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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)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
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)
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)
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.
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.
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.
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.
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.
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.
Integrating population programmes, statement made at 10th Asian Parasite Control Organization Family Planning Conference, Tokyo, Japan, 5 September 1983.
New York, N.Y., UNFPA, . 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.
Chichester, England, John Wiley, 1982. 317 p.This textbook provides basic information on social policies aimes at improving the welfare of the populations in developing countried and assessing the effectiveness of the major social policies which have been applied to the problems of poverty in these countried. The book is an outgrowth of experience gained in teaching a course in social policy and planning at London School of Economics. The focus is on social policied rather than on social planning techniques, and the central theme is that state intervention and the implementation of social policies are a necessary prerequisite for improving the welfare of the inhabitants of 3rd World countried. The chapter defines underdevelopment. It stresses the need for governments to develop social policies in accordance with their needs and resources and to develop policies which will redistribute resources to the most seriously disadvantaged segments of their population. The 2nd chapter defines poverty, describes the basic inequalities in living standards and income which exist in 3rd World countries, and discuss the major theories which have been put forward to explain poverty. The next 5 chapters discuss the problems of population growth, rural and urban development, health, and housing. The various policied which have been formulated to deal with each of these problems are described and compared in regard to their effectiveness. The next chapter discusses social work and the problems associated with the development of social welfare services in developing countries. The final chapter deals with international issues and assesses. The value of bilateral and multilateral aid. Major assumptions underlying the presentation of the material are 1)poverty impedes development, 2)poverty will not disappear without government intervention, 3)economic development by itself cannot reduce poverty, 4)poverty is the result of social factors rather than the result of inadequacies on the part of poor indiciduals, 5)socialpolicies and programs formulated to deal with problems in the developed countries are inappropriate for application in developing countries; 6)social policies must reflect the needs of each country; and 7)social planning should be an interdisciplinary endeavor and should utilize knowledge derived from all the social sciences.