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The ghosts of user fees past: Exploring accountability for victims of a 30-year economic policy mistake.
Health and Human Rights. 2013 Jun; 15(1):175-185.Today, there is an unmistakable shift in international consensus away from private health financing, including the use of user fees toward public financing mechanisms (notably tax financing), to achieve universal health coverage (UHC). This is, however, much the same as an earlier consensus reached at the WHO's World Health Assembly at Alma-Ata in 1978. When considering the full circle journey from Alma-Ata in 1978 to today’s re-emerging support for UHC, it is worth taking stock and reflecting on how and why the international health community took this nearly three decade detour and how such misguided policies as user fees came to be so widely implemented during the intervening period. It is important for the international health community to ensure that steps are taken to compensate victims and determine accountability for those responsible. Victims of user fees suffered violations of their human right to health as enshrined in Universal Declaration, ICESCR, and a number of other human rights treaties, and yet still cannot avail themselves of remedies, such as those provided by international and regional human rights fora or the various United Nations treaty-monitoring bodies, and the responsible institutions and individuals have thus far remained unaccountable. This lack of accountability suggests a degree of impunity for international organizations and health economists dispensing with health policy advice. Such a lack of accountability should be noted with concern by the international health community as it increasingly relies on the advice and direction of health economists. Steps must be taken to provide survivors of user fees with compensation and hold those responsible to account.
Genus. 2005 Jul-Dec; 61(3-4):185-192.I was asked by the organizers of this international conference to discuss, in my presentation, the effects of ageing on competitiveness. I will start by arguing that the key economic issue involved by ageing is growth rather than competitiveness per se, as ageing may reduce the growth potential of nations. I will however point out that there is nothing unavoidable about this effect of ageing on growth. Reforming pensions and labour market institutions in order to better exploit returns from experience, it is possible to counteract the effects of a declining workforce on growth and sustain a relatively high rate of capital accumulation even under older societies. But there are strong political obstacles to these reforms. These political obstacles should be fully understood, it is still a matter of positive economics, and possibly counteracted (the domain of normative economics). (excerpt)
26th Annual Conference of the Indian Association for the Study of Population on Population, Health and Environment, 9-11 February 2004. Organized by Annamalai University, Annamalainagar. [Abstracts of papers presented].
Annamalainagar, India, Annamalai University, Centre for Population Studies, 2004. 98 p.One of the objectives of Madhya Pradesh population policy 2000 is to reduce the risk of death due to complications of pregnancy and delivery from an estimated 498 maternal deaths per 1,00,000 live births in 1997 to 220 by the year 2011. The policy calls for making emergency obstetric care services available in all development block level health care institutions by 2011. In order to prevent maternal deaths it is however necessary that EmOc services are made available right up to the village level so as to make possible the management of obstetric emergencies as and when they arise. Making these services available only up to the block level may not contribute significantly in reducing maternal mortality. The extent and nature of emergency obstetric care services may vary in different tires of the health care delivery system. The conceptual framework that has been developed here follows an evidence based approach for making available emergency obstetric care services at different levels of health care delivery system. The conceptual plan focuses on what can be done at the level of community and at different tires of public health care delivery system in managing, treating and referring patients with emergency complications. Starting of immediate treatment and prompt transfer of the patients to a health care facility where specialized services are available can save many young lives. Obstetric first aid to stabilize the patient before referral is life saving delay may mean death. It is recommended that the plan should constitute the basis for developing and expanding emergency obstetric care services in Madhya Pradesh in the efforts towards reducing the maternal mortality rate. (excerpt)
IAEN and current issues. Notes and commentary. Eleventh Meeting of the International AIDS and Economics Network (IAEN) Conference, Current Issues in the Economics of HIV / AIDS, held at Kaiser Family Foundation, Washington D.C., April 24-25, 2003.
[Geneva, Switzerland], International AIDS Economics Network [IAEN], 2003. 11 p.Having raised and committed about US$1.5 billion to more than sixty countries, the Global Fund and its informal network of friends and supporters will need to show, through effective monitoring and evaluation (M&E) that the donors’ resources can be proved to be well spent. The two-day conference reflected on M&E data requirements, how country managers can be helped to show progress, and what factors, such as education, prospects for treatment via anti-retroviral therapy (ART), and strategic planning, can help demonstrate effective use of resources. The paragraphs below summarize meeting highlights. Sown among the comments are ample Web- links that aim to help the reader learn more on any of the topics of special interest. Author names and e-mail addresses appear at the end of this note. Alan Whiteside, Director of the Health Economics and HIV/AIDS Research Division of the University of Natal (HEARD), opened the meeting raising the three main challenges to the HIV/AIDS epidemic, 1) Prevention 2) Treatment and Care and 3) Mitigating the Impact. Alan Whiteside mentioned the two conferences he had recently attended relevant to the IAEN Conference. The first, Empirical Evidence for the Demographic and Socio- Economic Impact of AIDS, was held in Durban, South Africa. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Financing HIV / AIDS resource requirement and mobilization: recent developments, April 25, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 74 p.This is our concluding session and the first shall be last and the last first. A sensational group of specialists who have been watching after the flow of resources that pay for HIV/AIDS interventions. This is a sort of pet area of concern for me. And I hope others of you will find, will find this as, as interesting as I do. Unfortunately, for topics which involve all these numbers there is a, a risk of MIGO, as it’s called, My Eyes Glaze Over. The, it, it could be boring if we had less competent speakers. But because of the high quality of the speakers that we have here I am sure it will be a fascinating and positive experience. The first thing coming on the programs by a good friend and long time associate, Eric Life. Eric Life used to work for the US Congress, CBO I think, he used for OMB, and he used to work for members of the Congress. He is now an official at the State Department seconded to UNAIDS, where he has been in charge of watching after the flow of money. The Chair for this session as with, was the case with Maureen Lewis, the Chair is Susan Stout. She is of course not here. I will, I will serve in that stead until she, until she appears in the next few minutes. So let’s turn it over to Eric to start us off. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. AIDS and education, April 25, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 43 p.Each country with a slightly different focus on the piece of research and in Malawi, the piece I'm going to talk about today is really embedded in a much larger study, a larger longitudinal study. But because of some of the data that we're finding in our pupils and teachers in the conditions of AIDS in Malawi, we decided that we should look a little bit further into what the impact is on the classroom and specifically on learning, so that's going to be the focus of my remarks and I hope really it stimulates some discussion. We're at the beginning of looking at this issue more systematically in the classroom, so I hope I don't fall into the category that Steve referred to earlier as maybe I should have come next year instead of this year. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. India: Approaches to containing and treating the HIV / AIDS epidemic, April 25, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 50 p.Now I want to give you just the flavor of the conclusions before we launch into the explanation of what we actually did. We arrived at estimates at the costs per healthy life years saved from an anti-retro viral strategy in India and we have three different strategies which I will define in detail in a minute. The most cost effective of those treatment strategies would buy healthy life years at government expenditure of $146 dollars per healthy life year. The most expensive of the three would cost $280 dollars per healthy life year we estimate and those estimates are pretty large in comparison to the price of healthy life years that we're familiar with from making if you will (unintelligible) report and from other estimates that have been produced of gains that could be saved from (unintelligible) vaccination or even road traffic accidents per nation. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Contrasts and comparisons of simulation modeling exercises and their use in analysis of policy options and interventions, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 61 p.The problem that we were addressing with this model was the fact that most countries now have strategic plans for organizing the national HIV/AIDS effort. But, that there’s very little strategic analysis of the funding that goes into that plan. In fact, the costing (unintelligible) after the goals are already set. This creates a variety of problems, but the major one is that the funding and the goals are not linked in any way that allows you to see how changes in the funding, either in the total amount or in the allocation, effects the goals you can achieve. It means, it makes it difficult to set reasonable goals. It also makes it difficult to do strategic allocation funding. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. TRIPS and HAART: Recent developments, sound policies, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 50 p.What I'm going to talk about is the pricing of antiretrovirals and other AIDS drugs. Now this is to be within the framework of the intellectual property provisions of the Oriqui round treaty, the so called TRIPS Provisions once you recognize from the beginning that not all antiretroviral came under patents for many of the key source nations, TRIPS didn't take affect until after, well until a lot of AIDS drugs were already on the market. I'm going to assume that a drug has patent protection and then the question would be how should that drug be priced? And can we have slide one please, which… when a provider of a drug has essentially patent protection or some other reason for having a monopoly of the source, the ideal kind of pricing for it assuming that it's going to be trying to maximize it's profits is sometimes called tiered pricing, sometimes called differential pricing economist, and we've been talking about these kinds of problems for about 150 years now. Economists call it discriminatory pricing or even more technically Ramsey Brummel Bradford (Misspelled?) pricing, the basic idea is this. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Effective strategies for resource mobilization and resource allocation -- global and regional perspectives, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 49 p.I want to talk about now a kind of evaluation for a couple of minutes that is perhaps a little bit different than what we think about when we say monitoring and evaluation and I want to start out by whispering something that you are not allowed to repeat outside of this room and that's that, well I think we have very convincing evidence of the effectiveness of specific interventions intervention of HIV/AIDS. I don't think we know what works at the level of communities or countries. We have very little information about what works at that level. We have three very important randomize community trials that you are probably all familiar with. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Prospects for support and development of monitoring and evaluation (M&E) of HIV / AIDS assistance programs, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 50 p.Each of us who works in this field and who visits countries where HIV/AIDS is devastating society has their own tragic memories of people that we have met, of communities that we have visited, of parents, dying parents of children affected by HIV/AIDS, so I can't think of anything more important than this discussion on effective strategies for resource mobilization and resource allocation. This is and area that we are giving much greater attention at USAIDS as we have access to greater resources. We are now doing a specific strategic plan for each country, and of course those plans very much involve our relationship with our primary partner, the host country government (Unintelligible) in UNAIDS and we are constantly asking ourselves, what impact, what choices because we all know there are more good choices in which to invest HIV/AIDS and your money and so you really have to focus on what is the impact on human beings. Will you prevent an infection? Will you provide desperately needed care or treatment or will you help a family who sold all of its lands to those whose last resources. I guess two memories that keep me up at night are sitting with women in Uganda, part of that wonderful Ugandan women's group working against AIDS, who are making scrapbooks for their children that say, this is who your parents, as they are dying, this is who your father was, this is who your mother is. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Department of Vaccines and Biologicals, 2004. vii, 77 p. (WHO/V&B/04.02)In an effort to make information more readily available to those seeking to increase vaccine coverage worldwide and improve, manage, and deliver immunization services in developing countries, an annotated bibliography was developed. This document is intended as a tool for donor agencies, ministries of health and finance in developing countries, public health institutions and universities, as well as the Global Alliance for Vaccines and Immunization (GAVI). Within the context of immunization financing, this tool identifies literature and web resources on costing, cost–benefit analyses, financing, policy issues, tools, and other related topics. For copies of documents listed, please contact the author or publisher listed in the citation. A contact list of key institutions and individuals working on immunization issues is provided as well. This document contains the following: Background information on immunization financing issues; Summaries of 87 key articles related to immunization financing; List of 345 documents primarily from 1995 to the present; Directory of contacts and web sites for additional information. (excerpt)
The effect of structural characteristics on family planning program performance in Cote d'Ivoire and Nigeria. [Effet des caractéristiques structurelles sur les performances du programme de planning familial en Côte d'Ivoire et au Nigeria]
Social Science and Medicine. 2003 May; 56(10):2123-2137.This paper uses Côte d’Ivoire and Nigeria survey data on both supply and demand characteristics to examine how structural and demographic factors influence family planning provision and cost. The model, which takes into account the endogenous influence of service provision on average cost, explains provision well but poorly explains what influences service cost. We show that both size and specialization matter. In both countries, vertical (exclusive family planning) facilities provide significantly more contraception than integrated medical establishments. In the Nigeria sample, larger facilities also offer services at lower average cost. Since vertical facilities tend to be large, they at most incur no higher unit costs than integrated facilities. These results are consistent across most model specifications, and are robust to corrections for endogenous facility placement in Nigeria. Model results and cost recovery information point to the relative efficiency of the International Planned Parenthood Federation, which operates large, mostly vertically organized facilities. (author's)
Washington, D.C., Island Press, 1991. lxii, 272 p.In 1988, the World Meteorological Organization and the UN Environment Program established the Intergovernmental Panel on climate Change (IPCC) to consider scientific data on various factors of the climate change issue, e.g., emissions of major greenhouse gases, and to draw up realistic response strategies to manage this issue. Its members have agreed that emissions from human activities are indeed increasing sizably the levels of carbon dioxide, methane, chlorofluorocarbon (CFC), and nitrous oxide in the atmosphere. The major conclusions are that effective responses need a global effort and both developed and developing countries must take responsibility to implement these responses. Industrialized countries must modify their economies to limit emissions because most emissions into the atmosphere come from these countries. They should cooperate with and also provide financial and technical assistance to developing countries to raise their living standards while preventing and managing environmental problems. Concurrently, developing countries must adopt measures to also limit emissions as their economies expand. Environmental protection must be the base for continuing economic development. There must be an education campaign to inform the public about the issue and the needed changes. Strategies and measures to confront rapid population growth must be included in a flexible and progressive approach to sustainable development. Specific short-term actions include improved energy efficiency, cleaner energy sources and technologies, phasing out CFCs, improved forest management and expansion of forests, improved livestock waste management, modified use and formulation of fertilizers, and changes in agricultural land use. Longer term efforts are accelerated and coordinated research programs, development of new technologies, behavioral and structural changes (e.g., transportation), and expansion of global ocean observing and monitoring systems.
Freetown, Sierra Leone, Ministry of Education, 1984. 93 p. (UNFPA/UNESCO Project SIL/76/POI)The National Programme in Social Studies in Sierra Leone has created this textbook in the social sciences, with an emphasis on population education, for 2ndary school students. Unit 1, "Man's Origin, Development and Characteristics," describes Darwin's theory of evolution and explains how overproduction causes problems of rapid population growth and poor quality of life. Special attention is given to the problem of high infant mortality in Sierra Leone. Unit 2, "Man's Environment," discusses the interrelationships and interdependence among elements in the ecosystem, the food pyramid, and the effects of man's activities and numbers on the ecosystem. Unit 3, "Man's Culture," focuses on the processes of socialization and the different agents of socialization: the family, the group, the school, and the community. Unit 4, "Population and Resources," discusses human and natural resources as well as conservation measures. It also discusses the population composition, its effect on resources, and the uses and significance of population data. Unit 5, "Communication in the Service of Man," covers land, water and air transport; the effects of transport developments in Sierra Leone; and implications for population of changes in transport activities. Unit 6, "Global Issues: Achievements and Problems," deals with the young population, characteristics of the adolescent, common social problems among young people, and the role of the family unit. National and international action is also discussed.
Freetown, Sierra Leone, Ministry of Education, 1984. 80 p. (UNFPA/UNESCO Project SIL/76/POI)The National Programme in Social Studies in Sierra Leone has created this textbook in the social sciences for secondary school students. Unit 1, "Man's Origins, Development and Characteristics," presents the findings of archaeologists and anthropologists about the different periods of man's development. Man's mental development and population growth are also considered. Unit 2, "Man's Environment," discusses the physical and social environments of Sierra Leone, putting emphasis on the history of migrations into Sierra Leone and the effects of migration on population growth. Unit 3, "Man's Culture," deals with cultural traits related to marriage and family structure, different religions of the world, and traditional beliefs and population issues. Unit 4, "Population and Resources," covers population distribution and density and the effects of migration on resources. The unit also discusses land as a resource and the effects of the land tenure system, as well as farming systems, family size and the role of women in farming communities. Unit 5, "Communication in the Service of Man", focuses on modern means of communication, especially mass media. Unit 6, "Global Issues: Achievements and Problems," discusses the identification of global issues, such as colonialism, the refugee problem, urbanization, and the population problems of towns and cities. The unit describes 4 organizations that have been formed in response to problems such as these: the UN, the Red Cross, the International Labor Organization, and the Co-operative for American Relief.
Freetown, Sierra Leone, Ministry of Education, 1984. 80 p. (UNFPA/UNESCO Project SIL/76/POI)The National Programme in Social Studies in Sierra Leone has created this text in social studies, with an emphasis on population education, for 2ndary school students. Unit 1, "Man's Origins, Development and Characteristics," covers traditional, religious and scientific explanations of man's origin; man's characteristics and the effects of these characteristics; and the beginnings of population growth and the characteristics of human population. In Unit 2, "Man's Environment," the word environment is defined and geographical concepts are introduced. Unit 3, "Man's Culture," defines institution and discusses family types, roles and cycles, as well as traditional ceremonies and cultural beliefs about family size. Unit 4, "Population and Resources," primarily deals with how the family meets its needs for food, shelter and clothing. It also covers the effects of population growth. Unit 5, "Communication in the Service of Man," discusses the means and growth of communication and collecting vital information about the population. The last unit defines global issues and discusses the interdependence of nations, issues affecting nations at the individual and world level, and the UN.
Economics, health and development: some ethical dilemmas facing the World Bank and the international community.
Journal of Medical Ethics. 2001 Aug; 27(4):262-7.The World Bank is committed to "work[ing] with countries to improve the health, nutrition and population outcomes of the world's poor, and to protect[ing] the population from the impoverishing effects of illness, malnutrition and high fertility". Ethical issues arise in the interpretation of these objectives and in helping countries formulate strategies and policies. It is these ethical issues--which are often not acknowledged by commentators--that are the subject of this paper. It asks why there should be a focus on the poor, and explores the link between improving the health of the poor, and reducing health inequalities between the poor and better-off. It discusses difficult ethical issues at both the global level (including debt relief and the link between country ownership and donor commitment) and the country level (including user fees and whether providing assistance to the non-poor may in the long run be a way of helping the poor). (author's)
New York, New York, WEDO, 1996 Jun 1. 17 p.This Advocacy Chart complements the Women's Caucus line-by-line Recommendations on Bracketed Text offered to all government and nongovernment delegates from the Women's Caucus. With over one-half of Habitat Agenda in bracket, the Women's Caucus is focusing its advocacy efforts on ensuring positive outcomes from a gender perspective on the outstanding issues be negotiated by delegates. This chart clusters the various brackets under the following headings: Gender Equality, Human Rights, Economics, Environment and Sustainable Human Settlements, Health, Peace, and Implementation and Finance. Previously agreed UN language, which supports their position of retaining or amending much of what is in brackets, is also presented. It is hoped that this chart will be useful in their efforts to ensure that all the hard-won achievements of the global women's movements at previous UN conferences be reaffirmed and promoted.
In: Evaluation and development: proceedings of the 1994 World Bank conference, edited by Robert Picciotto and Ray C. Rist. Washington, D.C., World Bank, 1995. 61-75. (World Bank Operations Evaluation Study)This paper presents a macroeconomic framework for evaluating the effects of policy-based adjustment programs, with an illustration from a recent World Bank structural and sectoral adjustment lending evaluation, and offers guidelines on the design of conditionality. The framework is designed for situations in which an estimated model of the economy is not available. It is basically a version of Robert Mundell's policy assignment model, which assigns policy instruments to targets following the principle of comparative advantage. The paper focuses on a cross-country application of the framework and begins with a discussion of the assignment model. The example, which draws from World Bank experience in adjustment lending in 55 countries, strongly indicates that when a macro framework is introduced early in the design of an economic adjustment program and decisions on policy are guided by the framework, the policy instruments are more likely to have their intended impact and their results are more likely to be sustainable. This paper also includes a general discussion on the design of adjustment programs, including a section on the structure of loan conditionalities.
WORLD BANK POLICY AND RESEARCH BULLETIN. 1998 Jan-Mar; 9(1):1-5.According to the 1997 World Bank Policy Research Report "Confronting AIDS: Public Priorities in a Global Epidemic," 250 million people live in countries with generalized epidemics, where the rate of infection is highest among people who have the most risky behavior and at least 5% of women attending antenatal clinics are infected with HIV. Countries in this group include most countries of eastern and southern Africa, a few West African countries, and Guyana and Haiti. 1.6 billion people live in countries with concentrated epidemics, where more than 5% of those with the riskiest behavior are infected with HIV, but the rate of infection among pregnant women is low. Most of Indochina, Latin America, and West Africa, as well as China's Yunnan Province and about half of India are in this category. Half of the population of the developing world, 2.3 billion people, live in areas with nascent epidemics. Especially governments in countries with nascent epidemics need to take immediate action to prevent the further spread of HIV. This paper explains the reasons why government action is needed and what governments should do to prevent the spread of HIV infection and help people with AIDS. Prevention must be the key strategy of AIDS policy in developing countries, focusing upon changing the behavior of those at highest risk of contracting and spreading the virus. Efforts must also be made to disseminate information on HIV/AIDS, lower the cost of condom use, and lower the cost of unsafe injecting behavior. As much as they can with constrained resources, governments need to improve access to treatment for people with AIDS and prevent discrimination against them. Donor support for national AIDS programs is often critical.
In: Background papers, Human Development Report 1995, [compiled by] United Nations Development Programme [UNDP]. New York, New York, UNDP, 1996. 89-104.The introduction of this background paper for the UN's 1995 Human Development Report, which examines the analytical and political visibility of the work of social reproduction, notes that social reproduction currently occupies a blank space in current economic analyses that lack a macro-framework capable of revealing the role of social reproduction of people as well as the gender and class conflicts that exist in the capitalist relationship between profit production and social reproduction. The first section of the paper discusses the difficulty of integrating domestic work into economic analysis in a way that acknowledges the differences between the production of commodities and the reproduction of the species. Section 2 places the sector and process of reproduction in the more systematic analytical location through use of the perspective of livelihood economies. The third section offers a classical surplus approach as a means of visualizing the conflicts inherent in the capitalist production-reproduction relationship, and this approach is used in the fourth section to locate domestic work in a macro economic analysis. Section 5 presents the present structuring of the global labor markets as the context in which reproduction and paid/unpaid labor must be analyzed, and section 6 assesses the gender policies of the World Bank to determine their capacity for challenging mainstream theories. The final section argues for a strategic policy of reversing the direction of the production-reproduction relationship by making production and markets responsible and accountable institutions that contribute to human welfare.
Conservation of West and Central African rainforests. Conservation de la foret dense en Afrique centrale et de l'Ouest.
Washington, D.C., World Bank, 1992. xi, 353 p. (World Bank Environment Paper No. 1)This World Bank publication is a collection of selected papers presented at the Conference on Conservation of West and Central African Rainforests in Abidjan, Ivory Coast, in November 1990. These rainforests are very important to the stability of the regional and global environment, yet human activity is destroying them at a rate of 2 million hectares/year. Causes of forest destruction are commercial logging for export, conversion of forests into farmland, cutting of forests for fuelwood, and open-access land tenure systems. Other than an introduction and conclusion, this document is divided into 8 broad topics: country strategies, agricultural nexus, natural forestry management, biodiversity and conservation, forest peoples and products, economic values, fiscal issues, and institutional and private participation issues. Countries addressed in the country strategies section include Zaire, Cameroon, Sao Tome and Principe, and Nigeria. The forest peoples and products section has the most papers: wood products and residual from forestry operations in the Congo; Kutafuta Maisha: searching for life on Zaire's Ituri forest frontier; development in the Central African rainforest: concern for forest peoples; concern for Africa's forest peoples: a touchstone of a sustainable development policy; Tropical Forestry Action Plans and indigenous people: the case of Cameroon; forest people and people in the forest: investing in local community development; and women and the forest: use and conservation of forestry resources other than wood. Topics in the economic values section range from debt-for-nature swaps to environmental labeling. Forestry taxation and forest revenue systems are discussed under fiscal issues. The conclusion discusses saving Africa's rainforests.
Washington, D.C., World Bank, 1989. xiii, 100 p. (UNEP-World Bank Symposium)The World Bank and the UN Environment Programme (UNEP) have published a book of selected papers presented at a series of workshops (1983-1988) on environmental accounting and its use in development policy and planning. The book also contains three contributions not presented at the workshops but written by workshop participants. Most chapters centers on financial and economic factors and the possibilities of revising the UN System of National Accounts (SNA) to include environmental and natural resource issues. The first chapter reviews environmental and resource accounting and includes a discussion of the failings of current national income measures as well as the depletion of natural resources. The second chapter proposes a measure of sustainable net national product. The third chapter presents a proper measurement of income from depletable natural resources. The fourth chapter suggests a means to introduce natural capital into the SNA. The fifth chapter describes measuring pollution with the national accounts system. Next the book provides guidelines to correct national income for environmental losses. A whole chapter is devoted to the French model of environmental accounting in development policy. A chapter on linkages between environmental and national income accounts follows the French model. The ninth chapter is a discussion on environmental and nonmarket accounting in developing countries. The tenth chapter outlines a proposed environmental accounts system. The eleventh chapter discusses environmental accounting and the system of national accounts. An account of recent developments and future works conclude this volume. The appendix lists the participants at the joint UNEP-World Bank workshops.
Washington, D.C., World Bank, Population, Health and Nutrition Division, 1992 Jan. , 58,  p. (HSPR-32)Each year, neonatal tetanus causes the death of 750,000 infants and nonneonatal tetanus causes the death of 120,000 to 300,000 people. Immunization of women with tetanus toxoid and aseptic handling of the umbilical cord fully prevents neonatal tetanus. In unimmunized populations, prevention of neonatal tetanus decreases neonatal mortality as much as 50% and infant mortality as much as 25%. More and more people are realizing that the incidence of neonatal tetanus can serve as an indicator of the health status and welfare of mothers and newborns. Each case of neonatal tetanus confirms many breakdowns of the health system. The high incidence rates in poorer countries, high case fatality rates even with treatment, high costs of treatment, and availability of a safe, highly efficacious, and cost-effective vaccine point to the need to make prevention of neonatal tetanus a high priority in terms of resource allocation. Local health workers and communities themselves must determine strategies for vaccinating women with the tetanus toxoid. Some factors they should consider include incidence, amount of resources available, organization and utilization of health services, and cost effectiveness of other health interventions and strategies. Mass campaigns in Haiti and Indonesia have contributed greatly to reducing the surplus of the unimmunized in the target population. In most cases, however, continuous immunization through established health services is needed to ensure continued tetanus toxoid coverage. WHO is mobilizing to eliminate neonatal tetanus worldwide by 1995, but since Clostridium tetani is in the environment, it cannot be eradicated. Therefore, reaching this goal requires constant vaccination efforts to achieve active immunization forever. Most countries can afford to eliminate neonatal tetanus because its cost is reasonable (US$9.3-US$10.5 [the highest number is from a private hospital in Iran and far exceeds the cost found elsewhere]), but donors need to support the poorest countries.