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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)
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.
Report of the Expert Group Meeting on Fertility and Mortality Levels, Patterns and Trends in Africa and their Policy Implications.
In: United Nations Economic Commission for Africa [UNECA]. Population dynamics: fertility and mortality in Africa. Addis Ababa, Ethiopia, UNECA, 1981 May. 1-31. (ST/ECA/SER.A/1; UNFPA PROJ. No. RAF/78/P17)The Expert Group Meeting on Fertility and Mortality Levels, Patterns and Trends in Africa, held in Monrovia late in 1976, examined the various aspects of the interrelationships of fertility and mortality to development process and planning in Africa. Focus in this report of the Expert Group Meeting is on the following: background to fertility and mortality in Africa; usefulness and relevance of existing methodology for collecting and processing and for analyzing fertility and mortality data; fertility and mortality levels and patterns in Africa -- regional studies and country studies; fertility trends and differentials in Africa; mortality trends and differentials; biological and socio-cultural aspects of infertility and sterility; the significance of breast feeding for fertility and mortality; nutrition, disease and mortality in young children; evolution of causes of death and the use of related statistics in mortality studies in Africa; and fertility and mortality in national development. It was suggested that a strategy for development with equity must direct itself, among other things, to the issue of how to monitor progress in the elimination of underdevelopment, poverty, malnutrition, poor health, bad housing, poor education and employment through the use of indicators which measured changes in those variables at the national and local levels. In order to achieve development with equity, it was obvious that demographers and policymakers should ensure that there was regular monitoring of socioeconomic differentials in mortality and morbidity rates since such differentials essentially measured inequality in a society. The following were included among the recommendations made: recognizing that fertility and mortality data for a majority of African countries are now 20 years out of date, efforts should be directed toward collecting and analyzing fertility and mortality data by the use of both direct and indirect methods; and international and national organizations should support country efforts to improve the supply of data and analytical work on census and other existing data.