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Lancet. 2002 Jun 8; 359:2009.Carol Bellamy, head of UN Children's Fund (UNICEF), warned that immunization programs worldwide are threatened by the gross reduction of routine childhood- vaccines despite the fact that the risk of vaccine-preventable diseases is increasing. Although production of childhood vaccines normally requires about 2 years, countries funding such programs only commit funds for 1 year at a time. This makes it difficult for their poorer counterparts to make multiyear purchase commitments. As a consequence, UNICEF has been unable to sign long-term contracts with vaccine manufacturers. Thus UNICEF has been calling for long- term commitments from donors.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 10,  p. (USAID Contract No. DPE-5969-00-7064-00)A visit was made to Uganda to meet with the oral rehydration solution (ORS) promotion committee to review on ORADEX sales targets, formulate regional sales goals based upon current national sales targets, and discuss product distribution concerns; to draft a document with Medipharm, ARMTRADES, and Media Consultants to review the effectiveness of promotional materials; to meet the PRITECH representative and coordinate the supervision of promotional communications between Medipharm, ARMTRADES, and Media Consultants; to meet with USAID/KAMPALA to determine the status of additional monies and provide an update on current project status; and to meet with UNICEF and review roles for continued interaction on the ORS promotional program between USAID/Kampala, UNICEF, and Medipharm. 90,837 sachets of ORADEX were sold through the end of January, 1992; above the target of 79,000. ARMTRADES, however, sold only 42,741 of its 60,000 target, while Medipharm sold 48,096 sachets; substantially more than its 19,000 target. Medipharm expressed concern over ARMTRADES' weak ability to distribute amd market ORADEX, despite ARMTRADES' claim that its sales efforts are being undermined by freely available UNICEF sachets. In response, PATH worked to improve the operational efficiencies of both Medipharm and ARMTRADES. Medipharm's present transportation facilities and institutional capabilities are insufficient to allow it to handle national distribution independently. For now, it must rely upon ARMTRADES to distribute and market ORADEX. Moreover, Medipharm needs continued supervision to properly manage distributor relations to ensure that distributors receive timely and accurate invoices, monthly statements, and payment due notices. These steps combined with accurate production and inventory planning will eventually provide Medipharm with sufficient experience to distribute and maintain stock on its own. Otherwise, the promotion committee suggested revisions for new materials future support and sales personnel and pharmacist training were discussed; and reports were cited which indicate that ARMTRADES is doing well distributing and marketing condoms through a parallel social marketing program.
Plan of action for the control of diarrheal diseases in the region of the Americas. Interagency Coordinating Committee for the Control of Diarrheal Diseases (ICC/CDD). Plan de accion para el control de las enfermedades diarreicas en la region de las Americas.
[Unpublished] . , 32, , 32 p.The American made remarkable strides in reducing diarrheal mortality and morbidity during the 1980s. All of the nations here had in place a control of diarrheal diseases (CDD) program or CDD activities by early 1989. 1 goal for CDD projects in the region included ORS availability to 80% of all children <5 years old. 17 nations even produced their own oral rehydration solution (ORS). This contributed to the fact that more countries proportionally produced ORS in the Americas than in any other region. Still diarrhea continued to be 1 of the 3 leading causes of death and illness in children <5 years old in most countries in the Americas. Accordingly an Interagency Coordinating Committee (ICC/CDD) Task Force composed of representatives from PAHO, UNICEF, and USAID formed in 1989 to develop a framework for the region and countries to follow in designing plans of action. Each country in the Americas should foster effective cooperation among all organizations involved in CDD activities within that country. If an interagency process, e.g., child survival programs, already exists, the country should include the CDD program into it. National ICC/CDDs should define policies and prepare the plan of action incorporating both technical and financial support from the public and private sectors. They must also coordinate CDD training activities, especially those emphasizing correct case management. Further they should concur on communication projects and coordinate message development and relations with the mass media. These committees must also recognize problems, develop solutions, foster research, and amend national CDD programs as needed. PAHO is the technical secretariat for the regional ICC/CDD which works to foster optimum cooperation among PAHO, UNICEF, and USAID thereby providing maximum assistance to these programs.
In: ICORT II proceedings. Second International Conference on Oral Rehydration Therapy, December 10-13, 1985, Washington, D.C., [edited by] Linda Ladislaus-Sanei and Patricia E. Scully. Washington, D.C., Creative Associates, 1986 Dec. 83-5.At a recent international conference on Oral Rehydration Therapy (ORT) there were discussions on policy issues. Advances in oral rehydration solution (ORS) local production, and the use of private sector and public sector distribution. It was agreed that the roles of ORS packets and home solutions must be carefully thought through and the be the basis of the program. If ORS is going to be available at the household level then the use of the private sector should be considered. The policy to use informal distribution channels and traditional healers has shown to increase public access to ORS. Also, donor support of ORS commodities may not lead to self sufficiency. Governments should plan for self sufficiency in advance and should manage donor support. Advances in local ORS production include factors that promote low cost production such as efficient personnel, economical procurement of materials, appropriate choice of equipment, minimizing duties, and using existing production facilities. The adoption of a citrate ORS formula allows the use of cheaper packaging material. The private sector can and should be used to make ORS available on a wide scale. Product pricing is a highly complex problem and the mothers ability to pay must be balanced against the profit incentives in the distribution system. Subsidies have been necessary to encourage the private sector and mass media campaigns have proven to be a useful subsidy. The key factor in gaining wide coverage is the person who contacts the mother. Competition can be useful in gaining greater effective usage but there are tradeoffs. The high costs of import licenses and hard currency have been stumbling blocks for the private sector production in some countries. It was found that it is inadvisable to set up a separate distribution system for ORS and it should not be given priority over other child survival interventions. Also a policy of cost recovery can make a program more viable in the absence of donor assistance and has increased confidence in the product and therapy.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
Social Science and Medicine. 1983; 17(19):1419-31.The Japanese level of health is one of the highest in the world, although the level is not uniform throughtout Japan. Preventive health care services are not integrated with medical care services. While efforts are being made in the health education subsystem of the primary health care services, organization is weak and funding and training of personnel are inadequate. Health specialists have failed to grasp the real meaning of primary health care, which includes the integration of services. Medical specialists also do not fully understand the idea of comprehensive primary health care. According to the Alma Ata Declaration, a conference sponsored by WHO and UNICEF in 1978, primary health care is to be responsive to sociocultural and political conditions and intimately tied to the development of other sectors of society. The recommendations of the Conference, to be achieved by 2000 are: 1) Primary health care must be linked with all other sectors of development; 2) Maldistribution of health services facilities and personnel must be overcome, so that care is truly accessible to all people; with the help of the community, disparities in health indices can be corrected; 3) Training and education is needed to develop a full understanding of primary health care among the politicians, the administrators, the opinion leaders and the public in general; 4) Training in health education should be a part of the basic training of health policy decision makers. Health education for the public should emphasize planning and organizational skills as well as more basic health education; 5) Training and education is needed to develop among medical specialists a respect for the work of allied health professionals, an awareness of the necessity of team work in primary health care, and a willingness to participate in team efforts; 6) Medical practitioners must help foster awareness of components of healthy living and encourage lay people to assume greater responsibility to the medical practitioners; 7) Paramount is the need for integration of medical care services and health care services at all levels. The Ministry of Health and Welfare has recently proposed special legislation which would integrate health activities and medical care for the aged. Tables and charts provide statistical summaries of mortality, causes of death, age structure projections, urban-rural residence, life expectancy, medical expenditures, clinical load for physicians, number of hospital beds, and staffing of health centers for Japan and selected comparisons to other Western Countries.
WHO Chronicle. 1979; 33:131-4.The longterm objective of the World Health Organizations (WHO's) diarrheal diseases control program is to eliminate them as a public health problem by improving water supply and sanitation, promoting child care practices and health education, and undertaking other community hygiene measures. The immediate and medium-term objectives are to extend the use of oral rehydration therapy, to combine that therapy with proper feeding practices, and to encourage appropriate child care practices. The goal in 1979, the 1st year of program operation, is to cover about 50 million people, with extension of coverage in subsequent years. WHO recommends that country programs for diarrheal diseases control should take their place as part of national health programs and primary health care activities. Oral rehydration therapy has many advantages. It can be given by health auxiliaries and mothers at an early stage of the illness, thus reducing the risk of severe and frequently fatal dehydration. In both health centers and hospitals, it can essentially replace intravenous therapy and reduce the need for expensive intravenous fluids and for skilled personnel to administer them. When oral rehydration therapy is accompanied by education on proper feeding practices, there is an earlier improvement in appetite and better weight gain. 4 maternal and child care practices can do much to prevent diarrhea--breastfeeding, correct weaning practices, suitable and adequate nutrition for pregnant and nursing mothers, and good personal hygiene in the family. WHO and the United Nations International Childrens Emergency Fund (UNICEF) have reached agreement on an effective mechanism for collaborating at the country level to meet needs for the supply, production, and distribution of oral rehydration salts.
[Unpublished] 1980. 13 p.UNICEF and WHO are jointly sponsoring an education and supply program of oral rehydration therapy for the treatment of diarrheal diseases in developing countries. Studies on the feasibility, acceptability, and effectiveness of (ORS) oral rehydration salts have been conducted in many developing countries and have proven the worth of the therapy. The UNICEF/WHO program seeks to provide wide distribution and educational activities in these areas. General public health education will help the population in medical self help in the area of diarrheal diseases. For countries which have reached the appropriate state of program development, aid in establishing manufacturing facilities for ORS should be the next step. The UNICEF-supported program has plans for operation in at least 51 national programs. Tables present the level of UNICEF support which has already been provided in a great many countries, categorized by region.
New York, New York, UN. April 14, 1975. 39 pAny shortage in the supply of oral contraceptives (OCs) or condoms in the next 5-10 years will be a result of the planning and procurement system rather than shortages of raw materials or production capacity. Production of OCs could be doubled with existing facilities and trebled (if manufacturers were assured of demand) within 2 years; production of condoms is at capacity but could be increased quickly if industry were assured of demand. Because of the rapid growth of the public sector contraceptive market, which will probably overtake commercial sales within 5 years, an organized system that uses longer term planning for future needs and single-point negotiations with suppliers is needed to hold down costs and ensure continuity of supply. As part of this planning, manufacturers, family planning program directors, and international agencies support the institution of a data system to report contraceptive distribution on a regular basis by country, method, and sector, with the capacity to forecast demand by method and country over a 5-year period.