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POPULI. 1995 Jan; 22(12):4-5.According to speakers from 45 countries, at a UN General Assembly debate (November 17-18), "a major mobilization of resources and effective monitoring of follow-up actions are needed" in order to implement the Programme of Action of the International Conference on Population and Development (ICPD). Algeria spoke for developing countries in the Group of 77 (G77) and China; commended the Programme's recognition of the key role played by population policies in development and its new approach that centered on people rather than numbers; called for concerted international mobilization to meet ICPD goals for maternal, infant, and child mortality, and access to education; and, since G77 had agreed at the Cairo Conference that developing countries should pay two-thirds of the implementation costs of the Programme, asked industrialized countries to provide the remaining third from new resources, rather than by diversion of existing development aid. It was reported that G77 is preparing a draft resolution which will address distribution of ICPD follow-up responsibilities. Germany spoke for the European Union; commended the shift of focus from demographics and population control to sustainable development, patterns of consumption, women's rights, and reproductive health; and suggested that the World Summit on Social Development and the Fourth World Conference on Women, which will be held in 1995, could carry on the Cairo agenda (a point underscored by Thailand). It was reported that several Western European countries had already pledged substantial increases in population assistance. Indonesia and South Korea addressed increasing South-South cooperation in population and development. Nigeria and the Holy See noted the emphasis on national sovereignty in regard to law, religion, and cultural values. Many called for a global conference on international migration. To ensure a common strategy for ICPD follow-up within the UN system, UN Secretary General Boutros Boutros-Ghali has asked UNFPA Executive Director Nafis Sadik to chair an inter-agency task force. All UN agencies and organizations have been asked to review how they will promote implementation of the Programme of Action.
WORLD HEALTH FORUM. 1993; 14(4):333-44.WHO evaluated the implementation of the health-for-all strategy using data from 151 countries. 110 countries still endorsed the strategy. 95 have either completely implemented or further developed community involvement. Just 33 countries had more equitable distribution of resources. The percentage of gross national product (GNP) that the government dedicated to health rose in the least developed countries. Developed countries spent a higher proportion of their GNP on health than did developing countries (3.3% vs. 0.9%, 1991). Maldistribution of health personnel continued to be a major problem. Between 1985 and 1990, the proportion of people in developing countries with access to safe water rose from 68 to 75%. Adequate sewage disposal coverage rose from 46 to 71% (1985-1991). Prenatal care coverage by trained personnel increased from 58 to 67%. Tetanus toxoid coverage of pregnant women only increased from 24 to 34%. Most maternal deaths were a result of inadequate prenatal care, inadequate care during childbirth, pregnancies spaced too closely, multiparity, and poor health and nutritional status before the first pregnancy. Immunization coverage rose considerably in every region (e.g., 47-83% for diphtheria). Nevertheless, substantial differences in coverage existed between countries. A substantial trend towards more integrated primary health care occurred. Child survival rates improved, but the gap in infant mortality rates between developed countries and the least developed countries widened. The gap in health status between the poor and the wealthy had become larger. Developing countries in the process of the epidemiological transition continued to be burdened with both infectious and degenerative diseases. GNP and adult literacy rose, but less so in the least developed countries. These findings suggested that governments must sustain the commitment to reduce inequities, realign health systems, improve health financing systems, improve coordination between health sectors, and improve linkage between health and development.
ECONOMIST. 1993 Nov 13; 99-100.The World Health Organization (WHO) eradicated smallpox in 1977. This was the first time that an effective vaccine disseminated through a systematically organized inoculation program had been so successful. In the aftermath, WHO launched the Expanded Program on Immunization (EPI) with the objective of eradicating measles, diphtheria, whooping cough, tetanus, tuberculosis, and polio. These diseases were chosen because all caused major child mortality and effective vaccines existed against each. After 16 years, 80% of the world's children have been immunized and many lives have been saved, but only patchy geographical coverage of immunizations has been achieved and each targeted disease in still with us. In light of this situation, program critics saw the need to take an alternative approach and launched the Children's Vaccine Initiative (CVI) in 1990. EPI concentrated on increasing the effectiveness of bureaucracy to delivery vaccines, but 5 clinic visits in the first 15 months of the baby's life were nonetheless needed for a complete regimen of inoculations against all 6 target diseases. The WHO bureaucracy had trouble incorporating improved vaccines as they were developed and in maintaining the cold chain. The CVI, however, has only minority participation by WHO and the different strategy of focusing upon the development of simpler, more robust vaccines. The CVI is striving to develop a combined vaccine against all 6 diseases which would be affordable, unaffected by changing temperatures, and administered orally in 1 dose shortly after birth. The WHO chief, Nakajima, conceded to the flaws of EPI and agreed to merge the program and its resources with CVI in January, 1994. This move will bring a great deal of program money to CVI. Regarding specific technologies, Virogenetics of Troy, New York, is testing canary-pox-based vaccines on people with the goal of securing a vaccine capable of effectively carrying 7 different antigens. Timed-release capsules are being tested as a means of dealing with the need for repeated doses and it appears that using heavy water to make polio vaccine increases the latter's resistance to heat; researchers are trying to find out why.
In: Urban and rural development in Third World countries: problems of population in developing nations, edited by Valentine James. Jefferson, North Carolina, McFarland, 1991. 297-314.National security must be broadened to include national cultural survival in tandem with resource availability or scarcity, and tensions between developed and developing countries must be reduced. Budget priorities must accommodate a sense of fairness, humanness, and justice. Politics reflect priorities and values for scarce resources for US society and for the world. The needs of the Third World are described, followed by a presentation of a developmentalist alternative and a case study of Brazil and Central America. Attempts have been made to secure stability and harmony through unilateral armament, bilateral and multilateral treaty arrangements, and a European balance of power strategy. None of these strategies has been particularly successful. The UN Charter also provides for collective security arrangements and unilateral and regional defense systems. 9 objective and subjective criteria for a viable collective security system are listed. The US has never agreed on a definition of aggression or that it is totally undesirable. 157 nations are part of the UN, while others are still denied membership on ideological grounds. Confidence in the system and its members is lacking and nations have been unwilling to subordinate national behavior to UN standards. Collective security in the political world has not been realized. Nuclear deterrence has been used by the US since the 1950 for national security. Aristotle recognized that economic well-being is related to peace, and gross inequalities are related to conflict. The needs of developing countries are the reduction of poverty and of the gap between rich and poor nations. Poor nations are susceptible to corruption, capital flight, and increasing military expenditures. The US strategy has been to support corruptible repressive regimes. Budget priorities need to be reevaluated. An alternative developmentalist strategy would improve conditions to halt the spread of hostile ideologies and socioeconomic instability.
From empty-world economics to full-world economics: recognizing an historical turning point in economic development.
In: Population, technology, and lifestyle: the transition to sustainability, edited by Robert Goodland, Herman E. Daly, Salah El Serafy. Washington, D.C., Island Press, 1992. 23-37.The human economy has moved from an era in which manmade capital was the limiting factor in economic development to the present when remaining natural capital has become the limiting factor. Natural capital is the stock from which comes natural resources. As human populations have grown and many countries have developed economically, manmade capital has been developed and accumulated to exploit often unowned natural capital and resources as if they had no price. No self-interested social class exists to protect these resources from overexploitation. Current levels of extracting and harvesting natural capital are simply not sustainable. This concept of full-world economics, however, is not accepted as academically legitimate by those of the empty-world school. Neoclassical economics considers factors of production to be substitutable and not complementary; this is not the case for the world's stock of natural capital. Assuming that natural capital has become the limiting factor, economic logic dictates the need to maximize its productivity and increase its supply. Investment and technology should therefore focus upon preserving and restoring natural capital while improving the productivity of natural capital more than manmade capital. Population growth must be reduced in developing countries and both population growth and per capita resource use must be constrained in more developed countries. Supporting these objectives, the World Bank, the UN Environment Program, and the UN Development Programme have started a biospheric infrastructure investment called the Global Environment Facility. It will provide concessional funding for programs investing in the preservation or enhancement of the protection of the ozone layer, reduction of greenhouse gas emissions, protection of international water resources, and protection of biodiversity. These issues will gain prominence in development bank lending policies.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
INTEGRATION. 1989 Dec; (22):14-7.Affirming that international cooperation along North-North, North-South, and South-South lines is essential for mutual survival, Mr. Waiyaki calls upon international understanding, good w ill, determination, and compromise in achieving mutually beneficial socioeconomic development for developing nations, while avoiding serious international confrontation and internal civil strife. He cites remaining instances of colonialism and the debate over Africa's debt repayment as potential conflict areas, then provides previously suggested resolving steps involving the Organization for Economic Cooperation and Development and the Economic Commission for Africa. Regarding internal strife, he discusses the hardships imposed upon African populations by structural adjustment programs. Should such exacerbatory measures be implemented in the hope of fostering development, negative international ramifications are possible. Specifically, the potential failure of measures to redress regional population and environmental problems should not be discounted. Improved communications and increasing interdependence continue to make the world seem smaller, allowing regional changes to affect the world on a broader scale. Key issues in high population growth, especially in Africa, Latin America, and Oceania, and environmental concerns are explored. The address includes specific mention of determinant factors and suggestions for Northern country interventions in finding solutions to these comprehensive concerns.
HEALTH POLICY AND PLANNING. 1986 Mar; 1(1):37-47.This economic analysis assesses the probable costs of implementing various activities of the World Health Organization's (WHO's) global strategy of "health for all by the year 2000" and the likelihood that developing countries will be able to afford these costs, either on their own or with the assistance of developed countries. If this policy is to be transformed into concrete results, there must be a plan complete with budgetary requirements, planned activities, and expected results specified in adequate detail. The overall costs of the activities proposed by the global strategy would amount to approximately 5% of the gross national product of most developing countries, with water supplies and primary health care comprising the most expensive activities. Although there is a good match between estimated resource requirements and planned activities, the desired outcomes are often unlikely to result from the activities proposed. At present, all 25 industrial market and nonmarket industrial developed countries have already achieved the outcome goals of the global strategy; however, these countries account for only 25% of the world's population. Of the 63 middle-income countries, 54 have already achieved a gross national product per capita of over US$500, but only 22 have an infant mortality rate better than 50/1000. Very few low-income countries are close to reaching their targets for income, infant mortality, life expectancy, or literacy. On the basis of current trends, 25-33% of countries are considered unlikely to achieve the outcome goals by the year 2000. In general, it appears that expenditure targets are too low to cover the needed health services activities. Further research on the costs of health promoting activities such as immunization and primary health care should be given high priority.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
New York, New York, Population Council, Center for Poplicy Studies, 1985 Aug. 42 p. (Center for Policy Studies Working Papers No. 113)This analysis of family planning program funding suggests that current funding levels may be inadequate to meet projected contraceptive and demographic goals. Expenditures on organized family planning in less developed countries (excluding China) totaled about US$1 billion in 1982--about $2/year/married woman of reproductive age. Cross-sectional analysis indicates that foreign support as a proportion of total expenditures decreases with program duration. Donor support to family planning in less developed countries has generally declined from levels in the late 1970s. This is attributable both to positive factors such as program success and increased domestic government support as well as requirements for better management of funds and the worldwide economic recession. Foreign assistance seems to have a catalytic effect on contraceptive use only when the absorptive capacity of family planning programs--their ability to make productive use of resources--is favorable. The lower the stage of economic development, the less visible is the impact of contraceptive use or fertility per investment dollar. On the other hand, resources that do not immediately yield returns in contraceptive use may be laying the foundation for later gains, making increased funding of family planning programs an economically justifiable investment. The World Bank has estimated that an additional US$1 billion in public spending would be required to fulfill the unmet need for contraception. To increase the contraceptive prevalence rate in developing countries to 58% (to achieve a total fertility rate of 3.3 children) in the year 2000 would require a public expenditure on population programs of US$5.6 billion, or an increase in real terms of 5%/year. Improved donor-host relations and coordination are important requirements for enhancing absorptive capacity and program performance. A growing willingness on the part of donors to allow countries to specify and run population projects has been noted.
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.
New York, New York, United Nations, 1984. ix, 534 p. (International Conference on Population, 1984; Statements ST/ESA/SER.A/90)Contained in this volume are the report (Part I) and the selected papers (Part II) of the Expert Group on Population, Resources, Environment and Development which review past trends and their likely future course in each of the 4 areas, taking into account not only evolving concepts but also the need to consider population, resources, environment and development as a unified structure. Trends noted in the population factor include world population growth and the differences between rates in the developed and developing countries; the decline in the proportion of the population who are very young and the concomitant increase in the average age of the population. Discussed within the resource factor are the labor force, the problem of increasing capital shortage, expenditures on armaments, trends in the supply and productivity of arable land, erosion and degradation of topsoil and energy sources. Many of the problems identified overlap with the environment factor, which centers on the problem of pollution. The group on the development factor was influenced by a pervasiv sense of "crisis" in current economic trends. Concern was also expressed regarding the qualitative aspects of current development trends, defined as the perverse effects of having adopted inappropriate styles of development. Part II begins with a general overview of recent levels and trends in the 4 areas along with the concepts of carrying capacity and optimum population. Other papers discuss the impact of trends in resources, environment and development on demographic prospects; long-term effects of global population growth on the international system; economic considerations in the choice of alternative paths to a stationary population and the need for integration of demographic factors in development planning. The various papers on the resources and environment factor focus on resources as a barrier to population growth; the effects of population growth on renewable resources; food production and population growth in Africa; the frailty of the balance between the 4 areas and the need for a holistic approach on a scale useful for regional planning. Also addressed are: social development; population and international economic relations; development, lifestyles, population and environment in Latin America; issues of population growth, inequality and poverty; health, population and development trends; education requirements and trends in female literacy; the challenge posed by the aging of populations; and population and development in the ECE region.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
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.
International consultation of NGOs on population issues in preparation of the 1984 United Nations International Conference on Population: report of the consultation.
[Unpublished] . 83 p.196 individuals from 44 countries, representing national and international non-governmental organizations, bilateral agencies and intergovernmental organizations attended the consultation. The purposes of the consultation were: 1) to provide an overview of the contributions of non-governmental organizations to the implementation of the World Population Plan of Action through a wide range of population and population related programs carried out since the Plan was adopted in 1974; 2) to explore what non-governmental organizations believe needs to be done in the world population field during the balance of the century; 3) to prepare for participation in the January 1984 Conference Preparatory Committee meeting and in the Conference itself to be held in August 1984; and 4) to provide suggestions for activities of national affiliates relative to the 1984 Conference. This report provides a synopsis of the plenary sessions and their recommendations. Addresses by numerous individuals covered the following topics: the creative role of non-governmental organizations (NGOs) in the population field; vital contributions of NGO's to the implementation of the world population plan of action; the family; population distribution and migration; population, resources, environment and international economic crisis; mortality and health; and NGO prospects for the implementation of the world population plan of action.
London, England, IPPF, July 1982. 4 p. (IPPF Fact Sheet)Discusses the movement to establish groups of Parliamentarians on Population and Development throughout the world. The movement grew out of the need to create understanding among legislators and policymakers of the interrelationship between development, population, and family planning. Parliamentarian groups can help to ensure that population and family planning are included in development plans and that resources are committed to population and family planning programs. The main initiative for the establishment of Parliamentarian groups and for their regional and international cooperation came from the United Nations Fund for Population activities (UNFPA). The International Planned Parenthood Federation (IPPF) has been involved from the beginning and works closely with UNFPA. The meeting of Parliamentarians on Population and Development during 1981 resulted in important regional developments, with IMF affiliates playing a major role. The Washington Conference on Population and Development included Parliamentarians from the Caribbean and Latin America. Priorities for formulating population and development policies were identified. The African Conference of Parliamentarians on Population and Development marked the first time that a major conference on so sensitive an issue was held in Africa. The Beijung conference was attended by 19 Asian countries and resulted in a declaration calling on Parliaments, governments, UN agencies, and nongovernmental organizations to increase their commitment to all aspects of population and family planning. National developments in India and the Philippines are also discussed. Many of the countries with Parliamentary groups on Population and Development have governments that are involved in providing international population assistance. Greater commitment to population as a crucial factor in development through the establishment of links with governments and parliamentarians is an action area within the IPPF 1982-84 plan.
The private sector, the public sector, and donor assistance in economic development: an interpretive essay.
[Washington, D.C.], U.S. Agency for International Development, 1983 Mar. 52 p. (A.I.D. Program Evaluation Discussion Paper No. 16)A retrospective view of the ways in which the public policy of host countries coupled with the actions of donors have led to the growth of a vital private enterprise economy in less developed countries (LDC) is provided for the Agency for International Development (AID). Efforts are concentrated on examining the recent development history of 4 countries: Malawi, Cameroon, Thailand, and Costa Rica. These examinations contain a great deal of information on the process of economic development, the role of private enterprise production activities, the importance of free and competitive markets, and the possibilities of donor intervention to affect the speed and direction of economic development. The studies have revealed that free and competitive markets are efficient institutions for allocating resources, yet governments frequently intervene. In all of the countries studied, economic policy and economic ideology seem unconnected to the existing political system. Donors wishing to encourage private sector growth find themselves in an anomalous situation. Interventions need to be chosen to address contraints but little is known about the constraints inhibiting the growth of proprietal, entrepreneurial, and managerial firms. As a donor, one's role should be to facilitate the expression of the creative energies within the private sector by working with host governments on ways both can provide needed help and reduce unneeded hindrances to market activities.