Your search found 15 Results
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.
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
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.
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.
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.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
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.
Washington, D.C., SOMARC, .  p.This document contains briefing materials for the participants of an upcoming meeting of the advisory council and working groups of Social Marketing for Change (SOMARC), an organizational network, funded by the US Agency for International Development (USAID) and composed of 5 firms which work together in helping agencies, organizations, and governments develop contraceptive social marketing programs. Social marketing is the use of commercial marketing techniques and management procedures to promote social change. The briefing materials include 3 background and 18 issue papers. The background papers provide brief summaries of USAID's population activities and of the history of social marketing programs, an overview of USAID sponsored contraceptive social marketing programs in 14 countries and of 3 major non-USAID programs, and a listing of the skills and resources needed to develop effective contraceptive social marketing programs. The issue papers provide a focus for the discussion sessions which are scheduled for SOMARC's working groups on marketing communication, management, and research. USAID's objective is to promote the development of family planning programs which are completely voluntary and which increase the reproductive freedom of couples. Contraceptive social marketing programs are consistent with this objective. USAID provides direct funding for family planning programs as well as commodity, technical, and training support. USAID's involvement in social marketing began in 1971, and USAID is currently sponsoring programs in Jamaica, Bangladesh, Nepal, El Salvador, Egypt, Honduras, Ecuador, the Caribbean Region, Costa Rica, Guatemala, and Peru. In the past, USAID provided support for programs in Mexico, Tunisia, and Ghana. The Mexican project is now functioning without USAID support, and the projects in Tunisia and Ghana are no longer operating. Major non-USAID contraceptive social marketing programs operate in India, Sri Lanka, and Colombia. These programs received only limited technical support from USAID. To ensure the success of social marketing programs, social marketers must have access to the knowledge and skills of commercial marketers in the areas of management, analysis and planning, communications, and research. Social marketers must also have expertise in social development and social research. In reference to the issue papers, the working groups and the advisory council were asked to develop suggestions for 1) overcoming social marketing program management problems, 2) motivating health professionals toward greater involvement in social marketing programs, 3) improving the media planning component of the programs, 4) improving management stability and training for management personnel, and 5) improving program evaluation. Areas addressed by the issue papers were 1) whether social marketing programs should be involved in creating a demand for contraceptives or only in meeting the existing demand, 2) the development of a methodology for assessing why some programs fail and others succeed, 3) the feasibility of using anthropological and questionnaire modules for conducting social marketing research, 4) techniques for overcoming the high level of nonsampling error characteristic of survey data collected in developing countries, 5) techniques for identifying contraceptive price elasticity, 6) the feasibility of using content analysis in social marketing communications, 7) the applicability of global marketing strategies for social marketing, and 8) how to select an an appropriate advertising agency to publicize social marketing programs.
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.
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.
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.