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Strong ministries for strong health systems. An overview of the study report: Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening.
[Kampala], Uganda, African Centre for Global Health and Social Transformation [ACHEST], 2010 Jan.  p.This overview is adapted from the report Supporting Ministerial Health Leadership: A Strategy for Health Systems Strengthening by Dr. Francis Omaswa, executive director and founder of The African Center for Global Health and Social Transformation (ACHEST) and Dr. Jo Ivey Boufford, president of The New York Academy of Medicine (NYAM). The study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative, The study was initially designed to assess the potential value of three proposed programs to strengthen the leadership capabilities of ministers of health: a global executive leadership program for new ministers; an ongoing, regional, in-person and virtual leadership support program for sitting ministers; and a virtual global resource center for ministers and high level ministerial officials providing real-time access to information. During the course of the study, it became clear that it was essential to expand the inquiry to better understand the challenges and needs of ministries as a whole, as they and their ministers provide the stewardship function for country health systems.The content of the report was derived from six major activities:a comprehensive literature review of the theory and practice of effective leadership development and organizational capacity building, and an environmental scan to identify any existing or planned leadership development programs for ministers of health or any that have occurred in the recent past globally; a survey of the turnover of ministers of health; targeted interviews with ministers, former ministers, and key stakeholders who interact with them, conducted between October 2008 and September 2009, to better understand the roles of ministers and ministries, the challenges they face, resources at their disposal, and their thoughts on what additional resources might enhance their personal effectiveness and that of their ministries; a consultative meeting of experts and stakeholders held in Bellagio, Italy part way through the project; participation of the project leaders (Omaswa and Boufford) in relevant global and regional meetings, as well as individual meetings about the project with critical leaders in international and donor organizations and potential champions of this effort; and a consultation with African regional health leaders to discuss the final report, held in Kampala, Uganda. (Excerpt).
Oxford, England, Oxfam International, 2006. 122 p.This report shows that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services. Civil society organisations and private companies can make important contributions, but they must be properly regulated and integrated into strong public systems, and not seen as substitutes for them. Only governments can reach the scale necessary to provide universal access to services that are free or heavily subsidised for poor people and geared to the needs of all citizens -- including women and girls, minorities, and the very poorest. But while some governments have made great strides, too many lack the cash, the capacity, or the commitment to act. Rich country governments and international agencies such as the World Bank should be crucial partners in supporting public systems, but too often they block progress by failing to deliver debt relief and predictable aid that supports public systems. They also hinder development by pushing private sector solutions that do not benefit poor people. The world can certainly afford to act. World leaders have agreed an international set of targets known as the Millennium Development Goals. Oxfam calculates that meeting the MDG targets on health, education, and water and sanitation would require an extra $47 billion a year. Compare this with annual global military spending of $1 trillion, or the $40 billion that the world spends every year on pet food. (excerpt)
Finance and Development. 2004 Mar; 41(1):16-19.DEVELOPING countries and their international partners are increasingly adopting methods of financing health care activities in developing countries that link the availability of funding to concrete, measurable results on the ground. Such “performance-based” financing was advocated a decade ago in the World Bank’s 1993 World Development Report—Investing in Health and other policy documents in the early 1990s, although relatively little practical experience with this type of financing was available. Since then, much experimentation has taken place, and we are seeing with growing clarity the important potential—as well as the challenges—of performance-based financing for achieving national and global health goals. Governments and partner agencies are interested in performance-based financing for health for a number of reasons. First, there is a growing focus worldwide on achieving measurable results with development assistance, and performance-based financing spotlights such results. In terms of health care, these results are being closely tracked as governments and their partners strive to achieve the Millennium Development Goals (MDGs). The goals include reductions in child and maternal deaths; reductions in rates of infection from HIV, malaria, and tuberculosis; and improvements in the nutritional status of children. Governments and their partners are thus naturally attracted to the idea of providing funds for programs that achieve or make progress toward the MDGs in health or that at least show increases in some of the key services needed to reach the goals. For example, where immunization and prompt treatment of pneumonia are crucial for halting child deaths, funding for health care might be tied to advances in the coverage of these services. (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 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.
World Health Organization Technical Report Series. 1978; (616):1-142.The World Health Organization (WHO) Scientific Group on Neisseria gonorrhoeae and Gonococcal Infections, which met in Geneva November 2-8, 1976, set 3 goals: 1) to evaluate current knowledge regarding N. gonorrhoeae, gonococcal infections, and complications of these infections; 2) to determine research directions in light of public health priorities; and 3) to propose a control policy adapted to existing health structures and epidemiologic sitations. In addition to specific recommendations pertaining to individual facets of the problem of gonococcal infections, such as their pathogenesis, epidemiology, clinical manifestations, identification, and antimicrobial susceptibility, the Group made 5 principal recommendations. 1st, the gonococcal antigens that have been defined immunochemically should be intensively investigated with the aim of establishing a sensitive, selective serologic test for gonorrhea and assessing the potential value of these components in vaccines against gonorrhea. Research should also be directed toward the effects of gonorrhea on male and femlae fertility, child development, and perinatal morbidity and mortality. 2nd, health education and stricter control over the availability of microbials are needed to counteract the development of drug resistance on the part of gonococcal strains of bacteria. A system for the continuous surveillance of the antimicrobial susceptibility pattern should be set up in each epidemiologic area. 3rd, governments should set up the best possible services for the diagnosis and treatment of gonococcal infections. These services should involve a well-balanced range of techniques, continuously monitored to evaluate their relevance and cost-effectiveness. In areas where diagnostic laboratory support is unavailable, a simplified control program based on clinical diagnosis and contact treatment may be considered a temporary measure to reduce the spread of infection. 4th, health authorities must determine the prevalence of beta-lactamase-producing strains and attempt to limit their spread. The recent appearance of these strains is regarded as a serious public health threat which may produce a major increase in morbidity and mortality. 5th, governments are urged to facilitate research on the practical value of new findings and to cooperate with WHO in training programs to improve the effectiveness of gonorrhea control. A network of national and regional centers for research and training would be a positive development.
PAHO Bulletin. 1988; 22(4):416-29.This article, which is a summary of a World Bank policy study, states that the characteristics and performance of health sectors vary tremendously in developing countries. In most cases, the sector faces three main problems: insufficient spending on cost-effective health activities; internal inefficiency of public programs; and inequity in the distribution of benefits from health services. It is argued that each of these problems is due in part to the efforts of governments to cover the full costs of health care for everyone from general public revenues. Proposed policy reforms include: charge users of government health facilities; provide insurance or other risk coverage; use nongovernmental resources effectively; and decentralize government health services. However, it was pointed out that further analysis is needed on these proposed reforms.
BMJ. British Medical Journal. 1993 Apr 3; 306(6882):880-1.The Council on Health Research for Development (COHRED), an international agency based in Geneva, was newly established in March 1993 at the behest of a 12-member international commission on health research set up in 1990. Sponsors are the UN Development Program, Swedish and Canadian development agencies, and about 12 other agencies such as the Carnegie Corporation and the Ford Foundation in the US and the Overseas Development Corporation in Britain. The annual budget will be $2 million/year. The aim of COHRED is to encourage governments in developing countries to make research a high priority and an integral part of national health policy. Many countries fail to base health care on scientifically sound knowledge. COHRED will also act as a broker and channel for Western donor agencies who wish to conduct research projects in developing countries. The predecessor of COHRED was a task force on essential national health research, which guided 22 countries in Asia, Africa, and South America in starting programs and which has 13 countries interested in starting programs. Need has been demonstrated in countries where local health needs and determinants have not been decided. For example, in one country the minister of health had a polio vaccination program but there were still thousands of cases of polio occurring every year. Program implementation will involve the council in setting up, within countries, local working committees, which will be represented by village elders, health workers, and ministry officials. Workshops will be conducted to ascertain what the primary health problems are and what the research priorities should be. The council will ensure that all appropriate parties are involved in decision making. The establishment of COHRED was necessary because WHO was not fostering the scientific management of health services or helping governments build the necessary expertise and interest. COHRED will fall only if governments are not interested in making decisions based on scientific knowledge.
POPULATION RESEARCH ABSTRACT. 1991 Dec; 2(2):3-11.An overview, objectives, implementation, and research and evaluation studies of 2 India Population Projects in Karnataka are presented. The India Population Project I (IPP-I) was conducted in Karnataka and Uttar Pradesh. India Population Project III (IPP-III) took place between 1984-92 in 6 districts of Karnataka: Belgaum, Bijapur, Dharwad, Bidar, Gulbarga, and Raichur, and 4 districts in Kerala. The 6 districts in Karnataka accounted for 36% (13.2 million) of the total national population. The project cost was Rs. 713.1 million which was shared by the World Bank, and the Indian national and regional government. Due to poor past performance, these projects were undertaken to improve health and family welfare status. Specific project objectives are outlined. IPP-I included an urban component, and optimal Government of India program, and an intensive rural initiative. The urban program aimed to improved pre- and postnatal services and facilities, and the family planning (FP) in Bangalore city. The rural program was primarily to provide auxiliary nurse-midwives and hospitals and clinics, and also supplemental feeding program for pregnant and nursing mothers and children up to 2 years. The government program provided FP staff and facilities. IPP-I had 3 units to oversee building construction, to recruit staff and provide supplies and equipment, and to establish a Population Center. IPP-III was concerned with service delivery; information, education, and communication efforts (IEC) and population education; research and evaluation; and project management. Both projects contributed significantly to improving the infrastructure. A brief account of the types and kinds of studies undertaken is given. Studies were grouped into longitudinal studies of fertility, mortality, and FP; management information and evaluation systems for health and family welfare programs; experimental strategies; and other studies. Research and evaluation studies in IPP-III encompassed studies in gaps in knowledge, skills, and practice of health and FP personnel; baseline and endline surveys; and operational evaluation of the management information and evaluation system; factors affecting primary health care in Gulbarga district; evaluation of radio health lessons and the impact of the Kalyana Matha Program; and studies of vaccination and child survival and maternal mortality. Training programs were also undertaken.
NEW YORK TIMES. 1992 Apr 30; A12.The UN Population Fund's urgent plea for a sustained and concerted program to curb population growth in developing countries is reported. The reasons were to reduce poverty and hunger and to protect the earth's resources. The Fund released current world population figures which place 1992 population at 5.48 billion and project growth to 10 billion in 2050 with a leveling at 11.6 billion in 2150. These figures are 1 billion beyond projections made in 1980. The current rate of growth is at 97 million/year until 2000, 90 million/year until 2025, and 61 million/year until 2050. This rate of growth is the fastest the world has ever experienced. 34% of the rise will occur in Africa, and 97% in developing countries. The projected consequence of this growth is a continued migration to cities, increased hunger and starvation and malnutrition, and an increased pressure on the world's food, water, and other natural resources. This effect amounts to almost crisis conditions which places the world at great risk for future ecological and economic catastrophe. Food production has already lagged behind population growth in 69 of 102 developing countries between 1978-89. An urgent new campaign is called for to promote smaller families, better access to contraception, and better education and health care for women in developing countries. Women's status needs to be raised to allow for women being given property rights and improved access to labor markets. If the effort is successful, the population growth within the next decade could be reduced by 1.5-2 billion. Currently at least 300 million women do no have access to safe and reliable forms of contraception. The number of very poor has risen from 944 million in 1970 to 1.1 billion in 1985. The former strategy of urbanization and rising incomes have been found to be an unnecessary precondition for reducing family size. Poor countries, such as Sri Lanka and Thailand, have nonetheless shown sharp fertility declines with appropriate population policies, e.g., fertility dropped from 6.3 children/women in 1965 to 2.2 children/women in 1987. There have also been similar declines in fertility in China, Cuba, Indonesia, Tunisia and other poor countries. The agency's current budget is $225 million a year, and has been functioning without US aid since the 1976 ban over abortions in China.
Technical Working Group D report: government and donor support for breastfeeding in health and health-related programs.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 3 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The focus of the working group was to design a general strategy for government and donor support for breastfeeding promotion in health-related and other nonmaternity health programs. As a start, it is important to examine the reasons why government and donor agencies accept or reject programs to support. 3 steps must be followed for governments to accept breastfeeding: statistics showing declines in breastfeeding within the country need to be gathered; the benefits to the country of promoting breastfeeding would have to be demonstrated; and the link between increased breastfeeding and the decrease in child morbidity and mortality also would have to be demonstrated along with the fact that breastfeeding promotion programs can be done. Both economic arguments and data are necessary. For donor agencies to accept and promote breastfeeding enthusiastically, the benefits of breastfeeding should be shown to be synergistic with benefits from other donor priorities. 2 particular gaps in breastfeeding promotion that would be likely to garner donor support are training and communications. Regional centers for breastfeeding information, advanced training, even newsletter publication would be invaluable. Further, donor agencies could support projects like a review of textbooks and the effective distribution of donor publications.
Preliminary report of an identification mission for safe motherhood, Senegal: putting the M back in M.C.H.
INTERNATIONAL JOURNAL OF GYNAECOLOGY AND OBSTETRICS. 1988 Apr; 26(2):181-7.The government of Senegal, in March of 1986, requested assistance from the UN Development Program (UNDP) to formulate and execute a program for safe motherhood. Senegal, with an estimated maternal mortality rate of 580-760/100,000, was the 1st country to initiate a concrete national program to address the problem of maternal mortality. Despite the existence of a well-developed health infrastructure, data showed that the majority of Senegalese women deliver at home and that only 20% of maternal mortality is reported. Causes of mortality include endemic diseases (malaria and hepatitis), and abrupted placenta as a complication of hypertension. To identify the target areas of intervention, a "Mission of Identification" was organized by the UNDP in collaboration with the government of Senegal. 4 levels of the health infrastructure--village or rural maternity, the health post, the health center, and regional and national hospitals--were assessed as to existing and potential capacity to prevent maternal deaths. Epidemiology, social barriers to care, service delivery problems, and management issues were addressed. Results revealed a minimal knowledge of family planning, an expressed desire to solve the problems, and the strong influence of traditional beliefs in health care intervention, all of which contribute to maternal mortality. Interventions to reduce mortality were outlined based on identified causes of death and capabilities to address a specific problem. Over 50% of maternal deaths could be prevented by improved access and optimization of health care delivery and timely medical/surgical intervention. Adequate prenatal coverage and reducing pregnancy rates at the extremes of maternal age and parity were also cited as methods to reduce mortality. Estimates of the efficacy of these interventions were based on universal access, which does not now exist. A significant investment must be made to assure such access and to emphasize the priority given to maternal/child health by the government of Senegal.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
[Social mobilization and information, education, communication (IEC) in the area of population] Mobilisation social et information--education--communication (I.E.C) en matire de population.
FAMILLE, SANTE, DEVELOPPEMENT / IMBONEZAMURYANGO. 1988 Apr; (11):23-8.Despite efforts by Rwanda's National Office of Population (ONAPO) to increase awareness of Rwanda's population problems, there has been little change in the reproductive behavior of the rural population. ONAPO plans to formulate an overall information, education, and communication (IEC) campaign in the area of maternal-child health and family planning to inform the population about Rwanda's sociodemographic problems and the solution offered by family planning. The campaign will have 3 main components: 1) provision of information to the general population through the informal educational system 2) training and school-based population information and 3) production of educational materials to support the training and communication programs. IEC programs for maternal-child health and family planning will be integrated into more widely accepted activities having some degree of permanence, such as the school system, health centers, and religious institutions. The communal centers for development and permanent training will play an especially strong role in the integrated IEC plans for rural areas. Center personnel will help the population understand the connection between family planning and the socioeconomic and health status of families and will motivate couples to use family planning. The overall IEC plan will receive support from the National Revolutionary Movement for Development, the Association of Rwandan Women for Development, the Ministry of the Interior and of Communal Development, and the Ministry of Public Health and Social Affairs. Various other ministries, religious organizations, international organizations, and nongovernmental organizations should also support the IEC effort.
London, England, London School of Hygiene and Tropical Medicine, Evaluation and Planning Centre for Health Care, 1988 Spring. 75 p. (EPC Publication No. 15)In response to the resource shortages of government health systems in developing countries, the World Bank has called for charges to be introduced for some types of government health care. While this call may seem to be a pragmatic response to the sector's financing problems, it is also tied closely to the current political emphasis on greater efficiency. Equity considerations are of 2ndary importance. This paper challenges the World Bank's support for health care fees on 2 grounds. 1rstly, the limited importance given to equity within its proposals. 2ndly, the failure to address the problems of implementing its fee strategy. To support this challenge, the different political perceptions of social justice and the importance of equity as a policy goal are explored. The World Bank's position can be characterized as liberal tending towards libertarian and it is argued that the Bank is predisposed towards change in health financing systems by its support for the market-based allocation of care. This predisposition leads the Bank to overlook the difficulties of implementing a fee system that benefits the poor: inability to pay fees, unwillingness to use government care, the difficulty of making payment exemptions and the barriers to retaining fee revenue and using it effectively within government health systems. Starting instead from a collectivist emphasis on equity, alternative options for addressing the problems of resource shortages are also suggested. Improving the performance of government health systems within the available resources is the top priority and the feasibility of implementing other financing options is linked to such an improvement. Policy change should be promoted because it will improve the current situation and not for its own sake.
[Vaccination, the right of each child, World Day of Health 1987] Vacunacion: derecho de cada nino, Dia Mundial de la Salud 1987.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1987 Mar; 102(3):263-80.In the 10 years since the Panamerican Health Organization (PAHO) and the World Health Organization initiated the Extended Immunization Program in the Americas (PAI), coverage has increased from less than 1/3 to over 1/2 of children immunized in their first year against 6 major childhood diseases. Due mainly to the PAI, the incidence of measles, tetanus, and diptheria has been reduced by 1/2, that of whooping cough by 75%, and that of tuberculosis by about 5% annually. About 75% of children are immunized against polio, which has 1/10 as many victims today as 10 years ago. PAHO and several other organizations have targeted 1990 for eradication of polio from the South American continent. Since the PAI was established in 1977, more than 15,000 health workers have been trained, cold chains have been established to preserve vaccines, and more than 250 technicians have been trained to maintain and repair the needed equipment. The cost of the campaign to eradicate polio is estimated at US $ 24 million per year for the entire region--a low total compared to the costs of hospitalization and rehabilitation of the victims in the absence of such a program. The goal of immunizing all the world's children by 1990 proposed by the World Health Assembly in 1977 is achievable, but much remains to be done. The number of children immunized in the largest Third World countries ranges from 20-90% owing in part to national immunization days but also to assumption by local communities of the goal of universal immunization by 1990. All deaths produced by these 6 killer diseases are not registered, but the World Health Organization estimates that measles takes 2.1 million lives annually, neonatal tetanus 800,000, and whooping cough 600,000. Governmental and nongovernmental international organizations have made financial help available to countries needing it for their immunization programs. Most developing countries are expected to achieve the goal of universal immunization by 1990, but the 10 poorst countries of Africa and the Eastern Mediterranean may not be able to do so. At the worldwide level, 41% of the 118 million children who survive their first year have been vaccinated against measles and 46% against tuberculosis. 47% have received the full course of vaccine against diptheria, whooping cough, tetanus, and polio. The cost of these immunization is $5-15 per child and 80% is assumed by local countries. The World Health Organization recommends that all children, even the undernourished or slightly ill, be vaccinated, and that all health services vaccinate. Parents should be urged to return for the 2nd and 3rd doses of polio and DPT vaccines. Vaccination programs should pay more attention to impoverished urban populations. Several countries of the region have added innovations such as vaccination against other illnesses, house to house searches for unvaccinated children, or use of mass media to publicize national vaccination programs.
DEVELOPMENT FORUM. 1987 Mar; 15(2):1, 6.The author presents arguments to refute what he considers alarmist, unsupported generalizations about the origin and soread of AIDS (acquired immune deficiency syndrome) in Africa. The first myth is that AIDS originated in Africa, after a green monkey bit a man. There is no concrete evidence to support this theory. Moreover, if it were true, AIDS would have been known for years; there would be effective herbal remedies and folk traditions about the danger of green monkey bites. The syndrome is so distinctive, for example the oral candidiasis and striking wasting disease, called "slim" disease, that it would have been recognized long ago. Finally, numbers of cases have peaked in America first, a few years ago, and are now beginning to surge in some areas of Africa. A second myth is that countries are not reporting cases out of embarrassment. The author claims that reports to the WHO show far more cases of AIDS in the U.S. and Europe, and even if the 1000 cases in Africa as of 1986 were 1000-fold underestimated, they would be nowhere near the 5 or 10 million often printed. The third myth, that AIDS is out of control in Africa, is unsupported when the efforts of countries like Uganda are considered. Uganda has an extensive media campaign, significant funds relegated to fighting AIDS, foreign experts called in, blood testing equipment on order and in use in 2 hospitals. AIDS is only a problem in a few urban areas.
In: Planned parenthood in Europe: a human rights perspective, edited by Philip Meredith and Lyn Thomas. London, England, Croom Helm, 1986. 31-46.This paper examines the problems posed for planned parenthood associations by the rectitude of state interference in fertility behavior in pursuit of some common good. Planned parenthood associations stand as intermediaries between state and individual in the defense and promotion of fertility regulation rights. European associations collaborating in this International Planned Parenthood Federation (IPPF) project lay open to question their own "proper" function in this relationship. The rationale behind the project takes into account 2 developments common to Europe, which are believed to have far-reaching implications for Planned Parenthood Association (PPA) policies and activities in the future. The 1st development concerns the extent to which European states have taken control over and responsibility for the provision of fertility regulation services for their populations. The 2nd development is a continuation of low fertility rates in Europe, which are increasingly perceived as harboring negative social and economic consequences. The objective in this discussion is to examine conflicts of obligation confronting both PPAs and their governments as a result of these developments. The obligation to campaign for/provide the means for the full exercise of planned parenthood rights is compromised by the need to recognize/manage constraints on allocation of scarce health care resources (and the future economy in general). In principle, the role of the IPPF, as a federation of PPAs, is to intercede on behalf of individuals, where necessary, against the mangerial imperatives of states. If population management is an inevitable and even necessary responsibility of states, then IPPF's brief mirrors that of its member associations: to monitor as part of its work the extent to which the activities of the state, as manager of all social "interests," poses a threat to the sectional interests of planned parenthood, or responds to people's planned parenthood needs. The mass transfer of contraceptives through the IPPF from 1 nation state to another, on behalf of some 3rd world countries, may be seen to implicate the IPPF in the "management" of population. The greater the part it plays (or is requested to play) in decisions which are related to demographic objectives, the more it becomes allied, by default, with the managerial imperatives of "host" states. Both the 3rd world and the European situations present the planned parenthood movement with similar ideological paradoxes despite diametrically opposite fertility trends. This movement is compelled in both instances to direct its information and education activities at both governments and national populations at least with the conviction, if not the certainty, that a convergence of individual fertility desires and nationally planned economic growth or stability can be realized.
New York, New York, United Nations Fund for Population Activities, 1985. viii, 41 p. (Report Number 71.)This report contains the findings of the United Nations Fund for Population Activities' 2nd Basic Needs Assessment Mission to Pakistan (March 24-April 9, 1984). Pakistan, the world's 8th most populous country is projected to have over 200 million people by 2020. The current growth rate is 3.1%, total fertility is 5.84/woman, and urban growth is 4.4%. Governmental efforts emphasize and fund education, manpower, and health improvements, but much research on 1) family planning program cost effectiveness, 2) expected demographic effects of the 6th Plan, 3) relationships of nuptiality, fertility, and mortality rates and trends, 4) population projections, and 5) internal and international migration is needed. Population programs suffer from lack of trained manpower. The Government's 6th 5 Year Plan (1983-1988) strives to 1) raise the current family planning practice level from 9.5% to 18.6%; 2) raise the continuous family planning practice level from 6.8% to 13%, and 3) provide reproductive care and child health services. Mission recommendations include expanding outreach services, studying the use of traditional medical practioners (hakeems), and motivating younger couples to seek sterilization. Mission recommendations for improving population education include 1) greater primary school teacher training, 2) adding population education to only 2 or 3 subjects at each grade level, 3) introducing population education into the non-formal sector and into literacy programs, and 4) introducing a population component into projects for women and youth. The report also describes programs in Pakistan and external, multilateral assistance.
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
Report on the evaluation of UNFPA assistance to the maternal and child health programme of Malawi: project MLW/78/P03 (February 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. xi, 36,  p.The 3 initial objectives of the Maternal and Child Health Program of Malawi were health and nutrition education, training of traditional midwives, and immunization against measles and polio. The Evaluation Mission found that the strong points of the project are: the Government's commitment to improve the status of maternal and child health by its expansion of services and its recent acceptance of child spacing as part of its program in maternal child health; the high level of dedication of the personnel in the Ministry of Health; the attention given to strengthening the Health Education section; and the establishment of a good management information framework upon which planning, supervision and monitoring can be further developed. Factors which seem to have hindered the project have been the lack of trained staff at the supervisory and service delivery level caused in large part by the lack of accomodation at the various national training institutions; the failure to appoint international staff to key positions within the project; and the lack of adequate transportation for project personnel. As child spacing will soon be included in project activities, the present organization of the Central Medical Stores to procure and distribute contraceptives and other needed supplies will adversely affect project performance. In total, the evaluation Mission made 19 recommendations addressed mainly to the Government and a number to the World Health Organiation and the United Nations Fund for Population Activities for project management decisions.
Lancet. 1985 Oct 5; 2(8458):780.Despite the continuing war between government forces and the US backed-counter revolutionists, the Sandinista National Liberation Front, which came to power in Nicaragua in 1980, managed, with assistance from the World Health Organization and the UN Children's Fund, to greatly expand immunization coverage throughout the country. Between 1980-84, immunization coverage increased from 33%-97% for tuberculosis, 15%-33% for diptheria, pertussis, and tetanus, 20%-76% for polio, and 15%-60% for measles. Vaccinations are given as part of the routine care provided at health centers and health posts. In addition, measle and polio vaccinations are provided during mass community campaigns, which are held 3 times each year between January and June. During these campaigns about 20,000 volunteers, brigadistas, provide vaccinations for the children living in their own community. The volunteer force is made up of teachers, students, factory workers, housewives, farmers, and civil servants. 70% are women. A manual, using cartoon type pictures, is used to train the volunteers in vaccination procedures. The vaccination campaigns are extensively promoted in the mass media, and the results of each campaign are also publicized in the media. As a result of all of these efforts, no cases of polio were reported since 1982, only 3 cases of diptheria were reported in 1983, and the incidence of measles decreased markedly in recent years. Neonatal tetanus remains a serious problems, and a campaign to reduce the incidence of neonatal tetanus was instituted in 1983. By 1984, 27% of the female target group was vaccinated with 2 doses of tetanus toxoid. Due to expanded health care coverage, the infant mortality rate declined from 121/1000 live births to 80/1000 live births between 1978-83. The immunization effort is currently being curbed by increased contra activities and by the economic sanctions imposed by the US. Under these sanctions, it is difficult for Nicaragua to import items needed to conduct the vaccination program. In addition, many of the brigadistas now serve on medical teams which care for wounded military personnel or are helping to harvest the crops. This report was submitted by a physician who visited Nicaragua in 1984 and talked with health workers in Leon and in several nearby villages.
[Unpublished] 1984. Presented at the Union of National Radio and Television Organisations of Africa [URTNA] Family Health Broadcast Workshop (Nairobi, 19-23 November, 1984).  p.Statistical information on Zambia's population is provided, and the activities, goals, and achievements of the country's family health, maternal and child health (MCH), and expanded immunization programs are described. Zambia is a tropical country and has a 1-party participatory democratic form of government. The country is inhabited by 73 tribes speaking 62 languages. In 1983, the population size was 6,425,000, and 48.6% of the population was under 15 years of age. Population size, area, and density information for each province is provided. The general fertility rate was 220/1000 women of reproductive age. Life expectancy was 50 years for women and 46.7 years for men. The 6 major causes of death among women and children in 1979 were measles, malnutrition, pneumonia, malaria, diarrhea, and respiratory infection. The Ministry of Health is actively working to expand immunization and MCH services in the rural areas. The family health program is a training program charged with the task of providing training in family health for 600 enrolled nurses and midwives. Sessions include 6 weeks of classroom instruction followed by 6 weeks of clinical or field experience. Topics covered in the training sessions are health education, teaching and communication skills, management skills, child health, nutrition, immunization, prenatal and postnatal care, and child spacing. Graduates of the program are assigned to rural health facilities where they supervise the delivery of immunization and MCH services and initiate child spacing services. The family health program, initiated in 1980, is funded by the UN Fund for Population Activities and is guided jointly by the Ministry of Health and the World Health Organization. As of 1983, 19 registered nurse midwives and 442 enrolled nurse midwives were trained under the program. Information on the family health program is disseminated via radio, television, a Ministry of Health magazine, the World Health Day Exhibition, and agricultural shows. The development of MCH services in rural areas is emphasized by the 1980-84 national development plan. The major components of the MCH program are prenatal and postnatal care, family planning, children's clinics, vitamin and protein supplementation, immunization, and school health services. The Expanded Immunization Program (EIP) is integrated into the primary health care system and covers remote areas not as yet covered by MCH services. The specific goals of the program are to increase immunization coverage, establish a cold chain for vaccines, reduce vaccine wastage, and train health personnel to use and maintain cold chain equipment. The program is funded by various UN agencies and the national government. Family planning was introduced into Zambia by the Family Planning Association. The organization's name was later changed to the Planned Parenthood Association to overcome the mistaken impression that family planning meant the complete cessation of childbearing. In 1973, child spacing was integrated into the MCH program and family planning was assigned a high priority in the 1980-84 national development plan. Between 1980-84, the number of family planning acceptors increased from 49,412 to 101,803. In 1984, a number of evaluations were made of the MCH, EPI, and family health programs. The results of these evaluations will be available in the near future. Tables provide information on contraceptive usage, the Ministry of Health budget for 1983, the number and type of health staff in 1982, and the number and type of health facilities in the country.
Ippf Situation Report. 1974 Sep; 1-9.The current status of family planning in Sri Lanka was described, and relevant background information on population characteristics was supplied. Family planning services have been provided by the Family Planning Association of Sri Lanka since 1954. In 1958 the government initiated a family planning pilot project. In 1965 the government assumed full responsibility for providing family planning services, but the governemnt did not formulate or publicly endorse a family planning policy until 1972. Sri Lanka's population was 13,033,000 in 1972, and the annual average population growth rate was 2.3% between 1963-72. The crude birth and death rates were respectively 29.6 and 7.6 in 1971, and the infant mortality rate was 48 in 1973. 41% of the population was under the age of 15 in 1973. In 1972, per capita income was US 100. 71% of the population is Sinhalese, and 70% of the population is Buddhist. The country is primarily agricultural and derives 1/3 of its income from gorwing and processing tea. Education is compulsory for all children aged 5-14 and currently 89.7% of the males and 75.4% of the females are literate. Free medical care is provided, and in 1968 there were 310 hospitals and 3242 physicians. There are no laws restricting contraception in Sri Lanka. The Ministry of Health is responsible for operating the country's national program, and the goal of the program is to reduce the birth rate to 25 by 1975. The government provides family planning services through 496 family health bureaus, and oral contraceptives (OC) and condoms are distributed by midwives and through a variety of other channels at low cost. Service statistics for 1967-73 were provided. In 1973 the number of new acceptors was 27,528 for IUDs, 34,214 for OCs, 13,941 for traditional methods, and 20,248 for sterilizations. In 1973, 11 population and family planning projects, funded by the UN Fund for Population Activities were launched in collaboration with a number of government and UN agencies, labor and employer groups, and the University of Sri Lanka. A contraceptive knowledge, attitude, and practice survey was conducted in 1973, and a National Seminar on Law and Population was held in 1974. In 1973 an effort was launched to decentralize and intensify training for family planning personnel, and several new training courses for nurses, midwives, medical officers, health educators, and public health personnel were developed. The national program receives additional assistance from the International Planned Parenthood Federation, the UN Development Programme, the Swedish International Development Authority, the Canadian International Development Agency, the World Assembly of Youth, and the Population Council. During 1973, the Family Planning Association of Sri Lanka provided family planning services for 8174 new acceptors and 20,858 continuing acceptors at its 25 clinics, located primarily in Colombo. The Association conducts several industrial sector and rural programs which promote vasectomy and provide vasectomy services. Recently the Association conducted several mass mdeia educational campaigns, provided family training for 125 government physicians, and conducted several contraceptive studies, including a Depo-Provera study. In 1973, the Population Services International initiated a national social marketing project for distributing condoms.