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Government of Sierra Leone. National report on population and development. International Conference on Population and Development 1994.
Freetown, Sierra Leone, National Population Commission, 1994. , 15,  p.The government of Sierra Leone is very concerned about the poor health status of the country as expressed by the indicators of a high maternal mortality rate (700/100,000), a total fertility rate of 6.2 (in 1985), a crude birth rate of 47/1000 (in 1985), an infant mortality rate of 143/1000 (in 1990), and a life expectancy at birth of only 45.7 years. A civil war has exacerbated the already massive rural-urban migration in the country. Despite severe financial constraints, the government has contributed to the UN Population Fund and continues to appeal to the donor community for technical and financial help to support the economy in general and population programs in particular. Sierra Leone has participated in preparations for and fully supports the 1994 International Conference on Population and Development. This document describes Sierra Leone's past, present, and future population and development linkages. The demographic context is presented in terms of size and growth rate; age and sex composition; fertility; mortality; and population distribution, migration, and urbanization. The population policy planning and program framework is set out through discussions of the national perception of population issues, the national population policy, population in development planning, and a profile of the national population program [including maternal-child health and family planning (FP) services; information, education, and communication; data collection, analysis, and research; primary health care, population and the environment; youth and adolescents and development; women and development; and population distribution and migration]. The operational aspects of the program are described with emphasis on political and national support, FP service delivery and coverage, monitoring and evaluation, and funding. The action plan for the future includes priority concerns; an outline of the policy framework; the design of population program activities; program coordination, monitoring, and evaluation; and resource mobilization. The government's commitment is reiterated in a summary and in 13 recommendations of action to strengthen the population program, address environmental issues, improve the status of women, improve rural living conditions, and improve data collection.
Science and Technology for Development: Prospects Entering the Twenty-First Century. A symposium in commemoration of the twenty-fifth anniversary of the U.S. Agency for International Development, Washington, D.C., June 22-23, 1987.
Washington, D.C., National Academy Press, 1988. 79 p.This Symposium described and assessed the contributions of science and technology in development of less developed countries (LDCs), and focused on what science and technology can contribute in the future. Development experts have learned in the last 3 decades that transfer of available technology to LDCs alone does not bring about development. Social scientists have introduced the concepts of local participation and the need to adjust to local socioeconomic conditions. These concepts and the development of methodologies and processes that guide development agencies to prepare effective strategies for achieving goals have all improved project success rates. Agricultural scientists have contributed to the development of higher yielding, hardier food crops, especially rice, maize, and wheat. Health scientists have reduced infant and child mortalities and have increased life expectancy for those living in the LDCs. 1 significant contribution was the successful global effort to eradicate smallpox from the earth. Population experts and biological scientists have increased the range of contraceptives and the modes for delivering family planning services, both of which have contributed to the reduction of fertility rates in some LDCs. Communication experts have taken advantage of the telecommunications and information technologies to make available important information concerning health, agriculture, and education. For example, crop simulation models based on changes in temperature, humidity, precipitation, wind, solar radiation, and soil conditions have predicted outcomes of various agricultural systems. An integration of all of the above disciplines are necessary to bring about development in the LDCs.
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.
IPPF OPEN FILE. 1994 Jun; 1.The 1994 Human Development Report from the United Nations Development Program (UNDP) proposes a 20-20 Human Development Compact based on shared responsibilities between poor and rich nations, whereby poor and rich nations would help unmet basic human development needs such as primary education, primary health care, safe drinking water, and family planning over the next 10 years. This would require an additional US $30 to US $40 billion annually. Developing countries would commit 20% of their budgets to human priority concerns instead of the current 10% by reducing military expenditure, selling off unprofitable public enterprises and abandoning wasteful prestige projects. Donor countries would increase foreign aid from the current average of 7% to 20%. The report will propose a new concept of human security at the World Summit for Social Development to be held in March 1995, calling widespread human insecurity a universal problem. On average, poor nations have 19 soldiers for every one doctor. Global military spending has been declining since 1987 at the rate of 3.6% a year, resulting in a cumulative peace dividend of US $935 billion from 1987 to 1994. But this money has not been expended on unmet human needs. India ordered fighter planes at a cost that could have provided basic education to the 15 million Indian girls now out of school. Nigeria bought tanks from the UK at a cost that could have immunized all 2 million unimmunized children while also providing family planning to nearly 17 million couples. UNDP proposes a phasing out of all military assistance, military bases, and subsidies to arms exporters over a 3-year period. It also recommends the major restructuring of existing aid funds, and proposes a serious study on new institutions for global governance in the next century.
New York, New York, UNICEF, 1990 Aug. 61 p. (UNICEF Policy Review)The UNICEF approach in brief is the development of human capabilities and meeting basic needs with a country program approach. The UNICEF goals and strategies for children approved by the Executive Board in 1990 included in this document cover the following general areas: an earlier development review; unmet needs of children; unprecedented opportunities; goals for children for child survival, development, and protection in the year 2000; and sectoral goals for maternal health, child health, nutrition, safe water supply and environmental sanitation, basic education, literacy, early childhood development, and children in distress; strategic priorities such as: going to scale, reaching the unreached and (from small scale projects to a larger leading to universal coverage), hard to reach, disparity reduction, community participation, area-based program approaches, research and development, women's empowerment, advocacy and social mobilization, development addressing human concerns, environment soundness and sustainability, monitoring and evaluation, national capacity and building, building economic bases to meet human goals (alleviate critical poverty, debt relief, trade and commodity agreements, increased resource flows for development, and growth in industrialized countries); operational strategies for UNICEF, and UNICEF Board Decision. A table is provided as a review of selected goals and achievements of the 1st, 2nd and 3rd UN development decades and achievements in 1960, 1970, 1980, and 1988, as well as a figure for the annual number of under 5 years childhood mortality by 5 main causes and a figure for estimated deaths and lives saved under 5 years, 1980-2000.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27,  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.
New policies and approaches of health education in primary health care in attaining the objectives of health for all/2000.
IN TOUCH 1991 Mar; 10(98):34-6.This overview of what the WHO Alma Ata Declaration is and how the objectives translate to policy in the structure of health education involves manpower development, professional level training, community involvement, mass media, and related research. Alma Ata identified health education as the first of 8 essential activities in primary health care (PHC). Policy failures in health education included the inability to live up to expectations, the targeting of programs to specific diseases, and to the inappropriate conceptualization of community participation as a process which can be centrally controlled. Other factors were the gap in understanding the relationship between socioeconomic development and health, weak national structure which provided inadequate demonstration of health education project results, the inability of health education to solve individual problems such as working conditions or environmental pollution, and the lack of multisectoral cooperation. In order to achieve the Alma Ata objectives health education must be an agent of social change. Primary health care (PHC) - health education, development of a patient's educational skills, needs to be incorporated into the formal curricula of medical and nursing programs, as well as informal training, planning, and practice among rural and agricultural developers, public health engineers, and educators. Health workers need training in use of appropriate technology and in bridging the gap between the community and existing health care systems. The mass media needs to emphasize basic health necessities, and the importance of health, and solutions to problems. Broad public participation including voluntary organizations is necessary to the multisectoral approach. Research needs to be disseminated to administrators.
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.
[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.
Geneva, Switzerland, WHO, . 16 p.This report discusses the important place of women in health and development as perceived by WHO and as formulated in various World Health Assembly resolutions, particularly those concerned with the UN Decade for Women. Underlying all objectives is that of increasing knowledge and understanding about how the various socioeconomic factors that make up women's status affect and are affected by their health. The aim of WHO's Women, Health and Development (WHD) activities, is the integration or incorporation of a women's dimension within on-oing programs, specifically as part of "Health for All" strategies. Chief among WHD objectives and groups of activities are the improvement of women's health status, increasing resources for women's health, facilitating their health care roles and promoting equality in health development. Overall WHD activities stress the importance of data on women's health status, the dissemination of this and related information, and the promotion of social support for women. The WHD component of ongoing WHO programs focuses mainly on managerial and technical support to national programs of maternal-child health/family planning care. The present report also includes an update on the incorporation of women's issues within WHO's on-going programs in human reproductive research, nutrition, community water supply and sanitation, workers' health, mental health, immunization, diarrheal diseases, research and training in tropical diseases and cancer. Women's participation in health services is discussed mainly within the context of primary health care and is based on their role as health care providers. The results of a multi-national study initiated in 1980 on the topic of women as health care providers should be ready in early 1984 and are expected to contribute a basis for further action.
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.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1982; 35(1):2-10.The goal of health for all by the year 2000 was first stated at the 1977 World Health Assembly and global strategy was launched at the 32nd World Health Assembly in 1979. This article focuses on life expectancy at birth as the most widely used indicator of the health status of populations and also the health status indicators most closely correlated with socioeconomic development. Developing countries have set a target of life expectancy of 60 years; at present 86% of these countries are exposed to mortality conditions which leave life expectancy at age 50. Among 80 countries with GNP per capita of more than $500 61 have life expectancy over 60 years and of the 35 with a life expectancy of 70 or more 28 have GNP over $2500. The largest concentration of countries below the target level is in Asia. Discovering the leading causes of death is crucial in raising life expectancy; in developed countries they are cardiovascular disease, malignant neoplasms, and accidents, accounting for 70% of all deaths. In developing countries there is variation with regard to level of modernization of the cause of death structure but in at least 1/2 the 3 latter causes are also predominant with diarrheal disease and infectious and parasitic conditions related to malnutrition the main causes in the other 1/2. When assessing the health care needs of developing countries the difference between countries regarding their ability to reduce mortality from the traditional diseases must be considered before deciding on use of resources.
People. 1983; 10(2):6-9.The main findings of the World Health Organization (WHO) recent global review of the progress that has been made in the Health for All campaign are presented. The attempt was made to assess progress on the basis of the following 12 global indicators: endorsement of Health for All as a policy at the highest official level; establishing mechanisms for involving people in Health for All strategies; spending at least 5% of the gross national product (GNP) on health; a reasonable percentage of national health expenditures devoted to local health care; primary health resources equitably distributed; the number of developing countries with well-defined strategies for Health for All, accompanied by explicit resource allocations and sustained outside support; primary health care available to the whole population; adequate nutritional status for children; infant mortality rate to be below 50/1000 live births; life expectancy at birth of over 60 years; adult literacy for men and women over 70%; and gross national product per head over $500. 39 of the 70 countries have signed regional charters pledging themselves to strive to achieve Health for All by the Year 2000. Another 9 countries have committed themselves through other policy statements. 31 countries have reported on efforts to involve communities, half of them by adopting policies and half through actual mechanisms, although not necessarily on a national scale. 26 of the 70 countries are spending more than $5 a head each year on health care. Many countries are placing more emphasis on providing resources for local care, but the shift is nowhere near what is required. WHO has been unable to establish the per capita spending on primary health since it permeates so many levels and sectors of the health services. Activities to increase food supply and improve nutrition are being integrated into primary health care in the form of nutritional surveillance, preventing and controlling deficiency disorders, promoting breastfeeding, direct treatment of malnutrition, oral rehydration therapy, food supplements, immunization, and the addition of iodine to salt. Only 7 of the 54 countries reporting infant mortality rates were below 50/1000, and these included 3 developed countries. Rates in the remaining 47 ranged from 56/1000, to 250/1000. Of the 70 countries, 51 had life expectancy rates varying between 40 and 59; in 1979, 13 had rates over 60 and 6 did not report. Only 4 countries reported male and female literacy rates over 70%. Over 60% of the countries reviewed had a per capita GNP of less than $500.
Standard-setting activities of the United Nations system concerning the relationship between population matters and human rights, 1973-1980.
In: United Nations. Department of International Economic and Social Affairs. Population and human rights: proceedings of the Symposium on Population and Human Rights, Vienna, 29 June-3 July 1981. New York, New York, United Nations, 1983. 48-62. (ST/ESA/SER.R/51)During the past decade, within the context of a broad reappraisal of international development programs, the UN has tended to espouse a broad approach to population and human rights issues, relating them to developmental concerns and policies. The UN has adopted new instruments having a bearing of these issues, 2 of which are summarized in the text, the Declaration and the Programme of Action on the Establishment of a New International Economic Order. The background paper submitted by the Division of Human Rights to the 1st Symposium on Population and Human Rights contained a thorough analysis of UN human right norms concerning marriage and the family and the right to decide freely and responsibly on the number and spacing of children, including the provision of information and education in family planning as well as the means. During the International Year of the Child attention was drawn to the rights of children and the family. In 1975, the World Conference of the International Women's Year recognized the necessity, in the process of integrating women in development, of providing them with educational opportunities, adequate maternal-child health services, and family planning services. In the areas of mortality, morbidity, and health, WHO's long-term objective of "Health for all by the Year 2000" is relevant to the rights of an adequate standard of living, adequate food, and adequate health services. The UN has also addressed itself to human rights and international migration adopting a number of resolutions regarding the refugee problem, mass exodus, and migrant workers.