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[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.