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Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2017 Jan. 18 p. (Working Paper WP-17-171; USAID Cooperative Agreement No. AID-OAA-L-14-00004)In 2011, the U.S. Agency for International Development (USAID) published its Evaluation Policy. The policy emphasizes the need to conduct more evaluations of its programs to ensure greater accountability and learning, and it outlines best practices and requirements for conducting evaluations. Since releasing the policy, USAID has commissioned an increasing number of evaluations of its programs. The importance of evaluations for international public health programs has been long recognized, with demand for such evaluations coming from both internal and external sources. Donors or those external to program implementation seek evidence of accomplishments and accountability for resources spent, whereas those involved in program implementation seek evidence to inform and improve program design. Within USAID, the need for more evaluations was driven by the understanding that evaluations provide information and analysis that prevent mistakes from being repeated and increase the likelihood of greater yield from future investments. Finally, there is overall recognition that evaluations should be of high quality and driven by demand, and that results should be communicated to relevant stakeholders. Despite the increased demand for evaluations, there is limited evaluation capacity in many countries where international development programs are implemented. Before strategies to strengthen evaluation capacity can be implemented, it is important first to assess existing evaluation capacity and develop action plans accordingly. We conducted a review of existing assessment tools and guidance documents related to assessing organizations’ capacity to carry out evaluations of international public health programs in order to determine the adequacy of those materials. Here, we summarize the key findings of our review of the literature and provide recommendations for the development of future tools and guidance documents.
Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.
Archives of Pediatrics and Adolescent Medicine. 2009 Feb; 163(2):126-30.OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs.
International Family Planning Perspectives. 2008 Jun; 34(2):101-102.At the midpoint of the 15-year timetable for achieving the Millennium Development Goals, the majority of countries with high levels of maternal and child mortality are not on track to meet the targets for reductions in these outcomes by 2015, according to a recent analysis.1 Among the 68 countries that account for the vast majority of maternal and child deaths, only 16 are on track to reduce mortality among children younger than five to one-third of its 1990 level (Goal 4). Progress toward reducing maternal mortality by three-quarters (Goal 5) has been slow as well: In all 41 Sub-Saharan African countries included in the analysis, at least 300 maternal deaths occur per 100,000 live births. The research was conducted by Countdown to 2015, a collaboration of researchers, policymakers and other stakeholders that has been tracking progress toward the Millennium Development Goals in the 68 countries in which 97% of deaths among women of childbearing age and children younger than five occur. Researchers focused on determining coverage rates (the proportion of individuals in each country who need a service and are able to obtain it) for interventions that have been proven to avert maternal, newborn and child deaths, that can be widely implemented in resource-poor countries, and whose levels can be reliably estimated across countries and over time; these interventions include provision of contraceptive and STI services, skilled care during childbirth, and pre- and postnatal care. Most of the data were obtained through nationally representative household surveys. (excerpt)
MEASURE Evaluation Bulletin. 2001; (2):1-27.This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2008. 20 p.The first few days and weeks of life are among the most critical for child survival. Every year, an estimated 4 million children die during the first month of life. Almost all of these deaths (98%) occur in developing countries. Most neonatal deaths are due to ore-term birth, asphyxia and infections such as sepsis, tetanus and pneumonia. In 2006-2007, to support efforts by countries and regions to reduce newborn deaths, we worked to build capacity for the planning and delivery of improved newborn care services in health facilities and communities, to provide tools and guidance for extending population coverage, and to evaluate the impact of all those actions. (excerpt)
Putting young people into national poverty reduction strategies: a guide to statistics on young people in poverty.
New York, New York, United Nations Population Fund [UNFPA], . 35 p.Many national poverty reduction strategies overlook the needs of young people. Even where national strategies do have a youth focus, the analysis of their situation is limited because little or no reference is made to readily available data. For those advocating on behalf of young people in poverty, considerable scope exists to make use of simple but reputable statistics to mount a strong case for Governments and civil society to allocate more resources in addressing poverty among this major population group. The purpose of this guide is to show how relevant statistics on young people in poverty can be easily sourced for use in developing national poverty reduction strategies. The guide shows how to use accessible databases on the Internet to provide individual countries with sophisticated statistical profile of young people in poverty. (excerpt)
Monitoring the Declaration of Commitment on HIV / AIDS. Guidelines on construction of core indicators. 2008 reporting.
Geneva, Switzerland, UNAIDS, 2007 Apr. 139 p. (UNAIDS/07.12E; JC1318E)The primary purpose of this document is to provide key constituents who are actively involved in a country's response to AIDS with essential information on core indicators that measure the effectiveness of the national response. These guidelines will also help ensure the consistency and transparency of the process used by national governments. In addition, this information can be used by UNAIDS to prepare regional and global progress reports on implementation of the United Nations General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS. Countries are strongly encouraged to integrate the core indicators into their ongoing monitoring and evaluation activities. These indicators are designed to help countries assess the current state of their national response while simultaneously contributing to a better understanding of the global response to the AIDS pandemic, including progress towards meeting the targets in the Declaration of Commitment on HIV/ AIDS. Given the dual purposes of the indicators, the guidelines in this document are designed to improve the quality and consistency of data collected at the country level, which will enhance the accuracy of conclusions drawn from the data at both national and global levels. This document also includes an overview of global indicators that will be used by UNAIDS and its partners to assess key components of the response that are best measured on a worldwide basis. (excerpt)
Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice Collection; UNAIDS/07.11E; JC1291E)This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Bulletin of the World Health Organization. 2007 Oct; 85(10):734.posited that the process of development entails changes in incomes over time. Larger income levels achieved via positive economic growth, appropriately discounted for population growth, would constitute higher levels of development. As many have noted, however, the income measure fails to adequately reflect development in that per-capita income, in terms of its levels or changes to it, does not sufficiently correlate with measures of (human) development, such as life expectancy, child/infant mortality and literacy. The United Nations Development Programme's (UNDP) human development index (HDI) constitutes an improved measure for development. HDI has been modified to be gender-sensitive with variants that reflect gender inequality. Various measures reflecting Sen's "capability" concept, such as civil and political rights, have also been incorporated. Countries where the level of poverty is relatively large tend also to exhibit low values of human development, thus lowering the mean values of the development measures. Where inequalities of development indicators are very large, however, the average values may not sufficiently reflect the conditions of the poor, requiring the need to concentrate on poverty per se. (excerpt)
African Population Studies/Etude de la Population Africaine. 2006; 21(1):19-36.Relatively scant knowledge is available on the situations of older persons in sub-Saharan Africa. Reliable and accessible demographic and health statistics are needed to inform policy making for the older population. The process and outcome of a project to create a minimum data set (MDS) on ageing and older persons to provide an evidence base to inform policy are described. The project was initiated by the World Health Organization and conducted in Ghana, South Africa, Tanzania and Zimbabwe. A set of indicators was established to constitute a sub-regional MDS, populated from data sources in the four countries; a national MDS was produced for each country. Major gaps and deficiencies were identified in the available data and difficulties were experienced in accessing data. Specific gaps, and constraints against the production and access of quality data in the subregion are examined. The project and outcome are evaluated and lessons are drawn. Tasks for future phases of the project to complete and maintain the MDS are outlined. (author's)
Good practices in combating and eliminating violence against women. Expert group meeting. Organized by: United Nations Division for the Advancement of Women in collaboration with United Nations Office on Drugs and Crime, 17 to 20 May 2005, Vienna, Austria. Report of the expert group meeting.
[New York, New York], United Nations, Division for the Advancement of Women, 2005.  p.Comprehensive multidisciplinary strategies are necessary to combat violence against women. Governments, non-governmental organizations and women's rights activists all over the world have used different approaches in dealing with violence against women, with varying degrees of success. To gain an understanding of what makes an approach to combat violence against women effective, the United Nations Division for the Advancement of Women, in collaboration with the United Nations Office on Drugs and Crime, convened a group of experts in Vienna from 17 to 20 May 2005. The purpose of the meeting was to identify the factors which make a specific initiative, or type of initiative, a good practice example, evaluate the determinants or indicators of the effectiveness of strategies in various areas and identify legislation, plans, policies and other approaches that have been effective in combating violence against women. The aim of the expert group meeting was to arrive at a set of recommendations on 'good practice examples' in combating and eliminating violence against women. This report lays out the expert group's recommendations for elements of effective practices in combating violence against women in the areas of law, prevention, and provision of services. (excerpt)
Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation.
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:88-93.The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/ AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/AIDS [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:80-87.The paper critically analyzes, from the gender standpoint, official results presented in the Brazilian government report to the Joint United Nations Programme on HIV/ AIDS (UNAIDS). Specifically, the fulfillment of 2003 targets set forth in the United Nations Declaration of Commitment on HIV/AIDS, under the category of Human Rights and Reduction of the Economic and Social Impact of AIDS, are evaluated. Key concepts are highlighted, including indicators and strategies that may help civilian society better monitor these targets until 2010. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:94-100.The objective of this study was to analyze, on the national level, the process of monitoring the proposed UNGASS indicators through the use of the Brazilian National Program for STD/AIDS's indicators. Two groups of proposed indicators were analyzed in 2002 and 2005 respectively, as part of the monitoring of the progress of the UNGASS Declaration of Commitment. The availability of information and limitations in calculating the proposed indicators in Brazil were analyzed and the appropriateness of the indicators for monitoring the epidemic in Brazil was discussed. Of the 13 quantitative indicators originally proposed by UNGASS, five were not included in the National Program. One was not included due to its qualitative nature. Two of the indicators were considered to be of little use and two were not included due to the lack of available data needed for their calculation. As the epidemic in Brazil is characterized as being concentrated, within the second group of proposed UNGASS indicators those that refer to the accompaniment of epidemic among high-risk population groups were prioritized. The study highlights that the National Program concentrates its efforts in the development, adaptation, and sharing of sampling methodologies for hard to reach populations. Such activities are geared towards estimating the size of vulnerable population groups, as well as obtaining more information regarding their knowledge, attitudes, and practices. The study concludes that by creating the possibility of international comparisons between advances achieved, the proposal of supranational indicators stimulates countries to discuss and make their construction viable. In a complementary way, the national monitoring systems should focus on program improvement by covering areas that permit the evaluation of specific control and intervention actions. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S60-S65.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) African site was Accra, Ghana. Its sample was drawn from 10 affluent residential areas where earlier research had demonstrated the presence of a child subpopulation with unconstrained growth. This subpopulation could be identified on the basis of the father's education and household income. The subjects for the longitudinal study were enrolled from 25 hospitals and delivery facilities that accounted for 80% of the study area's births. The cross-sectional sample was recruited at 117 day-care centers used by more than 80% of the targeted subpopulation. Public relations efforts were mounted to promote the study in the community. The large number of facilities involved in the longitudinal and cross-sectional components, the relatively large geographic area covered by the study, and the difficulties of working in a densely populated urban area presented special challenges. Conversely, the high rates of breastfeeding and general support for this practice greatly facilitated the implementation of the MGRS protocol. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S53-S59.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) South American site was Pelotas, Brazil. The sample for the longitudinal component was drawn from three hospitals that account for approximately 90% of the city's deliveries. The cross-sectional sample was drawn from a community survey based on households that participated in the longitudinal sample. One of the criteria for site selection was the availability of a large, community based sample of children whose growth was unconstrained by socioeconomic conditions. Local work done in 1993 demonstrated that children of families with incomes at least six times the minimum wage had a stunting rate of 2.5%. Special public relations and implementation activities were designed to promote the acceptance of the study by the community and its successful completion. Among the major challenges of the site were serving as the MGRS pilot site, low baseline breastfeeding initiation and maintenance rates, and reluctance among pediatricians to acknowledge the relevance of current infant feeding recommendations to higher socioeconomic groups. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S66-S71.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S78-S83.The World Health Organization (WHO) Multicentre Growth Study (MGRS) Middle East site was Muscat, Oman. A survey in Muscat found that children in households with monthly incomes of at least 800 Omani Rials and at least four years of maternal education experienced unconstrained growth. The longitudinal study sample was recruited from two hospitals that account for over 90% of the city's births; the cross-sectional sample was drawn from the national Child Health Register. Residents of all districts in Muscat within the catchment area of the two hospitals were included except Quriyat, a remote district of the governorate. Among the particular challenges of the site were relatively high refusal rates, difficulty in securing adherence to the protocol's feeding recommendations, locating children selected for the cross-sectional component of the study, and securing the cooperation of the children's fathers. These and other challenges were overcome through specific team building and public relations activities that permitted the successful implementation of the MGRS protocol. (author's)
Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S27-S36.Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S37-S45.The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S5-S14.The rationale for developing a new international growth reference derived principally from a Working Group on infant growth established by the World Health Organization (WHO) in 1990. It recommended an approach that described how children should grow rather than describing how children grow; that an international sampling frame be used to highlight the similarity in early childhood growth among diverse ethnic groups; that modern analytical methods be exploited; and that links among anthropometric assessments and functional outcomes be included to the fullest possible extent. Upgrading international growth references to resemble standards more closely will assist in monitoring and attaining a wide variety of international goals related to health and other aspects of social equity. In addition to providing scientifically robust tools, a new reference based on a global sample of children whose health needs are met will provide a useful advocacy tool to health-care providers and others with interests in promoting child health. (author's)
Integration of the human rights of women and the gender perspective: violence against women. The Due Diligence standard as a tool for the elimination of violence against women. Report of the Special Rapporteur on violence against women, its causes and consequences, Yakin Erturk.
[Geneva, Switzerland], United Nations, Commission on Human Rights, 2006 Jan 20. 27 p. (E/CN.4/2006/61)This is my third report to the Commission in my capacity as the Special Rapporteur on the violence against women, its causes and consequences, submitted pursuant to Commission resolution 2005/41. Chapter I of the report summarizes my activities in 2005 and chapter II examines the due diligence standard as a tool for the effective implementation of women's human rights, including the right to live a life free from violence. The failure of international human rights law to adequately reflect and respond to the experiences and needs of women has stimulated much debate on the mainstream application of human rights standards. This has resulted in the transformation of the conventional understanding of human rights and the doctrine of State responsibility. The 1993 Declaration on the Elimination of Violence against Women as well as other international instruments adopted the concept of due diligence, in relation to violence against women, as a yardstick to assess whether the State has met its obligation. Under the due diligence obligation, States have a duty to take positive action to prevent and protect women from violence, punish perpetuators of violent acts and compensate victims of violence. However, the application of due diligence standard, to date, has tended to be State-centric and limited to responding to violence when it occurs, largely neglecting the obligation to prevent and compensate and the responsibility of non-State actors. (excerpt)
BMJ. British Medical Journal. 2006 May 6; 332(7549):1052.New growth charts for infants and young children can be applied globally, says the World Health Organization. The charts will enable doctors and others to detect and tackle growth related conditions, such as undernutrition, overweight, and obesity, at an early stage. The new child growth standards confirm that children given healthy growth conditions born anywhere in the world--be it India, Brazil, or Norway--have the potential to develop to within the same range of height and weight. They prove that differences in children's growth to the age of 5 are influenced more by nutrition, feeding practices, environment, and health care than by genetics and ethnic group. "The WHO child growth standards provide new means to support every child to get the best chance to develop in the most important formative years," said Dr Lee Jong-wook, WHO's director general. "In this regard, this tool will serve to reduce death and disease in infants and young children." (excerpt)
The challenge of Africa: ministers debate vicious cycle of poverty and conflict, new initiatives for development - UN Economic and Social Council.
UN Chronicle. 1995 Dec; 32(4): p..Faced with unrelenting impoverishment, marginalization and social strife engulfing Africa - home to the greatest proportion of least developed nations in the world - ministers from every region of the world convened during the 1995 session of the UN Economic and Social Council to tackle the complex range of interrelated issues and problems that have made the economic and social development of Africa a formidable challenge. "Today, this continent often baffles the world by continually giving the international community reasons for alternating between hope and discouragement", UN Secretary-General Boutros Boutros-Ghali said on 4 July in an address to the opening of the Council's three-day high-level segment, whose purpose is to set UN policy on major international matters. (excerpt)
Investing in people - eliminating poverty - includes related articles on Preparatory Committee's progress report and social development - World Summit for Social Development.
UN Chronicle. 1994 Dec; 31(4): p..A fifth of the world's population live in absolute poverty, earning scarcely 2 per cent of the world's income. The ill-effects of this economic deprivation are often compounded by ethnic tensions and warfare, which can lead to the local displacement of people and large refugee movements. There are some 17 million refugees and 20 million displaced persons in the world today, deprived of home, health and education, their lives and livelihoods destroyed. These people add not to their nations' productivity but to their overall economic burdens. "In the worst of instances, the survival of an entire society or nation is threatened because the essentials of life are beyond the reach of its people", concluded participants in the 46th Annual DPI/NGO Conference. (excerpt)