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