of adolescent fertility; determinants of adolescent fertility; adolescent sexuality; determinants of adolescent sexual activity; menarche; adolescent and contraception; obstetrical aspects of adolescent pregnancy; and the social consequences of adolescent pregnancy. The second part is a summary of research findings presented in bibliographic forms.
This paper discusses the situation of induced abortion in Kenya. Although trends in contraceptive prevalence have been encouraging, unwanted pregnancies and abortions continue to increase. Despite implementation of restrictive law, many women still resort to abortions that result in serious socioeconomic and health consequences. With the existing sociopolitical climate in Kenya, other alternatives were undertaken which could greatly benefit those who may need abortion services. These include 1) comprehensive information, education and communication/family planning (FP) education programs to communities, leaders and the youth; 2) accessibility of contraception services to all sexually active individual; 3) training and expansion of manual vacuum aspiration services in both public and private sector; and 4) provision of quality postabortal counseling and contraceptive services. Moreover, it was observed that the current FP services focus on the married woman and on preventing pregnancy; thus, neglecting those women with unwanted pregnancy due to inaccessibility of services or contraceptive failure. This paper concludes that the many organizations that provide FP services in Kenya could easily broaden their approach to encompass all aspects of reproductive health, including abortion.
This document, published by the UN Children's Fund, discusses the importance of childcare as taught by the Christian religion. Childhood is the period in life in which a child begins to develop a personality and form life-long habits and traits. In Myanmar, studies have indicated that Christian parents who say that they do not have family fun and recreation spend most of their leisure time by reading and listening to music and playing musical instruments. In a discussion of the importance of child life, several Holy Scriptures were cited presenting children as gift from God. It then presents the child-parent relationships as having a definitive place in the general welfare of children. Under this precept, the responsibilities of parents to children as well as duties of children to parents are discussed extensively. Moreover, the document emphasizes education, the Christian Church, and good health as importance elements for the development of children. Also, the document enumerates Holy Scriptures provisions, teachings and guiding principles relating to childcare and development. The final section presents several preventive measures that should be taken to ensure a life of love, joy and peace here on earth. These preventive measures are found in the Holy Scriptures to ensure good health and happiness.
Lessons in tetanus elimination revisited.
This article describes the successful efforts of Albert Schweitzer Hospital (ASH) to eliminate neonatal tetanus through a series of innovative hospital- and community-based activities. The immediate factors that contribute to the extremely successful effort to control neonatal tetanus was the implementation of several techniques that later became associated with social mobilization, social marketing, rapid assessment, ethnography, community mobilization, and cost analysis. The ASH program provided effective and convenient services for which the public felt a strong need, powerfully promoted the services, and utilized community resources both for service promotion and provision. The fund of goodwill and trust, which the ASH had built through years of service, greatly facilitated the community health outreach team's ability to cover the population of women in the hospital's district of 150,000 persons. The hospital leadership understood basic public health principles extremely well and took an incremental, problem-solving approach in addressing the problem of neonatal tetanus. Moreover, the long-term approach was extremely successful in mobilizing community resources and cooperation and in gradually incorporating complementary strategies. The hospital staff and community members were highly motivated to act, in large part due to the ubiquity of neonatal tetanus deaths. On the other hand, the folk health system was not only antagonistic but was in fact extremely supportive.
Urban population has increased dramatically during the last half of the century, particularly in the developing countries. According to the UN projections, majority of the world population will be urban by 2005, and by 2015, the cities of the developing world will be home to 3.2 billion of an estimated 4.1 billion city dwellers worldwide. Of the present 2.5 billion global urban residents, Asia accounts for 1.2 billion, followed by Europe with 535 million more, and Latin America and the Caribbean, which has about 358 million. By 2025, these numbers are expected to grow, with the highest rate of urban growth occurring in Africa. It was projected that by the period 2020-2025, the global urban growth rate will have declined to less than 2% per annum, but the urban population will increase by 93 million, exceeding the current annual increase in the total world population. There are more cities and more big cities, and by the early years of the next century, most of the population will be living in them.
In 1992, the Baby-Friendly Hospital Initiative (BFHI) program was launched in the Philippines by the Department of Health (DOH). The program aimed to encourage hospitals and maternity services to adopt practices known to promote the health and well being of newborns by creating an environment that is conducive to breast-feeding. The DOH specified the baby-friendly set of practices of the hospital. To determine the compliance levels to the BFHI of the hospitals and to examine correlation between differences in compliance levels of the hospitals and personnel and administrative factors, 129 hospital personnel from 8 government hospitals (6 provincial hospitals and 2 regional hospitals) in Region VI were surveyed. The data was collected through observation and questionnaire; the findings revealed a high compliance level to the policies of the BFHI program in government hospitals in Region VI. Furthermore, no significant difference was found between the compliance level in regional and provincial hospitals. Finally, no correlation was found between the compliance level and personnel and administrative factors.
A descriptive and analytical survey was conducted to describe and understand the dynamics that are associated with the overstaying of AIDS patients in the hospital, where 16 AIDS patients were admitted from January 1, 1993, to January 1, 1994, at the Research Institute for Tropical Medicine in the Philippines. Of the 16 patients, 8 went home within 2 days after a discharge order was made (on-time group); the other 8 stayed longer in the hospital (overstaying group). In comparing the 2 groups, the on-time group members had a higher education and professional occupations compared to those who overstayed. Access to and use of AIDS-related services were significantly associated with patients going home on time, which was exemplified by high levels of awareness of source information, utilization, and satisfaction. In addition, patients who received pre-test and initial post-test counseling before confinement were able to go home on time. Other factors associated with patient's going home on time include acceptance by the patient and his family of positive test result and the AIDS diagnosis, acceptance by their families, knowledge of AIDS facts, access to transportation, food/drugs, shelter and emotional support, and social support provided during hospitalization. Based on the findings, several recommendations were made.
This paper presents country profiles and various innovative projects of the 8 selected countries in South and East Asia, the world's most populous region. These countries include Bangladesh, India, Indonesia, Myanmar, Pakistan, Thailand, the Philippines, and Vietnam. Profiled are the countries' political and economic situations, demographics, reproductive health and gender, future population and reproductive health challenges, and the major thrust of the Population Council. In some of the countries, the following areas are included: geographic situation, population and population policy, education, and program initiatives. Other data presented are the countries' total population, total fertility rate, contraceptive prevalence rate, maternal mortality rate, infant mortality rate, and percent of population under age 15 years. Maps of the 8 countries are also shown.
Family-centered maternity care. Training of trainers curriculum, Ukraine, 1996.
This curriculum serves as the primary teaching tool for the Ukraine Training of Trainers in Family-Centered Maternity Care (FCMC), care which emphasizes the multiple needs of women and utilizes education and family involvement as major tools for engaging the woman in the process of her own care. It is also the basis for future training of additional Ukrainian women's health care providers in FCMC. The first section of the paper presents the entire flow of the curriculum from day 1 through day 5. Topics are outlined in table format, including the time allotment and teaching methods. Session outlines with their corresponding notes and support appendices are provided. Learning objectives for each day of the curriculum are described. Other activities, handouts, and overheads are also included in the paper.
Viet Nam Demographic and Health Survey, 1997.
The 1997 Vietnam Demographic and Health Survey (VNDHS-II) is a nationally representative survey composed of 5664 ever-married women aged 15-49 years that were selected throughout Vietnam. The survey was designed to provide information on levels of fertility, family planning knowledge and use, infant and child mortality, and indicators of maternal and child health. The VNDHS-II data demonstrated patterns of declining fertility, marked differences in fertility levels, and common prevalence of unplanned fertility despite high levels of contraceptive knowledge and use. While IUD was the most common method used, two traditional methods accounted for a significant amount of current use: periodic abstinence and withdrawal. Unmet need for family planning and discontinuation rates were low. Despite the wide availability of family planning services, findings also indicated lost opportunities to provide such services. The survey further showed substantial increases in the number of women receiving maternal care, high level of knowledge of AIDS among women, and wide availability of maternal and child health services. A declining trend was observed in the levels of infant and child mortality. About 98% of children are breastfed, with median duration of 16-17 months. Estimated vaccination rates among children 12-23 months of age for Bacillus Calmet Guerin, diphtheria, pertussis, and tetanus, and polio were 90% or higher while the estimate for measles was 77%. Approximately 2 out of 3 children (68%) with respiratory illness were taken to a health facility while 3 out of 4 children (72%) with diarrhea had received some type of oral rehydration therapy.
Management of childhood illness.
This document presents a guide for managing childhood diseases. Assessing, classifying, and identifying treatment are important first steps in the management guide. A chart to assess and classify those steps is illustrated, reflecting the symptoms, problem classification and appropriate treatment of the disease. Instructions on how to give oral drugs at home, including a drug's dosage table, as well as instructions on how to treat local infections in a home-based setting are presented. Treatments that can only be administered in the clinics are specified. A diagram illustrating the treatment plans for diarrhea, as well as guidelines for follow-up care are also provided. The paper includes a counseling guide for mothers whose children are experiencing feeding problems. The points to consider when advising a follow-up visit are discussed. Recording forms for the management of sick infants, age 1 week to 2 months, and the management of sick children, age 2 months to 5 years, are included.
DISH project. Basic reproductive health services curriculum.
The Basic Reproductive Health Skills Curriculum is designed for use in reproductive health skills training of nurses and midwives in Uganda. The curriculum is composed of seven modules: 1) introduction to integrated reproductive health services; 2) education and counseling for reproductive health services; 3) providing family planning services; 4) providing maternal health services; 5) performing life saving skills for maternal health; 6) providing sexually transmitted infections and HIV prevention services; and 7) organizing the clinic for reproductive health services. Each module presents the general and specific session objectives, content outline, trainer/trainee materials, and a list of trainer resource materials. Since the approach of the manual is to actively involve the participants in the learning process, the sessions included simulation skill practices, case studies, role-play, discussions, and clinical practice by using objective knowledge, attitude, and skills checklists. The training supplement materials include knowledge assessment questions and skills assessment tools used before, during, and after the training course and a trainee handbook containing reference materials for trainees to use during the training and on return to their work sites.
DISH project. Pre / post training skills performance assessment tools.
This document contains pre- and post-reproductive health skills training performance assessment tools. The reproductive health skills training trainee skills acquisition-monitoring tool serves to review feedback and to make a self-assessment of how well the objectives are being met. For the trainees and preceptors, the tools serve the following purposes: 1) to share information on trainee progress in meeting practicum objectives; 2) to identify areas needing close guidance and intervention; and 3) as a basis for making decisions on readiness for post skills assessment and weaning off the trainee from close supervision. Among the jobs that are evaluated in the skills performance assessment tools are conducting group client education for reproductive health services; counseling high risk clients to make a reproductive health decision; obtaining history from a pregnant mother at booking clinic; and monitoring labor by using a partograph.
DISH project. Observation checklists for LSS skills monitoring.
This manual presents observation checklists for life saving monitoring that also serves as a training tool for skills acquisition monitoring. The training tool was developed by the Delivery of Improved Services for Health, which aimed to provide information to trainees for review of feedback and making self-assessments in the success and enhancement of program implementation. Furthermore, the aim was to have trainees and preceptors share information on trainee progress in meeting practicum objectives, identifying areas needing close guidance and intervention, and providing a basis for decision-making in the readiness for post assessment and weaning off trainees from close supervision. Using this manual entails that feedback be given after each supervised procedure and tool completed and signed off by the preceptor or trainer. The same feedback process applies for the completion of all procedures performed on one client, and provision of commentaries on problem areas, while presenting specific aid given or needed as well as the progress made. Included in the manual are checklists for skills in the monitoring of labor by using a partograph, managing third stage of labor, manual removal of placenta, managing emergency uterine atony, initiating intravenous fluid in a peripheral vein, managing anemia, managing preeclampsia and eclampsia, administrating of blood transfusion, performing episiotomy and vacuum extraction.
DISH project. Reproductive health skills: nurses and midwives handbook.
The Reproductive Health Skills Nurses and Midwives Handbook is designed for trainers during reproductive health skills training workshops and after training at the trainees' work sites. This handbook consists of post training jobs and tasks, clinical objectives, and content reference and procedures for each module. The topics covered range from family planning and contraceptive use, maternal health services, transmission, prevention and control of sexually transmitted diseases, and organization of clinics for reproductive health service delivery. The first module presents an introduction to the integrated reproductive health services. The second module discusses the education and counseling services for reproductive health services, as well as communication, client discussion for reproductive health, the use of visual aids, overview of counseling in RHS, and counseling of high risk clients for RHS. Furthermore, the provision of family planning services was focused on in the third module. The fourth module discusses the services that are required in providing antenatal care, delivery, postpartum care, and postabortion contraception. The fifth module presents a training tool for performing life saving skills for maternal health. The sixth module provides background information and prevention services for sexually transmitted infections and HIV. The seventh module presents the development and establishment of clinics that provide reproductive health services.
This Statistical Yearbook for 1997 presents the statistical data on various geographical, social and economic aspects of Turkish Republic of Northern Cyprus. The first five sections focus on the climate, population and vital statistics, health, education, and judicial situation in Northern Cyprus. The emphases were on the rates of births and deaths, and marriages and divorces in 1997, as well as the educational system existing in North Cyprus. The succeeding 5 sections, on the other hand, present a discussion on the condition of social security and welfare, labor force and employment, agriculture, industry and construction. The data that was used in those sections was taken from the Ministries of Finance, Social Welfare, Labor and Health, Agriculture, and Economy. In addition, the last sections highlight the situation on money and banking, transport and communication, tourism, import and export trade, national accounts and public finance, prices and indices, and international statistics in North Cyprus. A comparative analysis from 1976 to 1997 is also provided.