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HEALTH FOR THE MILLIONS. 1993 Jun; 1(3):8-10.India has massive problems and is in need of improving and expanding non governmental organization (NGO) programs by broadening the scope of NGO activities, identifying successful NGO activities, and by moving closer to the community to participate in their activities. The problems and experience in the last few decades indicate that with expansion bureaucratization takes place. The institution begins to depend on donors and follows donor-driven agendas. As more money is given by the government, many more so called GONGO or Government-NGO projects materialize. Another problem is that the government almost always approaches the NGOs for the implementation of a project, and there is complete lack of cooperation at the planning stage. The government is considering a loan from the World Bank and UNICEF to launch a mother and child health program, but there has not been any discussion with the dozens of people who have worked on issues concerning mother and child health issues for many years. There is a need to be more demanding of the government about the various programs that are implemented for the government. Very few NGO health and family welfare projects are run by ordinary nurses or ordinary Ayurvedic doctors under ordinary conditions. Since successful NGO work has to be extended to other parts of the country, they will have to be run by ordinary people with very ordinary resources. Over the years, the NGO community has become preoccupied with its own agenda. Today, despite very sophisticated equipment and infrastructure, they are not able to reach the 60,000-70,000 workers and employees. Some of the ideas with respect to the strengthens and weaknesses of community participation have to be shared. NGOs should include all the existing non governmental organizations throughout the country, and have a dialogue with other nongovernmental bodies such as trade unions. The challenge is to adjust the current agenda, prevailing style, and present way of operating and move closer to the people.
Draft team member contributions to mid-term evaluation of the Population and Family Planning Project (608-0171) in Morocco.
[Unpublished] 1988 Mar. 13 p.The draft team member contributions to the mid-term evaluation of the population and family planning project in Morocco examine current progress and address future needs. Increased awareness of at least 1 method of family planning was attributed to a USAID-funded project. But, problems of access, religious constraints, and lack of method-specific media campaigns need to be addressed. An increased effort to direct promotion efforts toward men is needed, as a prior immunization program showed that the husband was a key factor in encouraging mothers to bring their children to be vaccinated. Because the local health worker plays a critical role at the community level, training and support for these workers should be emphasized. Media-specific and audience-specific campaigns, by the government and private sector, should focus on the most cost-effective means of reaching the provincial level population. Donor organizations (such as UNICEF, UNFPA and USAID) should address the IEC needs identified by the central health education office, whose role and supporting functions need to be strengthened. Content of family planning materials must be method-specific, using a systematic methodology to address problems of inappropriateness, inadequate contraceptive mix, and lack of field worker training materials. Improved distribution methods for existing materials, as well as increased use of television and mass media are viable options. Using the community more effectively by encouraging leader motivation and instituting incentives could help to improve promotional and distributional activities at the provincial level. An evaluation of training needs revealed that the workshop method of training may be overemphasized, and most health workers expressed a desire for lengthened training. The private sector could be sensitized to public health issues and needs and, in conjunction with out of country technical assistance, produce effective social marketing of contraceptives within the Moroccan context. Coordination with other donors would be beneficial, with the exchange of documents and meetings between the groups.
Report of the Task Force II on research inventory and analysis of family planning communication research in Bangladesh.
[Dacca, Bangladesh, Ministry of Information and Broadcasting] Oct. 1976. 85 p.Topics relevant to family planning such as interpersonal relationships, communication patterns, local personnel, mass media, and educational aids, have been studied for this report. The central theme is the dissemination of family planning knowledge. The methodology of education and communication are major factors and are emphasized in the studies. While the object was to raise the effectiveness of approaches, the direct concern of some studies was to examine a few basic aspects of communication dynamics and different human relationship structures. Interspouse communication assumes an important place in the family planning program and a couple's concurrence is an essential precondition of family planning practice. Communication between husband and wife varies with the given social system. A study of couple concurrence and empathy on family planning motivation was undertaken; there was virtually no empathy between the spouses. A probable conclusion is that there was no interspouse communication on contraception and that some village women tend to practice birth control without their husband's knowledge. Communication and personal influence in the village community provide a leverage for the diffusion of innovative ideas and practices, including family planning. Influence pattern and flow of communication were empirically studied in a village which was situated 10 miles away from the nearest district town. The village was found to have linkage with outside systems (towns, other villages, extra village communication network) through an influence mechanism operative in the form of receiving or delivering some information. Local agents--midwives, "dais," and female village organizers are in a position to use interpersonal relations in information motivation work if such agents are systematically involved in the family planning program and are given proper orientation and support by program authorities. These people usually have to be trained. 7 findings are worth noting in regard to the use of radio for family planning: folksongs are effective and popular; evening hours draw more listeners; the broadcast can stimulate interspouse communication; the younger groups can be stimulated by group discussions; a high correlation exists between radio listening and newspaper reading; most people listen to the radio if it is accessible to them; approximately 60% of the population is reached by radio. A positive relationship was found to exist between exposure to printed family planning publicity materials and respondents' opinions toward contraception and family planning. The use of the educational aid is construed as an essential element to educating and motivating people's actions.
Africa Link. 1979 Jul; 3-4.A meeting to discuss the development of strategies for audio-visual communciation in family planning programs was held in Nairobi, Kenya in April 1979. The meeting was part of a larger project concerning the role of audio-visuals in the IPPF African Region programs. The project was initated at a working session in Morocco in February 1979. The second phase of the project included field visits to Gambia, Sierra Leone, Liberia, Ghana, Lesotho, Swaziland, Mauritius, Zambia, and Kenya for the purpose of evaluating the present status of audio-visual communications in these countries. The Nairobi meeting represented the 3rd phase in the project and undertook the task of using the information collected in the field studies to develop recommendations for the future use of audio-visual materials. A final phase of the project will consist of 4 workshops to be held in Gambia, Mauritius, Togo, and Kenya during 1979 and 1980; the purpose of workshops will be to train fieldwork supervisors in the development and use of low-cost audio-visual materials. The present document presents a summary of the remarks made by the IPPF African Regional Director, Mr. Sozi, in his opening address to the Nairobi meeting participants. Mr. Soki recommended that 1) audio-visual materials should be relevant to each particular program and project goal; 2) the production and acquisition of these materials must take into account local needs, resources, and facilities; and 3) duplication of resources can be avoided by regional cooperative efforts. The eventual goal of the project is to help the African Region countries become self-sufficient in audio-visual communication.
Honolulu, Hawaii, East-West Communication Institute, July 1977. (A Synthesis of Population Communication Experience Paper No. 2) 148 pThe aims and purposes of communication training are examined, tracing the evolution of training in family planning communications from the early stages of national program developments to the present. Topics discussed include training needs and the clientele of training programs including those involved in face-to-face communications, personnel responsible for integrating interpersonal and mass communications, mass media personnel, and specialists in the production of communications materials. Other topics covered include training for integrated family planning and development programs, national and regional training centers, university based/academic programs, the training of trainers, and training facilities. Examples of both successful and unsuccessful training programs are used to illustrate the many different aspects of population/family planning communications training. An assessment is made of recent developments and future prospects in the field.(AUTHOR'S, MODIFIED)
IPPF Situation Report, June 1973. 10 p.The Indonesian Planned Parenthood Association (IPPA) was founded in 1957 and pioneered family planning services. It made little headway duri ng the pronatalist Sukarno regime, but in 1967 the present government announced an intensive family planning program and the IPPA was named as an implementing unit in 1971. 2 primary roles now are the training activities for fieldworkers and the development of community education and motivation programs. This complements the national mass media program. In 1970 the government took over all clinics except those in the Outer Islands (the islands outside Java, Bali, and Madura). The IPPA runs 150 clinics in the Outer Islands, is responsible for all supplies and maintenance, and has a number of model clinics in Java and Bali. The Community Education program has 8 components: speakers bureau, family planning clubs, mobile audiovisual units, exhibitions, tr aditional media, special events, local mass media support, and evaluatio n. In 1971 the 'ippa trained 2951 people; in 1972 this was increased by 25%. In 1973 the target is training 3000 fieldworkers with 16 centers for training and 16 field demonstration areas. An agreement with the U.N. Fund for Population Activities/International Development Association (UNFPA/IDA) will provide for building, equipping, and staffing. The research and evaluation function is also expanding to complement government activities. The government program aims to train 20,250 medical and paramedical personnel over 5 years and medical schools have incorporated the teaching of population and family planning. Government allowances are being curtailed for all children over 3 for government workers. An active clinic program aims to set up 1200 fully equipped and 1250 moderately equipped facilities by 1973. An active media campaign has been launched and for the 1st time in the population field the UNFPA and the IDA are helping to finance a project to expand a family planning program and broaden its activities. This su pport will provide for physical facilities, technical assistance, training, motivation, evaluation, research, and population education.
Seventh annual report of the St. Vincent Planned Parenthood Association, 1 January-31 December 1972.
Kingston, Jamaica, St. Vincent, 1973. 28 p.The activities during 1972 of the International Planned Parenthood Association on the island of St. Vincent, a 150 square mile dependency of Great Britain in the eastern Carribean with a population in 1972 of 92,000. Although supported by an annual Government grant, the IPPF program is the only one on the island. The events of Family Planning Week in June 1972, one of the IPPF's more important promotional activities, are described in the introductory section. Other social marketing activities of field nurses and fieldworkers, consisting primarily of visits to Government health clinics and maternity wards, as well as an average of 18 home visits a day by fieldworkers during the year, are emphasized. In addition, substantial follow-up efforts were conducted to get dropouts back into the program. Statistics are provided on the age groups and contraceptive method chosen by those who restarted. Other data are provided on the total number of active acceptors, contraceptive methods chosen by acceptors and the number of dropouts during 1972. Detailed financial statements of the St. Vincent Planned Parenthood Association, consisting of a balance sheet, revenue and expenditures, and fixed assets, are provided for the 1972 calendar year.
Country Profiles. 1971 Apr; 12.The 1970 estimated population of Indonesia was 118,000,000, making it the fifth largest nation in the world. In 1961 the mean age at marriage for males was 24.3 years, for females 19.2 years. The birthrate is estimated at 43 to 45 per 1000, and the death rate at 17-19, causing a growth rate of about 2.8%. In 1970 about 50% of the population was literate. Rapid population growth is helping to restrict economic development, increasing unemployment problems, and negating expansion of social welfare programs. While the government of Indonesia supports family planning, it still maintains several pronatalist policies. Existing health facilities are utilized for family planning information and to stimulate referrals to clinic facilities. In 1969, 26,400 new acceptors chose IUDs, 15,000 chose orals, and 9,000 chose other methods. While in the past the Indonesian Planned Parenthood Association conducted an equal role with the National Family Planning Institute. Because of grave economic problems Indonesia is now attaching high priority to the national family planning program to reduce the rate of population growth.
IPPF Situation Report, September 1972. 7 pHong Kong, with 3858 people/sq km, is 1 of the world's most densely populated areas. Family planning was introduced in 1936 by the Hong Kong Eugenics League and 5 clinics were operating by 1940. The Family Planning Association (FPA) was formed in 1950 and was a founder member of IPPF in 1952. Interest in family planning increased as massive immigration from China added to overcrowding. The government supports FPA (in 1972 the grant was U.S.$254,545) and houses 80% of the FPA clinics in government properties. At present there are 46 female clinics providing 189 sessions per week and 2 male clinics operating eac h week. The decline from 54 to 48 clinics is due to the new emphasis on full-time rather than part-time clinics. In 1971 there were 347,894 attenders, an increase of 18% over 1970, and 31,898 new acceptors, an increase of 4%. There has been continued increase in the number of patients requesting oral contraceptives (70.6% in 1971). The IUD began to decline after bad publicity surrounded a large number of loops which had broken in the uterus; in 1971 only 6% of acceptors asked for IUDs. Condoms account for 11.5% and injectables, 3.6%. FPA offers subfertility and marriage guidance services and is extending its Papanicolaou smear service. An active media campaign, exhibitions, and seminars are conducted. Until 1967 fieldwork consisted of random home visits. An efficiency study led to concentration on maternal and child health clinics, postnatal clinics, and follow-up home visits. Home visi ts are still made on request. A number of international trials for various contraceptives have been run in Hong Kong. Many church and international organizations are helping to finance family planning activities, both through FPA and through their own organizations.
Horizons. 1983 Apr; 2(4):14-20.In Honduras and the Gambia the US Agency for International Development's (AID's) Bureau for Science and Technology and its contractors, working with the Ministry of Health in each country and drawing upon experts in health communications, anthropology, and behavioral psychology, have developed a health education methodology that integrates mass media and health providers. The project uses radio, graphics, and the training of village health workers to teach mothers how to treat and prevent diarrheal dehydration. The World Health Organization (WHO) and the AID assisted International Center for Diarrheal Disease Research in Bangladesh, have demonstrated that lost body fluid and electrolytes can be replaced with an orally administered solution. The treatment is known as ORT, oral rehydration therapy. AID efforts in Honduras and Gambia are showing that semi-literate persons, contacted primarily through the mass media, can be taught to mix and administer ORT. The campaign also includes a number of preventive measures. The Gambian government chose to use ORT packets prepared according to the WHO formula at health centers as a backup to the similar home mix solution. Honduras chose to package their own ORT salts, following the WHO formula, for use both at health centers and in the home. In Gambia the Ministry of Health created a national contest which kicked off with the distribution of 200,000 copies of a flyer carrying mixing instructions to nearly 2000 Gambian villages. Repeated radio announcements in Gambia's 2 major languages told mothers to gather and listen to contest instructions. The radio announcer led listeners through each panel of the color coded flyer which told them how to mix and administer ORT. 11,000 women attended the 72 village contests. Of the 6580 who entered the mixing competition, 1440 won a chance to compete and 1097 won prizes for correct mixing. After 8 months of campaign activities, the number of mothers who reported using a sugar-salt solution to treat their children's diarrhea rose from 3% to 48% (within the sample of some 750 households). The number of women who could recite the formula jumped from 1% to 64%. In Honduras a keynote poster for the campaign that featured a loving mother was distributed simultaneously with the airing of the 1st phase of the radio spots and programs. Within a year 93% of the mothers knew that the radio campaign was promoting Litrosol, the name of the locally packaged ORT salts; 71% could recite the radio jingle stressing the administration of liquid during diarrhea, and 42% knew that Litrosol prevented dehydration. 49% of all mothers in the sample had tried Litrosol at least once during the campaign.
[Unpublished] . 24 p.Focus in this annual report of the Executive Director of the Planned Parenthood Federation of Nigeria (PPFN) for 1982 is on the following: program development and implementation; Planfed News Magazine; community education; family life education (FLE) for youth and adults; resource development and integration; FLE seminar for curriculum developers and trainees; family planning training for nurses and midwives; program impact evaluation; program management; administration and general services; commodities (contraceptives, clinic supplies and equipment, audiovisual equipment, and vehicles); volunteer inputs; branch activities, fieldwork; sessional clinic services; administrative and financial accounting; and interagency collaboration. The 1982 program year witnessed an era of new initiatives and renewed efforts in all aspects of PPFN operations, particularly in program development, management, and administration. Program implementation was improved and strenghened through the establishment of new and the revision of old operational procedures and guidelines. Staff of the Program Development Department (PDD) visited 15 branches to monitor and supervise activities and to provide technical assistance as required. The most prominent accomplishment for 1982 was in the area of contraceptive service delivery. A more than 22% increase was realized in the number of new family planning acceptors recruited and served, compared with the figure for 1981. Program development efforts for the year focused on initiating new or modifying and strengthening existing strategies that would enhance and facilitate the development of more effective, innovative, and community based family planning education and service projects and activities. 2 separate issues of Planfed News Magazine were published on schedule during the year, and 5000 copies of each were printed. The operational objectives of the community education project were the organization of radio and television discussion programs in Kano and Kaduna; broadcasting of radio spot announcements in Oyo, Lagos, Anambra, Bendel, Ondo, Rivers, and Cross River States; and the production of 5000 annual calendars and 5000 Christmas greeting cards. Program impact evaluation revealed that over 26% of the 925 respondents in 15 locations throughout Nigeria received family planning information from PPFN fieldworkers. Other sources of information included doctor, nurse/midwife, friend, relative, and the mass media.
Appropriate Technology for Health Newsletter. 1983; (12):1-22.Human nutrition is a dynamic science concerned with nutritional requirements, food composition, food consumption, food habits, the relationship between diet and health, and research in this field. This article touches on these aspects as they relate to prospective mothers and the care of their children, especially in the first 5 years of life, with a focus on developing countries. It deals with details of birth intervals, adequate breastfeeding, and adequate nutrition for both mother and child to help prevent malnutrition and deficiency diseases. Stress is laid on factors of children's growth such as body weight and height that primary health care workers must monitor while they work in the context of any culture. Programs for improved nutrition need to be drawn up with respect to the traditions and values of indigenous cultures. The article concludes with bibliographies dealing with 1) women, children and nutrition, 2) nutrition and primary health care, and 3) community development.
World Health Forum. 1983; 4(2):157-61.In developing countries, the delivery of basic health care services is often hampered by communications problems. A pilot project in Guyana, involving 2-way radio in 9 medex (medical extension) locations, was funded by USAID (United States Aid for International Development). A training manual was prepared, and a training workshop provided the medex workers with practical experience in using the radios. The 2-way radios have facilitated arrangements for the transport of goods, hastened arrangements for leave, and shortened delays in correspondence and other administrative matters. Communication links enable rural health workers to treat patients with the advice of a doctor and allow doctors to monitor patient progress. Remote medex workers report that regular radio contacts with their colleagues have lessened their sense of isolation, boosted their morale, and helped build their confidence. 1 important element of the project was the training given to the field workers in proper use of the radio and in basic maintenance. Another key to the success of the system appears to be the strength and professionalism of the medex organization itself. Satellite systems may eventually prove to be the most cost effective means of providing rural telephone and broadcasting services and may also be designed to include dedicated medical communications networks at very little additional cost.