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Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1987; (749):1-86.This report makes a special effort to present practical information on the control of intestinal parasitic infections. It covers the following: public health significance of intestinal parasitic infections (methods of assessment, helminthic infections, and protozoan infections); the costs of not having a control program (nutrition, growth, and development; work and productivity; and medical care); prevention and control strategies (epidemiological foundation, objectives and general approaches, implementation strategies, costs and financing, methodologies and tools, and strategy for prevention and control); national programs (justification; objectives and strategies; planning; program and implementation; training, education, and dissemination of information; program monitoring and evaluation; and technical guidance); and program support (the role of the World Health Organization, technical and research organizations, funding agencies, industry, and information flow). Current experience suggests that intestinal parasite control programs are appropriate and socially advantageous because people can actually see the effects of primary health care intervention and start to learn some simple facts about health care by watching their village or community become healthier as a result of the control measures. There are 3 major areas in which the lack of control program is responsible for significant losses: nutrition, growth, and development; work and productivity; and medical care costs. Countries in which intestinal parasitic infections and diseases constitute a significant health problem need to consider adopting a national policy for their prevention and control. Recent experience in various countries has demonstrated the effectiveness of periodic deworming and standard case management at the primary health care level in reducing most of the problems associated with intestinal parasitic infections. Support can come from outside the country as well as from national authorities. Support from the outside may be available in the areas of management, technical expertise (which includes research), funding, and exchange of relevant information. The World Health Organization can provide both technical and managerial expertise in the design of programs.
EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
Expanded Programme of Immunization Eastern Mediterranean Region. A report for the EPI Global Advisory Group Meeting, Alexandria, 21-25 October 1984.
[Unpublished] 1984. 10,  p. (EPI/GAG/84/WP.7.a)The strategy adopted by the Members States of the Eastern Mediterranean Region (EMR) to achieve the objective of the promotion of the Expanded Program of Immunization (EPI) through primary health care (PHC) concentrates on strengthening synergistic integration of EPI with other services. Activities have been planned and implemented or are being implemented at the Regional Office and at the country level. 21 countries of the Region now have either a full-time or part-time manager or an EPI focal point. This is a considerable development, for in 1982 there were EPI managers in 9 countries. Except for 3 countries, all national EPI managers/focal points have received senior level training in EPI. At delivery points, vaccination is performed to a large extent by multipurpose health workers, but full-time vaccinators are available in about 6 countries. All field workers have received training at their respective regional levels. Limited financial resources continue to be 1 of the primary constraints of the program in the Region. Plans to resolve this problem include: counteracting wastage factors; close collaboration with the UN International Children's Emergency Fund (UNICEF) and other international agencies at the country level to standardize approaches and avoid overlap; tapping regional and international voluntary agencies to increase their contributions; and increased use of associate experts, UN volunteers, and national technical staff. The overall information system is to some extent weak and suffers from irregularity and a lack of continuity. Regular reports are received from 9 countries which have World Health Organization staff. Repeated requests from other countries yield incomplete and at times contradicting data. Research efforts are directed towards operational areas, and research in strategies, integration, community, and surveillance areas is being encouraged.
[Unpublished] 1985. 8 p. (EPI/CCIS/85.2)This protocol provides a method for using Vaccine Cold Chain Monitors to make periodic reviews of a national cold chain. This protocol is based on experience that has been gained from information from 31 countries and from cold chain reviews in India and Tunisia. The purpose of a cold chain review is to make a nationwide or regionwide review of the effectiveness of the vaccine cold chain; and to find out how best to redirect cold chain development efforts into the areas that most need help. A review method is outlined and should be modified according to local conditions. A cold chain review should take about 7 months to complete and should be timed to precede or coincide with a wider EPI and primary health care review. A timetable is included. For the review: monitor cards are distributed with vaccine shipments from the manufacturers so that cards reach all cold chain stores; at each store in the cold chain and at each transport link, the cold chain monitor arriving with vaccines is checked, and any failures registered by the indicators are recorded on the monitor card; monitor cards are returned to a central office for sorting and analysis; and the results of this analysis then are used as a guide to identify and strengthen the weakest links in the cold chain. How many cold chain monitors are needed for a review depends on the size of the study area and the extent to which the monitors will be used. In general, each dispensary and outreach immunization session should receive at least 1 monitor card that has traveled through the cold chain from the central store during the study period. An extensive training program is needed before the review can begin. All health workers who will handle vaccines during the study must receive some training on how to fill in and interpret the readings on the monitors. Once the materials have been written, this training should be conducted in 3 steps for regional and district supervisors and maternal and child health staff and health assistants who work in health posts and outreach centers. The analysis of the results can be organized in many different ways. Each monitor that has been returned from a health center can have up to 23 items of information on it.
Evaluation of the USAID grant to the International Center for Diarrheal Disease Research, Bangladesh: Maternal and Child Health/Family Planning Extension Project.
Arlington, Virginia, International Science and Technology Institute, Population Technical Assistance Project, 1986 Sep 18. xi, 23,  p. (Report No. 85-68-039)This report evaluates a US Agency for International Development (AID) grant to the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), which supports the Maternal and Child Health/Family Planning Extension Project (EP). The EP operations research effort was initially designed to replicate the Matlab model in 2 upazilas, but shifted to an effort to initiate new approaches. Of the 13 major experiment undertaken during the project's 4-year history, over half have adopted by the Ministry of Health and Population Control, including a plan to add 10,000 female welfare assistants to the existing cadres. Considering the accomplishments of the EP to date, there is strong justification for continued funding of the project, at least until 1990 when the government's 5-year Plan concludes. It is recommended that the project's emphasis should continue to be to test various alternative strategies for improved implementation of family planning/maternal-child health programs within the overall framework of a limited number of clearly defined project objectives. The task of analyzing incremental costs should be given higher priority in the next 5 years and project documentation should be refined. The decision as to whether the project should be funded after 1990 or phased out should be deferred until a later date. Also presented in this report are specific recommendations regarding the selection of research topics, research procedures, dissemination of research results, addition of new staff, filling of staff vacancies, and Population Council involvement.
[Unpublished] . iv, 70,  p.To strengthen project development and reinforce the links between the United Nations Family Planning Association (UNFPA) and specialized agencies, it has been proposed to convene a series of meetings between UNFPA Policy and Technical Division/Program Division staff and staff working in the area of population communication. These meetings are further intended to improve ongoing monitoring of UNFPA communication activities, improve the flow of data on new developments in the field, and upgrade the quality of technical project documents. The background documentation and papers in this manual were prepared to serve as a basis for discussion at the meetings. Material is presented in 5 categories: review of trends and changes in population communication, examples of population communication programs assisted by UNFPA, UNFPA policy guidelines, project formulation and evaluation, and UNFPA basic need assessment guidelines. Supplementary papers focus on changes in development models, population communication research, preproject research, and ongoing projects in population communication and education. The documents stress that many IEC activities in developing countries have been based on research models derived from western mass communications research. It is essential that new models of communication research be developed for use in population programs that reinforce the role of community participation in development. UNFPA's main consideration in providing assistance for population education is to develop and strengthen national resources and programs and to improve local capacity for sustained action.
Geneva, Switzerland, WHO, 1985. 110 p.3 World Health Organization (WHO) Scientific Groups have examined different technical aspects of the problem of sexually transmitted diseases and their reports have been published in the Technical Report Series. This book has been prepared following the meeting of a scientific working group that was held in Washington in April 1982 to discuss the formulation of appropriate strategies and programs for the control of this group of diseases. This book emphasizes the need for such programs to be integrated into general programs for the control of communicable diseases and for the gynecologcal, obstetric, pediatric, and urological services to play an active and dynamic part. A control activity for sexually transmitted diseases is any activity which minimizes the adverse health effects of this group of diseases. Control activities may reduce the incidence of the disease; the duration of the disease; the effects of each case, including both the physical complications and psychosocial consequences; or the cost of achieving certain outcomes, i.e., increase the efficiency of services. Many different control activities, for example, clinical services, screening, and contact tracing, can reduce the effects of sexually transmitted diseases. A control program is composed of various control activities. Priorities are established, various options for control are examined, and appropriate methods are adopted. Control programs for sexually transmitted diseases define the population to be covered and specify the control activities related to that group. The 1st section of this book covers initial planning steps, focusing on estimating the public health importance of sexually transmitted diseases, priority groups, and sociological aspects of control. The section devoted to intervention strategies deals with health promotion, disease detection, national treatment programs, contact tracing and patient counseling, and clinical services. The 4 chapters that make up the support components section discuss centers for prevention of sexually transmitted diseases, information systems, professional training, and laboratory services. The 2 chapters devoted to implementation examine program management and evaluation of control programs. This book may appear to suggest that the disease control process should be highly systematic, comprehensive, and compartmentalized. Yet, in practice, many activities take place simultaneously and in a manner that is far from systematic, sequential, and ordered.
New York, New York, United Nations, 1985. v, 58 p. (Economic and Social Council Official Records, 1985. Supplement No. 10; E/1985/31; E/ICEF/1985/12)The major decisions of the UN Children's Fund Executive Board in their 1985 session were to: approve several new program recommendations and endores a major emergency assistance program for several African countries; approve initiatives to accelerate the implementation of child survival and development actions, particularly towards the goal of achieving universal immunization of children against 6 major childhood diseases by 1990; adopt a comprehensive policy framework for UN International Children's Emergency Fund (UNICEF) programs concerning women; approve UNICEF revised budget estimates for 1984-85 and budget estimates for 1986-87; and make a number of decisions on ways to improve the administration and the role of the Board. The Board members both reported on and heard evidence of the encouraging results of recent efforts to implement national child survival and development programs. Reports of the successful immunization campaigns in Burkina Faso, Colombia, El Salvador, and Nigeria were welcomed, along with the news that half a million children were saved during the year through the use of oral rehydration therapy. Stronger efforts were encouraged to improve results in the areas of breastfeeding and growth monitoring. Implementation issues in connection with child survival and development actions were a continuing focus of Board attention during the session. The accelerated implementation of child survival and development actions was accorded the highest priority in approving the medium-term plan for 1984-88. The Board also adopted a resolution that sought to draw the attention of world leaders, during their observance of the 40th anniversary of the UN, to the importance of reaffirming their commitment to accelerate the implementation of the child survival and development resolution and realizing universal immunization by 1990. Delegations commended the results of the World Health Organization/UNICEF joint nutrition support program but noted that malnutrition among women and children appeared to be increasing. Water supply and sanitation activities were encouraged, and the Board stressed that those actions should be linked with health and hygiene education. The Board endorsed the report on recent UNICEF activities in Africa. Many delegations spoke in support of the increased aid to Africa. Major emphasis was given to linking emergency responses with ongoing UNICEF programs. The Board approved new multi-year commitments from general resources totalling $303,053,422 for 28 country and interregional programs and noted 32 projects totaling $223,215,000 to be funded from specific-purpose contributions. The Board stressed the importance of ensuring that child survival and development actions were integrated with continuing efforts in other of UNICEF action. The Board approved a commitment of $252,550,443 for the budget for the biennium 1986-87.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: country reports.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xiv, 89 p.UNFPA has provided funding for various family life education (FLE) projects with particular emphasis on youth in the English-speaking Caribbean since the mid-1970s; this report is an independent evaluation of the projects in Antigua, Barbados, Dominica, Jamaica, St. Lucia, and St. Christopher and Nevis. Although birth rates are relatively low in the English-speaking Caribbean, the incidence of adolescent pregnancy and the number of births to women under the age of 20 is an important problem in the region. The Mission concluded overall that the projects have contributed to pioneering and groundbreaking efforts demonstrating that it is possible to initiate and make considerable progress in the implementation of FLE/FP programs for adolescents even when adolescent pregnancy and births are still highly sensitive and controversial issues and when there are no official policies in favor of such programs. The Mission concluded also that project design had improved over the years and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. All the projects included in the evaluation have contributed to the training in FLE/FP of a large number of family life educators, teachers, and nurses and, as a result, have significantly strengthened professional national capability. The projects have shown that despite the lack of official policy approving FLE in schools and generally overcrowded curricula, FLE can be introduced into schools. In the area of FP service delivery, the projects included in the evaluation have contributed to making FP services generally available through integration with the government maternal and child health services. The main management issues across the projects were similar and included staffing, coordination, supervision, monitoring and evaluation. There is a need to adjust project design so that gender separation is minimized and that the FLE content deals better with issues such as self-awareness, sex roles, and self-esteem. The wider impact of the projects included in this evaluation, to be reflected, for example, in reduced incidence of teenage pregnancy, reduced maternal and infant/child morbidity and mortality, and more generally in the life patterns of women, cannot yet be measured.
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.
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.
World Health Forum. 1984; 5(2):99-102.This report reviews the monitoring of progress towards the goal of health for all. It appears that a high level of political sensitization has occured and that the political will to achieve the goal of health for all exists in a large majority of the countries that have reported. Health policies have been or are being formulated with the objective of achieving universal coverage of the population through primary health care (PHC). Countries are beginning to look at their health systems with a view toward reorienting them to the PHC approach and to redistributing resources in a way that will strengthen their community based health services. Considerable efforts have been made to reorient health workers towards PHC. Most countries have officially recognized the right of people to participate in the health system, and several countries are trying various ways of promoting participation. In a few countries efforts are being made to stimulate othe relevant sectors to undertake intersectoral action in health. A number of observations can also made on the relative lack of progress. Few countries seem to have developed well-defined plans of action that include specific targets and objectives, a time frame, and data on the projection and allocation of resources. Even fewer countries can assess the resource flow from national and external sources to support their strategies. The overall response rate is good (118 of 162 Members States have reported), but the completeness and the quality of information leave much to be desired. At the global level, the consolidation of the progress reports tends to smooth over the findings, and it is difficult to reflect the wide variations among countries and regions. An important observation must be made: there is a striking lack of information that would enable analysis of even some of the critical aspects of implementation. It is difficult to determine at this stage whether such information is simply unavailable in countries or whether the efforts made to collect it were inadequate. Another critical area is the information on the resources currently available for health, especially the financial resources. Many countries encountered serious difficulties when trying to determine the proportion of gross national product spent on health, and even more could not estimate the percentage of the national health expenditure spent on PHC. Despite its limitations, the monitoring process has yielded useful information, even at this early stage, on the efforts governments are making to implement national strategies. Monitoring of implementation and evaluation must occur at the managerial and technical as well as the policy level, and these two must be interlinked.
In: Sattar E, ed. South Asian focus. Papers presented at the 1982 ICOMP International Conference. Kuala Lumpur, Malaysia, International Committee on the Management of Population Programmes, 1983 Nov. 156-69. (Management Contributions to Population Programmes Vol. 2)The primary study objective was to assess the contributions of external management assistance to the family planning and population program of Bangladesh and to identify the conditions and characteristics of successful assistance activities. Study focus was on 2 key questions: the extent of contributions of management assistance projects to the performance of the population program; and identification of the conditions for the characteristics of those projects which appear to be successful. The scope of this study was limited to the investigation of the 14 management assistance projects as well as the institutional settings of their implementation. These capture all substantive management assistance projects in Bangladesh initiated through external aid between 1968-78. The projects were studied in terms of content and substance of management assistance efforts. Administrative problems are common to all development programs in Bangladesh. In the population and health area administration problems are accentuated by shortages of skilled manpower; cumbersome procedures for the allocation, release, and use of funds; slow decision making process; absence of incentives to improve staff performance; and delays in recruitment of staff. The lack of community support is another barrier to the family planning program. The 14 management assistance projects, described briefly, were of a varied nature. These involved improvement in management of the existing program, reinforcing management capability, build up of a supportive management institution, specific program improvement, development of management assistance capability within the program, integration of maternal and child health (MCH) and family planning services, introduction of legal policy measures, and development of a cost effective services delivery system. The mode of assistance also varied considerably. These were in the form of consulting, institution building, evaluation, training, financial support, and research. The management assistance activities had different levels of success in terms of realizing their objectives. These varied from failure to meet objectives to a low level of success, moderate level of success, or to a high level of success. 4 management assistance activities were categorized as highly successful, 6 as moderately successful, 3 as minimally successful, and 1 as a failure. The management development activity individually and collectively contributed to developing better service delivery capability in the family planning and population program. This is reflected in the improved service statistics of the program. It can be argued that the increase in the acceptance level from 9.6% in 1975 to 14% in 1980 has been possible through improving the capability of service delivery through management improvement of the family planning and population program.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1982 Dec. xi, 44,  p. (Project SWA/75/P01)The long range objective of this project (1976-1981) was to improve and enhance the health and welfare of mothers and children, especially in rural areas. In assessing Project achievements and the degree to which progress toward the long term objective has been accomplished, the Evaluation Mission found that the immediate objectives had, to a large degree, been met within the general framework of the Ministry of Health's (MOH) development program. Service delivery points in governmental, mission private and industrial/plantation health facilities are now widely distributed throughout Swaziland. The integration of preventive and curative is clearly in place in the rural health clinics and health centers. Analysis of service statistics data indicates that a large % of pregnant women attend antenatal clinics. Family planning services are now offered in 86 clinics with 27,094 clinic attendances recorded for 1981. The pill is the most popular method, followed by condoms, injectables and IUDs. An adequate though incipient health education program is functioning. The MOH strengthened the health infrastructure for, and has in place a program of, maternal child health (MCH) and family planning (FP). The strong points of the program are the government's commitment to MCH/FP, the general strategy, the training component, the number and quality of staff involved in service delivery, the number of service delivery points and the system of recruitment and the employment of Rural Health Motivators (RHM). Weak points, which appear to have hindered a more effective program performance, are planning and management, the lack of solid socio-anthropological knowledge to base, the lack of a focal point for FP, supervision at all levels and the lack of monitoring and evaluation which, if properly undertaken, could have led to changes and adjustments in the program. Future activities supported by the United Nations Fund for Population in the organization and management of family planning activities within the MCH program and within other government and voluntary organizations. UNFPA should help the government prepare a new proposal for UNFPA assistance to family planning activities in the country and should consider supporting supervision and training activities.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.