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PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
Summary: field trip report, Agency for International Development, Sri Lanka, (Colombo, Kalutara, Kandy and Nuwara Eliya), July 14 to August 2, 1982.
[Unpublished] 1982. 19 p.This report, prepared for the US Agency for International Developement (USAID), provides a description and assessment of the 4 social marketing programs operating in Sri Lanka, an inventory of the program's current contraceptive supplies, an estimate of the programs' supply requirements for 1983-85, and several recommendations for improving social marketing activities in the country. The assessment was made during a brief visit to Sri Lanka in the summer of 1982. Supply requirements were difficult to assess since there is little coordination between the programs. The programs are supplied by a variety of donor organizations, and record keeping is inadequate in some programs. The 4 programs are operated by 1) the Family Health Bureau (FHB) of the Ministry of Health, 2) the Family Planning Association of Sri Lanka (FPASIL), 3) Population Services International (PSI), and 4) Community Development Services (CDS). The FHB program sells oral contraceptives (OCS) and condoms. During 1983-85, most of the program's supplies are expected to be obtained form the UN Fund for Population Activities. The FPASIL program was initiated in 1974 and distributes 10 brands of condoms and 3 brands of OCS. The program receives supplies from the International Planned Parenthood Federation and USAID. The PSI program trains Ayurvedic practitioners to distribute OCs and condoms. Most of the contraceptives are distributed free of charge but some are marketed. The program obtains its supplies from the FHB stocks and distributes them to the practitioners via the postal system. The Community Development Service is a privately run organization which conducts a variety of projects including the marketing of OCs and condoms through health workers and Ayurvedic practitioners. The program is supplied by several donors and is currently requesting condoms from USAID. Detailed information on the program is unavailable; however, it appears that the program overestimated its contraceptive needs for 1983. Between 1975-82, the proportion of married women of reproductive age relying on traditional methods increased from 17%-25%, the proportion relying on sterilization increased from 13%-17%, and the proportion using other modern methods increased from 11%-13%. In 1982, the proportion using OCs was 2.64% and the proportion using condoms was 3.19%. The marketing programs distribute primarily condoms and OCs. Estimated USAID delivery requirements for 1983 included 3,500,000 condoms for the FHB and FPASIL programs and 700,000 cycles of OCs for the FPASIL program. Requirements for 1984 could be estimated only for the FPASIL program and included 800,000 OC cycles and 8,500,000 condoms. The Ministry of Health should commission an outside review of all social marketing activities to identify appropriate and complementary functions for the 2 major programs (FPASIL and FHB) and a local review of the Ayurvedic practitioner training and distribution programs of CDS and PSI. Condoms provided by USAID for the FHB and CDS programs should differ in brand and packaging from those marketed by FPASIL. The progrms' service statistics and logistics should be improved. Research should be undertaken to identify factors contributing to the increase in the use of traditional contraceptive methods and to explore why only minimal increases in the use of modern contraceptives have occurred since 1975. Consideration should be given to setting up a central warehouse for stocking the nation's contraceptive supplies. All programs would then obtain their supplies from this central facilities. USAID assistance would be available for implementing a number of these recommendations.