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New York, New York, Oxford University Press, 1993. xii, 329 p.The World Bank's 16th annual World Development Report focuses on the interrelationship between human health, health policy, and economic development. WHO provided much of the data on health and helped the World Bank on the assessment of the global burden of disease found in appendix B. Following an overview, the report has 7 chapters covering health in developing countries: successes and challenges; households and health; the roles of the government and the market in health; public health; clinical services; health inputs; and an agenda for action. Appendix a lists and discusses population and health data. The report concludes with the World Development Indicators for 127 low, lower middle, upper middle, and high income countries in tabular form. All developed and developing countries have experienced considerable improvements in health. But developing countries, particularly their poor, still experience many diseases, many of which can be prevented or cured. They are starting to encounter the problems of increasing health system costs already experienced by developed countries. The World Bank proposes a 3-part approach to government policies for improving health in developing countries. Governments must promote an economic growth that empowers households to improve their own health. Growth policies must secure increased income for the poor and expand investment in education, particularly for girls. Government spending on health must address cost effective programs that help the poor, such as control and treatment of infectious diseases and of malnutrition. Governments must encourage greater diversity and competition in the financing and delivery of health services. Donors can finance transitional costs of change in low income countries.
In: The health of adults in the developing world, edited by Richard G.A. Feachem, Tord Kjellstrom, Christopher J.L. Murray, Mead Over, Margaret A. Phillips. New York, New York, Oxford University Press, 1992. 161-207.The consequences of adult ill-health are greater than previously believed. These consequences go beyond suffering and grief and consist of indirect adverse effects on society which increase the cost of adult ill-health in developing countries. At the household level, family and friends try to reduce the effects of an illness or injury afflicting an adult household member. Work colleagues increase their workload to pick up the slack of the ill or injured colleague. An unhealthy labor force results in slow work schedules and less specialization of employee job descriptions. These coping processes reduce the effects of illness, but are costly. Yet traditional empirical studies do not examine them. Anticipatory coping mechanisms to mitigate adverse consequences of adult ill-health include formal and nonformal insurance mechanisms, both of which bear high costs. Informal insurance mechanisms include high fertility and extended families and social networks. Formal mechanisms are investment and savings and formal health insurance. Further, adult ill-health harms children more than child ill-health harms adults. thus, the total ill-health burden of children is greater than originally surmised. Household costs of adult ill-health are effect on production and earnings, on investment and consumption, and on household health and consumption and psychic costs. At least 70% of hospital resources in developing countries goes to adult and elderly patients. A considerable proportion of primary care costs is also dedicated to adults. Even though researchers agree that disease affects income, this effect is preceded and overshadowed by the effect of disease on health status, of health status on functional capacity, and of functional capacity on productivity. In conclusion, adult ill-health restricts development in societies burdened by adult ill-health.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1989. , 12, 16,  p. (USAID Contract No. DPE-5969-Z-00-7064-00)In February 1989, a consultant went to Rwanda to provide technical assistance on creating Oral Rehydration Therapy (ORT) Corners and on oral rehydration solution (ORS) production and distribution. Major obstacles to setting up ORT Corners was limited manpower and financial resources. Recommendations for ORT Corners were that the government should emphasize ORT Corners' aim and role rather than the material and physical aspects and gain support of local and regional health officials. Annual consumption of ORS packets stood at 450,000. Since the goal was to have children use ORS for every diarrhea episode, needs would range from 8 to 10 million ORS packets/year. The cost would well surpass the ability of any government or donor agency to finance them, however. Thus the government should implement cost recovery procedures before introducing large-scale community-based distribution. Research was in the process of finding distribution mechanisms additional to the health services. Perhaps the nutrition centers, where about 60% of <2-year old children attend, could serve as ORS distribution points and impart ORT education. The consultant recommended more research on home available fluids to treat diarrhea without dehydration and not exclude them from diarrhea control programs. Since uncertainties existed about probable ORS demand levels, no one could determine needed production capacity or investment level. The consultant observed that it was not obvious who would purchase output. He concluded that Rwanda should continue to receive ORS packets from UNICEF until 1990 or 1991. It should only consider local ORS production when it has clearly identified financing and distribution options and determined demand.