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  1. 1
    320224

    Mali: Innovative design of the Multi-Sectoral AIDS Project (MAP).

    Khan AR

    Washington, D.C., World Bank, Knowledge and Learning Center, 2005 Nov. [2] p. (Findings Infobriefs No. 118; Good Practice Infobrief)

    The Mali Multi-sectoral AIDS Project (MAP) began implementation in late 2004 and is in the preliminary phases of the project cycle. This project has been commended by the World Bank's Board for its innovation and the involvement of the private sector to address HIV/AIDS. Mali is one of the poorest countries in the world due to factors such as its limited resource base, land-locked status and poor infrastructure. According to the 2001 Demographic and Health Survey (DHS) published by the Ministry of Health, Mali's HIV/AIDS prevalence rate is estimated at 1.7% in 2001. The project objective is to support the Government of Malis efforts to control the spread of the HIV/AIDS epidemic and provide sustainable access to treatment and care to those infected with or affected by HIV/AIDS. While Mali currently has a low HIV prevalence rate by Sub-Saharan African standards, it runs a high risk of experiencing an increase in prevalence rates. (excerpt)
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  2. 2
    101022

    Support for treatment programs with Mectizan: the NGO experience.

    Thylefors B

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 49-50.

    For optimal treatment compliance, the large-scale distribution of a drug such as Mectizan presupposes a well-structured support system through both governmental and nongovernmental channels, together with proper education and awareness at the community level. Beginning at the international level, the purpose and effectiveness of programs of treatment with Mectizan in onchocerciasis-endemic countries must be publicized to all development agencies and the community of international nongovernmental organizations. Within the United Nations system and related organizations, the specialized agencies concerned, such as the United Nations Development Programme, the Food and Agriculture Organization of the United Nations, the International Labor Organization, The World Bank, UNICEF, and, in particular, the World Health Organization, are well placed to initiate programs of treatment with Mectizan as part of development work having a bearing on health. Nongovernmental organizations can play a very significant role in various contexts for development of treatment programs by means of: advocacy, at the international, national, and community levels; project expertise and experience from work in developing countries; flexible, grassroots approaches that allow for tackling practical problems in a pragmatic manner; valuable experience from training health personnel and working with local staff in a wide variety of settings; being efficient resource mobilizers; and the possibility and experience of working with the local community considering particular needs and resources. At the national level, it is important that there be proper awareness of the socioeconomic impact of onchocerciasis. The Ministry of Health should play the main coordinating role with respect to support from NGOs and agencies. A policy of integration with primary health care should be implemented.
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  3. 3
    068475

    Condom services to prevent HIV transmission: are they workable? [editorial]

    Friel P

    AIDS HEALTH PROMOTION EXCHANGE. 1989; (3):1-2.

    This editorial argues that in order to increase the use of condoms in the fight against AIDS, WHO's Global Program on AIDS (GPA) must address the problems of weak condom distribution and promotion systems. The available data indicates that condom use can protect against HIV transmission. Studies in Zaire, Denmark, Germany, and Australia reveal that seropositivity among prostitutes who use condoms is much lower than among prostitutes who do not use condoms. However, the use of condoms largely depends on whether services are available to the people who practice risk behavior, and whether such people can be motivated to adopt safe sex practices -- including proper and consistent condom use. In order to bring about this desired behavior change, it is essential to have a strongly managed integrated program that combines condom services and health promotion, as well as specific plans and budgets to distribute and promote condoms. In supporting national AIDS programs, GPA's current strategy for condom services includes the following: 1) the provision of high-quality, low-cost condoms; 2) assistance in developing comprehensive program management and technical support plans and budgets for incorporation into subsequent funding cycles; and 3) support for research and development of new methods for preventing the sexual transmission of HIV -- including barrier methods that can be controlled by women.
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  4. 4
    028259

    Sri Lanka.

    International Planned Parenthood Federation [IPPF]

    Ippf Situation Report. 1974 Sep; 1-9.

    The current status of family planning in Sri Lanka was described, and relevant background information on population characteristics was supplied. Family planning services have been provided by the Family Planning Association of Sri Lanka since 1954. In 1958 the government initiated a family planning pilot project. In 1965 the government assumed full responsibility for providing family planning services, but the governemnt did not formulate or publicly endorse a family planning policy until 1972. Sri Lanka's population was 13,033,000 in 1972, and the annual average population growth rate was 2.3% between 1963-72. The crude birth and death rates were respectively 29.6 and 7.6 in 1971, and the infant mortality rate was 48 in 1973. 41% of the population was under the age of 15 in 1973. In 1972, per capita income was US 100. 71% of the population is Sinhalese, and 70% of the population is Buddhist. The country is primarily agricultural and derives 1/3 of its income from gorwing and processing tea. Education is compulsory for all children aged 5-14 and currently 89.7% of the males and 75.4% of the females are literate. Free medical care is provided, and in 1968 there were 310 hospitals and 3242 physicians. There are no laws restricting contraception in Sri Lanka. The Ministry of Health is responsible for operating the country's national program, and the goal of the program is to reduce the birth rate to 25 by 1975. The government provides family planning services through 496 family health bureaus, and oral contraceptives (OC) and condoms are distributed by midwives and through a variety of other channels at low cost. Service statistics for 1967-73 were provided. In 1973 the number of new acceptors was 27,528 for IUDs, 34,214 for OCs, 13,941 for traditional methods, and 20,248 for sterilizations. In 1973, 11 population and family planning projects, funded by the UN Fund for Population Activities were launched in collaboration with a number of government and UN agencies, labor and employer groups, and the University of Sri Lanka. A contraceptive knowledge, attitude, and practice survey was conducted in 1973, and a National Seminar on Law and Population was held in 1974. In 1973 an effort was launched to decentralize and intensify training for family planning personnel, and several new training courses for nurses, midwives, medical officers, health educators, and public health personnel were developed. The national program receives additional assistance from the International Planned Parenthood Federation, the UN Development Programme, the Swedish International Development Authority, the Canadian International Development Agency, the World Assembly of Youth, and the Population Council. During 1973, the Family Planning Association of Sri Lanka provided family planning services for 8174 new acceptors and 20,858 continuing acceptors at its 25 clinics, located primarily in Colombo. The Association conducts several industrial sector and rural programs which promote vasectomy and provide vasectomy services. Recently the Association conducted several mass mdeia educational campaigns, provided family training for 125 government physicians, and conducted several contraceptive studies, including a Depo-Provera study. In 1973, the Population Services International initiated a national social marketing project for distributing condoms.
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  5. 5
    267011

    On a national drug policy for Bangladesh.

    Islam N

    Tropical Doctor. 1984 Jan; 14(1):3-7.

    On April 27, 1982 the Ministry of Health of the government of Bangladesh, set up an 8-man expert committee to evaluate all the registered pharmaceutical products presently available, and to formulate a draft National Drug Policy. Objectives are: 1) to provide support for ensuring quality and availability of drugs; 2) to reduce drug prices; 3) to eliminate useless, nonessential, and harmful drugs from the market; 4) to promote local production of finished drugs; 5) to ensure coordination among government branches; 6) to develop a drug monitoring and information system; 7) to promote the scientific development and application of unani, ayurvedic, and homeopathic medicines; 8) to improve the standard of hospital and retail pharmacies; and 9) to insure good manufacturing practices. 16 criteria were agreed on as guidelines for evaluating the drugs on the country's market. Drugs in Bangladesh have been classified into 3 categories. The 1st is drugs that are positively harmful. They should be banned immediately and withdrawn from the market. There are 265 locally manufactured drugs and 40 imported drugs in this category. The 2nd, drugs to be slightly reformulated by eliminating some of their requirements. There are 134 drugs in this category. The 3rd is drugs that do not conform to 1 or more of the 16 criteria/guidelines. There are over 500 drugs in this category. The new drug policy will produce a saving of 800 million taka (US $32.4 million). Drug supply in Bangladesh is a problem. The public sector distributes 20% of the total. In the private sector, drugs are supplied through import and local production. Investment for research by the pharmaceutical companies is essential. The principles laid down by the International Federation of Pharmaceutical Manufacturers Associations for the supply of good medicine needs to be put into practice.
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  6. 6
    802984

    Program management and effectiveness: perspectives from the funding agencies.

    Kanagaratnam K

    In: Files LA, ed. Research on the management of population programs: an international workshop. Chapel Hill, NC, Univ. of NC, School of Public Health, Dept. of Health Administration and the Carolina Population Center, 1980. 91-108.

    There are 2 types of government-sponsored national family planning programs, those which operate within narrowly-defined parameters and recognize local constraints and those which, with the support of politicians, aim at all the national population problems. The trend has been toward the 2nd, more comprehensive type of program. Since population programs in most countries began as medically-based family planning programs, they have been cut off from broader affiliations. Once domestic funding increases, the programs will gain autonomy in program direction. The World Bank offers program funds aimed at establishing effective management policies for the national population programs. A 1st step in Bank funding is an assessment of organizational and managerial problems. The Bank also focuses on management and personnel at the micro level. Most Asian programs are felt to be strong and effective; Latin American programs fall slightly behind the Asian programs; programs in Africa lag far behind. Immediate future steps for the programs in each of the continental regions are outlined. A summary of management components in Bank population projects in several selcted countries is presented. A funding summary for these management activities is tabulated.
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  7. 7
    031613

    Summary: field trip report, Agency for International Development, Sri Lanka, (Colombo, Kalutara, Kandy and Nuwara Eliya), July 14 to August 2, 1982.

    Johnson WH

    [Unpublished] 1982. 19 p.

    This report, prepared for the US Agency for International Developement (USAID), provides a description and assessment of the 4 social marketing programs operating in Sri Lanka, an inventory of the program's current contraceptive supplies, an estimate of the programs' supply requirements for 1983-85, and several recommendations for improving social marketing activities in the country. The assessment was made during a brief visit to Sri Lanka in the summer of 1982. Supply requirements were difficult to assess since there is little coordination between the programs. The programs are supplied by a variety of donor organizations, and record keeping is inadequate in some programs. The 4 programs are operated by 1) the Family Health Bureau (FHB) of the Ministry of Health, 2) the Family Planning Association of Sri Lanka (FPASIL), 3) Population Services International (PSI), and 4) Community Development Services (CDS). The FHB program sells oral contraceptives (OCS) and condoms. During 1983-85, most of the program's supplies are expected to be obtained form the UN Fund for Population Activities. The FPASIL program was initiated in 1974 and distributes 10 brands of condoms and 3 brands of OCS. The program receives supplies from the International Planned Parenthood Federation and USAID. The PSI program trains Ayurvedic practitioners to distribute OCs and condoms. Most of the contraceptives are distributed free of charge but some are marketed. The program obtains its supplies from the FHB stocks and distributes them to the practitioners via the postal system. The Community Development Service is a privately run organization which conducts a variety of projects including the marketing of OCs and condoms through health workers and Ayurvedic practitioners. The program is supplied by several donors and is currently requesting condoms from USAID. Detailed information on the program is unavailable; however, it appears that the program overestimated its contraceptive needs for 1983. Between 1975-82, the proportion of married women of reproductive age relying on traditional methods increased from 17%-25%, the proportion relying on sterilization increased from 13%-17%, and the proportion using other modern methods increased from 11%-13%. In 1982, the proportion using OCs was 2.64% and the proportion using condoms was 3.19%. The marketing programs distribute primarily condoms and OCs. Estimated USAID delivery requirements for 1983 included 3,500,000 condoms for the FHB and FPASIL programs and 700,000 cycles of OCs for the FPASIL program. Requirements for 1984 could be estimated only for the FPASIL program and included 800,000 OC cycles and 8,500,000 condoms. The Ministry of Health should commission an outside review of all social marketing activities to identify appropriate and complementary functions for the 2 major programs (FPASIL and FHB) and a local review of the Ayurvedic practitioner training and distribution programs of CDS and PSI. Condoms provided by USAID for the FHB and CDS programs should differ in brand and packaging from those marketed by FPASIL. The progrms' service statistics and logistics should be improved. Research should be undertaken to identify factors contributing to the increase in the use of traditional contraceptive methods and to explore why only minimal increases in the use of modern contraceptives have occurred since 1975. Consideration should be given to setting up a central warehouse for stocking the nation's contraceptive supplies. All programs would then obtain their supplies from this central facilities. USAID assistance would be available for implementing a number of these recommendations.
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  8. 8
    268487

    Evaluation of UNFPA assistance to the family planning programme of the Dominican Republic, 1978-1982/3.

    Requena M; Echeverry G; Frieiro LB

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Aug. xii, 48, [11] p. (DOM/73/P01)

    This evaluation was carried out by an independent mission coordinated by the United Nations Fund for Population Activities (UNFPA) Evaluation Branch. The program's long-term objectives are to reduce the birth rate to 29/1000, reduce mortality rates, achieve a sustained reduction in fertility rates and to devise and implement a specific population policy. Immediate objectives are to acheive the functional integration and financial self-sufficiency to carry out family planning programs, offer family planning services to the entire population and increase the demand for them, to offer new methods, especially female sterilization, and alter the distribution of users by method; increase active users to 22% of the country's women and to increase the availability of health personnel. In general, the Evaluation Mission found that the project documents describing the objectives to be achieved, strategy, activities and inputs do not elaborate sufficiently on the relationship between objectives and activities and the inputs required and do not give details about the strategy for achieving objectives. The birth rate was estimated at 34.5/1000 in 1982. Infant mortality seems to be declining particularly fast in areas with active rural health promotors. No specific population policy has been enuciated. The program has, to a large extent, achieved the immediate objectives set for it, except that of financial self-sufficiency. The program's strongest elements are the considerable expansion of the physical and health personnel infrastructre; political and institutional willingness to carry out integrated maternal and child health and family planning programs; and the great demand for family planning services by the population. Week elements which have hindered the program's progress are the abence of a tradition of public health and preventive medicine in the country, which has resulted in inadequate training of medical personnel and a lack of motivation, and the extreme centralization of the health system and the consequent lack of delegation of authority and resources which limits the initiative and action of personnel at supposedly operational levels. Other weaknesses are the cultural models which favor authoritarianism and paternalism; the stressing of a clinic-based service delivery system as opposed to the Primary Health Care approach; the lack of direct information education and communication (IEC) action in the communities; the lack of a strategy to gather the knowledge existing in such communities to incorporate it in the joint planning of services, and deficiencies in supervision and evaluation which are aimed at measuring goals and results but not at identifying and analyzing problems.
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