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New York, New York, Council on Foreign Relations, 2005. 67 p.It is important to clarify the security dimensions of the HIV/AIDS pandemic because actions taken to confront the disease as matters of domestic policy or foreign aid may differ markedly from those taken to address threats to national security. Understanding the impact HIV is now having, much less forecasting its toll and effects twenty years hence, is difficult. Little scrupulous analysis of the political, military, economic, and general security effects of the pandemic has been performed, both because the area is poorly funded and the problem is extremely complex. The epidemic is unfolding in waves that span human generations, and societies are making incremental adjustments along the way as they try to cope with the horrible impact AIDS is taking, not only in terms of human lives lost, but in the devastation of families, clans, civil society, social organizations, business structures, armed forces, and political leadership. Further, the HIV/AIDS epidemic is occurring primarily in regions that are hard-hit by a range of other devastating diseases, acute and even rising poverty, political instability, and other conditions that may mask or exacerbate the various impacts of AIDS. (excerpt)
Habitat Debate. 2001 Jun; 7(2): p..Population and household projections are of crucial importance to both policy makers and researchers who depend on timely and reliable projections to make informed decisions and to produce quality research studies. Currently, one of the most problematic areas regarding projections is the demographic impact of the HIV/AIDS epidemic in countries with high prevalence rates i.e. how the epidemic is influencing population and household projections. At the end of the year 2000, 36.1 million people were estimated to be living with HIV/AIDS, of which 1.4 million were children. 47 per cent of the infected adults were women. 5.3 million people will be newly infected during this year. The pandemic does not spread homogeneously. The number of infections, the risk of dying, the access to medication and the principal transmission ways vary worldwide, and so does the impact of the HIV/AIDS epidemic on population structure and on household formation. In countries where the epidemic is endemic in the general population, the impact on the age and gender structure of the population is significant, and changes in the social context and behaviour are certain. (excerpt)
Washington, D.C., Population Reference Bureau [PRB], BRinging Information to Decisionmakers for Global Effectiveness [BRIDGE], 2004 Aug.  p. (USAID Cooperative Agreement No. GPO-A-00-03-00004-00)World population statistics tell a powerful story about how people and nations around the world are changing. The data can be used to gauge progress in a particular country, make comparisons across countries, and help project future trends. This policy brief provides highlights of PRB’s 2004 World Population Data Sheet, focusing on key demographic and health trends that are shaping the 21st century. The world’s population is growing substantially every year, but the pace of growth varies dramatically from one region to another. Some countries have aging populations and, as a result, face future population decline, while others still have young and rapidly growing populations. Each situation is associated with its own set of social, economic, environmental, and political challenges. In much of the developing world, policymakers and researchers are monitoring two major demographic and health trends—the trend toward smaller families and the progression of the AIDS epidemic. (excerpt)
AIDS. 2004; 18 Suppl 2:S67-S73.Objective: To assess the accuracy of demographic estimates that include the effects of HIV/AIDS on adult mortality. Design: To compare estimates of demographic indicators based on UNAIDS/WHO estimates and projections with newly available estimates based on cohort studies, hospital records, national surveys and other sources of data. Methods: New information has become available recently from a number of sites in Africa on the ratio of mortality among the HIV-positive and HIV-negative population, the proportion of all adult deaths attributable to AIDS, and the number of orphans. These data are compared with the same indicators calculated from UNAIDS/WHO estimates to assess the accuracy of those estimates. Results: Differences between demographic indicators based on UNAIDS/WHO estimates and study-based estimates are generally within the uncertainty range of the UNAIDS/WHO figures. Conclusion: Demographic estimates based on surveillance data and demographic models are close enough to study-based estimates to be useful for advocacy and medium-term planning. However, significant differences do exist that should be taken into account for short-term planning. (author's)
Paris, France, UNESCO, Section for Preventive Education, 1994. 45 p. (ED-95NVS-5)The AIDS pandemic confronts us with a full range of development issues...issues of poverty, entitlement and access to food, medical care and income, the relationships between men and women, the relative abilities of states to provide security and services for their people, the relations between the rich and the poor within society and between rich and poor societies, the viability of different forms of rural production, the survival strategies of different types of household and community, all impinge upon a consideration of the ways in which an epidemic such as this affects societies and economies. Across Africa, evidence for the seriousness of... downstream effects is accumulating rapidly; given the nature of the disease and the shape of the epidemic curve ...now is the time to take action to mitigate the worst effects in the next two decades. Because this is a long wave disaster...the effects we are seeing now in Uganda and elsewhere are the result of events (personal, communal, regional, national, and international) that occurred a decade or more ago. Action taken now cannot change the present, nor can it change the immediate future. It can change the way the situation will look in the years after 2010. (excerpt)
[Unpublished] .  p.The South-East Asia region is one of the most diverse and populous in the world. At midyear 1990, the total population of the world was estimated to be 5.3 billion people, of which 1.3 billion (24.6%) lived in the eleven countries of the South- East Asia region. During the next ten years it is expected to grow by 256.6 million, thus making up 25.3% of the world total (Health situation in south-east Asia 1991). The World Health Organization, WHO which is a pioneer organization working in the field of health. In May 1997 in the Thirtieth World Health Assembly adopted resolution WHA 30.43 in which it decided that the main social target of government and of WHO in the coming decades should be the attainment by all the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. This is popularly known as ‘health for all by the year 2000 ‘. What does ‘health for all’ mean? It means simply the realization of WHO’s objective of the ‘the attainment by all peoples of the highest possible level of health” and that as a minimum all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live. To attain such a level of health every individual should have access to primary health care and through it to all levels of a comprehensive health system. While the communities might be expected to have a similar general understanding of the meaning of health for all as outlined above, each country will interpret this meaning in the light of its social and economic characteristics, health status and morbidity patterns of its population, and state of development of its health system. In 1978 an International conference on Primary Health Care was held in Alma-Ata, USSR. This conference, which declared that primary health care is the key to attaining health for all, it emphasized that health development is essential for social and economic development, that the means for attaining them are intimately linked, and the action to improve the health and socioeconomic situation should be regarded as mutually supportive rather than competitive. The Declaration of Alma-Ata urged all government to formulate national policies, stategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. In the 1979, the Thirty-second World Health Assembly launched the Global Strategy for health for all when it adopted resolution WHA32.30.The Global Strategy indicates the broad lines of action to be taken I the health sector and in related social and economic sectors. It provided global targets to be considered by member states, taking into account their own socioeconomic and health situation and bearing in mind that all countries are aiming at the same targets for the year 2000. (excerpt)
Statement by the chairman of the Technical Working Group on the Demographic and Economic Impact of HIV Infection / AIDS in Women and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 44-6. (WHO/GPA/DIR/89.12)Extrapolation modelling of the acquired immunodeficiency syndrome (AIDS) epidemic suggests a cumulative total of 1 million cases of AIDS worldwide in adults by 1991. Although major increases in child mortality rates are anticipated in areas with a high prevalence of human immunodeficiency virus (HIV) infection in women, few projections have been made specifically for women and children. If HIV-infected women and their children are to be allocated adequate resources in terms of their health and social service needs, this deficit must be addressed. In severely affected areas, such as Central Africa, AIDS in women and children can be expected to consume more economic resources than any other disease. Even in developed countries, direct medical car costs for children with AIDS are higher than those for adult AIDS patients. In general, research must prioritize projections of the numbers and trends of HIV infections and AIDS cases in women and children as well as disease-related costs. Attention must also be given to the indirect costs associated with AIDS in women in developing countries. Women's contribution to Third World economies is often equal to that of their male counterparts due to women's role as food producers and homemakers. Evaluations of the costs of HIV infection in women and children should be conducted within the context of the prevalence and costs of other diseases also in need of resource allocation.
Gland, Switzerland, IUCN, 1987. 63 p.A special Task Force Report by the International Union for Conservation of Nature and Natural Resources focusing on population contains chapters on demographic trends, structural changes and future growth, population policies, family planning programs, relations between population, conservation and development, and recommendations. Unprecedented population growth in this century is such that most countries have people living who have seen their population triple, and Zimbabwe as an example of an African country has grown 8-fold in this period. Population growth is only 1 among many factors that aggravate conservation and development; others include decreasing food supply, inappropriate development patterns fostered by debt, trade imbalances, misguided aid, and even the food surpluses of the North. Current environmental crises will contribute to a predicted 33% loss in arable land by 2000. The report ends with 12 recommendations, e.g., corroboration by country-level population, conservation and development agencies by identifying relevant institutions and introducing coordinating mechanisms. Every couple should be provided with means to plan their family, an effort estimated to cost $6 billion more than the current $2 billion being spent. Women should be given the right of choice about pregnancy, education, and integration into socio-economic development.
Statement of the International Movement ATD Fourth World, an NGO in consultative status category ii with ECOSOC.
[Unpublished] 1984 Aug. Background note prepared for the International Conference on Population, held in Mexico City, August 6-13, 1984. 4 p. (E/CONF.76/NGO/15)This appeal on behalf of the world's poorest families seeks: the destruction of misery in order to build peace and ensure dignity; fair distribution of resources; guarantees of freedom and the right to self-determination for all, especially the poorest; the widest possible choices for all in family planning; and regular public evaluation of demographic policies and programs, especially for the most deprived.
Report of the evaluation of UNFPA assistance to the National Family Planning and Sex Education Programme of Costa Rica.
[Unpublished] 1980 Mar. 89 p.This report of the evaluation of UN Fund for Population Activities (UNFPA) assistance to Costa Rica's National Family Planning and Sex Education Program covers the following: 1) project dimension and purpose of the evaluation, scope and methodology of the evaluation, composition of the mission, and constraints; 2) background information; 3) 1974-77 family planning/sex education program (overview, immediate objectives, strategy, activities and targets, and institutional framework); 4) planned and actual inputs and rephasing in 1978-79; 5) family planning activities (physical facilities and types of services provided, recruitment of new users, continuation of users within the program, distribution of contraceptive supplies, sterilizations, and indicators of program impact); 6) training and supervision; 7) education, information, and communication (formal and nonformal education, educational activities in the clinics, and the impact of the nonformal educational program); 8) maternal and child health (maternal health indicators, cytological examinations, and infant mortality); 9) program evaluation and research; 10) population policy; 11) program administration; 12) some general conclusions regarding the performance of the program; and 13) the program beyond 1979. UNFPA evaluations are independent, in depth analyses, prepared and conducted by the Office of Evaluation, usually with the assistance of outside consultants. The process of analysis used in the evaluation follows a logical progression, i.e., that which underlines the original program design. Evaluation assessment includes an analysis of inputs and outputs, an investigation of the interrelationship among activities, an indication of the effectiveness of activities in achieving the objectives, and an assessment of duplication of activities or lack of coverage and the effect of this on realization of the objectives. The program was able to expand the coverage of family planning activities but has been unsuccessful in having a population policy established. The number of hospitals, health centers, and rural health posts providing family planning services was tripled in the 1974-77 period. The program could not achieve its targets in number of new users, and it recruited in 1977, only 11% of the total population of the country, against the 20% planned. It has been estimated that between 1973-77 around 231,200 births or 44.4% of those possible had been averted. Training and supervision has been a weak area of the program. A large number of professors have been trained in sex education, but no evaluation has been undertaken of the likely impact of this trained staff at the school level. The information, education, and communication (IEC) program has been successful in taking information and education to the population on family planning/sex education concerns but less successful in motivating the political groups to formulate a population policy.
POPULATION AND DEVELOPMENT REVIEW. 2000 Sep; 26(3):629-33.A report prepared by the Joint UN Programme on HIV/AIDS and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting "a grim picture with glimmers of hope"--the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135-page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst affected area, sub-Saharan Africa, is presented in this document. (author's)
[Unpublished] 1999. Presented at the United Nations Commission on Population and Development, Thirty-second session, New York, New York, March 22-31, 1999 3 p.In this document the Thai delegate to the Thirty-second Session of the UN Commission on Population and Development addresses the Commission. During the past couple of years, the delegate states, the world economy has been in a turbulent and devastating state, affecting particularly developing countries. Natural disasters and environmental degradation caused by unbalanced growth and resource mismanagement under the name of economic and technological development have worsened the situation. However, recovery from this severe hardship is expected to be long and difficult for these countries--among them Thailand. Aware of the difficult and complex nature of the situation, Thailand has placed great importance on a new approach to population and development strategies at all levels. Population trends and structure in Thailand have shown a classic pattern of progress, which has enabled the country to continue enjoying its demographic bonus. However, the economic crisis of 1997 together with some of the problems that arise from unbalanced economic growth, overly rapid urbanization, and large scale internal and cross border migration has caused many health and social problems. Thailand still needs external cooperation and support--specifically in the form of human resource development, resource mobilization, and strengthening of information management and monitoring systems. Despite the attendant difficulties, Thailand will remain firm in its strong commitment and determination to carry out and support the International Conference on Population and Development Program of Action.
[Unpublished] 1999. Presented at the United Nations Commission on Population and Development, Thirty-second session, New York, New York, March 22-31, 1999  p.In its statement at the Thirty-second Session of the UN Commission on Population and Development, the Swedish delegation praises the achievements of the Population Division in the methodology of population projections, and is particularly appreciative of the frequent revisions made in some assumptions behind mortality trends, more precisely in the demographic effects of AIDS. AIDS is just one of the fatal diseases that may take an increasing toll on humanity. Malaria is another one. In some regions, undernutrition is widespread and may worsen. Food insecurity is a serious issue of everyday life for many millions of people. The prospect of growing shortages of water and agricultural land make it unlikely that real advances will be made in reducing undernutrition in the short and medium terms. In its concluding remarks, the Swedish delegation proposes that the Commission should resolve the issues surrounding alternative mortality projections during its 34th session in 2001.
POPULATION AND DEVELOPMENT REVIEW. 1998 Sep; 24(3):655-8.The UN Program on HIV/AIDS and the World Health Organization jointly monitor the global HIV/AIDS epidemic. The agencies' most recent survey tracking the spread of the pandemic, published in June 1998, estimates that by the beginning of 1998, 30.6 million people were infected with HIV, including 12.1 million women and 1.1 million children under age 15 years, and that 11.7 million had already died from AIDS. An estimated 5.8 million people were newly infected with HIV in 1997, and 2.3 million people died during the year from AIDS. An estimated 8.2 million children under age 15 years since the beginning of the epidemic lost either their mother or both parents to AIDS. 21 million of the 30.6 million people living with HIV/AIDS reside in sub-Saharan Africa. Indeed, approximately 83% of the world's AIDS deaths have been in sub-Saharan Africa. Newly available sophisticated estimates of the impact of the epidemic upon adult mortality in some of the most severely affected sub-Saharan African countries are presented.
POPULI. 1995 Dec; 22(8):18-21.The authors discuss the impact of the 1994 International Conference on Population and Development. "If the spirit of Cairo is to succeed, family planning programmes must begin to do a better job of treating clients as the beneficiaries--in the true sense of the word--rather than as the objects of population policies. The implications of the shift from demographic targets to individual need are far-reaching. Family planning programmes should begin to strive for these objectives." (EXCERPT)
ICPD 94. 1994 Jun; (16):3.Based on the United Nations study, "AIDS and the Demography of Africa", population growth rates will remain high in African countries south of the Sahara despite high mortality due to acquired immunodeficiency syndrome (AIDS). The Population Division of the UN Department for Economic and Social Information and Policy Analysis (DESIPA) incorporated the demographic impact of AIDS in its biennial population estimates and projections for Benin, Burkina Faso, Burundi, Central African Republic, Congo, Ivory Coast, Kenya, Malawi, Mozambique, Rwanda, United Republic of Tanzania, Uganda, Zaire, Zambia, and Zimbabwe. 9 million additional deaths due to AIDS are projected by 2005; 61% will occur in Uganda, Zaire, Tanzania, and Zambia. From 2000 to 2005, the average life expectancy for the region (51.2 years) will be 6.5 years lower than that without AIDS; that in Uganda (42.9 years) will be 11.1 years less. Mortality is increasing and its hardest impact will be during the prime working and family care years. Socioeconomic effects may include reductions in the size and productivity of the labor force, decreased industrial and agricultural production, and changes in care of children and the elderly. Due to high fertility rates, however, population increases are projected for all 15 countries. Although its nearly 12.4 million years less (4%) than that expected without the effect of AIDS, the total population for the region is projected to be 297.9 million by 2005. The address for obtaining the document discussed is listed with the price.
In: Population transition in south Asia, edited by Ashish Bose and M. K. Premi. Delhi, India, B. R. Publishing, 1992. 19-27.The author notes that, despite recent UN estimates of falling global population growth rates, "the realities in both the developing and developed regions point to increasing, not decreasing, demographic pressures on resources and productive capacities. Global and regional potentialities for attaining rising levels of living in the face of prospective increases in numbers appear to be diminishing, not expanding....[He finds that] population policy, both in the industrially advanced and developing regions, can no longer be regarded as a peripheral part of development programming efforts." (EXCERPT)
Ann Arbor, Michigan, University Microfilms International, 1992. viii, 138 p. (Order No. 1350571)AIDS/HIV infection is pandemic. In Singapore and Thailand, however, the incidence of HIV infection has grown at an especially alarming rate due to the countries' status of being internationally recognized tourist destinations and the high prevalence of prostitution. The demographics, socioeconomics, health care systems, and geographical location also influence the course of the disease in the countries. This paper reviews the policies, management, current determinants, and distribution of HIV infection and AIDS in Singapore and Thailand. Projections for the future and prospects for prevention and control are offered. Different sections define AIDS; give the historical background of AIDS and origin of the virus; describe modes of transmission of HIV/AIDS and geographic patterns of AIDS; discuss the epidemiology of HIV/AIDS in Asia, the management of HIV/AIDS, the social impact of HIV/AIDS, future trends and projections of the HIV/AIDS epidemic, and effective policies and strategies in the prevention and control of the HIV/AIDS epidemic. Mortality and morbidity projections and the potential to manage the epidemic seem particularly grim for Thailand, although Singapore's regimental and authoritarian approach may prove more promising. Policy makers in these countries must get moving to prevent and control HIV/AIDS. The possibility of involving the World Health organization for technical assistance should be considered.
AIDS. 1992 Aug; 6(8):880-1.In 1985, the WHO proposed an essentially clinical case definition of adult and pediatric AIDS for national and international surveillance of AIDS cases in Africa, the Bangui definition. WHO initially intended this definition to be provisional and envisaged adopting the clinical definition for AIDS only after official evaluation in the field. In adults, the Bangui definition is derived from the most widely encountered picture of African AIDS, characterized by a particular cachectic syndrome (slim disease). The Bangui definition is easily applicable in the field, without laboratory facilities, and is equally applicable to HIV-1 and HIV-1 infections. Its positive predictive value for possible HIV infection is particularly high in endemic areas. Its 90% specificity is acceptable, except in certain patients suffering from cachectic syndromes, such as tuberculosis. However, its 60% sensitivity is relatively low, suggesting that there is substantial underrecognition of HIV-related diseases, notably the acute or subacute affections that tend to differ from slim disease. After 5 years' application in sub-Saharan Africa, the Bangui definition for AIDS in adults has been adopted by all health care workers dealing with AIDS. In contrast to the adult definition, the provisional WHO clinical case definition for pediatric AIDS has 2 major drawbacks that considerably limit its use for the surveillance of AIDS cases in African children. With its combination of 9 criteria, including 1 biological criterion (serological status of the mother), the Bangui definition is difficult to apply in field conditions. Although its 90% specificity is relatively high, its 35% sensitivity and positive predictive value are very low. These factors explain the failure of the Bangui definition to detect the majority of full blown pediatric AIDS cases in endemic areas, particularly when a child suffers predominately from acute or chronic respiratory diseases or from neurological disorders. We propose that the Bangui criteria for AIDS should not be revised. First, the HIV epidemic in Africa continues to spread, and AIDS in certain urban centers is already a major cause of infant death, emphasizing the urgent need for a valid definition of the epidemiological notification of AIDS cases. Second, whenever the laboratory diagnoses of HIV infection is not systematically applied in Africa, a clinical definition for AIDS is necessary. Indeed, since 1985, numerous data on African AIDS have been produced, leading to an improved understanding of the characteristics of African AIDS. Epidemiologists and clinicians should agree on the revised criteria and how to combine them. For example, the addition of neurological signs as a minor criterion could increase the sensitivity of both the adult and pediatric clinical definitions for AIDS and suppression of the criterion chronic cough could increase their specificity. A simple revision of the Bangui definition could increase the notification of AIDS in African countries, particularly in pediatric cases, thus having an important impact on public health. (full text) (6 references cited in original document)
Sustainable resource management in agriculture and rural development projects: a review of bank policies, procedures, and results.
[Washington, D.C.], World Bank, Environment Dept., 1988 Jun. iv, 37,  p. (Environment Department Working Paper No. 5)The results of 115 agriculture and rural development projects approved by the World Bank between 1983 and 1986 are analyzed. Most projects emphasize improved production and income generation for farmers, but only about 50% mention resource problems in the project rationale. Sustainable resource management is a goal of some projects including social forestry, watershed protection, and irrigation and drainage. The projects with greater resource problems include those with large changes in land use or those located in sensitive or marginal environments including resettlement, livestock credit, and irrigation. The settlement projects in Brazil and Indonesia have extensive documentation and reviews of resource issues. The irrigation projects typically mention concern over sedimentation, siltation, salinization, and waterlogging. The Mahaweli scheme in Sri Lanka is an irrigation project that involves extensive land clearing, and many studies have been completed to determine the resource implications of the projects. Rural industry projects generally do not contain any analysis of the environmental impact that such changes might have for a region. Even for projects with a major goal of resource management, such as India Watershed Management, the project is justified on the basis of the increased production. A trend toward smallholder projects is apparent in World Bank-assisted agriculture and rural development projects. In India the social forestry project encouraged tree farming to prevent encroachment and overharvesting of forest reserves. Sustainable resource management implies a process of adapting to the continuing evolution of changes in human populations, technologies, and socioeconomic conditions. The World Bank has a very inconsistent record in effectively dealing with longterm resource management issues, as resource management issues are an implicit rather than an explicit component of most projects.
In: Family planning programmes and fertility, edited by J.F. Phillips, J.A. Ross. Oxford, England, Clarendon Press, 1992. 3-9.There is increasing evidence that family planning (FP) programs shape demographic trends as substantiated by pronounced variations in fertility trends between countries and regions after a uniformly high level in the 1960s. The issues addressed include the debate on the role of FP programs as fertility determinants, methods for evaluating fertility outcomes, techniques for fertility assessment as codified in the 1970s by a committee of the UN Population Division, and the application of methods in research, training, and policy formulation. The recognition for theories to guide research on the demographic role of programs was summarized by a subcommittee on population of the US National Academy of Sciences stressing that theory was obliged to generate testable processes about the contraceptive service supply system. Community level factors affect FP services by putting constraints on parental demand for birth. Reductions in costs of family regulation can affect the demand for children. The Easterlin Synthesis Framework is used for examining the demand-supply paradigm. Programs as fertility determinants are examined in relation to social, familial, and programmatic influences on reproductive behavior. The demand for contraception is examined based on data collected by the Demographic and Health Surveys Project: demand reached 76% in 8 of 11 countries studied suggesting that fertility could be substantially lowered by meeting this unmet need. Adjustment and promotion affect the demand for contraception. The impact of effective, low-cost contraceptives on contraceptive behavior is analyzed along with how program intensity, convenience, and proximity increase contraceptive prevalence. Social and institutional factors also govern reproductive behavior as the limitations and successes of the 1-child policy of China illustrates.
Ann Arbor, Michigan, University Microfilms International, 1991. vii, 266 p. (Order No. 9116069)The effectiveness of official development assistance in responding to health problems in recipient countries may be examined in terms of 1) the results of specific aid-supported projects, 2) the degree to which the activities have contributed to recipients' institutional capacity, and 3) the impact of aid on national policy and the broader development process. A review of the literature indicates a number of conceptual and practical constraints to assessing health aid effectiveness. Numerous health projects have been evaluated and issues of sustainability have been studied, but relatively little is known about the systemic effects of health aid. The experience of Nigeria is analyzed between the mid-1970s and the late 1980s. In the 1970s, Nigeria's income rose substantially from oil revenues, and a national program was undertaken to increase the provision of basic health services. The program did not achieve its immediate objectives, and health sector problems were exacerbated by the decline of national income during the 1980s. Since 1987, a progressive national primary healthcare policy has been in place. Aid has been given to Nigeria in comparatively small amounts per capita. Among the major donors, WHO, UNICEF, and, most recently, the World Bank, have assisted the development of general health services, while USAID, UNFPA, and the Ford Foundation have aided the health sector with the principal objective of promoting family planning. 3 projects are examined as case studies. They are: a model of family health clinics for maternal and child care; a largescale research project for health and family planning services; and a national immunization program. The effectiveness of each was constrained initially by limited coordination among donors and by the lack of a supportive policy framework. The 1st 2 of these projects developed service delivery models that have been reflected in the national health strategy. The immunization program has reached nationwide coverage, although with uncertain systemic impact. Overall, aid is seen as having made a marginal but significant contribution to health development in Nigeria,a primarily through the demonstration of new service delivery approaches and the improvement of management capacity. (author's)
POPULATION TODAY. 1992 Feb; 20(2):8-9.A debate within the UK public health community has centered around the feasibility of campaigns to improve child survival rates in Africa in the absence of equally aggressive efforts to increase family planning acceptance. The central spokesperson in this debate, Maurice King of the University of Leeds, has argued that population growth in sub-Saharan countries is undermining the carrying capacity of available resources and threatening ecological collapse. These countries are not exhibiting the characteristic demographic transition pattern, in which declining death rates eventually create conditions conducive to lower birth rates. Instead, they have fallen into a "demographic trap " in which population increases are outstripping growth in food production. To remedy this situation, King advocates the introduction of the concept of sustainability of the ecological foundations of health into the World Health Organizations's official definition of health. Richard Jolly of UNICEF has countered King's articles with the insistence that UNICEF has long supported child survival within the broader context of family planning provision and advocacy of birth spacing.
HEALTH POLICY AND PLANNING. 1991 Jun; 6(2):107-18.The WHO estimates that 74% of the world's children were fully immunized against poliomyelitis by early 1990. Despite this, the disease is still paralyzing almost 1/4 of a million individuals each year and killing perhaps 25,000. This paper, 1 of a series undertaken on specific diseases for the World Bank's Health Sector Priorities Review on disease of major importance in the developing world, reviews available evidence on the cost effectiveness of polio prevention. This prevention would take the form of either immunization or case management of polio to minimize and rehabilitate disabilities. The power of available vaccines and the characteristics of disease suggest the technical feasibility of eradication of disease from polio (but not the polio virus) as a goal for the year 2000. With sustained national and international support, it is thus reasonable to hope for eradication by that year or soon thereafter. Rehabilitation of those disabled by polio (and other causes) has been neglected both by governments and by the international community. Although hard evidence on cost and effectiveness remains to be gathered, what is know strongly suggests that effective rehabilitation programs could be implemented at low cost and with the economic and welfare benefits far exceeding the expenditures. (author's modified)
International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.
[Unpublished] 1991. , 64 p.The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.