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WORLD HEALTH. 1988 Aug-Sep; 10-5.The 1978 International Conference on Primary Health Care (PHC) in Alma-Ata, USSR, sponsored by the World Health Organization (WHO) and by UNICEF, culminated in the Declaration of Alma-Ata. This Declaration, signed by representatives of 134 nations, pledged urgent action for the development of PHC and toward the goal of "Health for All by the Year 2000." Among the most important principles of PHC are these 5: 1) that care should be accessible to all, especially those in greatest need; 2) that health services should promote popular understanding of health issues, and should emphasize preventive as well as curative measures; 3) that health services should be adapted to local economic and cultural circumstances, and be effective; 4) that local communities should be actively involved in the process of defining health problems and developing solutions; and 5) that health development programs should involve cooperation among all the community and national development efforts that have an impact on health. Even before the Declaration 10 years ago, the concepts underlying PHC had been taking root around the world. Progress toward the ideals of PHC has been made. Immunizations rates increased from 5% in 1970 to 40% in 1980. Only 34 countries had under-5 mortality rates of 178/1000 or more in 1985. 1/2 the number of 25 years earlier. However, PHC has in general achieved much better coverage in the developed countries than in the developing ones. The increase in world poverty -- to 1 billion people in absolute poverty today -- is a major setback for PHC. A major cause of health problems in the 3rd World is the too-rapid growth of unwieldy cities. Another common problem is that the training of medical professionals has not prepared them for leadership roles in community-oriented, preventive health programs. The ideals of PHC have been widely accepted throughout the world, and progress has been made, but much remains to be done.
WORLD HEALTH. 1987 Oct; 4-6.3 years ago, the Central American countries of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama began a subregional initiative with PAHO/AMRO named "Health as a Bridge to Peace." Formally called "Priority Health Needs in Central America and Panama," this initiative has included: 1) A temporary cease-fire in El Salvador each year between government and guerrillas, permitting a 3-day nationwide immunization campaign throughout the country; 2) Belize's inclusion for the 1st time in an annual meeting of the Ministers of Health in Central America and Panama. The directors of the Social Security Institutions also participated. Although recent conflicts had strained international dialog, the initiative spurred cooperation between all countries of the region, including formal agreement between the Ministers of Health of Honduras and Nicaragua to conduct joint border monitoring to prevent the spread of malaria and other tropical diseases, mutual spraying in malaria endemic areas by Nicaragua and Costa Rica, and training and technical cooperation exchanges between the countries and their neighbors. Last year, in the 1st joint purchase from a revolving fund for essential drugs, the countries obtained some 17 drugs more than 300% cheaper than each had purchased them seperately the previous year. Priorities of the initiative are health services, human resources, essential drugs, food and nutrition, tropical diseases, and child survival. It concentrates on mothers and on children under 5, on refugees and displaced persons, and on the urban and rural poor.
Assignment Children. 1985; 69/72:397-414.The recent immunization campaign in El Salvador has been a success despite the civil war. Both the government and the guerrillas agreed that the goal of immunizing children was an ideal transcending all differences, and that immunization should be taken to all parts of the country and all Salvadorian children. The campaign had the personal support of the head of state, the church, UNICEF, PAHO/WHO, ICRC and other organizations who worked with the parties to implement the campaign. The 3 national immunization days, held on February 3, March 3, and April 21, 1985 were transformed into days of tranquillity. This article describes how the campaign was organized and presents an assessment of its achievements. An executive committee was created and both UNICEF and PAHO/WHO took part in its meetings. Specific commissions handled channeling, training, supplies, the cold chain, information and evaluation, and promotion and education. The plan of action proposed that all branches of government and the private sector support the immunization campaign and a national support council was establish for this purpose. The original goal was to immunize 400,000 children under 3 years of age against diphtheria, pertussis, tetanus, polio, and measles. The goal was extended to cover children under 5 years of age. Funding was provided from both public and private organizations. Reasons the campaign was a success despite war conditions include: the campaign was backed by political commitment; the mechanisms created to implement the campaign functioned smoothly; mobilizing the media generated a change in opinion and attitude. The campaign rested on solid technical and political foundations. It reached 87% of children under 5 in the area.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: country reports.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xiv, 89 p.UNFPA has provided funding for various family life education (FLE) projects with particular emphasis on youth in the English-speaking Caribbean since the mid-1970s; this report is an independent evaluation of the projects in Antigua, Barbados, Dominica, Jamaica, St. Lucia, and St. Christopher and Nevis. Although birth rates are relatively low in the English-speaking Caribbean, the incidence of adolescent pregnancy and the number of births to women under the age of 20 is an important problem in the region. The Mission concluded overall that the projects have contributed to pioneering and groundbreaking efforts demonstrating that it is possible to initiate and make considerable progress in the implementation of FLE/FP programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues and when there are no official policies in favor of such programs. The Mission concluded also that project design had improved over the years and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. All the projects included in the evaluation have contributed to the training in FLE/FP of a large number of family life educators, teachers, and nurses and, as a result, have significantly strengthened professional national capability. The projects have shown that despite the lack of official policy approving FLE in schools and generally overcrowded curricula, FLE can be introduced into schools. In the area of FP service delivery, the projects included in the evaluation have contributed to making FP services generally available through integration with the government maternal and child health services. The main management issues across the projects were similar and included staffing, coordination, supervision, monitoring and evaluation. There is a need to adjust project design so that gender separation is minimized and that the FLE content deals better with issues such as self-awareness, sex roles, and self-esteem. The wider impact of the projects included in this evaluation, to be reflected, for example, in reduced incidence of teenage pregnancy, reduced maternal and infant/child morbidity and mortality, and more generally in the life patterns of women, cannot yet be measured.
Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C.
Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 210 p. (International Conference on Oral Rehydration Therapy, 1983, proceedings)With over 600 participants from more than 80 countries, the International Conference on Oral Rehydration Therapy (ICORT) was a testimony to the international health community's recognition of the seriousness of diarrheal disease, the value of oral rehydration therapy, and the commitment to primary health care. The conference, initiated by the Agency for International Development, was cosponsored by the International Center for Diarrheal Disease Research, Bangladesh, the United Nations Children's Fund, and the WHO. The conference focused on oral rehydration therapy, an important treatment of diarrhea. 1 out of 10 children born in developing countries dies from the effects of diarrhea before the age of 5. A 70% reduction in the mortality rate can result from ORT--a major breakthrough for primary health care. Excellent laboratory investigation, well-conducted clinical studies, and careful field observation have led to this effective therapy. Many papers presented at the conference demonstrated the effectiveness of ORT. Participants agreed on the best formula for ORT in terms of electrolyte content and on the need for an international commitment to expand implementation of ORT. Problems in implementing oral therapy programs are discussed. Possible areas of investigation include: 1) improving the solution through the addition of glycine, other amino acids, or cereal-based substrates; 2) developing methods for teaching ORT; and 3) investigating better methods of program evaluation. Innovative approaches to informing the public about the use and benefits of oral therapy were also discussed. Participants, recognizing that problems are shared among many different programs and nations, exchanged ideas and addresses, pledging to keep each other abreast of their ORT research and implementation efforts. The conference closed with a strong call for action to attain near universal availability of ORT in the next 10 years.
El autentico espiritu de la cooperacion international. The true spirit of international cooperation, statement made at the Meeting of the National Population Council of the Government of Mexico, Mexico City, Mexico, 16 March 1981.
New York, N.Y., UNFPA, . 8 p. (Speech Series No. 63)Mexico's achievements in the field of population and development stand out clearly among the countries of the Western Hemisphere. The family planning program has made considerable progress since it was initiated in 1973. A major reason for the success is the commitment of the Government. This support is reflected in Mexico's unique 1974 General Population Law which established the National Population Council and which provides legal basis for the population programs. With this legislation, Mexico has taken the lead among the countries in Latin America in recognizing the population factor as an integral component of the development process. UNFPA has provided modest assistance to the Government of Mexico, but it has been a partnership in the true spirit of international co-operation.
The World Fertility Survey: a basis for population and development planning, statement made at the World Fertility Survey Conference, London, England, 7 July 1980.
New York, N.Y., UNFPA, . 5 p. (Speech Series No. 54)The World Fertility Survey (WFS) is the largest social science research survey undertaken to date. From its inception in 1972 the WFS has received the full support of the UN and the UNFPA. This program has not only enhanced considerably our knowledge of fertility levels and fertility regulation practices in developing as well as developed countries but has also provided the UN system with internationally comparable data on human fertility on a large scale for the 1st time. The methodology developed by the WFS has made it possible to collect data on the individual and the household as well as the community. Information has become available not only on fertility levels, trends and patterns but also on fertility preferences and nuptiality as well as knowledge and use of family planning methods. Initial findings document the rather dramatic fertility decline taking place in many developing countries under various socioeconomic and cultural conditions. They also show the magnitude of existing unmet needs for family planning in the developing world which must be continuously brought to the attention of the governments of all countries. A most encouraging effect of the program, however, has been the fact that 21 industrialized countries have carried out, entirely with their own resources, fertility surveys within the WFS framework and in accordance with its recommendations, making it truly an internationally collaborative effort.
Assessments: the operational scene, statement made at the Second Committee of the 30th Session of the United Nations General Assembly, New York, 24 October 1975.
New York, N.Y., UNFPA, . 4 p.This statement on the UNFPA details the operational activities for development. As of October, 1975, a total of US$239 million were pledged to UNFPA by 78 countries, 18.5% above that of 1974. Resources were allocated by UNFPA to 1350 projects in 106 countries. In addition to the 128 governments participating in these projects, all organizations concerned in the UN system are involved. A few of the major advances of the past year are outlined in this report, as well as several problems encountered by the UNFPA. 4 significant advances include: 1) the 1st conference on Population Activities in the Arab States--it unanimously adopted a series of resolutions marking the advent of a systematic approach to population matters throughout the Arab world; 2) a pronounced improvement in the rate of implementation of UNFPA projects throughout the world; 3) a 70% increase in UNFPA-supported projects which governments are executing; 4) compilation and publication by UNFPA of an inventory listing all population projects receiving international support in 1973 and 1974. The major problem facing the UNFPA is that of finance. Despite the increase in contributions, the requests of governments outstrip the Fund's resources. The resources gap produces a 2nd basic problem: when funds can no longer meet all requests, it becomes necessary to choose between requests. This forced establishment of priorities is very difficult.
[Population and the new international economic order] La poblacion y el neuvo orden economico internacional.
Medicina y Desarrollo. 1977 May; 13-16.The problem of population received little attention in the meetings on the New International Economic Order. Historically, governments have equated population increases with prosperity. Recently, governments have accepted the necessity to reduce population for the succcess of social and economic programs. This article points out the advances made by several countries in the areas of health, nutrition, education, contraception, legal aspects, planning, and research methods since 1972. The collaboration of different governments with UNFPA and their solicitation of help from this organization are regarded as further evidence of the advances made. Difficulties for the acceptance of family planning in developing countries such as social sanctions, lack of demographic data, and the role of UNFPA in the amelioration of these problems are discussed. Since population politics are seen as long-term strategical weapons, an intensification of persuasive methods in all countries and an increase in aid to underdeveloped countries are recommended.
Evaluation of UNFPA assistance to the family planning programme of the Dominican Republic, 1978-1982/3.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Aug. xii, 48,  p. (DOM/73/P01)This evaluation was carried out by an independent mission coordinated by the United Nations Fund for Population Activities (UNFPA) Evaluation Branch. The program's long-term objectives are to reduce the birth rate to 29/1000, reduce mortality rates, achieve a sustained reduction in fertility rates and to devise and implement a specific population policy. Immediate objectives are to acheive the functional integration and financial self-sufficiency to carry out family planning programs, offer family planning services to the entire population and increase the demand for them, to offer new methods, especially female sterilization, and alter the distribution of users by method; increase active users to 22% of the country's women and to increase the availability of health personnel. In general, the Evaluation Mission found that the project documents describing the objectives to be achieved, strategy, activities and inputs do not elaborate sufficiently on the relationship between objectives and activities and the inputs required and do not give details about the strategy for achieving objectives. The birth rate was estimated at 34.5/1000 in 1982. Infant mortality seems to be declining particularly fast in areas with active rural health promotors. No specific population policy has been enuciated. The program has, to a large extent, achieved the immediate objectives set for it, except that of financial self-sufficiency. The program's strongest elements are the considerable expansion of the physical and health personnel infrastructre; political and institutional willingness to carry out integrated maternal and child health and family planning programs; and the great demand for family planning services by the population. Week elements which have hindered the program's progress are the abence of a tradition of public health and preventive medicine in the country, which has resulted in inadequate training of medical personnel and a lack of motivation, and the extreme centralization of the health system and the consequent lack of delegation of authority and resources which limits the initiative and action of personnel at supposedly operational levels. Other weaknesses are the cultural models which favor authoritarianism and paternalism; the stressing of a clinic-based service delivery system as opposed to the Primary Health Care approach; the lack of direct information education and communication (IEC) action in the communities; the lack of a strategy to gather the knowledge existing in such communities to incorporate it in the joint planning of services, and deficiencies in supervision and evaluation which are aimed at measuring goals and results but not at identifying and analyzing problems.