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  1. 1
    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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  2. 2

    Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.

    United Nations Development Programme [UNDP]

    New York, New York, Oxford University Press, 2003. xv, 367 p.

    The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
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  3. 3
    Peer Reviewed

    Ideological dimensions of community participation in Latin American health programs.

    Ugalde A

    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.
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  4. 4

    Population projections: methodology of the United Nations.

    United Nations. Department of International Economic and Social Affairs

    New York, N.Y., United Nations, 1984. 85 p. (Population Studies, No. 83; ST/ESA/SER.A/83)

    Upon a recommendation of the Population Commission, at its 20th session in January 1979, the Secretary General of the United Nations convened an Ad Hoc Group of Experts on Demographic Projections from 16 to 19 November 1981 at the UN Headquarters to discuss the methodology used for demographic projections and to consider the relationship of demographic projections to development change and population policies. The expert Group was also requested to provide guidelines and make recommendations to the Secretary-General on how to incorporate demographic changes into the methodology to be used for the next round of world population projections to be prepared by the UN Population Division in collaboration with the regional commissions. The papers prepared by members of the Expert Group as well as those prepared by the Population Division are reproduced in this publication. The recommendations of the Expert Group and a summary of the papers and discussion are also included. The topics addressed in this publication are: 1) problems in making population projections; 2) integration of socioeconomic factors in population projections; 3) population projections as an aid to the formulation and implementation of population policies; 4) current projection assumptions for the United Nations demographic projections; 5) expectations and progressive analysis in fertility prediction; 6) use of the intermediate factors in fertility projections; 7) family planning and population projections; 8) progress of work on a fertility simulation model for population projections at the UN Secretariat; 9) mortality trends and prospects in developing countries: some "best data" indications; 10) the urban and city population projections of the UN: data, definitions and methods; 11) a critical assessment of urban-rural projections with special reference to UN methods; and 12) projections in Europe: some problems.
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  5. 5

    Population growth and development concerns.

    Cabello O

    In: D'Souza AA, de Souza A, ed. Population growth and human development. New Delhi, India, Indian Social Institute, 1974. 17-26.

    Although demographic statistics are grossly inadequate, a fairly convincing panorama of the population situation and trends has been prepared by demographers based on fragmentary information, coupled with assumptions and tested against collateral information. Population study reveals a 1st stage early in the recent historic perspective during which fertility and mortality rates were very high and the corresponding rates of natural growth were low. The 2nd stage of the transition begins with a decline in the death rates while fertility rates remained at high levels, and even increases, population growth accelerates during this period. This stage is characterized by rapid urbanization provoked by displacement of population from rural areas to urban centers. Fertility rates begin to decrease at a later period, in some cases more than 20 years after the decline of death rates--tending to level off with death rates at low levels. In this stage, population growth is near zero and has in some cases decreased. The entire transition may take at least 50 years. The key question is how to determine the crucial character of the interactions between population and the critical problems of our society: poverty; underdevelopment; gaps of income between and within countries; food; and environment. In 3 symposia at Cairo, Honolulu, and Stockholm, it was concluded that there were 3 schools of thought. 1 considered rapid population growth as a major cause of structural rigidities of the less developed economies, and therefore reduction of population growth as a 1st priority for improvement of living standards. Another, putting its faith in technological innovation, considered that the way to development was by socioeconomic changes rather than demographic paths of action. The 3rd considered the demograpic approach as one of many leading to the attainment of economic and social progress. The consensus was that there are limits to the growth of population both in the short-term and in the long-term. A World Population Conference held in Bucharest, Rumania in 1974 addressed the issues of recent population trends; relations between population change and economic and social development; relations between population, resources, and environment; and population, family, and well being.
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  6. 6

    Rural development: issues and approaches for technical co-operation.

    United Nations Development Programme [UNDP]

    New York, UNDP, June 1979. 243 p. (Rural Development Evaluation Study; No. 2)

    This paper is based on a study carried out by UNDP staff. It begins with an examination of a series of key facts about rural life and the rural context in developing countries. Rural development is seen to have emerged as a crucial issue because rural areas contain on average 75% of the national population of the developing countries and 80% of the "poverty group"--people earning 50 US dollars or less per year, or whose income is 1/3 the national average. Analyzing rural development as a process of socioeconomic change, the report assesses the implications for development strategies, for linkages between various economic and social sectors, for specific government policies and programs, and for action at the international level, including UNDP supported technical cooperation. It is concluded that 2 basic shifts are needed in rural development strategy: closer involvement of the local population in the full process of rural development planning and implementation, and stronger commitment by governments to redistribute to the rural poor resources and the means to permit capital accumulation. (author's modified)
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  7. 7
    Peer Reviewed

    U.S. population policies, development, and the rural poor of Africa.

    Green E

    Journal of Modern African Studies. 1982; 20(1):45-67.

    Discusses the question of government policy toward control of population growth in its relation to economic development, especially in Africa, where population growth rates are high and the rate of economic growth very low. The author reviews the debate between supports of Marx and Malthus, and the family planning versus development debate which he sees as evolving from it. Merit may be found in the arguments of all sides, but some middle ground between the radical positions must be found. It must be recognized that a population problem exists, and that family planning can play a supportive role in keeping fertility rates down, but that a certain level of socioeconomic development must be reached before much can be done about the problem while recognizing that high fertility is itself and impediment to reaching this level of development. Cultural conditions leading to high fertility must also be considered, as well as the political and administrative dimension; both are briefly examined. The author concludes that assistance for population activities is worthwhile and desirable, but not at the expense of other areas of development which contribute to lowered fertility by themselves. The United States should review its policies with this in mind. In a postscript, the author notes that U.S. policy would appear to be undergoing review by the current administration; a shift towards urban Africa and towards encouragement of participation by private industry, evidently underway, would lessen the effect of U.S. development assistance on poverty and the high fertility rates in Africa.
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  8. 8

    Honduras: country development strategy statement, FY 83.

    United States. Agency for International Development [USAID]

    Washington, D.C., U.S. International Development Cooperation Agency, 1981 Jan. 59 p.

    This strategy statement prepared by the USAID field mission includes a brief description of the political background of aid to Honduras and an analysis of the country's economic situation including an examination of the extent and causes of poverty among different population subgroups, an overview of the economy and assessment of its ability to absorb aid, a discussion of development planning as reflected in the 5-year plan and "Immediate Action Plan" drafted in late 1980; an assessment of progress to date in development efforts and of the Honduran govenment's commitment to development objectives; and a discussion of other donors. Favorable and unfavorable factors influencing achievement of development efforts are then identified, program strategy prior to and during the current planning period are discussed, and specific issues such as the role of the private sector, human rights, the role of women, and public sector management are examined. AID's sectoral objectives and courses of action in agriculture and rural development, population, health and nutrition, education, urban and regional development, and energy are outlined, with problems, current activities, and strategy for 1983-87 identified for each sector. Efforts to improve regional cooperation and AID program efficiency are described. Proposed assistance levels and staff levels are discussed. A series of tables containing data on public sector operations, central government budget expenditures, balance of payments, and key economic indicators are included as appendices.
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  9. 9

    Report of the Expert Group Meeting on Fertility and Mortality Levels, Patterns and Trends in Africa and their Policy Implications.

    United Nations. Economic Commission for Africa. Population Division

    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.
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  10. 10

    World food and nutrition: the scientific and technological base.

    Wortman S

    SCIENCE. 1980 Jul 4; 209(4452):157-64.

    In order to combat the growing food problem in developing countries, efforts must be directed toward 1) increasing food production through agricultural intensification and through improving transportation, water, storage, communication, banking, and processing systems; 2) increasing the purchasing power of the poor; and 3) slowing down population growth. Science and technology can play a significant role in increasing food production and generating rural income. Agricultural technology cannot be transfered directly from the developed nations, located primarily in temperature zones, to the developing countries, located primarily in tropical and sub-tropical zones. A 3 tiered research system aimed at developing appropriate agricultural techniques and crops for developing countries is evolving. The 1st tier consists of small, national research centers, located in the developing countries. These centers conduct applied research aimed at determining which seed varieties, fertilizers, disease and pest control methods, and cropping methods are most appropriate for their own farm areas. The 2nd tier consists of a number of international or regional research institutes, located in developing countries and directed toward solving specific regional problems. For example, the International Rice Research Institute in the Philippines conducts research aimed at improving rice yields and trains people to use these techniques while the Center for Agricultural Research in Dry Areas, located in Lebanon and Syria, seeks to develop seeds and cropping systems tailored for use in dry regions. In 1969 a number of these institutes recognized that a united effort would be advantageous, and the CGIAR (Consultative Group on International Agricultural Research) was established. CGIAR, sponsored by the World Bank, the United Nations Development Programme, and the Food and Agriculture Organization, supports the work of these institutes and helps develop new institutes. At the present time the CGIAR supports 13 centers and has an operating budget of $120 million. The CGIAR advisory committee, composed of 13 agricultural experts, sets global priorities and monitors the work of the institutes. The 3rd tier in the research system consists of institutes, which are located in developed countries and which engage primarily in basic agricultural research. In the future, greater efforts should be made to 1) increase private sector participation; 2) strengthen the links between the research levels; and 3) encourage political leaders to commit themselves to solving the hunger problem.
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  11. 11

    Report on the FAO/UNFPA Inter-Country Workshop on Population Education for Small Farmer Development, Quezon City, Philippines, November 29-December 8, 1977.

    Food and Agriculture Organization of the United Nations [FAO]

    Rome, Italy, FAO, 1978. 56 p.

    The objectives of the Inter-Country Training Workshop on Population Education for Small Farmer Development were to review the progress and exchange experiences on the FAO/ASARRD Field Action Projects for Small Farmer Development in the participating countries, Bangladesh, Nepal, and the Philippines. Population education guidelines, curriculum, methods, and teaching materials were discussed in the context of use for small farmers. The 6 elements in the strategy for reaching small farmers in Asia were: 1) formation of self-help local groups under their own leaders; 2) group organizers to guide efforts; 3) group planning from below; 4) action geared to the unique needs of the social group; 5) special access to capital; and 6) action-based research to evaluate content and procedures. Each participating country has a Small Farmers Development Team of 4 technical officers and a National Coordinating Committee headed by a high-level government official. Evaluation of the second year of the program determined that population components should be integrated into the training. The workshop plan included understanding basic concepts of population dynamics; understanding population education concepts; demonstrating materials and guidelines; obtaining country group analysis of educational contents; and planning and preparing specific, initial teaching materials relevant to their needs.
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  12. 12

    Women, population, and development.

    Oppong C; Haavio-Mannila E

    In: Hauser PM, ed. World population and development: challenges and prospects. Syracuse, New York, Syracuse University Press, 1979. 440-85.

    Although there is a growing awareness of the relationship between the status of women, fertility patterns, and economic development many programs and research endeavors in the population field are still based on mistaken assumptions and culturally biased views about the role of women and its significance. Women must be able to exert control over their own lives if family population programs are to meet with success. In economically and politically male dominated societies women cannot obtain this control. In most developing countries women are employed in low status agricultural and domestic service work or are engaged in small trading operations. Programs which seek to reduce family size by simply increasing wormen's work force participation in these employment areas will not be effective. These work roles are not incompatible with child rearing and the increased income may actually increase fertility. To expect the negative relationship between increased labor force participation and lower fertility, which characterizes the industrial countries, to hold under these conditions, is ethnocentrically naive. It should also be recognized that the status and role of women varies from society to society depending on the level of economic development and the religious, political, and cultural traditions of the society. For example, it should not automatically be assumed that the decision to have a child is made mutually by a husband and wife when the couple resides in an extended family. The attitude of relatives as well as the availability of child raising assistance will enter into the decision making process. Many hypothesized relationships in the population field fail to take into consideration differences such as these. Some of these biases can be ameliorated by permitting women to play a more active role in formulating programs aimed at serving them. Tables based on information from many countries show crude birth rates, education levels, and political positions of women according to the % of service workers in the population, and according to the type of society. Other tables show the work status of women according to the % of construction and industry workers and the % of service workers in the population and according to the type of society.
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  13. 13

    Involving the community: Thailand.

    Viravaidya M; Potts M

    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.
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  14. 14

    Country development strategy statement: Senegal.

    United States. Agency for International Development [USAID]

    Washington, D.C., USAID, 1979. 26 p.

    Senegal is a poor country with limited economic resources in the Sudan-Sahelian climatic zone. The population of 5.1 million is largely rural, with 70% working in agriculture. The mean per capita income is about $300 per year with many farmers making $75 per year. The AID development strategy emphasizes assisting the rural poor in agricultural development, particularly the groundnut basin, the Fleuve, and the Casamance, which have the greater concentrations of rural poor and the most potential for increased production. Small-scale farms consisting of 360,000 units account for 70% of the population and produce over 95% of Senegal's agricultural production. With the exception of lands held by religious leaders, there are no tenant-landlord relationships or landless poor classes. Health programs are also needed to increase agricultural productivity. Human resource development is needed because people must be sensitized to the need for change and trained to play an active role in their development. The key limitations to implementation of projects are lack of trained Senegalese, administrative delays, and local costs. Basic infrastructure development is necessary for Senegal's long-term development, particularly large-scale irrigation projects.
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  15. 15

    Rural outmigration as a component of development strategies.

    Baldwin GB

    In: International Union for the Scientific Study of Population. Economic and demographic change: issues for the 1980's. Proceedings of the Conference, Helsinki, 1978. Vol. 2. Liege, Belgium, IUSSP, 1979. 261-74.

    Rural outmigration will continue to grow during the 1980's. Although rural development is exhorted by planners, the more sophisticated politics of the cities will continue to dominate allocation decisions. In the 1960's about 100 million people moved to the city; in the 1980's 193 million are expected to urbanize. Development strategies should try to soften the impact. In 1975 there were 10 cities with 5 million or more population; the UN projects 43 such cities by 2000. Cities will experience pressure from rural migration with sharply rising land values, spreading slums, and increased urban unemployment. Food supplies in urban areas will be a problem of increasing concern. Trained city planners are needed for public services, shelter construction, slum management, and allocation of development funds. Moderating rapid population growth through fertility control will influence the strength of migration in future decades. To slow the migration the most important steps to take are as follows: improve the terms of trade of agriculture and develop special programs for expanding rural employment. The World Bank's new strategy is to provide economic stimulation to the poor in ways designed to increase overall national growth, rather than developing lead sectors with the only goal that of growth. Education, housing, health services, and nutrition are the modern investments. (Summary in FRE)
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  16. 16

    Changing approaches to population problems.

    Wolfson M

    Paris, Organisation for Economic Cooperation and Development, Development Centre, 1978. 193 p. (Development Centre Studies)

    The World Population Conference which took place in Bucharest in 1974 witnessed many debates and rhetorical controversies over the role of family planning programs in Third World countries and their relation to development. This report is the result of a collaborative study realized by the Development Centre and the World Bank which investigates how developing countries, as well as aid agencies, are thinking about population problems and, as a consequence, about population assistance in the "post-Bucharest era." The report includes detailed surveys of 12 developing countries, representing Asia, Africa, Latin America and the Middle East. It also interviews and reports on the activities of a large number of population assistance agencies. The roles of international organizations such as the UNFPA, the UN population division and the World Bank itself are assessed in terms of their impact on national development through population control efforts. Reviews of assistance provided to developing nations by nongovernmental agencies, private foundations and developed nations are also presented. Each country paper presented provides an overview of the country's demographic characteristics; a summary of history of population policies, pre- and post-Bucharest era; an overview of population strategies past and present, their integration with other-sector activities; family planning program administration; and a survey of all forms of population assistance available and utilized by the country. Macro-level analyses of changes in family planning assistance by organizations since Bucharest, as well as micro-level, country-specific studies of how each nation has assimilated these changes and has developed a specific population policy are provided.
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  17. 17

    Draft National Health Policy: comments and suggestions of the Indian Medical Association.

    Indian Medical Association

    JOURNAL OF THE INDIAN MEDICAL ASSOCIATION. 1979 Mar 16; 72(6):137-43, 148.

    The International Conference on Primary Health Care called for urgent and effective national and international action to develop and implement primary health care throughout the world. All government agencies should support primary health care by channelling increased technical and financial support to health care systems. Any national health policy designed to provide for its people should recognise the right to health care as a fundamental right of people. The sociocultural environment of the people should be upgraded as a part of health care. The government's expenditure on health should be regarded as an investment, not as a consumption. Health should be a purchasable commodity. Medical education should be reoriented to the needs of the nation. The government should establish as its ultimate goal the provision of scientific medical service to every citizen. Industrial health and mental health disciplines should establish clear-cut methodologies to achieve the same objectives as medical science. Practitioners of indigenous systems of medicine should be allowed to practice only those systems in which they are qualified and trained. Integration of the modern and traditional systems has failed. In order to encourage people to adopt small family size, facilities for maternal and child welfare clinics, coupled with immunisation and nutrition programs, are needed.
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  18. 18

    Botswana's self-help community.

    Endrst J

    IDRC Reports. 1979 Sep; 8(3):12-3.

    Gaborone, the new capital of Botswana, has grown rapidly from 600 inhabitants in 1966 to 30,000 currently. People squatted in what was to have been a temporary labor camp zoned for industrial development. The Naledi camp was illegal until 1975 when the government dropped its zoning category and, with aid from the Canadian International Development Agency, began laying plans for turning 116 hectares of squatter land into 2000 individual plots housing 10,000 people. Naledi is now a suburban housing development that combines modern toilet facilities, street lighting, 2 primary schools, a health clinic, and a community center with traditional Tswana culture. A Certificate of Rights must be obtained for a plot of ground. The owner must construct a house within 12 months and pay a levy for road maintenance, water supply, and trash pickup. The Self-Help Housing Agency provides loans for building materials, payable in 15 years. The first thing a Naledi house-owner does is have it blessed by a minister of 1 of some 40 African churches in the settlement. The community is in the formative stages of organization. There is no single headman and no police. Elders are sometimes called upon to settle disputes. Naledi residents often view their plot as their second home. Many have their primary dwellings, and their head of cattle, in their native villages, living in Gabarone solely for economic reasons.
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  19. 19

    A new method of co-operating with the very poor countries.

    Williams MJ

    In: Williams MJ. Development cooperation: efforts and policies of the members of the Development Assistance Committee: 1977 review. 1st ed. Paris, Organisation for Economic Co-operation and Development, 1977. 133-46.

    The Club Sahel was formed after the severe drought of 1968-73. It is composed of members of the Interstate Permanent Committee for Drought Control (CILSS), Cape Verde Islands, Chad, Gambia, Mali, Mauritania, Niger, Senegal, and Upper Volta. The Working Group of the Club has drawn up a plan for development of the Sahel from 1978-2000. The primary objective of the plan is increased agricultural production and food sufficiency. To accomplish this goal the Sahelians must double the production of maize, millet, and sorghum, meat from beef cattle, sheep, and goats, and increase rice production 5 times. An area of more than 500,000 hectares will have to be irrigated. Per capita farm income in the Sahel declined or stagnated between 1960-70 while national income increased. The development plan intends to narrow the gap between urban and rural income. Well organized marketing structures will be accompanied by new price policy to enable Sahelian producers to compete with imports in urban areas. Sound domestic policies by the Sahelian government are the underpinning of the development strategy. More aid is needed from the donor countries, enough to cover the development period. It is not likely that aid will be sustained that long, but many countries, including the United States and Canada, are increasing their committments.
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  20. 20

    Thailand: report of mission on needs assessment for population assistance.

    United Nations Fund for Population Activities [UNFPA]

    New York, UNFPA, June 1979. (Report No. 13) 151 p

    This report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
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  21. 21
    Peer Reviewed

    Primary health care and developing countries.


    Social Science and Medicine. 1979 Aug; 13A(5):505-514.

    The focal point of Primary Health Care (PHC) is the community. PHC represents a natural outcome of a political ideology implying that health service is not something to be delivered to the people from above; with the high cost technology teaching hospital as the center of medical universe. But rather, PHC is a concept of health services generated within the community and linking up with a referral system; and it is firmly established as the avenue which most developing countries will explore in the next 20 years. This commitment is largely the result of the Alma-Ata Conference which clarified many of the political; technical; social; administrative and educational aspects of PHC. This paper summarizes this process of consolidation of the concept; gives more examples of national plans in Sudan, Tanzania, Ghana, and India; and then deals with types of support that facilitate community participation. Because PHC involves people rather than merely technology, the role of social scientists is one which needs greater emphasis.
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  22. 22

    Rural community development and planning: promise and reality.

    United Nations. Department of Economic and Social Affairs

    International Social Development Review, No. 2, 1970. p. 28-33.

    Community development is concerned with stimulating people in decisions to change. Participation and involvement of village members enhances the development process by including them in the change. The question is how to organize administrative and executive machinery without losing local participation. Much depends on individual staff members skill at coordination at all levels of village life. Community development should fulfill certain goals expressed in national development policies. Planning for the fullest use of existing resources, acting as a communication medium, promoting volunteer organizations, modernization, encouraging civic responsibility, using labor surplus, creating conditions for social mobilization, aligning national and local aspirations, and paving way for local government should be the goals of a plan for community development.
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  23. 23

    The World Bank and poverty.

    Lipton M; Shakow A

    Finance and Development. 1982 Jun; 19(2):16-9.

    During the 1970s it was World Bank policy to use its funds to raise the productivity and living standards of the poor. It has increased its lending for sector and subsectors considered to offer the most direct benefits to the poor such as rural development, population, health, and nutrition. Projects with particular emphasis on poverty have benefitted large numbers of poor people and have had good economic rates of return. Lending for rural projects increased in the 1970s from US$2.6 billion in 1969-73 to over US$13 billion in 1978-81; rural development projects audited in 1979 benfitted 660 small farmers for every US$1 million loaned compared with 47 farmers/US$1 million in other agricultural projects. Some problems are: 1) low-risk technical packages appropriate for poor farmers in semi-arid rainfed areas are not readily available; 2) the Bank's rural development strategy seeks mainly to raise the production of small farms, but other aspects need to be emphasized; 3) domestic pricing and postharvest policies often undermine the success of projects aimed at the rural poor; and 4) success in rural development often rests on sociological and cultural factors, difficult areas that deserve more attention. For urban areas the Bank has strongly endorsed providing "sites and sources" instead of structures; since 1972, 52 Bank projects centered on urban shelter involving US$1.6 billion have been undertaken. Cost recovery is established at 66-95%. About 5% of Bank lending is for education and despite the importance of population, health, and nutrition, these areas absorb less than 1% of the Bank's total lending program. Only US$400 million in population loans were made to 13 countries in the 1970s and only recently have separate health projects been started. Emphasis for the 1980s must be on rural development, urban shelter, primary education, health, education, and population.
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  24. 24

    Thailand: report of Second Mission on Needs Assessment for Population Assistance.

    United Nations Fund for Population Activities [UNFPA]

    New York, New York, UNFPA, May 1983. 74 p. (Report No. 55)

    Reports on the need for population assistance in Thailand. Areas are identified which require assistance to achieve self-reliance in formulating and implementing population programs. Thailand has had a family planning program since 1970 and UNFPA has been assisting population projects and programs in Thailand since 1971. A Basic Needs Assessment Mission visited the country in April 1981. Thailand is experiencing a rapid decline in the population growth rate and mortality rates have been declining for several decades. The Mission makes recommendations for population assistance and identifies priority areas for assistance, such as population policy formation; data collection; demographic research; health and family planning; population information, education, and communication; and women and development. The Mission recommends that all population efforts be centralized in a single agency with no other function. Thailand is also in need of more personnel in key agencies dealing with population matters. The Mission also recommends that external aid be sought for technical assistance and that population projections be revised based on the 1980 census. Thailand has made a great deal of progress in developing its health infrastructure and services, but some problems still remain, especially in areas of staff recruitment and deployment and in providing rural services. The Mission also recommends that external assistance be continued for short term training seminars and workshops abroad for professionals. Seminars should be organized to assist officials in understanding the importance of population factors in their areas.
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  25. 25

    Integrating population programmes, statement made at 10th Asian Parasite Control Organization Family Planning Conference, Tokyo, Japan, 5 September 1983.

    Salas RM

    New York, N.Y., UNFPA, [1983]. 6 p. (Speech Series No. 95)

    The relationship between the Japanese Organization for International Cooperation in Family Planning (JOICFP) and UNFPA has been a vital force in the integration of family planning programs with nutrition and health services. The success of the integrated programs is evidenced by its rapid expansion from a pilot project in 1975 to projects in many countries in Asia, the Pacific and Latin America. The programs are efficient and effective in delivery of family planning services, as well as in linking and integrating these family planning services with other social and development programs. The programs have been designed to meet the needs of the people at the village level, taking into account their cultural sensitivities. This approach has encouraged acceptance and cooperation by the local communities and has made the program credible to the villagers. In fact, this seems to be the key to effective implementation of any type of development project. The coming 1984 International Conference on Popultion is also discussed. It is hoped that the present meeting will produce policy and operational suggestions which can be discussed at the International Conference.
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