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Journal of Adolescent Health. 2003 Oct; 33(4):240-251.The contemporary health problems of young people occur within the context of the physical, social, cultural, economic, and political realities within which they live. There are commonalities and differences in this context among developed and developing countries, thus differing effects on the individual’s personal as well as national development. Internationally, the origins and evolution of health care for adolescents can be viewed as an unfolding saga taking place particularly over the past 30 years. It is a story of advocacy and subsequent achievement in all corners of the world. This paper reviews the important developments in the international arena, recognizes major pioneers and milestones, and explores some of the current and future issues facing the field. The authors draw heavily on their experiences with the major nongovernmental adolescent health organizations. The special roles of the World Health Organization, Pan American Health Organization, and United Nations Children’s Fund (UNICEF) are highlighted, and special consideration is given to the challenge of inclusion through youth participation. (author's)
Geneva, Switzerland, WHO, 1985. 101 p. (WHO/CDD/85.13)The Diarrheal Diseases Control (CDD) Program, initiated in 1978, is a priority program of WHO for attainment of the goal of Health for All by the Year 2000. Its primary objectives are to reduce diarrheal disease mortality and morbidity, particularly in infants and young children. This report describes the activities undertaken by the Program in the 1983-1984 biennium. During this period, the Program collaborated with more than 100 countries in the implementation of national diarrheal disease control and research activities. The biennium has witnessed a growing interest of other international, bilateral, and nongovernmental agencies in diarrheal disease control; their financial support and commitment have contributed in a large measure to furthering the development of CDD programs and related research in many countries. During the biennium, the services component continued to expand both the quantity and scope of its activities at global, regional, and national levels. This is readily seen from the increase in global acess to Oral Rehydration Salts (ORS) packets from less than 5% in 1981 to 21% in 1983. Other significant developments were a substantial increase in the number of countries planning and implementing programs and the initiation of a new management course in supervisory skills. Successful implementation of national primary health care systems was recognized as necessary for the achievement of the Program's objectives. Efforts of both developing and industrialized countries must continue in a joint endeavor to reduce the problem of diarrheal diseases, especially cholera, the most severe diarrheal disease. The following areas are discussed: the health services component; the research component; information services; program review bodies; program resources and obligations; and program publications and documents for 1983-1984.
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
In: Change: threat or opportunity for human progress? Volume V. Ecological change: environment, development and poverty linkages, edited by Uner Kirdar. New York, New York, United Nations, 1992. 88-107.A new global geopolitical structure is taking shape, a multipolar system strengthened by various regional economic powers (e.g., the European Economic Community). These powers will inevitably vie for global status. This system will be based on a succession of bridges and linkages of global interdependence on human rights and freedom, energy and environmental management, international trade and finance, technological and science development, and modern communications. These bridges and linkages should effect a more balanced global structure. The best prospect for a system of cooperation and interdependence among nations is the UN. Proper engineering of these bridges and linkages within a global and regional framework can bring about sustainable development. If competition between various economic power blocs is the guiding principle of these bridges and linkages, the world will experience a new era of regional and global conflict. For example, developed countries and their transnational companies once controlled the oil industry. They exploited huge oil reserves in developing countries and did not provide them appropriate compensation for depletion of their most important natural resource. Host countries reacted to this unfair treatment and took over and nationalized the companies, leading to a sizable increase in oil prices in the 1970s. This then caused global economic instability and general mistrust between exporting and importing countries. Demand for oil fell, and the producing countries could not decide how to distribute the oil sales reduction among themselves, so the buyers took control and still have control of the oil market. The demand for oil is rising and preserves are shrinking which will result in a rapid increase in oil prices. Thus, all nations must invest in development of new sources of energy. Oil should be just a short bridge towards sustainable development. Developed countries should place peaceful resolution of regional conflicts and bilateral disputes at the top of their agenda. Internationalism should replace nationalism and multilateralism should replace bilateralism.
WORLD HEALTH. 1993 Mar-Apr; 46(2):4-6.A 1990 meeting of vaccine research and application specialists ended in the Declaration of New York stating that current science can be used to develop vaccines which can be administered earlier in life, requiring 1-2 doses instead of many doses, and in the form of cocktails of several vaccines; maintain their potency in warm temperatures; and are affordable. In 1991, WHO, UN Development Programme, UNICEF, the World Bank, and the Rockefeller Foundation established the Children's Vaccine Initiative (CVI). Its main goal is 1 oral immunization to be administered shortly after delivery to protect all babies against all major childhood diseases. CVI also aims to streamline the provision of an adequate supply of affordable, safe, and effective vaccines; to expedite the development and production of new and improved vaccines; and to simplify the complex logistics of vaccine delivery. As of spring 1993, CVI partners have created an organizational structure to guide and manage CVI activities, begun a strategic planning process, and developed a heat-stable poliomyelitis vaccine and a single-dose tetanus toxoid vaccine. CVI consists of a Secretariat, a Consultative Group, a Management Advisory Committee, a Standing Committee, and Product Development Groups. Many specialists are currently working to advance strategic planning, biotechnology, immunology, epidemiology, vaccine supply, quality control, regulatory matters, licensing, patents, and financial and legal issues. The high cost of research and development through more and more sophisticated technologies (e.g., genetic engineering), high insurance premiums to obtain liability coverage, and limited companies doing research and development, possibly resulting in price-setting, contribute to the rising costs of vaccine development and production, posing a considerable obstacle for CVI. International vaccine producers have proposed a 2-tier price structure: a market price for developed countries and an affordable price for developing countries. The private sector awaits means to match corporate profits with public health goals before participating fully in CVI.
POPULI. 1992 Oct; 19(4):10-1.The United Nations Conference on Environment and Development welcomed world leaders in Rio de Janeiro in June 1992. At a parallel Global Forum 39 treaties on the environment, development and population were also drafted by nongovernmental organizations (NGOs). These were considered more significant than the officially adopted Earth Charter, a statement of principle, and Agenda 21, a plan for sustainable development. The NGO treaties are action plans hammered out by more than 3000 people over 15 days of negotiation aimed at building alliances between diverse organizations from all over the world. Many groups condemned overpopulation scare tactics claiming that unfair trading practices and international debt force many Southern governments to exploit their environments to make debt payments. Most NGO participants concurred that population growth declines when women have free access to community-based family planning. The NGO Treaty on Population, Environment, and Development supports womens reproductive rights, free choice, and access to fertility planning. It rejects forced methods of limiting family size and contraceptive experimentation. It condemns militarism, debt, unequal trade, and structural adjustment policies. It calls for consumption and production changes to keep the most privileged 1/4 of humanity from consuming more than 70% of global natural resources with the attendant environmental degradation. It endorses women centered managed, and controlled reproductive health care with contraception, abortion, sex education, and male education programs. Other goals include accountability in contraception and genetic engineering, provision of child care facilities, and community-based responses to the AIDS epidemic and to other sexually transmitted diseases. The NGO Commitment to Biotechnology contains recommendations applicable to some of the new reproductive technologies.
Common responsibility in the 1990's. The Stockholm Initiative on Global Security and Governance, April 22, 1991.
Stockholm, Sweden, Prime Minister's Office, 1991. 48 p.Common responsibility in the 1990s is the result of the working of the Stockholm Initiative on Global Security and Governance, which represents the interests of prominent members of 4 international commissions: the North-South Commission, established by Willy Brandt, West Germany; the Independent Commission on Disarmament and Security, established by Olaf Palme, Sweden; the World Commission on the Environment and Development or the Brundtland Commission, established by the Secretary-General of the UN; and the South Commission, established by developing countries and chaired by Julius Nyerere, Tanzania. The basic tenet of the April 22, 1991, initiative states that no nation can resolve its own problems without relying on others. The document is concerned with the following issues: peace and security which strengthens the UN and has regional security arrangements and arms trade limitations and the peace dividend; development which focuses on poverty and a conducive international environment; the environment, population, democracy, human rights; and global governance and international institutions, which provide universality in world economic cooperation, and follow in the spirit of San Francisco. Peace can be improved with a UN global emergency system and law enforcement arrangement with assured financial and organizational support, regional conferences outside Europe, monitoring world arms trade, government contributions to the peace dividend, and the commitment by the South to reduce armed forces and to invest in human development. Development has a set goal to end extreme poverty in 25 years with primary education for all children, equal participation of the sexes in education, and reduction by 33% of child mortality, and by 50% of maternal mortality. Commercial debt needs to be restructured. 1% of the gross national product is to be committed to international development. Also proposed is the levying of fees (e.g.; for carbon dioxide emissions), and promotion of more efficient use of energy resources and alternative and renewable energy replacement. Sustainable development is a primary focus. Also proposed is limiting population growth and stabilizing goals. Popular internal will to live up to human and democratic rights must be recognized by strengthening international observance of violations. The UN Security-Council, the Secretary-General, and social and economic fields must be strengthened. World summits on global governance need to continue.
Final report: First Caribbean Health-Communication Roundtable, St. Philip, Barbados, 16-18 November 1987.
[Unpublished] 1987. , 30,  p.To create a mechanism from which to mobilize communications media as a force for health in the Caribbean, the 1st Caribbean Health Communication Roundtable was held in 1987. Organized and initiated by the Pan American Health Organization (PAHO) and cosponsored by UNESCO and the Caribbean Community (CARICOM), the summary of the objectives discussed at the roundtable are presented in this report. Objectives include sensitizing the media to the health concerns of AIDS, disaster preparedness, nutrition and chronic diseases, and the examination of different types of health communication methodologies. Roundtable participants drafted a series of recommendations for submission to all relevant national, regional, and international agencies. 6 major recommendations covered various aspects of health communication. Workshops at the national and sub-regional level to train media and communications specialists were a suggested means of improving information techniques for health educators. Improvements in coordination and cooperation between Ministries of Health and Ministries of Information, requested by CARICOM, was recommended to strengthen health communication. The addition of an information specialist to the staff of the PAHO office was recommended, as well as the promotion of alternative communication methods and practices. Establishing a regional center for the identification, collection, cataloging, and dissemination of communication ideas, experiences and other resources was another major recommendation. In addition, evaluation of regional communication projects was suggested. Pre- and post-Roundtable questionnaires are reproduced in the Appendices, as are the program schedule, rationale, and list of participants.
WORLD HEALTH FORUM. 1989; 10(3-4):397-402.Persons who line in developing countries are awarded fellowships for study abroad. They are given by many donors, the UN and the World Health Organization among them. It is important to know whether the money is used effectively. Many donor agencies have done evaluations, but difficulties arise. The recipient governments should evaluate the fellowships. The current selection process may be politicized, and fellowships are not officially advertised. There may also be irregularities in employing the returned fellows. It is hard to see what changes could be brought about by a donor's evaluation that hinted at a country's misuse of fellowships. Recipient countries have the right to run their own affairs. However, they should understand the advantages and responsibilities of this. Many donor's evaluations are not of much worth to recipients. Some criteria used by donors are not meaningful to recipients. There may be conflicting opinions about needs and technologies. Attempts may be made to get fellows from third world countries even if the courses are not terribly suitable. The influences that the fellows may be exposed to are very important. Many governments provide awards to their citizens for overseas training. It would be very useful for countries to analyze all fellowship activity. This could give information about overlapping. In Lesotho, too much emphasis was put on rural development. Recipient countries are in a better position to find former fellows. Donor studies tend to be bureaucratized, evaluated from habit rather than need. Occasionally reports have not come to the attention of authorities, which does no one any good. Oversimplified attempts may take place. Research should be adapted to standard methods. If recipient countries do not have the experience required to evaluate fellowships, it could be done jointly by donors and recipients.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)Breastfeeding is on the decline in most countries, despite the fact it can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. The World Health Organization (WHO) and the UN International Children's Emergency Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding. In the most developed countries, breastfeeding has increased despite generally unsupportive hospital environments, the availability of clean water, and the fact that breastfeeding was virtually a lost practice in these countries 40 years ago. An increased awareness of the benefits, some of which are outlined, coupled with mother-to-mother support are most likely to have influenced this increase. The guidelines developed by WHO/UNICEF seek to put into practice specific recommendations agreed upon by pediatricians, obstetricians and gynecologists, nutritionists, nurses, midwives, and other health care providers in national and international forums. The main points of the guidelines are as follows: every facility providing maternity services should develop a policy on breastfeeding, communicate it to all staff, define specific practices to implement the policy, and ensure that all staff are adequately trained in the skills necessary to ensure implementation of the policy; facilities for 24-hour rooming-in, initiation of breastfeeding immediately after delivery, and demand-feeding are essential in every maternity ward; every pregnant mother should be informed fully about how breast milk is formed, the proper way to nurse a child, and the benefits of breastfeeding; and harmful practices, such as the use of bottles and teats for newborn infants, should be eliminated during this early period and exclusive breastfeeding maintained for at least 4-6 months from birth. These activities, when fully implemented, will ensure that every mother/infant couple reached prenatally, at birth, and postnatally gets off to a good start. Then, other support services will be more effective. These standards have been successful in the field and have had a positive impact on the rates of breastfeeding. A need exists for collaboration and an interdisciplinary approach to the promotion, protection, and support of breastfeeding, and, hopefully, this workshop is the first of a series of technical consultations.
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.
[New York, United Nations, 1986.] 27 p.The ongoing crisis confronting women and children in the Third World--where disease and hunger are taking millions of lives of young children every year and where population growth still proceeds at an unacceptably high rate--is actually worsening in some areas. The European Parliamentarians' Forum on Child Survival, Women, and Population: Integrated Strategies was held under the auspices of The Netherlands government and organized in cooperation with 3 UN organizations: the World Health Organization, UNICEF, and the UN Fund for Population Activities. It is critical that the world regain the momentum of past decades in reducing appalling child mortality rates, improving the health and status of women, and slowing population growth. Development programs from health education to agriculture are hampered or crippled by the inability of development planners to recognize the centrality of the woman's role. Maternal and child health is the logical entry point for primary health care. Education is the springboard for rescuing women in the Third World from poverty, illness,endless childbearing, and lowly social status. One should educate women to save children. Women in the developing world must be given access to basic information to be able to take advantage of new, improved or rediscovered technologies such as 1) oral rehydration therapy, 2) vaccines, 3) growth monitoring through frequent charting to detect early signs of malnutrition, 4) breast feeding, and 5) birth spacing. Education is the single most documented factor affecting birth rate, status of women, and infant and child health. The presentations at The Hague threw into sharp relief the close links, the cause and effect chains, and the synergisms associated with all the factors connected, directly or indirectly, with child survival, women's status, and population--factors such as education, economic opportunities, and overall development questions. A 4-point agenda includes 1) encouraging UN agencies and organizations concerned with social development to work closely together and to enhance the effectiveness of their programs, 2) seeking greater support for the UN's social development programs, 3) focusing public attention on the interrelatedness of health, maternal and child survival and care, women's status, and freedom of choice in family matters, and 4) maintaining and strengthening commitment through the dialogue of parliamentarians.
New York, New York, Longman, 1988. xv, 223 p.In 1964 Wilbur Schramm, on a grant from the United Nations Educational, Scientific and Cultural Organization (UNESCO), wrote a book called "Mass Media and National Development." It painted a glowing picture in which the mass media would reveal the way to development and enable the Third World countries to achieve in a few decades the development that had occurred over centuries in the West. By the 1970s it became clear that population growth was overtaking development. The Third World nations began to see the mass media as tools of the conspiracy of transnational corporations in their to keep the Third World a source of cheap labor. The Third World countries began to seek an alternate route to development, without help from either the East or the West. Their ideal and model was China, where the radical alternative had been shown to work. The Third Word countries joined together as the "Non-Aligned MOvement," a organization which had been founded in Indonesia in 1955. By the 1970s the Third Word countries constituted a majority in UNESCO, which they turned into a forum of resentment against the Western mass media, which they perceived as using dominance over world news flow to keep the Third World in a state of cultural dependency on the West. The poverty of the Third World nations, they claimed, was the heritage of colonialism, and the West owed them restitution. The Western news media were identified as the modern day equivalent of the colonial armies of imperialism. The debate over the dominance of Western influence in world news flow was launched in UNESCO by a request from the Soviet Union in 1972 for "a declaration on the fundamental principles governing the use of the mass media with a view to strengthening peace and understanding and combatting war, propaganda, radicalism, and apartheid." The debate in UNESCO took on a new name, the "New World Information Order," in which the Third World nations argued that they had the right to restrict the free flow of news across their borders. UNESCO Director General, Amadou M 'Bow, tabled the resolution and appointed a commission, headed by Sean MacBride, to undertake general review of communications problems in modern society. The report, entitled "Many Voices, One World," was in many ways vague, but it at least endorsed the Western values of free flow of information. The Us offered technological assistance to the Third World under the auspices of the International Program for the Development of Communication. This institution was designed as a world clearinghouse for communication development, but as such it accomplished little. Meanwhile, the Third World countries gave priority to developing their own national news agencies and the Non-Aligned News Agencies Pool, dedicated to the "journalism of national development." What this meant, if effect, was journalism limited to "development news" (which by definition was always good)and to "protocol news," i.e., ribbon-cutting and other ceremonial events. By the time of the US withdrawal from UNESCO at the end of 1984, the issue was becoming, if not resolved, at least quiescent, with some indications of progress. At the 1983 conference at Talloires, the World Press Freedom Committee and the Associated Press put together a list of 300 journalistic exchange, training, and internship programs in 70 countries. The World Bank issued a report on "Telecommunications and Economic Development," and a report by the Organization for Economic Cooperation and Development and the International Telecommunications Union pointed out the cost-benefit relationship of telecommunications to economic development. Finally, a report by an international commission headed by Sir Donald Maitland stressed the importance of shifting existing resources to telecommunications so that basic communications services would be available to everyone on earth by the early 21st century.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
In: UNFPA: 1986 report, [by] United Nations Fund for Population Activities. New York, New York, UNFPA, 1987. 6-31.The implications of population growth and prospects for the future are examined in a 1987 UNFPA report on the state of world population. Demographic patterns in developed and developing countries are compared, as well as life expectancy and mortality rates. Although most countries have passed the stage of maximum growth, Africa's growth rate continues to increase. Changes in world population size are accompanied by population distribution and agricultural productivity changes. On an individual level, the fate of Baby 5 Billion is examined based on population trajectories for a developing country (Kenya, country A), and a developed country of approximately the same size (Korea, country B). The report outlines the hazards that Baby 5 Billion would face in a developing country and explains the better opportunities available in country B. Baby 5 Billion is followed through adolescence and adulthood. Whether the attainment of 5 billion in population is a threat or a triumph is questioned. Several arguments propounding the beneficial social, economic, and environmental effects of unchecked population growth are refuted. In addition, evidence of the serious consequences of deforestation and species extinction is presented. The report concludes with an explanation of the developmental, health and economic benefits of vigorous population control policies, especially in developing countries.
New York, New York, United Nations Population Fund, 1988. xi, 477 p. (Population Programmes and Projects Vol. 1.)This is the 5th edition of the GUIDE to be published. A new edition is issued every 3 years. The GUIDE was mandated by the World Population Plan of Action, adopted by consensus at the World Population Conference held in Bucharest, Romania, in August 1974. Each entry for an organization describes its mandates, fields of special interest, program areas in which assistance is provided, types of support activities which can be provided, restrictions on types of assistance, channels of assistance, how to apply for assistance, monitoring and evaluation of programs, reporting requirements, and address, of organization. International population assistance is broadly construed as 1) direct financial grants or loans to governments or national and non-governmental organizations within developing countries; 2) indirect grants for commodities, equipment, or vehicles; and 3) technical assistance training programs, expert and advisory services, and information programs. To gather information for this edition of the GUIDE, a questionnaire was sent to more than 350 multilateral, regional, bilateral, non-governmental, university, research agencies, organizations, and institutions throughout the world.
The contribution of the United Nations to the development of population policy in developing countries.
[Unpublished] 1988. 13 p.The UN has been actively engaged in population questions--including policy issues--from its very beginning. In 1946, the UN's Economic and Social Council established the Population Commission to arrange for studies and advise on the size and structure of populations, the interplay of demographic and socioeconomic factors, and policy. The UN has 3 leading functions that it carries out in relation to population questions: 1) the formulation of population policies and recommendations for action as agreed to by the community of nations, 2) organizing and maintaining a flow of resources and technical assistance, and 3) assembling, analyzing, and disseminating research findings that contribute to effective policy formulation. Although the population policies adopted by the UN are not treaties and lack the force of law, the existence of an international consensus can serve to help legitimate a policy at the national level as well as giving governments an incentive to formulate their own position. International policy formulation can also guide the financial support, technical assistance, and research activities of the UN system. 2 risks that must be overcome for the effective use of intergovernmental fora to arrive at population policies are 1) the risk that population issues may become politicized, and 2) the risk that attempting to define policies acceptable to all nations will result in a policy so general that it loses all impact. The leading role in the promotion of population programs of the UN system was given to the UN Fund for Population Activities in 1967. To implement its broad and flexible mandate, the Fund has developed a core program covering 1) family planning, 2) population education, 3) basic data collection, 4) population dynamics, and 5) population policy. The leading questions facing the UN now as it seeks to continue its contribution to population policy at the national level are 1) the possibility of holding a 3rd international conference on population in 1994, 2) continuing high rates of fertility and growth in Sub-Saharan Africa, 3) near or below replacement fertility in some countries, 4) changes in the structure and the roles of women, 5) the AIDS epidemic, 6) urban growth and rural decline, and 7) the residual effects of past international migration.
Policy initiatives of the multilateral development banks and the United Nations specialized agencies.
In: Migration and development in the Caribbean: the unexplored connection. Boulder, Colorado, Westview Press, 1985. 301-20. (Westview Special Studies on Latin America and the Caribbean.)The International Labour office (ILO) of the UN analyzes manpower supply and demand and creates guidelines on the treatment of both legal and illegal migrant workers. The UN Economic and Social council (ECOSOC) oversees economic and social issues concerning population. The World Health Organization (WHO) oversees health issues relating to population. The World Bank has been the active member of the World Bank group in Latin America and the Caribbean because only Haiti qualifies to borrow from the soft loan affiliate of the Bank--the International Development Association (IDA). In 1983, the World Bank/IDA made 12 loans to the Caribbean countries totaling $205 million, $120 million of which went to Jamaica. The Bank has shown that special techniques are needed for successful rural development projects involving community understanding and participation, and that traditional development techniques will not work. An interesting change in World Bank philosophy and policy has been the recognition of the need for devising and adopting appropriate technologies to the needs of the rural areas; such technologies include community involvement in water and sanitation, the use of simple hand pumps, low-cost housing, and small-scale irrigation. These solutions are a far cry from the earlier belief that the large dam and power station and the mechanization of agriculture are the cure-all. The 3rd institution specifically geared to making loans to the Caribbean countries is the Caribbean Development Bank, whose accumulated lending amounted to $435 million as of 31 December 1983.
WORLD HEALTH FORUM. 1988; 9(2):185-99.This article explains how the concept of health for all developed within the context of the history of the World Health Organization (WHO). By the early 1970s a new idea was taking shape in WHO. Medical services were failing to reach vast numbers. Health would have to emerge from the people themselves. In the heat of discussion the new strategy was clarified and given a name--primary health care (PHC). An ambitious target was set for it--no less than health for all by the year 2000. It was decided that the community itself had to be involved in planning and implementing its own health care. A new type of health worker was called for, chosen by the people from among themselves and responsible to the community but supported by the entire health system. In virtually all countries, the emphasis on curative care would have to be balanced by an equal emphasis on prevention. Almost 90% of WHO's Member States were prepared to share with one another detailed information about the problems facing their health systems. Industrial countries were beginning to realize that sophisticated medical technology was no guarantee of good health and that health for all through PHC offered an alternative. Millions of health workers have been trained, extending services to low-income groups that had no access to modern health care. Among health professionals, lack of understanding of the PHC concept and insufficient concern for social equity remain the principal constraints. Another problem is that expenditure on health care tends to be viewed as a drain on scarce resources rather than as an investment in the nation's future. The mommentum of health for all can be sustained only by governments implementing at home the policies they have collectively agreed on at The World Health Assembly in Geneva.
WORLD HEALTH FORUM. 1988; 9(2):143-6.This article summarizes the activities and the philosophy of WHO in its effort to improve worldwide health care since its inception some 40 years ago. At the 1st World Health Assembly in 1948 it was pointed out that little could be achieved by medical services unless the existing economic, social and other relations among peoples have been improved. The immediate priorities of the new Organization were more limited: to build up health services in the areas destroyed by the war, and to fignt the spread of the big infectious killer diseases. It took almost 30 years before the WHO really got down to trying to do something about the economic, social and other conditions which lie at the heart of most health problems. The Alma-Ata Declaration in 1978 heralded a new era in health. The concept of primary health care and the global health-for-all strategy to implement it are now rapidly gaining ground. In villages, towns and districts, people are waking up to the fact that they can contribute to their own health destiny. As WHO embarks on its 5th decade, there are grounds for optimism: health is moving in the right direction in spite of major obstacles.
ASSIGNMENT CHILDREN. 1987; (3):3-84.Recent findings from xerophthalmia studies in Indonesia have served as a catalytic force within the international health and nutrition community. These analyses conclude that, in Indonesia, there is a direct and significant relationship between vitamin A deficiency and child mortality. Further research is under way to determine the degree to which these findings are replicable in other countries and contexts. At the same time, representatives from international, bilateral, national and private organizations are critically examining their programs in vitamin A deficiency and xerophthalmia control for future planning. At UNICEF, there has been a special concern for vitamin A issues because of the possible implications in child survival. This is noted in the 1986 State of the World's Children Report. UNICEF recruited a consultant in January 1986 to examine its existing vitamin A programs, review scientific findings and meet with specialists to prepare policy options for consideration in future UNICEF involvement in the area of vitamin A. A brief background is given on the absorption, utilization, and metabolism of vitamin A, and its role in vision, growth, reproduction, maintenance of epithelial cells, immune properties, and daily recommended allowances. Topics cover xerophthalmia studies, treatment and prevention, prevalence, morbidity and mortality, program implications and directions, and procurement of vitamin A. Target regions include Asia, the Americas and the Carribean.
[Vaccination, the right of each child, World Day of Health 1987] Vacunacion: derecho de cada nino, Dia Mundial de la Salud 1987.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1987 Mar; 102(3):263-80.In the 10 years since the Panamerican Health Organization (PAHO) and the World Health Organization initiated the Extended Immunization Program in the Americas (PAI), coverage has increased from less than 1/3 to over 1/2 of children immunized in their first year against 6 major childhood diseases. Due mainly to the PAI, the incidence of measles, tetanus, and diptheria has been reduced by 1/2, that of whooping cough by 75%, and that of tuberculosis by about 5% annually. About 75% of children are immunized against polio, which has 1/10 as many victims today as 10 years ago. PAHO and several other organizations have targeted 1990 for eradication of polio from the South American continent. Since the PAI was established in 1977, more than 15,000 health workers have been trained, cold chains have been established to preserve vaccines, and more than 250 technicians have been trained to maintain and repair the needed equipment. The cost of the campaign to eradicate polio is estimated at US $ 24 million per year for the entire region--a low total compared to the costs of hospitalization and rehabilitation of the victims in the absence of such a program. The goal of immunizing all the world's children by 1990 proposed by the World Health Assembly in 1977 is achievable, but much remains to be done. The number of children immunized in the largest Third World countries ranges from 20-90% owing in part to national immunization days but also to assumption by local communities of the goal of universal immunization by 1990. All deaths produced by these 6 killer diseases are not registered, but the World Health Organization estimates that measles takes 2.1 million lives annually, neonatal tetanus 800,000, and whooping cough 600,000. Governmental and nongovernmental international organizations have made financial help available to countries needing it for their immunization programs. Most developing countries are expected to achieve the goal of universal immunization by 1990, but the 10 poorst countries of Africa and the Eastern Mediterranean may not be able to do so. At the worldwide level, 41% of the 118 million children who survive their first year have been vaccinated against measles and 46% against tuberculosis. 47% have received the full course of vaccine against diptheria, whooping cough, tetanus, and polio. The cost of these immunization is $5-15 per child and 80% is assumed by local countries. The World Health Organization recommends that all children, even the undernourished or slightly ill, be vaccinated, and that all health services vaccinate. Parents should be urged to return for the 2nd and 3rd doses of polio and DPT vaccines. Vaccination programs should pay more attention to impoverished urban populations. Several countries of the region have added innovations such as vaccination against other illnesses, house to house searches for unvaccinated children, or use of mass media to publicize national vaccination programs.
New York, New York, United Nations, 1987. vi, 247 p. (Population Studies, No. 102; ST/ESA/SER.A/102)WORLD POPULATION POLICIES presents, in 3 volumes, current information on the population policies of the 170 members states of the UN and non-member states. This set of reports in based on the continuous monitoring of population policies by the Population Division of the Department of International Economic and Social Affairs of the UN Secretariat. It replaces POPULATION POLICY BRIEFS: CURRENT SITUATION IN DEVELOPING COUNTRIES, POPULATION POLICY BRIEFS: CURRENT SITUATION IN DEVELOPED COUNTRIES, and POPULATION POLICY COMPENDIUM. Except where noted, the demographic estimates and projections cited in this report are based on the 10th round of global demographic assessments undertaken by the Population Division. Country reports are grouped alphabetically; Volume I contains Afghanistan to France. Each country's entry includes demographic indicators detailing population size, a structure, and growth; mortality and morbidity; fertility, nuptiality, and family; international migration; and spatial distribution and urbanization. Current perceptions of these demographic indicators are included, along with the country's general policy framework, institutional framework, and policies and measures. A brief glossary of terms and list of countries replying to the 1st, 2nd, 3rd, 4th, and 5th inquiries are appended.
[The Expanded Programme on Immunization: the results of its realization, problems and prospects] Rashirennaia Programma Immunizatsii: resultaty osushchestvleniia, problemy i perspektivy.
ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGII I IMMUNOBIOLOGII. 1985 Feb; (2):114-20.A report to interested physicians in the USSR explained the progress of and problems associated with the World Health Organization (WHO) expanded immunization program, set up by resolution in 1974, to inoculate every child in the world up to age 1 against measles, pertussis, tetanus, polio, diphtheria, and tuberculosis by 1990. The program called for distribution of DTP anatoxin, live polio and measles virus, and Calmette-Guerin bacillus. By 1983, 50% of children in Europe, America, the Peoples Republic of China, and the immediately contiguous areas had been vaccinated against polio and DTP, but in developing countries the figures were only 24% and 31% respectively, and only 26% and 14% for measles and tuberculosis respectively. The decision was made in 1983 to concentrate more effort and resources on establishing national health programs by training higher level administrative workers and technicians to work at the local level in storing and delivering vaccines, and operation and maintenance of the refrigeration equipment, which is of vital importance in tropical regions. Refrigeration equipment has been developed recently to meet the unique conditions of the developing nations, periodic comprehensive evaluation of program implementation is conducted, and a series of laboratory and field studies are now underway to improve efficiency of implementation by improving the thermal stability of vaccines and the refrigeration chain, increasing availability of vaccines to the population, and improving the economy of operations. Audits show that vaccine losses now account for only 14% of expenditures, with 45% going for labor. Almost 80% of all costs are now being met by the countries involved. Thus, international cooperation has been instrumental in the results of the expanded immunization program.
In: Latin American Conference on Population and Development Planning, Cartagena, Colombia, 1979. Final report. New York, New York, United Nations Fund for Population Activities, 1979. 1-17. (RLA/78/P15; UNFPA/79/CDPP/LA/3)This paper examines UNFPA's role in promoting the integration of population into development planning, with a special emphasis on the Latin America region. The 1st section traces the resolutions and instruments adopted by the UN in the last 25 years on the subject of population and development, later framed in the broader context of a new international development strategy. UNFPA's general mandates and its intercountry activities are described in the 2nd section. The 3rd section summarizes the general situation in Latin America in regard to the integration of population policies and development planning, and outlines the response of UNFPA to the requests of governments at the regional and country levels. The 4th section is a concluding statement indicating UNFPA's willingness to seek guidance from Member States on its course of action and to meet requests for assistance from governments as it considers this necessary and desirable.