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Geneva, Switzerland, UNAIDS, 2004 Sep. 217 p. (UNAIDS/04.35E)This progress report summarizes the achievements of the Country and Regional Support Department in 2003 and presents selected highlights in greater detail. The first section outlines the strategic framework for action, Directions for the Future, the status of its implementation, the associated capacity strengthening of UNAIDS at country level, and challenges for 2004 and the next biennium. Text boxes in this section highlight “UNAIDS corporate tools” employed to implement the strategic framework. The second section reviews the Country and Regional Support Department’s efforts to translate global initiatives into results at country level. UNAIDS is involved in numerous global initiatives, three, which required particular involvement of UNAIDS resources at country level, are highlighted here. The third section reviews regional progress towards implementing the strategic framework for action. The examples cited, whilst not being an exhaustive review of country work, illustrate how UNAIDS has worked as a catalyst for national AIDS response. This report concludes with a collection of two-page country situation and progress summaries from 70 of the 134 countries with the UN Theme Groups on HIV/AIDS. (excerpt)
Report of the fifteenth meeting of the UNAIDS Programme Coordinating Board, Geneva, 23 and 24 June 2004.
Geneva, Switzerland, UNAIDS, 2004 Jul 30. 62 p. (UNAIDS/PCB(15)/04.15)The fifteenth meeting of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Programme Coordinating Board (PCB) took place at the Ramada Park Hotel, Geneva, Switzerland, on 23 and 24 June 2004. The participants are listed in Annex 3. On behalf of Zambia, the outgoing Chair of the PCB, H.E. Dr Brian Chituwo, Minister of Health, opened the fifteenth meeting of the PCB and welcomed all those attending. Dr Chituwo stated that it had been an honour and a privilege on behalf of Zambia to chair the PCB. In light of various international proclamations, including the United Nations Millennium Development Goals, the Copenhagen Consensus and the World Health Organization (WHO) Commission on Macroeconomics and Health, he felt that the global community had given a broad mandate to UNAIDS to take the fight against the pandemic to higher levels, and he noted that UNAIDS had responded by scaling up activities significantly. He warned against complacency, however, and cited the particular challenges posed by the “3 by 5” Initiative, including his country’s own efforts to scale up treatment. He paid tribute to Dr Peter Piot (Executive Director of UNAIDS) and his team and thanked them for their close support during his tenure in office. In closing, he urged all to remain united in the fight against HIV/AIDS. (excerpt)
Summary measures of population health in the context of the WHO framework for health system performance assessment.
In: Summary measures of population health: concepts, ethics, measurement and applications, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers and A.D. Lopez. Geneva, Switzerland, World Health Organization [WHO], 2002. 1-11.This volume addresses the conceptual, ethical, empirical and technical challenges in summarizing the health of populations. This is critical for monitoring whether levels of population health are improving over time and for understanding why health differs across settings. At the same time, it is also important to recognize that improving population health is not the only goal of health policy and to understand the way health improvements interact with these other goals. For that reason, we briefly review the World Health Organization (WHO) framework for assessing the performance of health systems and the role of summary measures of population health (SMPH) in this framework. Following the recent peer review of the methodology used for health system performance by WHO (Anand et al. 2002), this framework will continue to evolve in response to the detailed recommendations of the scientific peer review group and to ongoing scientific debates and research. (excerpt)
Moscow, Russia, RFPA, .  p.This pamphlet describes the goals and activities of the Russian Family Planning Association (RFPA) and its relationship with IPPF. The Russian government supports RFPA, but it is nonetheless a voluntary public organization. RFPA's goals include improvement of reproductive health, particularly among youth, and reduction of the rates of abortion and sexually transmitted diseases (STDs). Its activities revolve around promotion of family planning and modern contraception, sex education for youth, helping youth through medical and psychological counseling on sexual health and contraception, increasing awareness of safe sex and reproductive health care, family planning training for medical and nonmedical professionals, and setting up RFPA branches in Russia and supporting their efforts. In 1993, RFPA branches and units operated in the regions of Altay, Archangel, Ivanovo, Leningrad, Krasnodar, Magadan, Moscow, Novosibirsk, Primorsky, Rjazan, Samara, Sakhalin, Sverdlovsk, Smolensk, Stavropol, Tomsk, Tula, Udmurtia, Uljanovsk, and Khabarovsk; the cities of Miass, Orsk, and Surgut; and the republics of Burjatia and Carelia. RFPA works with state and public groups addressing family and youth sex education. It distributes IPPF publications on sex education and family planning; an international medical journal; and films, TV, and radio programs. RFPA arranges for eminent national and international family planning specialists to conduct seminar and training all over Russia. A training center operates out of RFPA headquarters in Moscow. RFPA is creating a computer data bank on family planning and reproductive health. It has established a network of its branches that follow sociodemographic, cultural, and national characteristics of Russian territories. RFPA adheres to the ideology and strategies of IPPF.
In: Breaking the earthenware jar. Lessons from South Asia to end violence against women and girls, [by] Ruth Finney Hayward. Kathmandu, Nepal, UNICEF, Regional Office for South Asia, 2000. 403-5.This appendix presents a summary of some of the UN milestones for women and girls' human rights. It compares the way women's human rights were addressed first in the UN Charter and the Universal Declaration on Human Rights (UDHR) with the way various women's human rights have been treated over the years, so far as the UN system and its treaties and declarations are concerned. Highlighted is the 1945 UN Charter, which makes no special mention of women's rights but affirms equality between women and men and prohibits distinction on the basis of sex. Other achievements of the UN highlighted in this appendix include the adoption of the UDHR, the Convention on the Elimination of All Forms of Discrimination Against Women, the Conventions on the Rights of the Child, the Declaration on the Elimination of Violence against Women, the 1993 Vienna Declaration and Program of Action, the International Conference on Population and Development, the Fourth World Conference on Women in Beijing in 1995. In addition, through the agreements reached at Vienna, Cairo, and Beijing, governments commit themselves to eliminating violence against women. Moreover, committed organizations are beginning to work together for the fulfillment of the human rights of both women and children, and to focus on what happens in the family.
ECONOMIST. 2001 May 26 - Jun 1; 79-80.On May 22, 2001, the WHO concluded the annual jamboree--the World Health Assembly, bringing together representatives from 191 states to assess the achievements and discuss future activities under the leadership of director-general Dr. Gro Harlem Brundtland. Unlike her predecessor, Dr. Hiroshi Nakajima, Dr. Brundtland has had some experience in government. However, her leadership has created varied reactions and criticisms from several member states, such as her high-profile campaigns on malaria and tuberculosis (TB) and tobacco. Some people close to the organization argue, however, that apart from their snappy slogans such as "Roll Back Malaria" and "Stop TB", they have little improvements. Moreover, some nongovernmental organizations fret about potential conflicts of interest from the overtures of WHO to drug companies. Despite these criticisms, her strategy paid off in financial terms, with big donors, such as the US and UK, being positive about the changes. Moreover, Dr. Brundtland has been considered a passionate public advocate preaching the gospel of health care investment as a key to poverty eradication and has moved health and WHO into the center of the global debate on development.
POPULI. 1999 Dec; 26(4):6-7.This article focuses on the leadership achievements of the UN Population Fund (UNFPA) in Africa. For 30 years, UNFPA has played an irreplaceable role in providing technical and financial assistance in the country. By promoting the role of women and helping African governments to define population strategies, UNFPA enabled many African governments to strengthen their ability to implement population and development policy. In a span of 30 years, their focus of population challenges changed from controversy to consensus. It should be noted that the Fund has contributed considerably to social and economic development of many developing countries by promoting reproductive and sexual health, prevention and control of sexually transmitted diseases, and abortion reduction. Moreover, the leadership initiatives of UNFPA made the women to assert themselves into the mainstream of development. Considering the numerous achievements UNFPA has had in many African countries and other parts of the world, there is no doubt that some time in the future it shall become indispensable to the continent.
VIETNAM POPULATION NEWS. 1999 Apr-Jun; (11):1-2.The 1999 UN Population Award was given to Vietnam's National Committee for Population and Family Planning (NCPFP) for its contribution to plummeting infant mortality rates and rapidly declining fertility rates. The award was announced in New York by the Chairman of the Award committee, Ambassador Jose Luis Barbosa Leao Monteiro of Cape Verde. Vietnam's NCPFP shared the award with Iran's former Minister for Health and Medical Education, Dr. Seyed Alireza Marandi. The two winners were chosen from among 33 nominations: 18 of those nominated were individuals and 15 were institutions. According to Tran Thi Trung Chien, the Viet Nam Committee Minister, the award is not for NCPFP alone but for all of Viet Nam.
JOICFP NEWS. 1997 Apr; (274):1.This article focuses on the accomplishments of a prominent Japanese demographer, Toshio Kuroda, and his receipt of the 1997 UN Population Award. Kuroda is director emeritus of the Nihon University Population Research Institute and a board member of JOICFP. He was honored for his research, publications, and leadership contributions in Japan and throughout Asia and the world. His first population experience was with the Institute of Population Problems of the Japanese Ministry of Health and Welfare in 1947. Eventually he became director of the Institute before assuming a position at Nihon University as director of NUPRI. Kuroda served as a Japanese representative in the UN Population Commission, at the 1972 Stockholm Conference on the Environment, and at the 1974 Bucharest International Conference on Population. He served as a resource person for Asian population conferences, Japanese nongovernmental groups, and the Mainichi Newspapers Population Problems Research Council. He developed a reputation as a consensus builder among Japanese leaders and policymakers, has maintained a long-standing relationship with JOICFP, and served as a resource person at its many forums and training courses. Since 1985 he has served as a major resource person on JOICFP's aging program for the Asian region. Since 1988 he has supervised the development of UNFPA's annual State of World Population Report for Japan. Kuroda is known for his views on the integration of micro- and macrolevels of analysis and discussion. He believes that a high level of education is key to the promotion of family planning. Girls should be enrolled in school through high school. Toshio Kuroda was one of three people and the second Japanese person to receive the UN Population Award.
SUSTAINABILITY MATTERS. 1995 Dec; 1(3):1.Advocacy has advanced the cause of family planning greatly as demonstrated during the Women's Conference in Beijing in 1995 where family planning and reproductive health were featured. After four decades of arduous work the International Planned Parenthood Federation (IPPF) could claim that family planning was recognized around the world both by ordinary people and by political leaders. In the Western Hemisphere, advocacy plays an important role in sustaining the family planning programs. The President of Peru, Alberto Fujimori, recently strongly advocated family planning by calling for equal access to services and information. In 1990, IPPF recognized Fujimori's potential by presenting him with the Outstanding Individual Contribution to Family Planning Award. The affiliate family planning association in Peru, INPPARES, also supported the government's efforts relating to family planning. Over the years, advocacy has made it possible for IPPF to overcome resistance to family planning. This advocacy responded to the increasing opposition in the US and in the rest of the hemisphere, which was accompanied by deep cuts in funding. Two participatory training seminars were held in advocacy skills development to counter this challenge.
Geneva, Switzerland, WHO, 1992 Mar. 15 p. (WHO/EPI/GEN/92.2)This progress report highlights the current status of immunization programs and details a conceptual framework for EPI for the 1990s. The global achievement of the 1990 target of 80% immunization coverage among infants worldwide with BCG and measles vaccines, and the third dose of DPT and of oral poliovirus vaccines is directly attributable to the efforts of national governments, WHO, UNICEF and other bodies of the United Nations system, bilateral development agencies, and nongovernmental organizations. At current levels of immunization coverage, it is estimated that immunization programs prevent each year some 3.2 million deaths from measles, neonatal tetanus and pertussis, as well as some 440,000 cases of paralytic poliomyelitis. The World Summit for Children clearly set the major objectives for immunization programs in the 1990s as follows: maintenance of immunization coverage (at least 90% of children under one year of age by the year 2000) against diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis and against tetanus for women of childbearing age; by 1995, reduction by 95% of measles deaths and reduction by 90% of measles cases compared to preimmunization levels; elimination of neonatal tetanus by 1995; and global eradication of poliomyelitis by the year 2000. The activities to achieve the immunization coverage goals will require significantly more resources, including more vaccine. Immunization and disease control plans of action will be formulated at all levels, and revised as necessary to establish policies and strategies. Training is crucial in developing the human resources. Communication can promote and sustain health behavior change in a target group. Vaccine supply is emerging as a priority in the 1990s. In the 1990s monitoring of immunization coverage will increasingly be refined to ensure that immunization coverage levels can ultimately be recorded and reported in all communities. Continued research and development activities will be directed at solving operational problems.
PLANNED PARENTHOOD CHALLENGES. 1996; (1):12-4.The International Planned Parenthood Federation's Vision 2000 Strategic Plan has emphasized advocacy and the training of family planning associations (FPAs) in the Western Hemisphere region. During the summer of 1995 training programs in advocacy leadership management were sponsored for six FPAs in the Bahamas, Suriname, Belize, Colombia, Honduras, and Brazil. At the Western Hemisphere Regional Council Meeting in September 1995 awards were presented to FPAs for media outstanding projects. These FPAs used outreach to the community to promote the goals of Vision 2000. The Bahamas FPA won the Rosa Cisneros Award for articles published in a magazine that is distributed in primary and secondary schools and deals with the activities, achievements, and opinions of students. Issues include: love, relationships, responsibility, and teen pregnancy. A weekly television talk show also addresses the issues facing youth including education, music, community work, sexuality, pregnancy, and the relationship between teenagers and adults. The Family Planning Association of Honduras was also nominated for the award for a radio show on the health of mothers and children, the problems of adolescents, and FP. The newspaper Tiempo received the award for feature articles on social issues and FP. In 1994 the Association distributed thousands of booklets on contraceptives as well as fliers on vasectomy, female sterilization, oral contraceptives, IUDs, condoms, responsible parenthood, high-risk pregnancy, vaginal cytology, and cervical cancer. Similar posters were placed in hospitals and health centers, in 1997 FP posts, and 400 commercial outlets. The Family Planning Association of Suriname also carried out an impressive advocacy program during the period of 1968-93 with the goals of establishing a balance between population growth and the available resources to achieve well-being with regard to education, health care, nutrition, and housing.
In: Family planning. Meeting challenges: promoting choices. The proceedings of the IPPF Family Planning Congress, New Delhi, October 1992, edited by Pramilla Senanayake and Ronald L. Kleinman. Carnforth, England, Parthenon Publishing Group, 1993. 709-21.The rise of voluntary family planning (FP) has been a remarkable phenomenon in the second half of the 20th century. Demographic and Health Surveys show that 20-27% of married women in developing countries do not want more children. In 1992 in Zambia 63% of women either wanted no more children or did not want another child for another two years, yet the availability of contraceptives was limited. After 1975 FP services improved in Bangladesh; in 1992 about 40% of women were using contraceptives, and the total fertility rate had fallen to 4.8. In Pakistan with a similar level of literacy only 12% of women used contraceptives because of deficient FP services. Since the International Planned Parenthood Federation (IPPF) was founded in 1952 in Bombay hundreds of million of women have suffered because they had no access to FP. The costs of FP service delivery can vary, but social marketing may be the most cost effective way of distributing contraceptives. Cost sharing by clients in addition to government and donor subsidies of FP programs are economical. In the 1990s an estimated 100 million new contraceptive users must be recruited just to maintain the existing rate. The total budget needed to achieve the median UN population is $2.6 billion a year. Another estimate drafted by the UN Population Fund in 1988 set the figure at $9 billion, but it also included maternal care and integrated FP and development programs. The $9 billion figure is preferable with the proviso of giving priority to providing FP to a very large number of people and to use resources in a cost-effective manner. The role of the IPPF is to promote policies to help FP associations succeed.
In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 17-8.The World Health Organization (WHO) was selected as the Executing Agency for the Onchocerciasis Control Programme (OCP) in West Africa, and The World Bank agreed to mobilize funds from the donors and the beneficiary African governments. Because of the severity and spread of the disease and the flight range of the vector, Simulium damnosum, a large area was demarcated for vector control activities. Most of the vector breeding sites were inaccessible to land-based vehicles, and the only control tool available was aerial larviciding. Work started in 1975. By 1986, the original 7-country treatment area was expanded to include 11 countries with a total population of 30 million. Weekly larvicide treatments were continuing in 1987, when chemotherapy with Mectizan was added. As a result of intensive research, today there are 6 pesticides and Mectizan, a microfilaricide suitable for mass distribution. In the original program area, OCP has been ahead of schedule in removing the disease as a public health and socioeconomic development problem: a) None of the 30 million people living in the OCP area risk getting onchocerciasis; over 150,000 cases of blindness have been prevented. b) 25 million hectares of fertile land have been liberated and, in many areas, production of cereal, animals, and fish has increased. More than 400 indigenous scientists and health workers have been formally trained, and over 98% of OCP staff are Africans. Merck & Co. tested Mectizan in large-scale clinical trials that were conducted in association with OCP and WHO. By 1986, about 1200 patients had been treated and, of those, over 1000 were in the OCP region. In October 1987, Mectizan was registered for human use, and Merck & Co. donated the drug to all patients. Since then, OCP has used over 3 million tablets. Mectizan is well accepted by the patients; it controls the disease, and, in combination with larviciding, it dramatically affects transmission.
Donation of Mectizan: a global challenge to control onchocerciasis and prevent onchocercal blindness.
In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 9-11.According to the World Health Organization (WHO), 85 million people are at risk of onchocerciasis in 27 countries in Africa and in 6 countries in Latin America, and 18 million are infected with the parasite, leading to visual impairment in 1 million and blindness in more than 400,000. At present, the Onchocerciasis Control Program (OCP) is the largest vector control program in the world. During the past 10 years, onchocerciasis transmission has been reduced to below the accepted limit of tolerability in over 90% of the treatment area. The advent of Mectizan and its donation by Merck & Co. Inc. for the treatment of onchocerciasis has brought hope to afflicted communities. In Nigeria, the primary health care system had been in place in 1986 by establishing village health services and health centers staffed by village and community health workers. At that time the process of health services development began in a country of 88 million people, 589 local governments, and over 100,000 villages. Since the completion of the National Onchocerciasis Prevalence Survey, carried out between 1988 and 1989, which revealed that the disease was present in all regions of Nigeria, the phased integration of treatment with Mectizan into the primary health care services began in 1991. Recently, WHO agreed to join the Ministry in exploring the most effective method of incorporating the program into the Primary Health Care System. The River Blindness Foundation, Sight Savers, Africare, and The International Eye Foundation have all made major contributions to the effort. Finally, the WHO Special Programme for Research and Training in Tropical Diseases in Geneva is supporting operational research in onchocerciasis with US $300,000 over 3 years. Together, they delivered approximately 1 million treatments through December 1991. In 1992, 2 million Nigerians will be protected from blindness by the use of Mectizan.
WORLD HEALTH FORUM. 1994; 15(3):293-4.Recent data show that some 1.2 million Ugandans are infected with the parasite that causes onchocerciasis (river blindness). Similar figures are emerging from other countries in Africa (which accounts for more than 99% of cases). In Equatorial Guinea, 60,000 are now infected, 5 times as many as previous estimates. These new figures were disclosed by the World Health Organization (WHO) Expert Committee on Onchocerciasis Control, which met in Geneva in December, 1993. The widening availability of a drug to cure the disease, ivermectin, has spurred countries to carry out more thorough surveys. River blindness is endemic in large areas of Sub-Saharan Africa and in isolated areas of Latin America and Yemen. The Expert Committee estimated that some 270,000 people are blind today as a result of the disease and that an equal number are severely visually impaired. Hundreds of thousands also suffer from skin lesions. Onchocerciasis is caused by infective larvae of the Onchocerca volvulus parasite, which are transmitted by the bite of Simulium blackflies. Over the years, as the burden of worms increases, severe skin damage and blindness ensue. Ivermectin (Mectizan) kills the microfilariae but not the adult worms. The UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases in conjunction with the Onchocerciasis Control Programme in West Africa proved that a single tablet once a year stops the onset of blindness, reverses minor eye damage, and reduces the unpleasant skin problems. In many countries, WHO rapid assessment techniques should be urgently applied, and national programs to treat the disease with ivermectin should be established in every affected country. Onchocerciasis has been eliminated in 11 countries in Sub-Saharan Africa by the spraying of insecticides against the blackflies. In Burkina Faso in 1975, some 600,000 people were infected and blindness rates were extremely high. Now hardly anyone is infected and transmission has been completely halted.
GLIMPSE NEWSLETTER. 1994 Mar-Jun; 16(2-3):10-1.In Bangladesh, the head of the UN Development Programme (UNDP) gave an acceptance speech at an awards ceremony celebrating the key role of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in the discovery of oral rehydration solution [ORS]. UNDP has worked closely with ICDDR,B since 1978. The UNDP leader praised ICDDR,B for its role in ORS development and also praised the government and people of Bangladesh for maintaining an environment in which ICDDR,B can succeed. He also recognized BRAC for its role in distributing information about ORS, resulting in ORS becoming a household item in Bangladesh. 10 years ago, just the scientific community knew about ORS. Today, 33% of families in developing countries uses ORS. Every family can prepare this inexpensive intervention that saves millions of lives each year at home. ORS represents the type of appropriate technology we all need to achieve sustainable human development. Around 95% of rural and urban mothers in Bangladesh know about ORS. 68-77% have used it to treat childhood diarrhea. Nevertheless, diarrhea still claims millions of lives each year, showing the need to make further progress in human development. We must extend our boundaries of knowledge, the generation of new technologies, and better delivery systems. Promotion of household food security is needed to thwart malnutrition, which is directly associated with diarrhea.
WORLD HEALTH FORUM. 1994; 15(1):1-8.2000 years ago, the world's population was approximately 300 million, which persisted for the next 1000 years. By the turn of the 19th century, there were close to 1000 million people. In 1994, the figure was well over 5000 million. In 1952, the international Planned Parenthood Federation and the Population Council were established. The UN Population Trust Fund came into being in 1967. By the early 1980s, over 120 governments were supporting family planning (FP) programs. In 1972, the World Health Organization, [WHO] assumed responsibility for a global research program on human reproduction. The program covers most aspects of reproductive health, with priorities of FP, maternal and child health care, and the prevention of sexually transmitted diseases (STDs), especially in developing countries. In the developing countries, contraception prevalence rose from 9% in 1960-65 to 51% in 1985-90. In the Third World, there are an estimated 100 million couples with an unmet need for contraception. More than 200 multi-center clinical trials, involving some 275,000 subjects and 232 centers in 58 countries, have been conducted since 1972. Work has proceeded on once- a-month injectable contraceptives, 2- and 3-monthly injectables (over 230 new compounds for testing), hormone-releasing vaginal rings, implantable contraception, postovulatory methods, a birth control vaccine, male methods of fertility regulation, and natural methods. Since much infertility is caused by STDs, the program studies improved barrier methods and the development of a vaccine for Chlamydia. More than 10,000 infertile couples have so far been studied. Numerous epidemiological studies have been conducted on the long-term safety of fertility-regulating methods, with reference to neoplasia, cardiovascular diseases, breast-feeding, AIDS, and pelvic inflammatory disease. Since 1986, 54 institutions in the Third World have benefited from long-term development grants. Well over 1200 scientists have received research training grants since 1972; and approximately 300 seminars, workshops, symposia and training courses have been organized. Denmark, Norway, Sweden, the United Kingdom, and the UN. Population Fund have contributed financially to the program.
SOMARC III HIGHLIGHTS. 1994 Mar; (10):1-2.Morocco's Protex condom project was introduced in September, 1989, by Social Marketing for Change (SOMARC). Since September, 1993, when Protex became self-sufficient, the local distributor, Moussahama, has maintained strong sales, with 1993 fourth quarter sales 18 percent higher than they were the year before. Moussahama is purchasing the condoms directly through the International Planned Parenthood Federation. Moussahama continues to expand distribution to non-traditional outlets. Condom sales are projected to reach three million units in 1994, nearly 40 percent higher than in 1993. An important component of SOMARC's project was a media campaign designed to improve attitudes toward condom use. A recent study measuring the impact of the campaign documented that current condom use of any brand among married men has increase from 3% in 1989 to 20% in 1993; 93% of all married men interviewed were aware of Protex, and nine out of ten condom users said they use Protex most often. The Okey condom in Turkey became self-sufficient in December, 1993, attributed chiefly to SOMARC's having obtained from Eczacibasi, the Turkish distributor, a commitment to directly purchase all condoms to be sold in the social marketing project. Eczacibasi has covered all commodity as well as management and distribution costs of the product since its initial launch. During this time, USAID saved over US $700,000 which it would otherwise have spent providing condoms to the project. Sales of Okey have increased rapidly since the condom's introduction in June, 1991, and are expected to exceed seven million units 1994. Eczacibasi budgeted over US $450,000 in 1994 for advertising and promotion for the Okey brand. A recent study evaluating the impact of SOMARC's condom social marketing in Turkey has increased by a dramatic 124 percent. The success of the Okey condom has encouraged the London Rubber Co. to take a more active role in marketing condoms in Turkey.
The more resources will be needed, Chairman of the National Family Planning Coordinating Board (BKKBN) of Indonesia Haryono Suyono says, "as the program becomes more successful".
INTEGRATION. 1992 Aug; (33):11-8.The National Family Planning Coordinating Board (BKKBN) of Indonesia adopted Norplant as a program contraceptive soon after its introduction. 400,000-450,000 Indonesian acceptors use Norplant/year followed by the US where use sharply increased after FDA approval. The collaboration of BKKBN with its Vietnamese counterpart started after the Prime Minister requested assistant in implementing proposals, and a memorandum of understanding was signed on population and family planning in April 1992. Indonesia donated 40,000 gross of condoms, 10,000 cycles of pills, 10,000 injectables, and 1000 IUDs to Vietnam. Among the key factors of Indonesia's family planning achievements are strong community participation, the commitment of 500,000 voluntary field workers, almost 300,000 acceptor groups, and 76,000 village contraceptive distribution centers. The continuity of contraception use is stressed whether it be the pill, IUD, or injectable. Sterilization accounts only for 5-10% of acceptors in East Java province where the total fertility rate is 2.1, considered replacement level. 94.6% of married women know at least 1 contraceptive method according to the 1991 Indonesia Demographic and Health Survey. Nongovernmental organizations get assistance from UNFPA, USAID, and Pathfinder but not from the Indonesian government which, however, assists village acceptor groups and religious organizations. The training of 5000-7000 midwives/year was initiated by the Ministry of Health and BKKBN some years ago to be sent to villages where more than 15,000 are working, and 35,000 will serve 65,000 villages in another 5 years to improve maternal-child health care services. The concept of the small, happy, and prosperous family is also promoted, and a law was passed and signed in 1992 to this effect.
INTEGRATION. 1992 Aug; (33):24-6.The UN Population Fund (UNFPA) is influential with governments because of its international coordinating role in line with the Amsterdam Declaration of 1989. The present shortage of funds for UNFPA can be traced to the weak world economy, monetary needs in eastern Europe and in the former USSR, and the stagnation of voluntary contributions to UNFPA. The reduction of funding has affected the Indonesian family planning (FP) program called BKKBN. Indonesia is a priority country for UNFPA because of the self-reliance and success of the national program; the efficient utilization of a staff of 46,000 working for 19 million acceptors; the total fertility rate drop from 5.6 in 1971 to 3.1 in 1991; a 95% and 93% knowledge of FP and contraceptives among married women, respectively; and the national contraceptive prevalence is 49.7%. Smaller private projects and strategies are recommended for nationwide adaptation. Unfulfilled needs include adolescent reproductive health care, slums, quality of services, and reaching remote fishing or highland communities. BKKBN has been assisting its Vietnamese counterpart with technical advice which is in accordance with the international objectives of UNFPA. BKKBN has also assisted Bangladesh, Pakistan, Nigeria, and Kenya. Indonesia could contribute condoms, pills, and IUDs to the UNFPA effort to increase its share, although not on the same order as Japan and the Netherlands. The 4th Asian and Pacific conference is scheduled to be held in Bali in August 1992 in preparation for the World Population Conference to be arranged in Egypt in 1994 with an agenda of policies and strategies for all the regions of Asia, Pacific, Middle East, and Latin America. The formulation of a World Population Declaration is envisioned on South to South cooperation on FP beholding BKKBN's experience in FP information exchange with other countries.
In: Adjustment with a human face, Vol. I: protecting the vulnerable and promoting growth, edited by Giovanni Andrea Cornia, Richard Jolly, and Frances Stewart. Oxford, England, Clarendon Press, 1987. 287-97.Between 1980-85 each year there were about 47 countries with structural adjustment policies (SAP's) introduced by the International Monetary Fund. These SAP's contributed to the rapid deterioration of the human condition because most of the programs depended on depressed employment and real income and the macroeconomic policies effected the welfare of the most deprived groups (rising food prices, cuts in food subsides and cuts in social expenditures). The chapter concludes with outcomes from the 10 studies that alternative adjustment policies at both the macro and micro levels are necessary and children do not have to suffer during the process of adjustment. There is a need for a broader definition of SAP which is "adjustment with a human face" which includes 6 policy components: 1) more expansionary macroeconomic policies; 2) the use of meso policies; 3) sectoral policies aiming at restructuring the productive sector; 4) improving the equity and efficiency of the social sector; 5) contemporary programs; and 6) monitoring of the human condition. Examples from South Korea, Brazil and Zimbabwe demonstrate that with implementation of expansionary macro policies, expanded economic growth is experienced. Governments can improve their social services even during periods of economic hardship by introducing low- cost interventions such as primary health care, basic education, and self-help housing by implementing targeting and effective management systems. Adjustment with a human face "involves restructuring the economy so that major imbalances are eliminated and investment in human capabilities are developed...it is a precondition for long-term growth." However, in order to achieve such structural changes there must be community participation within countries; governments need good leadership and political commitment to change and donors need to offer increased and long-term financial aid and changes in the world economic environment.
INTEGRATION. 1990 Apr; (23):4-11.Since 1976, the Integrated Family Planning and Parasite Control (IP) has been conducted by the Population and Community Development Association (PDA) through the financial support of the Japanese Organization for International Cooperation in Family Planning (JOICFP). Family planning was integrated with other activities starting with parasite control and then environmental sanitation. In 1976, PDAs activities were focused on a community-based delivery (CBD) system for contraception in rural Thailand. In the IPs first years, the PDA conducted mass treatment campaigns using both the local plant "maklua" and modern medicines. Various motivational activities were included, such as letting children see the parasites under a microscope. Many villagers showed up for treatment. Later, however, they were reinfected and failed to get further treatment. Since 1981, the major emphasis of the IP rural program has been to push building of latrines and improved water resources. PDA has started a major project for safe storage of rainwater. Some 11,300 liter bamboo-reinforced concrete rainwater storage tanks are being built in northeast Thailand. Giant water jars for rainwater catchment with a 2000-liter capacity are produced. The financing of PDAs environmental sanitation construction activities is unique. Villagers pay back the cost of the raw materials of the tank, latrine, or jar they received. Repayments go into a revolving fund which can be lent to other families. Peer pressure has made repayment levels approach or exceed 100% in target districts. Villagers are trained to produce the casings, bricks, and other things needed for building. Individuals from building crews are selected and given special training in construction techniques and are taught the potential health benefits of each activity. These people become village sanitation engineers. Villagers can engage in income-generating activities and receive technical assistance from the PDA. The IP has taken on a community participation approach. The PDAs Family Planning (FP) Health Checkup Program is the urban version of the IP. In 1989, the PDA sold 11,109 cycles of pills and 2100 packages of 3-piece condoms through FP volunteers based in 459 enterprises. These FP volunteers also tell their co-workers about parasite control and other issues that they learned from the annual refresher courses. The PDA also does school health checkup services. The PDA generated funds to keep the programs ongoing. The Thai government actively supports the work of the nongovernmental organizations.
BERC BULLETIN. 1987 Mar; (15):18-20.20 years of instability in government in Uganda has lead to an economic collapse and a breakdown in the health care system. The water system failed, hospitals and equipment collapsed, and doctors and medical personnel left the country. Many children who die or are disabled are victims of lack of education. UNICEF has joined with local religious organizations to fight this problem and educate communities on good health practices, especially immunization for children. Use of the mass media is an important part of this program and private print as well as government television and radio are used. The scouts and guides program with UNICEF trained 1000 on immunization service and they will train 10,000 parents. A child health care center developed, with the assistance of UNICEF, conducts workshops in child survival and trains nurses and medical students. An expert panel sets up curricula for schools which includes the following issues: nutrition, water, sanitation, immunization, common diseases, family health, social problems, accidents, and primary health care. This program has been tested in 20 primary schools, and is expected to become country wide. The Child-to Child program is a world-wide group that teaches school age children to become aware of their health. It also promotes public awareness of child health including physical, mental, and social needs. This program has set up many activities including the following: workshops with teachers, students, parents, and others for health education, hospital visits to children, school cleaning competitions, artist workshops, contracts in other countries such as Norway, time on government television and radio, and book publication.
JOURNAL OF TROPICAL PEDIATRICS. 1989 Aug; 35(4):197-8.The 'Child Survival Revolution' (CSR) which emphasizes the technological approaches of Primary Health Care (PHC) as defined in Alma Ata, disregards the structural conditions and processes that lead to seldom diminishing morbidity and mortality rates among the poor in the Third World. The CSR may save some lives, but will not attack the underlying and basic causes of child mortality in developing countries. We must not rely on GOBI as a technical solution to what is essentially a socioeconomic and political problem. Choices to seek or not to seek better health for family members are all intimately linked to the state of poverty of most potential beneficiaries of GOBI-FF. Some additional empowerment of the people is needed for meaningful choices to become realistic options. GOBI-FF and the CSR are a combination of new technologies communicated by social marketing with mostly a top-down implementation, taking for granted the existing social and political institutions. Although the messages of the program call for political will, for social mobilization, for involvement of the population, and for changes in the health infrastructure, these concepts are used in a very inconsistent, demagogic, fuzzy and empty way. GOBI is too strongly supply oriented and ignores the social constraints behind a weak demand for the effective utilization of existing or new health services. Third World countries often end up following rules dictated from or set-up outside the country. Social marketing too, makes people mostly consumers, not protagonists and promoters. People need access to significant remedial interventions; knowledge is not enough. Evidence shows that people are 'patterning' their behavior to what the provider wants from them just to receive the program's benefits. Health professionals must help create the necessary support systems to empower the poor. (author's modified)