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Health service delivery in early recovery fragile states: lessons from Afghanistan, Cambodia, Mozambique and Timor Leste.
Arlington, Virginia, Partnership for Child Health Care, Basic Support for Institutionalizing Child Survival [BASICS], 2006 May.  p. (USAID Contract No. GHA-I-00-04-00002-00)This case study explores some key themes in the emerging literature on service delivery in fragile states in light of the health sector experience in four early recovery countries - Afghanistan, Cambodia, Mozambique, and Timor Leste. The analysis considers the various impacts of foreign assistance on state stewardship of the health sector and the programming implications. The investigation starts with state effectiveness and legitimacy. Findings point to the importance of and structural impediments to donor harmonization in reestablishing health services in a post-conflict context. United Nations (UN) coordination in all four countries was constrained by state avoidance strategies, a spike in aid flows that were out of sync with emerging government capacity, and-in Cambodia and Mozambique-an emphasis on highly visible but largely unsustainable infrastructure projects that were limited by the absence of a planning framework. Harmonization and alignment of aid systems and accountability requirements-current pillars of fragile states programming-were enabled through joint frameworks, common approaches, and trust funds that offered direct budget support that strengthened government systems, accountability, and a common policy framework in Afghanistan and Timor Leste. (excerpt)
Washington, D.C., National Academies Press, 2003. xii, 57 p.The present monograph--on rebuilding the health sector in East Timor following the nation's struggle for independence--is the second in this series. It provides an overview of the state of the health system before, during, and after reconstruction and discusses achievements and failures in the rebuilding process, using an informative case study to draw conclusions for potential improvements to the process in other post-conflict settings. Other topics under consideration in the series include reviews of current knowledge on psychosocial issues, reproductive health, malnutrition, and diarrheal diseases, as well as other case studies. (excerpt)
Report: Second Conference of Asian Forum of Parliamentarians on Population and Development, 23-25 September 1987, Beijing, China.
New York, New York, United Nations Population Fund [UNFPA], 1987. , 72 p.The formal proceedings of the 1987 Asian (AFPPD) Conference of Parliamentarians on Population and Development (FPPD) are provided in some detail. 23 countries participated. The Asian Forum Beijing Declaration preamble, program of action, call to action, and rededication are presented. Background information indicates that these conferences have been ongoing since 1984 to exchange information and experience, to promote cooperation, and to sustain involvement of Parliamentarians in population and development issues. Official delegations represented Australia, Bangladesh, China, Korea, India, Iraq, Japan, Malaysia, Maldives, Mongolia, Nepal, Pakistan, Philippines, north and south Korea, Sri Lanka, Syria, Thailand, and Vietnam. Observers were from Bhutan, Cyprus, Indonesia, Kiribati, and Tonga. The UN Fund for Population Activities (UNFPA) was involved as Conference Secretariat as well as the Preparatory Committee of China. Other UN and nongovernmental organizations and Parliamentary Councils of the World, Africa, and Europe were involved. Summaries were made of opening conference addresses of Mr. Takashi Sato, Mr. Zhou Gucheng, Chinese Premier Zhao Zivang, Japanese Prime Minister Takeo Fukuda, Dr. Nafis Sadik from the UNFPA, Mrs. Rahman Othman for Mr. Sat Paul Mittal of AFPPD, Australian Prime Minister R.J.L. Hawke, India Prime Minister Rajiv Ghandi, Sri Lankan Prime Minister R. Premedasa, Philippine President Corazon Aquino, Pakistan President Mohammad Zia-ul-Hag, and Bangladesh President Hussain Muhammad Ershad. Election of officers was discussed. The plenary sessions reported on the present situation and prospects for Asian population and development, basic health services and family planning (FP), urbanization, population and food, and aging. Reports were also provided of an exchange among Parliamentarians, the adoption of conference documents and the AFPPD constitution, election of officers, and the closing speakers. Appendices provide a complete list of participants, the constitution which was adopted, and the addresses of Mr. Zhou Gucheng from China's National People's Congress; Mr. Zhao Ziyang, Premier of the State Council of the People's Republic of China; Mr. Takeo Fukuda of the Global Committee of FPPD, Dr. Nafis Sadik, Executive Director, UNFPA; and Mr. Sat Paul Mittal, Secretary General, AFPPD.
Report of the second advisory group meeting held in Kuala Lumpur at the Hotel Majestic on the 18-19 September 1972.
[Unpublished] 1972. 67 p.This report of the proceedings of the 2nd Advisory Group Meeting covers the following: the workshop sessions; the progress report; the role and functions of the Intergovernmental Coordinating Committee (IGCC); and the speech of Encik Mohd. Khir Johardi. The progress report reviews all the projects and programs that will be initially implemented by the Secretariat IGCC: the regional program for observation and exchange of information; the regional program for exchange of experience through workshop in the various activities of family and population planning; clearinghouse activity; regional research project on thromboembolic disease; the special project to assist member countries without a national family planning program (Laotian Seminar, consultants for Khmer Republic, training 12 Khmers in the Philippines, the contraceptive supplies for the Khmer Republic); population and development planning workshop; joint ECAFE/IGCC/Government of Malaysia Training Course for Statisticians and Demographers; workshop on adult education and family planning; regional incentive program; Second Ministerial Conference and Third IGCC Meeting; and first obstetrician and gynecological meeting within the IGCC Member Countries. Member of the senior government officials who met at the 1st and 2nd Meeting were keen on the idea of exchange of professional staff among member countries for a short period of time. Some of the participants particularly at the 2nd Senior Government Officials Meeting felt that it is necessary to set up IGCC Regional Training Center to be utilized for the training of all facets of family planning program within the IGCC Region. Appendixes review backgrounds and objectives of the visits to Singapore, Indonesia, and the Philippines; report on the 1st Regional Training Workshop in Jakarta during December 1972, progress to date on clearinghouse activities, the ECAFE trip during August 1972, and the First National Seminar on Population and Family Well Being during August 1972; and discuss the population and development planning workshop proposal, the proposed workshop by IGCC on adult education and family life planning, and the proposed meeting of panel of regional advisers on sexual sterilization.
Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986.
New York, New York, United Nations, 1987. vi, 169 p. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)The Seminar on Mortality and Health Issues was held at Beijing from 22 to 27 October 1986 as a cooperative venture between the UN Economic and Social Commission for Asia and the Pacific (ESCAP) and the Institute of Population Research, People's University of China, as part of the project, "Analysis of Trends and Patterns of Mortality in the ESCAP Region." Part 1 of the report includes a summary of the Beijing recommendations on health and mortality and the report of the seminar. Part 2 contains papers on a comparative analysis on trends and patterns of mortality in the ESCAP region, an overview of the epidemiological situation in the region, health for all by the year 2000, and inequalities in health.
FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.
[Unpublished] 1985 Nov 19. Presented to the Executive Board, Seventy-seventh Session, Provisional Agenda Item 18. 20 p. (EB77/27)The Expanded Program on Immunization (EPI) has made major public health gains in the past decade. The central EPI strategy has been to deliver immunization in consonance with other health services, particularly those directed toward mothers and children. However, in the least developed countries and many other developing countries, it does not appear likely that national budgets will be sufficient by 1990 to support full immunization coverage on a sustained basis or that an adequate number of national managers can be assembled to staff effective programs. At the November 1985 meeting of the EPI Global Advisory Group, recommendations were made to accelerate global progress. These recommendations reflect optimism that the 1990 goal of reducing morbidity and mortality by immunizing all children of the world can be achieved, but also acknowledge that many fundamental problems of national program management remain to be resolved. 3 general actions needed are: 1) promote the achievement of the 1990 immunization goal at national and international levels through collaboration among ministries, organizations, and individuals in both the public and private sectors; 2) adopt a mix of complementary strategies for program acceleration; and 3) ensure that rapid increases in coverage can be sustained through mechanisms which strengthen the delivery of other primary health care interventions. The 4 specific actions needed are: 1) provide immunization at every contact point, 2) reduce drop-out rates between first and last immunizations, 3) improve immunization services to the disadvantaged in urban areas, and 4) increase priority for the control of measles, poliomyelitis, and neonatal tetanus. Continued efforts are also required to strengthen disease surveillance and outbreak control, reinforce training and supervision, ensure quality of vaccine production and administration, and pursue research and development.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.Mortality has declined in all the countries of the Economic and Social Commission for Asia and the Pacific (ESCAP) region, but the declines have been far from uniform. Development may mean greater input into health services and public health, but it can also mean better transportation, more schools, higher wages, more job opportunities, and better housing. Each of these factors affects the health of the population. Mortality decline may be due to either a reduction of exposure to risk or an increased proportion of the population protected from the risk by immunization or other preventive measures. A disease may disappear, such as smallpox has, or a new treatment may substantially reduce case fatalities; both processes may be happening at once. The effective control of "preventable deaths" is the path to modern low mortality levels. Only a few ESCAP countries, those with reasonably accurate cause of death statistics, show modernized mortality levels. Deaths from infectious and parasitic diseases decline with modernization, and deaths from cancer increase. The U-shaped age pattern of mortality, in which infant and child deaths are predominant, becomes a J-shaped curve with greater mortality risk at older ages. Socioeconomic change affects mortality at national, community, and individual or household levels. Life expectancy at birth rises with per capita gross national product. On the individual level, mother's education, family income, family size, and child spacing all affect child mortality. Other sociobiological factors affect mortality risk on an individual level, such as late use of modern health services. Future mortality research needs to examine all these factors and cross discipinary lines.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.In the Economic and Social Commission for Asia and the Pacific (ESCAP) region, life expectancy at birth varies from less than 45 years in Afghanistan, Bhutan, Democratic Kampuchea, Lao People's Democratic Republic, and Nepal to 70 years and above in Japan, Australia, and New Zealand. Generally, mortality has declined in the ESCAP region in the last 25 years. Early mortality improvements can largely be attributed to new disease control technologies, such as immunization and effective disease treatment. Large-scale epidemics became rare, as did large-scale famines. In countries where population was concentrated in urban areas, such as in Singapore and Hong Kong, and in countries where health services were extended to the rural sector, such as China, mortality fell to developed country levels. Health services are not the sole agent in this process; increasing literacy, social welfare policy, adequate housing and water supplies, sanitation, and economic growth are also participants. At the root of mortality differentials between and within countries are problems associated with differential rates of socioeconomic development, income distribution, and the inadequacy of health care systems to cope with their responsibilities. Health services alone may alleviate only some of the major health problems. The sophisticated approach of Western medicine may be inappropriate for these countries. The most prevalent health problems in the least developed countries of the ESCAP region are water and airborne infectious diseases, complicated by malnutrition. Treatment, although bringing immediate relief, may not have a lasting effect on the person who must return to a disease-ridden environment.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
New York, New York, UNFPA, 1984 May. xii, 156 p. (Report No. 67)A Needs Assessment and Program Development Mission visited the People's Republic of China from March 7 to April 16, 1983 to: review and analyze the country's population situation within the context of national population goals as well as population related development objectives, strategies, and programs; make recommendations on the future orientation and scope of national objectives and programs for strengthening or establishing new objectives, strategies, and programs; and make recommendations on program areas in need of external assistance within the framework of the recommended national population program and for geographical areas. This report summarizes the needs and recommendations in regard to: population policies and policy-related research; demographic research and training; basic population data collection and analysis; maternal and child health and family planning services; management training support for family planning services; logistics of contraceptive supply; management information system; family planning communication and education; family planning program research and evaluation; contraceptive production; research in human reproduction and contraceptives; population education and dissemination of population information; and special groups and multisectoral activities. The report also presents information on the national setting (geographical and cultural features, government and administration, the economy, and the evolution of socioeconomic development planning) and demographic features (population size, characteristics, and distribution, nationwide and demographic characteristics in geographical core areas). Based on its assessment of needs, the Mission identified mjaor priorities for assistance in the population field. Because of China's size and vast needs, external assistance for population programs would be diluted if provided to all provincial and lower administrative levels. Thus, the Mission suggests that a substantial portion of available resources be concentrated in 3 provinces as core areas: Sichuan, the most populous province (100,220,000 people by the end of 1982); Guandong, the province with the highest birthrate (25/1000); and Jiangsu, the most densely populated province (608 persons/square kilometer. In all the government has identified 11 provinces needing special attention in the next few years: Anhui, Hebei, Henan, Hubei, Hunan, Jilin, Shaanxi and Shandong, in addition to Guangdong, Jiangsu, and Sichuan.
New York, UNFPA, 1985 Mar. viii, 68 p. (Report No. 70)The UN Fund for Population Activities (UNFPA) is in the process of an extensive programming exercise intended to respond to the needs for population assistance in a priority group of developing countries. This report presents the findings of the Mission that visited Burma from May 9-25, 1984. The report includes dat a highlights; a summary and recommendations for population assistance; the national setting; population policies and population and development planning; data collection, analysis, and demographic training and research;maternal and child health, including child spacing; population education in the in-school and out-of school sectors; women, population, and development; and external assistance -- multilateral assistance, bilateral assistance, and assistance from nongovernmental organizations. In Burma overpopulation is not a concern. Population activities are directed, rather, toward the improvement of health standards. The main thrust of government efforts is to reduce infant mortality and morbidity, promote child spacing, improve medical services in rural areas, and generally raise standards of public health. In drafting its recommendations, whether referring to current programs and activities or to new areas of concern, the Mission was guided by the government's policies and objectives in the field of population. Recommendations include: senior planning officials should visit population and development planning offices in other countries to observe program organization and implementation; continued support should be given to ensure the successful completion of the tabulation and analysis of the 1983 Population Census; the People's Health Plan II (1982-86) should be strengthened through the training of health personnel at all levels, in in-school, in-service, and out-of-country programs; and the need exists to establish a program of orientation to train administrators, trainers/educators, and key field staff of the Department of Health and the Department of Cooperatives in various aspects of population communication work.
Planned parenthood and women's development in the Indian Ocean Region: experience from Bangladesh, India and Pakistan.
London, England, International Planned Parenthood Federation, 1984 Sep. 43 p.The Indian Ocean Region (IOR) of the International Planned Parenthood Federation (IPPF) has been involved in Planned Parenthood and Women's Development (PPWD) since the program was launched in 1976. This paper, which brings together the experience of the projects and approaches from 3 countries of the region -- Bangladesh, India, and Pakistan, aims to help the region analyze the progress made and assess strategies which can be more widely replicated. The Bangladesh Family Planning Association (BFPA) initiated PPWD projects in mid-1977, the majority in collaboration with well-established women's organizations. These projects generally provide income-generating activities, including training and assistance in the marketing of the products resulting from such activities. In 1979, together with the Mahila Samity (the national women's organization), the FPA was able to integrate women's development into its programs in 19 unions. Each union has a population of 20,000 and the FPA undertakes family planning motivation and services committees. Since 1977 the FPA has collaborated with the Chandpur Dedicated Women to promote family planning and women's development activities. A project to reach women through child-centered activities was initiated by the FPA in 1979 in response to the International Year of the Child. A case study is included of the Sterilized Women's Welfare Samity Project in Mymensingh. For some years the Family Planning Association of India (FPAI) has worked through existing women's clubs or Mahila Mandals as a way of reaching rural and semirural women. The Mahila Mandals have been instrumental in involving young women in development activities and in establishing youth clubs and also have been a focal point for mobilizing community resources. The use of government facilities by the integrated projects in Malur and Karnataka and the cooperation with various extension services is noteworthy. In 1977 the FPAI decided to launch a number of specific projects, including as the Pariwar Pragati Mandals (family betterment clubs) popularly know as PPM, and the Young Women's Development Program. Project case studies are included. The Family Planning Association of Pakistan launched its PPWD program in 1978 with the objective of creating conditions within which responsible parenthood could become a way of life, particularly among underprivileged rural women, and to strengthen links between family planning and other individual and community problems. Most of the original PPWD projects were initiated in 1978 and were conducted with other community development and womens's organizations. Since 1978, the PPWD program has undergone several changes and more emphasis is now placed on family planning and on involving young women. Case studies are included. Common features of the PPWD programs of Bangladesh, India, and Pakistan are identified.
Migrant workers: summary of reports on conventions nos. 97 and 143 and recommendations nos. 86 and 151 (Article 19 of the Constitution). (International Labour Conference, 66th Session, 1980) Report III, part 2.
Geneva, Switzerland, ILO, 1980. 151 p.Article 19 of the Constitution of the International Labor Organization (ILO) provides that Members shall report to the Director General at appropriate intervals on the position of their law and practice in regard to the matters dealt with in unratified Conventions and Recommendations. The reports summarized in this volume concern the Migration for Employment Convention (Revised) (No. 97) and Recommendation (Revised) (No. 86), 1949, Migrant Workers (Supplementary Provisions) Convention, 1975 (No. 143) and Migrant Workers Recommendation, 1975 (No. 151). The governments of member States were asked to send their reports to the ILO Office by July 1, 1979, and this summary covers country reports received by the Office up to November 1, 1979. Reports are included for the following countries: Argentina, Austria, Belgium, Benin, Bolivia, Botswana, Brazil, Cameroon, Colombia, Congo, Cuba, Cyprus, Czechoslovakia, Dominican Republic, Egypt, El Salvador, Fiji, Finland, France, Gabon, German Democratic Republic, Guyana, Hungary, India, Japan, Kuwait, Lebanon, Luxembourg, Madagascar, Malaysia, Mali, Malta, Mauritius, Mexico, Mongolia, Morocco, Netherlands, Niger, Nigeria, Norway, Pakistan, Panama, Peru, Philippines, Poland, Portugal, Romania, Rwanda, Senegal, Sierra Leone, Singapore, Spain, Sri Lanka, Sudan, Surinam, Swaziland, Sweden, Switzerland, Tanzania, Turkey, USSR, UK, Uruguay, Venezuela, and Zambia.
Geneva, Switzerland, WHO, 1980. 412 p.This report on the world health situation comes in 2 volumes, and this, the 2nd volume, reviews the health situation by country and area, with the additions and amendments submitted by the governments, and an addendum for later submissions. Information is presented for countries in the African Region, the Region of the Americas; the Southeast Asia Region, the European Region, the Eastern Mediterranean Region, and the Western Pacific Region. The information provided includes the following areas: the primary health problems, health policy; health legislation; health planning and programming; the organization of health services; biomedical and health services research; education and training of health manpower; health establishments; estimates of the main categories of health manpower; the production and sale of pharmaceuticals; health expenditures; appraisal of health services; demographic and health data; major public health problems; training establishments; actions taken; preventive medicine; and public health.
New York, UNFPA, 1978 Jun. 53 p. (Report No 3)The present report presents the findings of the Mission which visited Afghanistan from October 3-16, 1977 for the purpose of assessing the country's needs for population assistance. Report focus is on the following: the national setting (geographical, cultural, and administrative features; salient demographic, social, and economic characteristics of the population; and economic development and national planning); basic population data; population dynamics and policy formulation; implementing population policies (family health and family planning and education, communication, and information); and external assistance (multilateral and bilateral). The final section presents the recommendations of the Mission in detail. For the past 25 years Afghanistan has been working to inject new life into its economy. Per capita income, as estimated for 1975, was $U.S. 150, a relatively low figure and heavily skewed in favor of a very small proportion of the population. The country is still predominantly rural (85%) and agricultural (75%). In the absence of reliable data, population figures must be accepted tentatively. According to the 7-year plan, the population in 1975 was 16.7 million and the rate of growth around 2.5% per annum. The crude birth rate is near 50/1000 and the crude death rate possibly 25/1000. The Mission endorses the priority given by the government to the population census and recommends continued support on the part of the United Nations Fund for Population Activities (UNFPA) to help the Central Statistical Office in the present effort and in building up capacity for future work. The Mission recommends that efforts be concentrated on the reduction of infant, child, and maternal mortality levels and that assistance be continued to the family health services and to programs of population education. Emphasis should be on services to men and women in rural areas. The Mission also recommends a training program for traditional birth attendants.
World Health. 1982 Jun; 28-9.The Lao People's Democratic Republic, a country faced with the problem of ensuring an outlet to the sea, suffers from all the undesirable economic and social consequences which being a landlocked country entails. Foreign products which Laos needs will be bought at a high cost in time and in scarce foreign exchange, but without foreign exchange the country is unable to obtain what it needs for economic and social development. The local manufacture of many items that are important for the country's growth remains limited because its dependence on supplies from abroad has always retarded technical development. At this time the national economy is advancing too slowly in relation to its capacity and to domestic demand. A factor seriously affecting the capacity for development has been the protracted war in which Laos has been embroiled by its geographical position. Health services, particularly in rural areas, reflect this situation as do all the other essential services. Defective communication networks have contributed to the weakness of the health sector. For many years the country has been receiving assistance from the World Health Organization (WHO) tailored to its needs, but the insecurity created by the war has precluded penetration into the most remote and poorest areas. Currently, the low rate of graduation from secondary schools limits the recruitment of people to be trained for the many vacant posts in the health services. WHO has the technical capacity for helping Laos to speed up its health development process, but it must first overcome the most important hurdle by introducing a more efficient system of management and creating among the staff the necessary confidence and decision making ability that are required. WHO is now helping Laos to deal with the priority problems that have been identified, i.e., the most common and most serious diseases. Malaria has been brought under control in 2 of 13 provinces. A drinking water supply project is being financed, and an immunization campaign against the common diseases of childhood has been initiated. Health education is another problem area. In rural areas WHO is primarily concerned with a project for developing primary health care so that improved health services can be made available in the most remote regions.