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Universal access to reproductive health. Accelerated actions to enhance progress on Millennium Development Goal 5 through advancing Target 5B.
Geneva, Switzerland, World Health Organization [WHO], 2011.  p. (WHO/RHR/HRP/11.02)The World Health Organization (WHO) Department of Reproductive Health and Research convened a technical consultation involving stakeholders from countries, regions and partner agencies to review strategies applied within countries for advancing universal access to sexual and reproductive health with a view to identifying strategic approaches to accelerate progress in achieving universal access. Case-studies from seven countries (Brazil, Cambodia, India, Morocco, United Republic of Tanzania, Uzbekistan and Zambia) illustrating application of a variety of strategies to improve access to sexual and reproductive health, lessons learnt during implementation and results achieved, allows identification of a range of actions for accelerated progress in universal access. In order to achieve MDG 5 a holistic approach to sexual and reproductive health is necessary, such that programmes and initiatives will need to expand beyond focusing only on maternal health and address also family planning, sexual health and prevention of unsafe abortion. Programmes should prioritize areas of engagement based upon country and regional needs while establishing practical ways to ensure equity through integration of gender and human rights. The strategic actions in countries outlined here will help accelerate progress towards attainment of MDG Target 5B within the wider context of implementation of the WHO Global reproductive health strategy. (Excerpt)
Achieving the millennium development goals for health and nutrition in Bangladesh: key issues and interventions--an introduction.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):253-60.Among the mega-countries, Bangladesh stands out in terms of the density of population. As opposed to other countries with a population exceeding 100 million, the density of population in Bangladesh is more than twice the density of other populous countries, and the population continues to grow. Bangladesh is only half way up the population curve such that, during the next 50 years, the difference in density between Bangladesh and other countries will widen even further. Thus, the density of population, as well as poverty, and the rapid urbanization of the country are major constraints for Bangladesh while it attempts to achieve the Millennium Development Goals (MDGs). Hopefully, the fertility rate will continue to fall to levels less than needed for replacement, since this will ease one of these constraints. (excerpt)
Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
International Journal of Gynecology and Obstetrics. 2007 Jun; 97(3):227-228.The Alliance for Women's Health is a FIGO-based interagency consortium, comprising the World Health Organization, United Nations Population Fund, World Bank, UNICEF, International Planned Parenthood Federation, International Confederation of Midwives and International Pediatric Association. In conjunction with the XVIII World Congress of Gynecology and Obstetrics in Kuala Lumpur in November 2006, the Alliance held a precongress workshop examining access in five priority emerging issues: human papillomavirus vaccine/cervical cancer screening, emergency contraception, adolescent reproductive health, emergency obstetric care and sexually transmitted infections. Reports from the five working groups, published in this and subsequent issues of the International Journal of Gynecology and Obstetrics, provide current evidence-based recommendations on improving access to sexual and reproductive health services supported by applicable rights. The World Bank presented a framework for the discussion during theopening plenary session. The importance of sexual and reproductive health services is well recognized and was articulated in the Programme of Action of the International Conference on Population and Development which was held in Cairo in 1994. However, the inclusion of universal access to reproductive health as a target for the Millennium Development Goals (MDGs) only occurred in October 2006 after prolonged negotiations reflecting the reluctance, in circles of influence, to provide support where there are certain sociopolitical sensitivities. (excerpt)
Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals.
[New York, New York], United Nations Development Programme, UN Millennium Project, 2006.  p.Sexual and reproductive health (SRH) was given an international consensus definition at the International Conference on Population and Development (ICPD) in 1994. At its core is the promotion of healthy, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage, that are fundamental to human well-being. Sexuality and reproduction are vital aspects of personal identity and key to creating fulfilling personal and social relationships within diverse cultural contexts. SRH does not only involve the reproductive years but emphasizes the need for a life-cycle approach to health. It touches on sensitive, yet important, issues for individuals, couples and communities, such as sexuality, gender discrimination and male/female power relations. Attainment of SRH depends vitally on the protection of reproductive rights, a set of long-standing accepted norms found in various internationally agreed human rights instruments. The ICPD adopted the goal of ensuring universal access to reproductive health by 2015 as part of its framework for a broad set of development objectives. The Millennium Declaration and the subsequent Millennium Development Goals (MDGs) set priorities closely related to these objectives. Progress towards the MDGs depends on attaining the ICPD reproductive health goals. The leaders of the world ratified that understanding in the 2005 World Summit Outcome Document. (excerpt)
Journal of Health, Population and Nutrition. 2006 Dec; 24(4):377-379.A new target-universal access to reproductive health by 2015-was endorsed in October 2006 under Millennium Development Goal 5 (MDG 5) to improve maternal health. And while the international reproductive health community could finally celebrate this official recognition of reproductive health on "centre stage of international efforts to defeat poverty and preventable illness" (1), the field reality is far from the target. What does it take to improve sexual and reproductive healthcare practices, including self-care practices at the home and use of services? Generated by a call for papers on these topics, this issue of the Journal contains selected papers describing current practices, examining specific barriers to improved practices, and providing results of interventions aimed at improving self-care practices or use of services. Most practices described relate to improving maternal and newborn* health or care; only two articles provide information on practices in other sexual and reproductive health areas-one on male sexuality and another on women with HIV/AIDS. No papers were received concerning care-seeking for family planning, menstrual regulation, or abortion care-a red flag perhaps signaling the marginalization of these topics in the current day. (excerpt)
Finance and Development. 2003 Dec; 40(4):14-19.With just 12 years left to achieve the W Millennium Development Goals, a greater sense of urgency is needed by all sides if the targets are to be met. Many developing countries are making substantial progress toward the MDGs as a result of improved policies, better governance, and the productive use of development assistance. But they could do more with the right mix of policy reforms and additional help. Scaling up efforts to meet the MDGs by 2015 presents both opportunities and challenges. By acting now, developed countries can hasten progress by providing more and better aid and by allowing greater access to their markets. Developing countries, for their part, will need to continue to improve their policies and the way they are implemented. Without greater impetus, there is a serious risk that many countries will fall far short on many of the goals. (excerpt)
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
Lancet. 1993 Aug 14; 342(8868):440.The World Bank's world development report is an appraisal of the main health problems and strategies for health promotion and disease control, as described in a July 10 editorial. It contains issues such as poor peoples' access to basic health care, implying that such access is a fundamental human right. The World Bank has softened some of its ideologically-driven policies in favor of more pragmatic approaches. Past advocacy of provision of health services by profit-making professionals has been toned down, possibly in view of findings that privatization is no panacea. However, the report pays little attention to the historical and social contexts that bolster or block the effectiveness of pubic health measures. HIV/AIDS control is very much a matter of socioeconomic development, which includes education , income, and welfare. Sociocultural, and also legal, empowerment and the respect for human rights are crucial. But the World Bank pushes mainly technocratic answers and neglects social movements, which have successfully widened access to resources that promote better health for everyone. It is also short on the history of the interaction between donors and developing countries. Structural adjustment programs imposed by the World Bank have compelled recipients to cut their health services. Donors now emphasize the importance of protecting sectors such as health care and education. However, structures have fallen apart; health planners, managers, and grassroots workers have lost their jobs. The report proposes a package of interventions but fails to recognize that many poor countries are unable to provide even a minimal service. Half the population of sub-Saharan Africa is expected to be below the poverty line by the year 2000, and unequal trade with developed countries continues with a crushing debt burden. The views of this report should be adopted by the macro-economic branches of the World Bank.
Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific, 1987. xii, 282 p. (ST/ESCAP/434.)Growing worldwide recognition of the unequal participation of women in development culminated in the declaration of 1975 as International Women's Year and of the subsequent 10 years as the UN Decade for Women: Equality, Development and Peace (1976-1985). The present report summarizes the progress achieved for and by women in Asia and the Pacific during the UN Decade for Women. This report should be read critically since the coverage of the country responses to the UN Economic and Social Commission for Asia and the Pacific (ESCAP) questionnaires was uneven. The international attention directed to the issue of women and development spurred the establishment of national machineries for the promotion of women's interests in many of the Asian and Pacific countries where none had existed, and the strengthening of those already active. In Bangladesh, Indonesia, Sri Lanka, and New Zealand, the national machinery was formed at the ministerial level. In other countries, a ministry already has the task of advancing women. In other countries, focal points are positioned directly under the leadership of the head of the executive branch. In Afghanistan, China, Mongolia, and Viet Nam the responsibility has been given to the national women's organizations that emerged after radical socio-political transformations. Countries of a 4th group have attached their machineries to a sectoral ministry or organization. During the UN Decade for Women, India, Nepal, Samoa, and Thailand included for the 1st time in their planning history a separate chapter in their national development plans on the integration of women into the development process. India, Japan, Malaysia, Nepal, Pakistan, and Thailand formulated separate national plans of action for the advancement of women. In other countries, including Fiji and Vanuatu, national plans of action were drafted and submitted to their governments by non-governmental women's organizations. 17 ESCAP member countries have signed, ratified, or acceded to the UN Convention on the Elimination of All Forms of Discrimination Against Women.
An examination of the population structure of Liberia within the framework of the Kilimanjaro and Mexico City Recommendations on Population and Development: policy implications and mechanism.
In: The 1984 International Conference on Population: the Liberian experience, [compiled by] Liberia. Ministry of Planning and Economic Affairs. Monrovia, Liberia, Ministry of Planning and Economic Affairs, . 111-36.The age and sex composition and distribution of the population of Liberia as affected by fertility, mortality, morbidity, migration, and development are examined within the framework of the Kilimanjaro Program of Action and recommendations of the International Conference on Population held in Mexico City. The data used are projections (1984-85) published in the 2nd Socio-Economic Development Plan, 1980. The population of Liberia is increasing at the rate of 3.5% and will double in 23.1 years. 60% of the population is under 20 and 2% over 75. Projected life expectancy is 55.5 years for women and 53.4 years for men. The population is characterized by high age dependency; 47.1% of the people are under 15 and 2.9% are over 64, so that half of the population consists of dependent age groups, primarily the school-age children (6-11 years). If these children are to enter the labor force, it is estimated that 19,500 jobs will have to be created to employ them. Moreover, fertility remains at its constant high level (3.5%), so, as mortality declines, the economic problem becomes acute. Furthermore, high fertility is accompanied by high infant and maternal mortality. High infant mortality causes couples in rural areas to have more children. These interdependent circumstances point up the need for family planning, more adequate health care delivery systems, and increasing the number of schools to eradicate illiteracy, which is currently at 80%. Integrated planning and development strategies and appropriate allotment of funds must become part of the government's policy if the Kilimanjaro and Mexico City recommendations are to be implemented.
New York, New York, United Nations, 1986. vii, 483 p. (UNDP/Series A/No. 16)The United Nations Development Program (UNDP) Compendium of Approved Projects contains a listing of ongoing UNDP-assisted projects financed under the Indicative Planning Figures (IPF), Special Program Resources, Special Measures Fund for Least Developed Countries, and Special Industrial Services. Part I of the Compendium presents summary tables for the program as a whole, classified by source of funds, type of project, sector, executing agency, region, and by country within each region. In Part II the following information is shown for each approved project, listed by country: Executing agency; date of approval; estimated completion date; and estimated project cost in US dollars, equivalent, including UNDP contribution, 3rd-party and government cost-sharing, and government contribution in cash and kind. The cost-sharing component of projects has been separated from "government inputs in cash and in kind" in Part II. Part III provides information on approved intercountry projects (regional, interregional, and global). Following Part III is detailed information on the participants in intercountry projects. Part IV presents a detailed listing of all projects with 3rd-party cost sharing and the donor. Program categories include: political affairs; general development issues, policy, and planning; natural resources; argriculture, forestry, and fisheries; industry; transport and communications; international trade and development; population; human settlements; healthl; education; employment; humanitarian aid and relief; social conditions and equity; culture; and science and technology.
[Unpublished] 1986 Aug. 71,  p. (AID Contract No. DPE-3024-C-00-4063-00)The evaluation of the Resources for Awareness of Population in Development (RAPID II) Project was initiated on June 18, 1985, 25 months into the project operation, to determine if the results of actions undertaken thus far have been adequate to justify the time and money spent on them and to find ways to improve the efficiency and effectiveness of the program efforts. The objective of the 5-year RAPIDS II project is to assist those involved in development planning to better understand the relationship between population growth and socioeconomic development and thereby increase the less developed country (LDC) commitment to efforts designed to reduce rapid rates of population increase. This evaluation report discusses the development assistance context and then focuses on the following: RAPID II operations over the 1984-85 period; policy analyses and LDC subcontracting; the RAPID model and its presentation; visits by the evaluation team to the countries of the Dominican Republic, Ecuador, Cameroon, and Liberia; what works in terms of population policy development; some major problems and potential resolutions; and RAPID II activities over the 1985-88 period. US Agency for International Development (USAID) officials in Washington as well as in the field described RAPID II as being of continuing utility in helping to create a climate favorable to more effective population policies. The review of RAPID II activities was generally positive. The project was identified as useful in several countries of sub-Saharan Africa and Latin America. Due to the evidence of satisfactory performance in the field, the evaluation focused on differences between plan and midterm results with a view toward suggesting course corrections that can improve project performance. As population policy development is an inherently ambiguous field of activity, it has not been possible to draw clear lines between specific policy development activities and policy change in particular countries. Yet, there has been an improvement in the environment for population programs in LDCs. There were significant differences between planned and actual expenditures under the several subcategories of project expenditure. RAPID II total expenditures in the first 2 years of the project equalled budgeted expenditures when the contract was signed, but the distribution of expenditures by category was substantially different from what had been anticipated. It is recommended that emphasis in the project must shift predominantly to policy analyses (80% of remaining funds) and that that RAPID-style presentation resources (20%) be used carefully for only the highest priority requests. In regard to development of LDC subcontracts for policy analysis, efficiency has been low.
FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.
New Delhi, India, World Health Organization, Regional Office for South-East Asia, 1985. vii, 126 p. (SEARO Regional Health Papers No. 8)The progress of activities to improve the health status of women in Southeast Asia, including WHO programs in family health, maternal and child health, and the training of women health workers, is examined in this paper. Data and information on the health and socioeconomic situation of women was drawn from Bangladesh, Bhutan, Burma, the Democratic People's Republic of Korea, India, Indonesia, Maldives, the Mongolian People's Republic, Nepal, Sri Lanka, and Thailand. Compared to 1975, there is now a definite focus on women's issues in national and international forums, deeper understanding of women's position and role in the development of nations, and more emphatic advocacy of women's rights. Several Southeast Asian nations have enacted legislation outlawing discrimination and protecting women from exploitation at work and at home, but the amount of resources devoted to implementing and enforcing change has been far less than needed. Each country in the region is profiled individually giving national policies on women, data on women's health status, the socioeconomic situation, status of women in the health professions, health legislation and social support to women, and women's non-governmental organizations.
Social Science and Medicine. 1985; 21(1):41-53.This paper explores the emergence of an international fad aiding and monitoring community participation efforts and projects its future outcome based on lessons from previous experiences in other than the health sector. The analysis suggests that the promotion of community participation was based in all cases on 2 false assumptions. 1) The value system of the peasantry and of the poor urban dwellers had been misunderstood by academicians and experts, particularly by US social scientists, who believed that the traditional values of the poor were the main obstacle for social development and for health improvement. However, the precolumbian forms of organization that traditional societies had been able to maintain throughout the centuries were not only compatible with development but had many of the characteristics of modernity: the tequio guelagetza minga and even the cargo system stress collective work, cooperation, communal land ownership and egalitarianism. 2) Another misjudgement was the claim that the peasantry was disorganized and incapable of effective collective action. In Latin America historical facts do not support this contention. A few examples from more recent history show the responsiveness and organizational capabilities of rural populations. The Peasant Leagues in Northeastern Brazil under the leadership of Juliao is perhaps 1 of the best known example. The question is thus raised as to why international and foreign assistance continues to pressure and finance programs for community organization and/or participation. It is suggested that the experience in Latin America (except perhaps Cuba and Nicaragua) indicates that community participation has produced additional exploitation of the poor by extracting free labor, that it has contributed to the cultural deprivation of the poor, and has contributed to political violence by the ousting and suppression of leaders and the destruction of grassroots organizations. Information presented on community participation in health programs in Latin America illustrates that they have followed closely the ideology and steps of community participation in other sectors. A country by country examination indicates that health participation programs in Latin America in spite of promotional efforts by international agencies, have not succeeded. The real international motivation for participation programs was the need to legitimeize political systems compatible with US political values. Through symbolic participation, international agencies had in mind the legitimation of low quality care for the poor, also known as primary health care and the generation of much needed support from the masses for the liberal democracies and authoritatrian regimes of the region. Primary health care delivery can be successful without community participation, in contradiction to what international agencies and governments maintain.
New York, New York, UNFPA, 1984 Jul. vii, 59 p. (Report No. 68)This report of a Mission visit to Ghana from May 4-25, 1981 contains data highlights; a summary of findings; Mission recommendations regarding population and development policies, population data collection and analysis, maternal and child health and family planning, population education and communication programs, and women and development; and information on the following: the national setting; population features and trends (population size, growth rate, and distribution and population dynamics); population policy, planning, and policy-related research; basic data collection and anaylsis; maternal and child health and family planning (general health status, structure and organization of health services, maternal and child health and family planning activities, and family planning services in the private sector); population education and communication programs; women, youth, and development; and external assistance in population. Ghana gained independence in 1957. The country showed early promise of rapid development. Although well-endowed with natural and human resources, Ghana now suffers from food scarcity, inadequate infrastructure and services, inflation, inequities in income distribution, unemployment, and underemployment. Per capita gross national product (GNP) was $400 in 1981; between 1960-81 the average annual growth of GNP was -1.1%. A high rate of natural increase of the population has compounded development problems by intensifying demands for food, consumer goods, and social services while simultaneously increasing the constraints on productivity. The population, estimated at 13 million in mid-1984, is growing at a rate of 3.25% per annum. Immigration and emigration have contributed to changes in the size and composition of the population. Post-independence development policies favored the urban areas, encouraging a steady rural-to-urban shift in the population. At the same time, worsening socioeconomic conditions spurred the emigration of professional, managerial, and technical personnel and skilled workers. Ghana was the 1st sub-Saharan African nation to establish an official population policy. Since the formulation of the policy in 1969, successive governments have remained committed to its emphasis on fertility reduction while increasing attention to the problems of mortality and morbidity and rural/urban migration. Recognizing the need to intensify the commitment to population policies, the Mission recommends support for a program to further the awareness of policy makers of the relationship between population trends and their areas of responsibility. The Mission recommends the creation of a special permanent population committee and the strengthening of the Ministry of Finance and Economic Planning's Manpower division. The Mission also makes the following recommendations: the provision of training, technical assistance, and data processing facilities to ensure the timely provision of demographic data for socioeconomic planning; data collected in the pilot program of vital registration be evaluated before the system is expanded; the complete integration of maternal and child health and family planning and general health services within the primary health care system; and improvement in women's access to resources such as education, training, and agricultural inputs.
[New York, United Nations Fund for Population Activities], 1984. 8 p. (UN/ICP/83/E/100,000; E/CONF.76/L.4)This pamphlet reproduces the Declaration on Population and Development prepared by representatives of 29 countries and adopted by the International Conference onn Population held in Mexico City August 6-14, 1984. The Conference noted the widening disparities between developed and developed countries, and reaffirmedd its commitment to improving the standard of living and equality of life of all peoples of this planet. Population issues are increasingly recognized as a fundamental element in development planning, and such plans must reflect the links among population, resources, environment, and development. Experience over the past decade suggests the need for full participation by the entire community and grassroots organizations in the design and implementation of policies and programs. Such an approach not only ensures that programs are relevant to local needs and consistent with personal and social values, but also promotes awareness of demographic problems. In addition, community support is essential to facilitate the integration of women into the process of social and economic development. Major efforts must be made to ensure that couples and individuals can decide freely, responsibly, and without coercion the number and spacing of their children and have the information, education, and means to make this decision. Increased funding is needed to develop new methods of contraception as well as to improve the safety, efficacy, and acceptability of existing methods. As part of the goal of health for all by the year 2000, special attention should be given to maternal and child health services within a primary health care system. Breastfeeding, adequate nutrition, clean water, immunization programs, oral rehydration therapy, and birth spacing offer the potential to improve child survival dramatically. Attention must also be given to the social and economic implications of recent changes in the age structure of the population, rapid urbanization, and international migratory movements. Governments as well as nongovernmental organizations continue to have a critical role in the implementation of the World Population Plan of Action, and should be supported by adequate international assistance.
Popleone. 1984 Jul; 1(1):2-4.Sierra Leone has no national population policy; however, the government is promoting numerous programs which impact on population problems, and in 1983 the government established a National Population Commission. A number of government health programs seek to reduce mortality and morbidity, particularly for mothers and children. Government programs provide 1) maternal and child health (MCH) care, primary health care, and immunization services; 2) training for traditional birth attendants, community health nurses, and paramedical personnel; 3) child spacing and fertility advisory services at some government MCH centers; and 4) construction of health centers. In addition, the government supports the inclusion of UN Fund for Population Activities' Fertility Advisory Services in the programs of several MCH centers, and, with assistance from the US Agency for International Development, is planning to make family planning services available at 120 MCH centers. The government is also supportive of the activities of the Planned Parenthood Association of Sierra Leone. Abortion is legal only in cases where the life of the mother is in jeopardy. Sierra Leone has no specific policies aimed at population redistribution; however, government agricultural development programs to equalize economic conditions in rural and urban areas should help reduce migration to urban centers. The National Population Commission is charged with the tasks of 1) formulating a national population policy, 2) promoting family planning, and 3) coordinating and promoting population activities in reference to development policies and program. The commission members represent a broad spectrum of the community, and the commission is composed of a working committee and a secretariat. A number of task forces are currently developing recommendations in the areas of fertility, mortality, morbidity, migration, labor, population law, women in development, policy and the environment, and population information dissemination.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
Asian-Pacific Population Programme News. 1984; 13(2):25-30.Differences between the Report of the UN World Population Conference and the Report of the Third Asian and Pacific Population Conference were discussed in reference to 1) the relative importance placed on family planning and development in lowering fertility levels, 2) the degree to which family planning and development programs should be integrated, and 3) setting family planning targets. The UN conference was held in Bucharest, Hungary, in 1974 and the Asian and Pacific Conference was held in Colomb, Sri Lanka in 1982. The relative importance of family planning and development on fertility was a major issue at the Bucharest conference. The World Population Plan for Action (WPPA) formulated at the Bucharest conference did not recommend family planning as a strategy for reducing fertility; instead, the WPPA recommended that countries interested in reducing fertility should give priority to development programs and urged developed countries to promote international equity in the use of world resources. In contrast, the Asia-Pacific Call for Action on Population and Development as formulated at the Colomb conference, strongly recommended both development and family planning programs as a means to reduce fertility. It urged governments to adopt strong family planning policies, to make family planning services available on a regular basis, and to educate and motivate their populations toward family planning. In regard to integration strategies, the WPPA called for integrating family planning programs and development programs wherever possible, and particularly recommended integrated delivery of family planning and health services. The Asia-Pacific Call for Action supported an integrated approach, but only in those situations where it was proven to be a workable approach, i.e., where it improved the efficiency of family planning services. Combining family planning and maternal and child health programs is known to be an advantageous approach, but the consequences of integrating family planning with other health programs and with development programs needs further study. The WPPA recommended that governments set targets for life expectancy and infant mortality, but it did not mention setting fertility targets or establishing an ideal family size. It did urge governments to create the type of socioeconomic conditions which would permit couples to have the number of children they desired and to space them in the manner they wished. The WPPA noted that substantial national effort would be required to reduce the birthrate to the UN projected rate of 30/1000 population in developing regions by 1985. The Asia-Pacific Call for Action urged countries to set specific targets which would make it possible for them to attain replacement level fertility in the year 2000. It will be interesting to observe the degree to which the Asian and Pacific countries will be able to influence the participants at the upcoming International Conference on Population to their way of thinking on these critical issues. A copy of the Asia-Pacific Call for Action on Population and Development is included in an annex to the article.
New England Journal of Medicine. 1983 Fall; 61(4):659-86.In this examination of Saudi Arabia's health care accomplishments, it is argued that the World Health Organization's primary health care model is not the most appropriate for Saudi Arabia and countries like it. Saudi Arabia's health care policy is closely linked to its very rapid emergence as a new and distinctive society. Whereas most developing countries export physicians, Saudi Arabia imports them because the demand for physicians services cannot be met by the supply of indigenous physicians. Saudi health care development is very different from that of most of the third world. Although the country does have a great deal of western technology, Saudi Arabia seems to be following a different course of development from both the third world and the West. Unlike the West, the cost of medial technolgoy is not a problem for Saudi Arabia. Rather, it solves the problem of how to allocate its oil wealth to maintain political stability. The Saudis intend to make the best health care available to all its citizens; they are very concerned about the effect of modern technology on tradition. Therefore, the selection of technology is based on its cultural compatability, rather than on its costs. Primary care may be more technological and specialized than in the West. In Saudi Arabia primary health care may eventually be delivered entirely by specialists, rather than by general or family practitioners. The Saudis are expected to develop a health care system that will meet their particular needs. As with Saudi Arabia itself, health care is experiencing unprecedented change. Thus, the emerging Saudi system will be unique and innovative. Some of its accomplishments will be adopted by other developing countries; Western countries may look to Saudi Arabia as a natural laboratory of health care experimentation.
Geneva, Switzerland, World Health Organization, 1982. (WHO Offset Publication No. 61)The objectives of the World Health Organization (WHO) study reported in this volume, and formulated in 1978, were as follows: to identify the main policies, objectives, and thrusts in the health manpower development (HDM) program of WHO during its 1st 32 years of existence, 1948-1980; to identify the factors influencing or determining these policies and to see how they have shaped the HMD program through changing emphases and various modes of implementation; to judge how far policy changes and achievements in health manpower development in the WHO Member States (156 in 1980) over the past 3 decades could be correlated, if at all, with HMD policies and programs in WHO; and to draw conclusions for the sound formulation of policies and programs in WHO for the near and longterm future. Information on the development of HMD policies and programs in WHO and its Member States was gathered along several lines. Reviews and critical analyses were made of the following 5 types of WHO materials: records of the governing bodies of WHO; major reports or documents submitted by the Director-General; regional office records and reports; technical books and reports; and WHO periodicals. Further information was gathered in several other ways outside the sphere of WHO. These sources and research methods included: questionnaire survey of expert opinion; country field studies; selected country literature search; general HMD literature search; health status and health manpower statistical analysis; and miscellaneous sources. Information is presented in the following categories: international health and manpower problems; the evolution of WHO manpower policy objectives; and other perspectives (experiences in the countries of Ethiopia, Indonesia, Malaysia, Gabon, Costa Rica, and Barbados and world trends in health manpower). Analytical review of HMD problems identified over the 1948-1980 period and of the policy objectives formulated in response reveals a complex evolution. HMD policy objectives in WHO have evolved since 1948 approximately as follows: increased quantity of conventional health personnel; improved quality of all types of health personnel; cross-national equality of health personnel training; geographic coverage of countries with health personnel; efficiency in production and use of health manpower; national planning of health manpower; relevance of health personnel to national needs; and integration of health services and health manpower development.
Geneva, Switzerland, WHO, 1980. 290 p.This Sixth Report on the World Health Situation tries to bring out the main ideas on health and health care issues and how to deal with them that arose during the 1973-1977 period. The primary sources of information used in the preparation of the report were the following: information routinely passed on by Member Governments to the World Health Organization (WHO); country reviews specially submitted by Member Governments for the Sixth Report; information routinely collected by other organizations of the United Nations system; and information for the reference period collected by WHO on an "ad hoc" basis to meet specific policy and program requirements. A background chapter focuses on general considerations, population, food and nutrition, education, social changes, economic trends, employment, poverty, health-related behavioral factors, evaluation of development progress and data needs, and policy issues. Subsequent chapters examine health status differentials, health action, research, and the outlook for the future in terms of demographic prospects, social and economic aspects, health status trends, health manpower supply and demand, and world health policies. Most significant during the 1973-1977 period was the explicit recognition of the view that health development is a reflection of conscious political, social, and economic policy and planning rather than merely an outcome (or by-product) of technology. The goal of "health for all by the year 2000" expresses the political commitment of health services and the agencies responsible for them to a "new Health order." Primary health care is the most important vehicle for achieving this new health order. The most important social trends during the report period are reflected in the still low and in some areas worsening nutritional level of the majority of the population. The overall picture with regard to mortality continues to be mixed, with a few notable cases of marked decline and many of continuing unspectacular decline. The data on morbidity are even less reliable than those on mortality, but it appears that there has been a significant increase or resurgence of certain communicable diseases. There is evidence of decreasing dependence on physicians in some parts of the world and a related strengthening of various paramedical and auxiliary groupings. Some of the important new health programs are to be found in the area of family health. The overall role and importance of primary health care are emphasized in many parts of the report. There are some specific indications of ways in which primary health care activities are being integrated with the more traditional activities of the health sector.
In: Potts M, Bhiwandiwala P, eds. Birth control: an international assessment. Baltimore, Maryland, University Park Press, 1979. 71-91.The planning, implementation, achievements, and existing problems facing a pilot community-based distribution (CBD) family planning program in Thailand are described. The program was begun in 1973-74 under auspices of IPPF following the Thai government decision to allow trained midwives to dispense oral contraceptives. Experience with the program has shown that such programs can provide adequate levels of medical supervision, be culturally acceptable, and have a decided impact on national fertility within 2 years. Administrative, financial, and structural elements of the program are summarized. The program was started to provide an alternative to existent clinical services and provide more complete coverage in rural areas. The IPPF donor relationship was useful to the launching of the program. The program has concentrated on training local nonmedical personnel for distribution of oral contraceptives and condoms. Both local doctors and field supervisors are available for advice to the distributors. The program now extends to all areas of the country. Communications activities play a large role in the program. Demographic effects of the program to 1977 are tabulated. The pilot project also involved an institutional and a private sector distribution program. There is need for a greater variety of contraceptive methods available through the program sources. Integrated family planning/development projects are now being tried.