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  1. 1
    027442

    Health and health services in Judaea, Samaria and Gaza 1983-1984: a report by the Ministry of Health of Israel to the Thirty-Seventh world Health Assembly, Geneva, May 1984.

    Israel. Ministry of Health

    Jerusalem, Israel, Ministry of Health, 1984 Mar. 195 p.

    Health conditions and health services in Judea, Samaria, and Gaza during the 1967-83 period are discussed. Health-related activities and changes in the social and economic environment are assessed and their impact on health is evaluated. Specific activities performed during the current year are outlined. The following are specific facets of the health care system that are the focus of many current projects in these districts; the development of a comprehensive network of primary care programs and centers for preventive and curative services has been given high priority and is continuing; renovation and expansion of hospital facilities, along with improved staffing, equipment, and supplies for basic and specialty health services increase local capabilities for increasingly sophisticated health care, and consequently there is a decreasing need to send patients requiring specialized care to supraregional referral hospitals, except for highly specialized services; inadequacies in the preexisting reporting system have necessitated a continuting process of development for the gathering and publication of general and specific statistical and demographic data; stress has been placed on provision of safe drinking water, development of sewage and solid waste collection and disposal systems, as well as food control and other environmental sanitation activities; major progress has been made in the establishment of a funding system that elicits the participation and financial support of the health care consumer through volunary health insurance, covering large proportions of the population in the few years since its inception; the continuing building room in residential housing along with the continuous development of essential community sanitation infrastructure services are important factors in improved living and health conditions for the people; and the health system's growth must continue to be accompanied by planning, evaluation, and research atall levels. Specific topics covered include: demography and vital statistics; socioeconomic conditions; morbidity and mortality; hospital services; maternal and child health; nutrition; health education; expanded program immunization; environmental health; mental health; problems of special groups; health insurance; community and voluntary agency participation; international agencies; manpower and training; and planning and evaluation. Over the past 17 years, Judea, Samaria, and Gaza have been areas of rapid population growth and atthe same time of rapid socioeconomic development. In addition there have been basic changes in the social and health environment. As measured by socioeconomic indicators, much progress has been achieved for and by the people. As measured by health status evaluation indicators, the people benefit from an incresing quantity and quality of primary care and specialty services. The expansion of the public health infrastructure, combined with growing access to and utilization of personal preventive services, has been a key contributor to this process.
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  2. 2
    202637

    Botswana: report of mission on needs assessment for population assistance.

    United Nations Fund for Population Activities [UNFPA]

    New York, New York, United Nations Fund for Population Activities, 1984. viii, 60 p. (Report No. 79)

    This report presents the findings of a mission from the UN Fund for Population Activities to ascertain the needs for population assistance for the Republic of Botswana. Botswana's population is growing at a rate of 3.46% (1980-1985), a consequence of continuing high fertility and decreasing death rates. While there is an awareness of the implications of he high growth rate for development, the government appears to have relaxed its emphasis on controlling population growth, limiting its role to maternal and child health, and concentrating on the family welfare aspects of fertility control. The Mission expressed concern about the absence of a clearly articulated policy on population. However, it is hoped that the creation of the Botswana Population Council will result in the inclusion of such a policy in future national development plans. Migration is a major problem facing planners. The high rate of rural to urban migration and the reduction of migration to the Republic of South Africa for employment, have resulted in high unemployment rates within Botswana, particularly among unskilled workers. Critical gaps have been identified in the collection, analysis, and dissemination of population data, which are essential for the formulation of appropriate development strategies in this area. The Mission recommends that support in the form of training and technical assistance be provided to both the Central Statistics Office and the Registry of Births and Deaths, in the case of the latter to promote the establishment of a nation-wide civil registration system. Present health policy focuses on the concept of primary health care, with an emphasis on preventive health and community participation. Due to the shortage of health manpower and heavy dependence on expatriate personnel, the Mission's recommendations in this area stress support for the training of health workers at all levels and the inclusion of population components in this training. A high proportion of households, particularly in rural areas, are headed by women, and many of these households are poor. The Mission's recommendations seek to enhance women's economic status and improve their access to resources such as vocational training and agricultural extension services.
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  3. 3
    039142

    Basis for the definition of the organization's action policy with respect to population matters.

    Pan American Health Organization [PAHO]

    [Unpublished] 1984 May 8. 31 p. (CE 92/12)

    This report shows how demographic information can be analyzed and used to identify and characterize the groups assigned priority in the Regional Plan of Action and that it is necessary for the improvement of the planning and allocation of health resources so that national health plans can be adapted to encompass the entire population. In discussing the connections between health and population characteristics in the countries of the region, the report covers mortality, fertility and health, and fertility and population increase; spatial distribution and migration; and the structure of the population. Focus then moves on to health, development, and population policies and family planning. The final section of the report considers the response of the health sector to population trends and characteristics and to development-related factors. The operations of the health sector must be revised in keeping with the observed demographic situation and the projections thereof so that the goal of health for all by the year 2000 may be realized. In several countries of the region mortality remains high. In 1/3 of them, infant mortality during the period 1980-85 exceeds 60/1000 live births. If measures are not taken to reduce mortality 55% of the population of Latin America in the year 2000 will still be living in countries with life expectancies at birth of under 70 years. According to the projections, in the year 2000 the birthrate will stand at around 29/1000, with wide differences between the countries of the region, within each of them, and between socioeconomic strata. High fertility will remain a factor hostile to the health of women and children and a determinant of rapid population growth. Some governments view the present or predicted growth rates as excessive; others want to increase them; and some take no explicit position on the matter. The countries would be well advised to assign values to their birthrate, natural increase, and periods for doubling their populations in relation to their development plans and to the prospects for improving the standard of living and health of their populations. An important factor in urban growth is internal migration. These migrants, like some of those who move to other countries, may have health problems requiring special care. Regardless of a country's demographic situation, the health sector has certain responsibilities, including: the need to promote the framing and adoption of population and development policies, in whose implementation the importance of health measures is not open to question; and the need to favor the intersector coordination and articulation required to ensure that population aspects are considered in national development planning.
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  4. 4
    199512

    Observations based on the experience of selected countries in the ESCAP region.

    Ruzicka LT

    [Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok. [13] 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.
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  5. 5
    199511

    Mortality trends and differentials in selected countries of the ESCAP region.

    Ruzicka LT

    [Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok. [23] 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.
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  6. 6
    033687

    Demographic trends and their development implications.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    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.
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  7. 7
    031969

    China: report of Mission on Needs Assessment for Population Assistance.

    United Nations Fund for Population Activities [UNFPA]

    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.
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  8. 8
    031976

    Ghana: report of Mission on Needs Assessment for Population Assistance.

    United Nations Fund for Population Activities [UNFPA]

    New York, New York, UNFPA, 1984 Jul. vii, 59 p. (Report No. 68)

    This report of a Mission visit to Ghana from May 4-25, 1981 contains data highlights; a summary of findings; Mission recommendations regarding population and development policies, population data collection and analysis, maternal and child health and family planning, population education and communication programs, and women and development; and information on the following: the national setting; population features and trends (population size, growth rate, and distribution and population dynamics); population policy, planning, and policy-related research; basic data collection and anaylsis; maternal and child health and family planning (general health status, structure and organization of health services, maternal and child health and family planning activities, and family planning services in the private sector); population education and communication programs; women, youth, and development; and external assistance in population. Ghana gained independence in 1957. The country showed early promise of rapid development. Although well-endowed with natural and human resources, Ghana now suffers from food scarcity, inadequate infrastructure and services, inflation, inequities in income distribution, unemployment, and underemployment. Per capita gross national product (GNP) was $400 in 1981; between 1960-81 the average annual growth of GNP was -1.1%. A high rate of natural increase of the population has compounded development problems by intensifying demands for food, consumer goods, and social services while simultaneously increasing the constraints on productivity. The population, estimated at 13 million in mid-1984, is growing at a rate of 3.25% per annum. Immigration and emigration have contributed to changes in the size and composition of the population. Post-independence development policies favored the urban areas, encouraging a steady rural-to-urban shift in the population. At the same time, worsening socioeconomic conditions spurred the emigration of professional, managerial, and technical personnel and skilled workers. Ghana was the 1st sub-Saharan African nation to establish an official population policy. Since the formulation of the policy in 1969, successive governments have remained committed to its emphasis on fertility reduction while increasing attention to the problems of mortality and morbidity and rural/urban migration. Recognizing the need to intensify the commitment to population policies, the Mission recommends support for a program to further the awareness of policy makers of the relationship between population trends and their areas of responsibility. The Mission recommends the creation of a special permanent population committee and the strengthening of the Ministry of Finance and Economic Planning's Manpower division. The Mission also makes the following recommendations: the provision of training, technical assistance, and data processing facilities to ensure the timely provision of demographic data for socioeconomic planning; data collected in the pilot program of vital registration be evaluated before the system is expanded; the complete integration of maternal and child health and family planning and general health services within the primary health care system; and improvement in women's access to resources such as education, training, and agricultural inputs.
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  9. 9
    030879

    Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.

    United Nations. Department of International Economic and Social Affairs. Population Division

    In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)

    This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
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  10. 10
    030016

    Integration of population factors into development planning and programmes.

    United Nations. Department of Technical Co-operation for Development; United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. Population Division

    In: Population, resources, environment and development. Proceedings of the Expert Group on Population, Resources, Environment and Development, Geneva, 25-29 April 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 175-86. (Population Studies No. 90; ST/ESA/SER.A/90; International Conference on Population, 1984)

    In carrying out the recommendations of the World Population Plan of Action, the UN has expanded its technical cooperation activities with the countries concerned in diverse population development fields, including studies of the interaction between social, economic, and demographic variables, the formulation and implementation of policies, the integration of demographic factors in the planning process, the training of national staff, and the improvement of the data base and institutional arrangements. Discussion focuses on country problems and policies, national institutional capacity in population and development planning, strengthening national institutional capacities, and integration of population and development in the Economic and Social Commission for Asia and the Pacific (ESCAP) region. The interaction between structural change in population and social and economic development is generally recognized at the aggregate, sectoral, and regional levels, yet it has not thus far been possible to take this factor fully into account in the development planning process in many countries. In too many cases, population policies have been formulated and implemented in isolation and not in harmony with development policies or as an integral part of overall development strategy. Deficiencies in achieving integrated population policies and integration of demographic factors in the development planning process often have been caused or aggravated by a deficient knowledge of the interactions between demographic and socioeconomic factors and by insufficient expertise, resources, and proper institutional arrangements in the field. The population policies most frequently formulated and implemented during the last decade dealt with fertility, population growth, migration (internal and international), and mortality. Many governments continue to assign relatively low priority to the formulation of population policy and the formulation of related institutional arrangements. The fact that population is still understood as family planning by a number of governments also delays the legislative procedure necessary to establish government institutions for population research and study. The need exists to create a viable national institutional capacity through the establishment of a population planning unit within the administrative structure of national planning bodies. The substantive content of the work programs of these units would vary from country to country. There also is a need for a broader approach to the adoption of population policies and development planning strategies. Some progress has been made in integrating population into development planning in the ESCAP region, but the progress has been slow.
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  11. 11
    030013

    General overview. A. Population, resources, environment and development: highlights of the issues in the context of the World Population Plan of Action.

    United Nations. Department of International Economic and Social Affairs. Population Division

    In: Population, resources, environment and development. Proceedings of the Expert Group on Population, Resources, Environment and Development, Geneva, 25-29 April 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 63-95. (Population Studies No. 90; ST/ESA/SER.A/90; International Conference on Population, 1984)

    The acceptance by the international community of the importance of the interrelations between population, resources, environment, and development has been in large measure an outgrowth of the search for development alternatives that would reduce the disparities between developed and developing countries and ameliorate poverty within countries. Possibly the most important task of the Expert Group on Population, Resources, Environment, and Development is to identify more clearly the role of population within these interrelationships, i.e., to identify through which mechanisms population characteristics condition and are conditioned by resource use, environmental effects, and the developmental structure. To a considerable extent the incidence of poverty forms the root cause of many of the problems derived from the interrelationships between population, resources, environment, and development in developing countries. Affluence appears to be the major cause of many of the environmental and resource problems in the developed countries. The first 2 sections are devoted to issues considered crucial in the alleviation of poverty. Lack of food, adequate nutrition, health care, education, gainful employment, old age security, and adequate per capita incomes perpetuate poverty of large numbers of people in developing countries and therefore also their production and consumption patterns, which undermine, through environmental and resource degradation, the very resources on which they depend for their livelihood. The discussion of environment as a provider of resources first considers supplies of minerals, energy, and water. Attention is then directed to the stock of agricultural land that can be expanded through fertilization and irrigation and which may be reduced as a result of desertification, deforestation, urbanization, salinization, and waterlogging. Another section focuses on the need for integrating population variables into development planning. In the formulation of longterm development objectives, population can no longer be regarded as an exogenous force, but rather becomes an endogenous variable which affects and is affected by development policies, programs, and plans.
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  12. 12
    029799

    Planned parenthood and women's development in the Indian Ocean Region: experience from Bangladesh, India and Pakistan.

    Aziz F

    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.
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  13. 13
    267551

    Basic community services through primary health care: a training approach, 2nd ed., rev.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; UNICEF. East Asia and Pakistan Regional Office

    Bangkok, Thailand, ESCAP, 1984 Apr. 175 p. (ESCAP Programme on Health and Development Technical Paper No. 65/BCS 12; ST/ESCAP/291)

    The recognition of the necessity of involving the community in development efforts has been a turning point in the evolution of development thinking in recent years. Since 1978, the UNICEF Regional Office for East Asia and Pakistan and ESCAP have been conducting a series of training seminars where local development, basic services and primary health care are discussed as part of village reality. This volume reviews this experience, generalizing it to enhance adaptation. The seminars are a learning by doing and experience-sharing process. Group discussion and reflection on relevant issues are focused on. The seminars are oriented to community life as a whole, considering primary heatlh care as an entry point for coummunity development which involves generation of services within the community, supplemented by delivery of services from other institutional levels. This report describes the overall framework, including the organization of the 1983 seminar and the training approach, and the syllabus and evaluates the seminars. The goal of the seminar is the promotion of basic community health care in the countries of the region to improve the quality of life of the poor. Each participant discusses his/her work experience. Basic needs, basic services and primary health care are examined and a field-study phase at village-level is organized. Planning capabilities are developed by a phase of planning for basic and community services and primary health care. A module on national development, basic needs approach and production-oriented development is introduced. Finally, each participant prepares a draft project proposal for training for his/her own country situation. The evaluation of a program includes both its delivery system component and its eventual impact. The seminars used questionnaires, special group discussions and interviewing of the participants. The aim was to scrutinize the relevance and potential for modification of knowledge, attitudes and practice (KAP) rather that the actual impact actual impact achieved. Behavioral change should be evaluated on at least 2 levels: the individual and the collective. The structure, clustering and frequency of response to a given question in an evaluation questionnaire and the average level of awareness about a particular issue are 2 important measures to analyze. Seminar participants were mainly middle level personnel, but included some junior and senior officials from ministries of health, interior or home affairs and agriculture; training institutes; rural development institutes; planning commissions and universities.
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  14. 14
    028813

    Forum on Population and Development for Women Leaders from Sub-Saharan African Countries, New York, 15-18 May, 1984.

    United Nations Fund for Population Activities [UNFPA]

    New York, UNFPA, 1984. 39 p.

    The Forum I and Forum II meetings, held during May 1984, were part of the UN Fund for Population Activities (UNFPA) initiatives to increase participation by women leaders and women's organizations in all aspects of population programs. Objectives were: to review the extent of women's participation in population programs; to identify issues and topics which enhance or restrict the active participation of women in population and development releated efforts; to identify strategies designed to broaden the integration of African women into population programs at regional, national, and international levels to examine the types of project which could improve the situation of African women and formulate practice proposals to intensify their participation in population programs; to identify interested women leaders and women's organizations willing to cooperate with UNFPA in implementing population policies and programs responsive to women's needs and concerns and enable them to participate in such programs; and to identify possible solutions to population-related issues and topics of special concern to women, e.g., fertility, infant and maternal mortality, and migration, and to discuss how to address these issues during the forthcoming Women's Conference in Nairobi. This document includes the proceedings of both forums. In general, participants at Forum I agreed that efforts to improve the status and welfare of women and to afford them greater prominence in national development efforts should become an integral part of a country's development strategy. The following recommendations were made: UNFPA's funding policies should be more flexible in support of activities at present considered to be of low priority, such as the supply of time and labor saving devices, vocational training, and income generating activities; UNFPA should play a leading role in programs designed to support the advancement of women and coordinate such efforts with other UN organizations to make programs more effective and achieve a comprehensive approach to measures for improving the status of women; support should be given to planning and management and to applied technology and science training; UNFPA should continue the dialogue with women's organizations and women leaders; UNFPA's budget for projects designed to improved the status of women should be increased substantially to finance the described interventions; and women's organizations and women as individuals should involve themselves in activities beyond traditional women's programs Forum II emphasized the need to relieve women of the excessive burden of childbearing and of time and energy consuming domestic chores. Participants are listed along with the names and affiliations of observers and representatives of the UN system.
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  15. 15
    028381

    A watershed of ideas.

    Rowley J

    People. 1984; 11(4):4-7.

    A significant happening at the International Conference on Population, which took place in Mexico City during August 1984, was the world consensus on the need to act more urgently to deal with the interrelated problems of population and development and to provide the conditions of life and means by which everyone can plan their family. The note of concern about the impact of population growth and about its distribution and structure was consistent. Support for expanded family planning services came from all sides, including Africia and Latin America. The UN agencies and the World Bank came nearest to injecting a visionary and emotional charge into the occasion. Their near universal message was the need to release and mobilize the energies of the people and slow excessive population growth by investing in their health, education, environment, employment opportunities and in family planning. Bradford Morse, Administrator of the UN Development Program, added a powerful plea, that the international factors of protectionism, debt, and high increase rates, arms spending, and ddeclining aid flows must be addressed if the goals of the original Plan of Action, i.e., to promote "economic development, wuality of life, human rights, and fundamental freedoms," were to be dealt with. James Grant, Executive Director of UNICEF, stated tha the experience of the past decade confirms "that development and population programs are interacting, mutually reinforcing efforts that work with the 'seamless' web of income, nutrition, health, education, and fertility." The final document put the same idea into various paragraphs. This consensus position was simple and consistent, but in its way, revoluntionary. The elements which brought about this agreement were made clear from the start. The 1st was the change in government attitudes towards population. In 4/5 of the world governments regard population as a key factor inn development strategy. A 2nd factor was that governments now feel more independent and less under external pressure. A 3rd element was that women in nearly all countries desire fewer children than they wanted previously and many are coming out openly and stating that they did not want their last child. A 4th factor was the awareness that population problems affect developed countries as well as developing countries. Along with these changes has come greater awareness of the health and social benefits of family planning. These ideas find expression the the 38 pages of recommendations which were eventually agreed on. The most significant of these was the added emphasis given to the role and status of women.
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  16. 16
    027804

    Country statement: Ethiopia.

    [Unpublished] 1984. Presented at the Second African Population Conference, Arusha, Tanzania, January 9-13, 1984. 21 p.

    This discussion of Ethiopia focuses on: sources of demographic data; population size and age-sex distribution; urbanization; fertility; marital status of the population; mortality and health; rate of natural increase; economic activity and labor force activity rates; food production; education; population policies and programs; and population in development planning. As of 1983, Ethiopia's population was estimated at 33.7 million. Agriculture is the mainstay of the economy. Ethiopia has not yet conducted a population census, however, the 1st population and housing census is planned for 1984. The population is young with children under 15 years of age constituting 45.4% of the total population; 3.5% of the population are aged 65 years and older. The degree of urbanization is very low while the urban growth rate is very high. Most of the country is rural with only 15% of the population living in localities of 2000 or more inhabitants. In 1980-81 the crude birthrate was 46.9/1000. The total fertility rate was 6.9. Of those aged 15 years and older, 69.2% of males and 71.3% of females are married. According to the 1980-81 Demographic Survey the estimates of the levels of mortality were a crude death rate of 18.4/1000 and an infant mortality rate of 144/1000. At this time 45% of the population have access to health services. It is anticipated that 80% of the population will be covered by health care services in 10 years time. Ethiopia is increasing at a very rapid rate of natural increase; the 1980 estimation was 2.9% per annum. Despite the rich endowments in agricultural potential, Ethiopia is not self-sufficient in food production and reamins a net importer of grain. Enrollment at various levels of education is expanding rapidly. There is no official population policy. Financial assistance received from the UN Fund for Population Activities and the UN International Children's Emergency Fund for population programs is shown.
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  17. 17
    028281

    Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.

    Mullan F; Bryant JH

    Jama. 1984 Dec 14; 252(22):3146-8.

    The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
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  18. 18
    028145

    The family planning movement within the African Region of the International Planned Parenthood Federation. Le mouvement pour la planification familiale dans la Region Afrique de la Federation Internationale pour la Planification Familiale.

    Sozi MK

    Africa Link. 1984 Sep; 1, 3-11.

    The African Region of International Planned Parenthood Federation (IPPF) was established in 1971 to: encourage and sustain voluntary groups, provide information about family planning as a basic right, provide limited family planning services where acceptable and needed, and eventually influence change in public opinion so that governments could accept some responsibility for family planning programs. Today almost all of Anglophone Africa is covered by IPPF-funded activities, progress is being made in Francophone Africa, and Lusophone Africa is a target for the 1980s. National family planning associations and the IPPF have laid a firm foundation for family planning and raised its credibility to acceptable levels. However, both inadequate logistic infrastructures for the smooth flow of services and overcaution in adopting innovative methods such as community-based delivery systems to those not easily reached by coventional delivery systems have led service to lag behind demand. Leaders at all levels must join efforts to solve this dilemma. Family planning associations are the best suited channels for family planning work in the African Region, but they lack the capacity to cover all needs. As a result, these associations are shiftingg their efforts toward supplementing government work in this area. Although the government response has been far from uniform, governments have shown an ability to accommodate the operations of family planning organizations and have integrated family planning into national health services. Although 19 governments in the Region consider the fertility levels in their countries to be satisfactory and a few consider fertility too low, family planning is accepted as an instrument for the promotion of family welfare. The importance of national leadership in promoting and implementing family planning programs is increasingly recognized. Parliamentarians can formulate national policies favorable to family planning, promote awareness among their constituencies, and vote for more resources for the family planning effort.
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  19. 19
    023989

    African women blaze a trail.

    Mojekwu V

    World Health. 1984 Apr; 24-6.

    Women in 24 villages throughout Africa are participating in the World Health Organization's (WHO) African Regional Program for Women in Health Development. This program involves women's organizations in primary health care delivery through a system of self-reliant cooperatives that work for rural development. WHO's African Regional Office works with the women's organizations to identify areas where their activities could have an impact, to establish links with government officials, and in project planning and fund raising. Local thrift and credit clubs, state-run cooperative societies, traditional age-grade unions, religious groups, and market women's associations have been identified as potential points of impact. Male elders are drawn into the projects in the preliminary stage in order to break down prejudice and produce unified communalism. To prepare a project proposal, a consultant is sent to live in the village for a 3-week period to learn about the resources and expressed needs of the community. The program has emphasized training that will enable women to plan their own income-generating activities. The most difficult problem has been to motivate the involvement of national and international organizations. The ultimate objective is to turn self-development and self-reliance for promoting health-related projects into permanent features of the village women's social activities. Through the process of participating in health development, African women have realizaed their potential leadership skills and are submerging longstanding sex prejudices.
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