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  1. 1
    Peer Reviewed

    Estimating the costs of achieving the WHO-UNICEF Global Immunization Vision and Strategy, 2006 -- 2015.

    Wolfson LJ; Gasse F; Lee-Martin SP; Lydon P; Magan A

    Bulletin of the World Health Organization. 2008 Jan; 86(1):27-39.

    The objective was to estimate the cost of scaling up childhood immunization services required to reach the WHO-UNICEF Global Immunization Vision and Strategy (GIVS) goal of reducing mortality due to vaccine-preventable diseases by two-thirds by 2015. A model was developed to estimate the total cost of reaching GIVS goals by 2015 in 117 low- and lower-middle-income countries. Current spending was estimated by analysing data from country planning documents, and scale-up costs were estimated using a bottom-up, ingredients-based approach. Financial costs were estimated by country and year for reaching 90% coverage with all existing vaccines; introducing a discrete set of new vaccines (rotavirus, conjugate pneumococcal, conjugate meningococcal A and Japanese encephalitis); and conducting immunization campaigns to protect at-risk populations against polio, tetanus, measles, yellow fever and meningococcal meningitis. The 72 poorest countries of the world spent US$ 2.5 (range: US$ 1.8-4.2) billion on immunization in 2005, an increase from US$ 1.1 (range: US$ 0.9-1.6) billion in 2000. By 2015 annual immunization costs will on average increase to about US$ 4.0 (range US$ 2.9-6.7) billion. Total immunization costs for 2006-2015 are estimated at US$ 35 (range US$ 13-40) billion; of this, US$ 16.2 billion are incremental costs, comprised of US$ 5.6 billion for system scale-up and US$ 8.7 billion for vaccines; US$ 19.3 billion is required to maintain immunization programmes at 2005 levels. In all 117 low- and lower-middle-income countries, total costs for 2006-2015 are estimated at US$ 76 (range: US$ 23-110) billion, with US$ 49 billion for maintaining current systems and $27 billion for scaling-up. In the 72 poorest countries, US$ 11-15 billion (30%-40%) of the overall resource needs are unmet if the GIVS goals are to be reached. The methods developed in this paper are approximate estimates with limitations, but provide a roadmap of financing gaps that need to be filled to scale up immunization by 2015. (author's)
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  2. 2
    Peer Reviewed

    Global costs of attaining the Millennium Development Goal for water supply and sanitation.

    Hutton G; Bartram J

    Bulletin of the World Health Organization. 2008 Jan; 86(1):13-19.

    Target 10 of the Millennium Development Goals (MDGs) is to "halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation". Because of its impacts on a range of diseases, it is a health-related MDG target. This study presents cost estimates of attaining MDG target 10. We estimate the population to be covered to attain the MDG target using data on household use of improved water and sanitation for 1990 and 2004, and taking into account population growth. We assume this estimate is achieved in equal annual increments from the base year, 2005, until 2014. Costs per capita for investment and recurrent costs are applied. Country data is aggregated to 11 WHO developing country subregions and globally. Estimated spending required in developing countries on new coverage to meet the MDG target is US$ 42 billion for water and US$ 142 billion for sanitation, a combined annual equivalent of US$ 18 billion. The cost of maintaining existing services totals an additional US$ 322 billion for water supply and US $216 billion for sanitation, a combined annual equivalent of US$ 54 billion. Spending for new coverage is largely rural (64%), while for maintaining existing coverage it is largely urban (73%). Additional programme costs, incurred administratively outside the point of delivery of interventions, of between 10% and 30% are required for effective implementation. In assessing financing requirements, estimates of cost should include the operation, maintenance and replacement of existing coverage as well as new services and programme costs. Country-level costing studies are needed to guide sector financing. (author's)
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  3. 3

    What will it cost to attain the health MDGs? [editorial]

    Nordstrom A; Edejer TT; Evans D

    Bulletin of the World Health Organization. 2007 Apr; 85(4):245-324.

    There is an old saying that "amateurs talk strategy and professionals talk logistics". A professional approach to achieving the health-related Millennium Development Goals (MDGs) requires us to move beyond the discussion of possible strategies that could be used. It requires active planning of the practical actions that need to be taken, including raising the necessary funds to ensure these actions can be financed. This cannot be done without information on the costs of implementing the logistical plans. Without detailed plans, countries cannot be sure if they will meet the MDGs. Without accurate costing, countries and donors do not know the extent of the additional funds that will be required. This is a particularly important issue now that we are nearly halfway between the signing of the Millennium Declaration and the target date for achievement, 2015. All recent assessments suggest that few countries are on track and that intensified efforts to raise and use funds well are needed. How much additional funding is required, and where should it be spent? (excerpt)
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  4. 4

    The Millennium Development Goals, how realistic are they?

    Keyzer M; Wesenbeeck L

    Economist. 2006; 154(3):443-466.

    In its Millennium Declaration of September 2000, the United Nations adopted the Millennium Development Goals (MDG), to be reached in 2015 through concerted efforts worldwide. According to UN-calculations, the estimated costs in terms of additional development aid of meeting the MDGs in all countries vary from 121 billion US dollars in 2006 to 189 billion US dollars in 2015. The present communication reviews the figures reported. It appears that while Asia is well on track to achieve the goals, essentially through efforts of its own, Africa is lagging behind, albeit that according to detailed survey data on weight-for-length among adults collected in Africa for the US aid agency, rates of undernutrition are about 58 percent of the levels used as a reference by the UN, which are based on assessment of food production. Yet, child undernutrition comes out higher in these surveys. Besides mentioning reservations about the adequacy of these MDG-yardsticks, we consider the cost estimates for Africa as presented in the UN-reports and subsequently assessed in the literature. It appears that these estimates are too low, even if all MDG-funds were concentrated on this continent, essentially because they are set up as shopping lists that are necessarily incomplete and, among others, disregard many of the indirect cost of delivering the goods to the target beneficiaries, including the cost of providing adequate security and avoiding corruption. Nonetheless, recalling how hopeless the situation looked some 30 years ago for China, India, and Bangladesh, where unprecedented numbers have now escaped extreme poverty during the past decade and a half, we submit that over a time horizon of about twice the 15 years of the MDG's and with adequate international support, realization of the MDG-targets should be possible for Africa too. (author's)
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  5. 5

    Restriction of access is displacement: a broader concept and policy.

    Cernea MM

    Forced Migration Review. 2005 May; (23):48-49.

    The conceptual apparatus in forced migration and population resettlement research is being continuously enriched. One important – but still relatively unknown – development was introduced recently into the resettlement policies of the World Bank, African Development Bank and Asian Development Bank. This new thinking is set out in the revised (January 2002) World Bank Operational Policy (OP) 4.12 on resettlement. This significantly defines the ‘restricting of access’ to indigenous and other people in parks and protected areas as ‘involuntary displacement’ even when physical displacement and relocation are not required. The justifying rationale is that restrictions impose impoverishment risks and these risks lead to severe deprivations. Significantly, this new definition has come from major international agencies themselves involved in instituting ‘restricted access’ regimes. As the definition has been adopted, the world’s major development agencies have moved towards policy consensus that restricted access is a form of displacement. (excerpt)
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  6. 6
    Peer Reviewed

    Costs of scaling up health interventions: a systematic review.

    Johns B; Torres TT

    Health Policy and Planning. 2005; 20(1):1-13.

    National governments and international agencies, including programmes like the Global Alliance for Vaccines and Immunizations and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have committed to scaling up health interventions and to meeting the Millennium Development Goals (MDGs), and need information on costs of scaling up these interventions. However, there has been no systematic attempt across health interventions to determine the impact of scaling up on the costs of programmes. This paper presents a systematic review of the literature on the costs of scaling up health interventions. The objectives of this review are to identify factors affecting costs as coverage increases and to describe typical cost curves for different kinds of interventions. Thirty-seven studies were found, three containing cost data from programmes that had already been scaled up. The other studies provide either quantitative cost projections or qualitative descriptions of factors affecting costs when interventions are scaled up, and are used to determine important factors to consider when scaling up. Cost curves for the scaling up of different health interventions could not be derived with the available data. This review demonstrates that the costs of scaling up an intervention are specific to both the type of intervention and its particular setting. However, the literature indicates general principles that can guide the process: (1) calculate separate unit costs for urban and rural populations; (2) identify economies and diseconomies of scale, and separate the fixed and variable components of the costs; (3) assess availability and capacity of health human resources; and (4) include administrative costs, which can constitute a significant proportion of scale-up costs in the short run. This study is limited by the scarcity of real data reported in the public domain that address costs when scaling up health interventions. As coverage of health interventions increases in the process of meeting the MDGs and other health goals, it is recommended that costs of scaling up are reported alongside the impact on health of the scaled-up interventions. (author's)
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  7. 7

    World population monitoring 2001. Population, environment and development.

    United Nations. Department of Economic and Social Affairs. Population Division

    New York, New York, United Nations, 2001. [89] p. (ST/ESA/SER.A/203)

    The present report has been prepared in response to Economic and Social Council resolution 1995/55 of 28 July 1995, in which the Council endorsed the terms of reference and the topic-oriented and prioritized multi-year work programme proposed by the Commission on Population and Development at its twenty-eight session. According to the multi-year work programme, which was to serve as a framework for the assessment of the progress achieved in the implementation of the Programme of Action of the International Conference on Population and Development, a new series of reports on a special set of the themes would be prepared annually. The Commission, in its decisions 1999/1 and 2000/1, decided that the special theme for the year 2001 should be population, environment and development, which is the topic of the present report. (excerpt)
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  8. 8
    Peer Reviewed

    Child health development after Alma Ata declaration.

    Chandra P

    Indian Pediatrics. 2001 Oct; 38:1129-43.

    Through the 1978 Alma-Ata Declaration, the governments of the world officially accepted the principle of primary health care and promised to bring it into being in all nations within the next 22 years. The Declaration further stated that health is a fundamental human right and that the gross inequalities in health status are unacceptable. To fulfill its commitment of health for all, India's government developed a National Health Policy in 1983, laying down specific goals with quantifiable targets. This paper discusses the impact of the 1993 National Health Policy and its subsequent various policies and acts. Overall, it is noted that globalization and structural adjustment programs increased poverty, malnutrition, and child mortality. Privatization of medical care and education are also making health care inaccessible to the poor. In addition, irrational or useless drugs and diagnostic procedures increased the cost of health care. Moreover, the World Trade Organization is destroying public sector health services and the self-reliant pharmaceutical sector.
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  9. 9

    Misconstruing the "population problem" [editorial]

    Sachs A

    WORLD WATCH. 1994 Sep-Oct; 7(5):2.

    While there is a growing public awareness that the Earth's limited resources cannot support unlimited population growth, many people do not really understand what is going on. Western Europeans blame high fertility in northern Africa for immigration and scarce employment opportunities, while Americans blame high fertility in Mexico for immigration to the US also resulting in fewer job opportunities for US citizens, increased levels of crime, traffic congestion, and environmental degradation. Experts argue, however, that overpopulation is not the cause of the world's problems, but the effect of underlying socioeconomic inequity between the rich and the poor. Population stabilization alone will not produce employment, make resources more plentiful, stop political violence, or curb migration. The author emphasizes his hope that the 1994 UN International Conference on Population and Development will create a comprehensive population policy to promote universal human justice and well-being, and not simply dwell upon reducing fertility at all costs.
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  10. 10

    Statement of India.

    Shankaranand B

    [Unpublished] 1994. Presented at the International Conference on Population and Development [ICPD], Cairo, Egypt, September 5-13, 1994. [4] p.

    In his address to the 1994 International Conference on Population and Development, the Minister of Health and Family Welfare for India stated that mankind is poised at a crucial moment in its history. A global economic crisis exists along with a severe economic imbalance that has lead to prosperity for some and deprivation for others. This situation has been exacerbated by unprecedented spending on weapons of destruction instead of devoting those resources to human health and development needs. Significant achievements in increasing life expectancy and reducing infant and child mortality rates has been matched by a failure to reduce mortality rates as much as possible and by the AIDS epidemic. Developing countries, in which more than 90% of the current growth in population is taking place, have to break the connection between fertility rates, poverty, morbidity, and illiteracy in order to achieve economic development. In India, the Family Welfare Program provides family planning services within the broad context of maternal and child health care. A new Child Survival and Safe Motherhood Program is currently being implemented. Women have benefitted from new employment opportunities, a special credit fund, and special provisions in the Integrated Rural Development Program. A National Commission for Women has been established to safeguard the constitutionally protected equal rights of women. The empowerment of women will ultimately help them overcome the sociocultural traditions which make them subordinate to men and will also lead to faster economic growth. Together we must work to make the world a healthy and happy home for future generations.
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  11. 11

    International migration in North America, Europe, Central Asia, the Middle East and North Africa: research and research-related activities.

    Russell SS

    Geneva, Switzerland, United Nations, Economic Commission for Europe, 1993. v, 83 p.

    As a joint effort of the World Bank and the Economic Commission for Europe, the aim of this report was to identify international migration research and research-related activities in major political and institutional context, general overviews, and data sources, migration is discussed in terms of demography, international policies, economic and labor market aspects, highly skilled workers, development, integration, migration networks, ethnic relations, refugees and asylum seekers. East-west migration is also treated in a political and institutional context, with general overviews and data sources cited. The development and labor markets as well as ethnicity and return migration are considered. South-north migration is examined in a broad manner, with special emphasis on migration in the Mediterranean Basin and the Middle East. The review is meant to serve as a useful resource and as a stimulus for dialogue. Basic data are missing on east-west migration and labor, migration patterns within the Middle-East, and north-south movements other than from North Africa. Basic institutional sources for data and research on international migration are available from the Council of Europe; the Organization for Economic Cooperation and Development (OECD); the International Labor Organization; the International Organization for Migration; the Office of the UN High Commissioner for Refugees; the Intergovernmental Consultations on Asylum, Refugee, and Migration Policies in Europe, North America, and Australia; and the European Community. 13 major publications are primary sources of data, of which the most extensive is OECD's SOPEMI Report. 9 sources of data pertain to demographic aspects of migration. The 1986 SOPEMI report and updates document national policies and practices of entry control in OECD member countries; the UN Population Division also published a survey of population policies, including migration policies. The Commission of European Communities policies, including migration policies. The Commission of European Communities also publishes a document on noncommunity citizens. Researchers who have analyzed recent trends are identified, and research papers are cited for labor aspects of migration, highly skilled workers and migration, migration and development, integration and ethnic relations, migrant networks, refugees and asylum seekers, security, return migration, clandestine migration and ethical issues.
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  12. 12

    Assuring health sector policy reforms in Africa: the role of non-project assistance.

    Foltz AM

    [Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27, [1] p.

    In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
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