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FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.
Indian Pediatrics. 1983 Apr; 20(4):235-42.This article discusses implementation of the Alma Ata Declaration on primary health care in developing countries, particularly in India. Tasks are outlined in the areas of health indicators, training of health personnel, allocation of resources, integration of traditional health workers, drug policy, and health delivery strategies. The success of the primary health care strategy hinges on the support of the rest of the health system and of other social and economic sectors. Each country will have to specify its own health goals and priorities within the context of overall development policies, particular circumstances, social and economic structures, and political and administrative mechanisms. The training of health personnel, which is an essential part of primary health care, should be geared to the health needs of the community rather than patterned after the health services in developed countries. In particular, greater use should be made of community health workers. Traditional practitioners represent another potential reservoir of personnel for primary health care, and their integration into the modern system of medicine should be organized. The Government of India has adopted a strategy aimed at integrating promotive, preventive, and curative aspects of health care through a decentralized approach that involves the community in planning, providing, and maintaining the health services. 580,000 community health volunteers, as well as 1 traditional birth attendant for each village, are scheduled to be trained. A subcenter with 1 male and 1 female multipurpose worker is planned for every 5000 population; a subsidiary health center staffed by a doctor, 2 health assistants, and 2 multipurpose workers is proposed for every 25,000 population; and a primary health center is proposed for every 50,000 population, with 1 in every 4 centers to be upgraded to a rural hospital. The Integrated Child Development Services (ICDS) program delivers maternal and child health services at the village level. The number of ICDS projects is proposed to be increased to cover 913 of the 5011 community blocks and 87 urban slum areas by 1985.