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Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
The role of health centres in the development of urban health systems: report of a WHO Study Group on Primary Health Care in Urban Areas.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (827):i-iv, 1-38.The WHO Study Group on Primary Health Care (PHC) in Urban Areas has written a report after examining the development of reference health centers in urban areas in various parts of the world. It considers such centers to be a potentially important way to improve urban health services. Reference health centers, with real roots in the community and good links to first level and referral level care, can address the problems of access to health care and intersectoral collaboration. Each center should be based on a general model, but its exact operation depends on local conditions and on a comprehensive situation analysis that considers social and financial factors and the level of organizational development. Each reference center should determine what needs to be done locally with local and national resources. Outside donors should only provide assistance for operational costs and a last resort. To plan services adequately, decision makers must define geographical catchment areas and travel times. These definitions must see to it that services integrate with each other vertically (with services at health post and hospital levels), and horizontally (with government, and nongovernmental, and community projects). A solid epidemiological understanding of major local health problems is essential for expanding PHC through reference health centers. This knowledge comes from an assessment of demographic, morbidity, mortality, and social data an evaluation of coverage of underserved and marginal groups. Reference health centers would be in an ideal position to gather and analyze these data. Innovative ways to obtain the resources for urban PHC are collection of user fees and close supportive links with universities and nongovernmental organizations. The Study Group looks at how reference health centers in Cali, Colombia; Manila, the Philippines; and Newark, New Jersey in the US, developed.
In: Population distribution and migration. Proceedings of the United Nations Expert Group Meeting on Population Distribution and Migration, Santa Cruz, Bolivia, 18-22 January 1993. Convened in preparation for the International Conference on Population and Development, Cairo, 5-13 September 1994, compiled by United Nations. Department of Economic and Social Affairs. Population Division. New York, New York, United Nations, 1998. 364-9. (ST/ESA/SER.R/133)This paper discusses the health risks that urbanization has brought to developing countries. Urban dwellers, particularly children, women, and elderly people, are vulnerable to health threats associated with overcrowding, pollution, and a host of familiar urban problems that include mental and physical diseases, homelessness, drug abuse, and sexually transmitted diseases as well as violence and social alienation. The evidence available indicates that poor populations have higher rates of maternal mortality and infant mortality and morbidity. Environmental conditions influence certain health risks. The environment exposes children to a high risk of diarrheal diseases and parasitic diseases such as Chaga's disease, filariasis, leishmaniasis, and schistosomiasis. Moreover, urban malaria has become an urgent problem in countries where the disease is endemic. In addition, there is a high risk of accidents and injuries caused by unsafe and overcrowded transport systems. The impact of these problems on the health of urban dwellers requires an assessment of environmental health services and a revitalized role of public health in solving them. The WHO continues to play a role in the development of the concept of adopting a holistic and integrated approach to improving the health status of the population.
URBANISATION AND HEALTH NEWSLETTER. 1996 Mar; (28):7-13.This article identifies some urban health challenges and discusses World Health Organization (WHO) concepts of public health, a Municipal Health Plan, and the WHO Healthy Cities Program (HCP). A healthy city is defined as one that continually creates and improves the physical and social environment and expands community resources for enabling the mutual support among population groups for living. Urbanization is advancing rapidly, but government resources are not keeping pace with people's needs. By 1990, at least 600 million urban people in developing countries faced life and health threats. There is poverty, inadequate food and shelter, insecure tenure, physical crowding, poor waste disposal, unsafe working conditions, inadequate local government services, overuse of harmful substances, and environmental pollution. Poor people in cities frequently must satisfy all their basic needs in health, welfare, and employment. There is exposure to early sexual activity of adolescents, transient relationships, high levels of prostitution, and limited birth control. Unsustainable use of natural resources and environmental destruction pose threats to urban productivity and restrict future development options. The WHO launched a "Health for All" campaign in 1978, based on 4 basic principles. The HCP, which is based on these principles, has expanded to many cities. It measures the health burden and makes health issues relevant and understandable to local agencies through analysis and policy advocacy. The Municipal Health Plan facilitates awareness of environmental and health problems in schools, work and marketplaces, health services, and among other organizations.
In: Urban health in developing countries: progress and prospects, edited by Trudy Harpham and Marcel Tanner. London, England, Earthscan Publications, 1995. 142-52.This book chapter describes UNICEF's program experience with urban health programs, which began in the late 1960s. By the late 1970s, an Urban Basic Services (UBS) strategy was adopted in over 40 countries. UNICEF's most recent support for urban women and children focuses on Universal Child Immunization, Oral Rehydration Therapy drives, UBS programs, street children, advocacy on macroeconomic issues affecting the urban poor, and advocacy among mayors for assessing the situation of children. After the Alma Ata Conference in the 1980s, UNICEF joined with the World Health Organization (WHO) in sponsoring regional health meetings. Since the 1970s, the UBS initiatives are the most consistent effort directed at the urban poor, comprising: community empowerment, universal coverage, convergence of services, advocacy, use of low-cost technologies, capacity building, sustainability, institutionalization, and going to scale. UBS means urban primary health care and includes sectoral interventions in several countries. Multisectoral linkages are not automatically established until late in program development. UBS projects in three cities in Kenya, however, include mutual support of the community health organization and the formal health system in a multisectoral framework. Constraints to UBS are lack of community confidence and a need to focus on community development rather than on women and children; a long time-frame before major impacts; lack of national sectoral linkages; limited monitoring and evaluation; and the small scale of projects. UNICEF now implements WHO's Health Cities Initiatives. Programs are moving toward sustainability and achievement.
In: Urban health in developing countries: progress and prospects, edited by Trudy Harpham and Marcel Tanner. London, England, Earthscan Publications, 1995. 123-41.This book chapter discusses the history of World Bank (WB) assistance for health improvements in developing countries and uses examples of urban health programs. The WB's focus on health began in the 1976. The first major health policy statement occurred in 1980. WB support for health increased in the late 1980s. In 1990, the WB devoted over 20% of the $4.8 billion in total external assistance in developing countries to health. The WB disburses about $1.0 billion annually to health, which is the largest source of aid to the health sector. The rapid increase in analyses of health issues was stimulated by a focus in general on human resource development. The WB is concerned with alleviating poverty. Investment in low-cost, preventive care is a way of mitigating poverty and enhancing poor people's productivity and income and ability to educate their children. WB involvement in health is justified because of the widespread poverty in urban areas and national investment in urban-based hospitals. Health projects are geographically diverse and generally focus on improving access to and quality of basic health services for the urban poor. The WB is involved in investments in related sectors: water and sanitation, urban development, and the environment. The key issues for the future include identifying interventions that have the greatest impact on the health of the urban poor, determining the appropriate role of government and the private sector in delivery of health services, targeting vital health services to the urban poor, and defining the responsibilities of local government and central health agencies.
In: Urban health in developing countries: progress and prospects, edited by Trudy Harpham and Marcel Tanner. London, England, Earthscan Publications, 1995. 110-22.This book chapter discusses the efforts of the World Health Organization (WHO) to strengthen urban health and environmental services. The first recognition of urban health and environmental concerns was in 1963, by the Expert Committee on Urban Health Services of WHO. A meeting on the effects of urbanization in 1970, recognized research needs but ignored time factors. The Alma Ata Conference in 1978, focused attention on vulnerable urban people and their health problems. The Art Report in 1984 and 1989, by UNICEF and WHO, called attention to the magnitude of urbanization and its implications for health. The Division of Strengthening of Health Services (SHS) followed the report's mandate and focused specifically on the development of health services for the urban poor. In a 1986 meeting, case studies were presented to illustrate the usefulness of offering primary health care services in urban areas and to promote and facilitate a review of structures. SHS formulated a program of activities and guidelines for conducting rapid appraisals of health needs. Four themes were identified in meetings in 1989: the importance of understanding the scale of the problem, the location of responsibilities for health in the city, the importance of broader issues, and the identification of ways to address the health needs of the urban poor. WHO is preparing a new global environmental health effort. Agenda 21 was adopted in 1992. The Healthy Cities Project has regional offices and aims to strengthen the capacity of city governments and to provide opportunities. Six recommendations and some research priorities are identified. The World Health Assembly in 1991, focused on strategies for health for all.
WORLD HEALTH FORUM. 1997; 18(3-4):287-93.With the industrial revolution, peasants began moving into towns in industrializing countries, beginning a slow, but steady process of urbanization. At the beginning of the 19th century, just 3% of the world's population lived in towns. However, after the Second World War, large numbers of people migrated to urban areas at rapid rates, especially in the newly independent and Latin American countries. By 2015, approximately 20% of the urban population in developing countries will be living in 27 megacities and an additional 28% will be living in approximately 700 cities with populations larger than 500,000. Weak administrative structures and limited resources will be the norm in many of these cities as populations grow rapidly and uncontrolled. In the shantytowns of developing countries, health hazards are associated with the prevailing poverty, lack of water and sanitation, and substandard housing; changes in living conditions and lifestyles; chronic diseases related to modernization; lung diseases; accidents; mental and psychosomatic disorders; and social instability, cultural and social alienation, and the social and mental ill-effects of degrading living conditions and extreme crowding. While urban health care absorbs the bulk of most national health budgets, up to 85% of those funds are spent on curative services delivered through large specialist hospitals located in the cities. Many people in the surrounding shantytowns and slums have no access to cities' services or do not use them because they do not respond to their needs. The health services which are available tend to be poorly managed. Political will can, however, lead to improved urban health.
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.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
Lancet. 1986 Jan 25; 1(8474):223.This article summarizes the conclusions and recommendations of a joint UNICEF/WHO consultation on primary health care in urban areas. The meeting, which was held in Guayaquil, Ecuador, in October 1984, was attended by representatives from 9 countries: Brazil, Colombia, Ecuador, Ethiopia, Guatemala, India, Philippines, Republic of Korea, and Peru. 5 priorities were emphasized: the need for comprehensive rather than partial coverage, the use of simple 1st-line remedies such as oral rehydration, the reallocation of resources, intersectoral and interinstitutional collaboration, and the supporting responsibility of governments and international agencies. Community participation is an essential component of primary health care. Once the process of community development is launched, the balance within the existing health care system must be adjusted to prepare for the explosive tempo of urbanization. Cities, regions, and countries must move with sustained determination toward full primary health care coverage for the urban poor. Ongoing close collaboration between UNICEF and WHO is of great importance to the future of primary health care. Specifically, the consultation recommended: 1) consciousness raising activities to make governments, the world public, international organizations, and nongovernmental organizations aware of the scale of the need; 2) continuing support to projects and the informal network of people dedicated to the development of primary health care and the subsequent transformation of health systems; and 3) help with scaling up the health care system.
Food and Nutrition Bulletin. 1982 Jan; 4(1):7-16.This study describes 3 nutrition intervention programs in Sri Lanka; Lanka Jathika Sarvodaya Samgamaya; Redd Barna, the Norwegian Save the Children Program; and the US Save the Children fund. The Sarvodaya Shramadana Sangamaya is a private, nonprofit organization that began in 1958 devoted to mobilizing voluntary labor for village reconstruction. It is now engaged in a series of development projects in over 2,000 villages. One of its main objectives is to mobilize community resources for development. The children's service now integrates pre-school, nutrition, and community health services. There are an estimated 86 day care centers. The main service available in these day care centers, apart from physical care, is the provision of nutrition. Pre-school nutrition programs are also administered. The program costs about Rs230/beneficiary per year. The International Council of Educational Development from the United States was invited to review the program. Recommendations are given. The Norwegian Save the Children (Redd Barna) program in Sri Lanka was started in 1974. Projects are of 2 types: 1) settlement projects; and 2) integrated community development projects which aim to improve the standard of living with particular attention to child welfare. The US Save the Children Fund (SCF), a private, nonprofit voluntary organization, began its 1st project in Sri Lanka in urban community development in a slum and squatter settlement within Colombo. It focused on housing, but also includes other programs such as health and nutrition. These activities are carried out through a pediatric clinic, a home visits register, a nutritional status survey, a supplementary feeding program, nutrition, education, and a day care center. The approximate cost of the nutrition program would be Rs7700/month for an average of Rs13/month, or Rs156/year/beneficiary.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 11-7. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)In developing countries systems of "bare-foot doctor" health care are being used. The goal is to provide a health service that is within the reach of each individual and family in the community, is acceptable to participants, that entails their full participation at a cost suitable to the individual and the nation. As opposed to hospital oriented Western medicine, there is usually a health officer from the local community, trained and provided with a dispensary, who returns to the home community. 2 projects in progress which were having negative results, 1 in Zaire and 1 in Senegal, were evaluated. The principles which redirected the programs are discussed. Problems such as mobile centers versus fixed sites for health centers, single aim projects and self-administration of the centers are explored. The acceptance of responsibility by the local public by using funding and resources of its own was judged to run the least risk of failing in the long term. In Senegal a new law on administrative reform was passed which allowed district health committees dealing with about 100,000 people to be set up. With a system of self-financing, more than 500,000 people were treated in 3 years. The fees were modest and 65% of the income from fees was used to keep drug supplies up to date. 3 dangers were identified and overcome: risk of embezzlement by district treasurers, overconsumption of drugs, and stocking excessively expensive products. The basic conditions necessary to provide an efficient network of health services in a rural environment (Zaire) and an urban environment (Senegal) are joint financing of activities through contractual financial participation, local administration, improved medical personnel, standardized medical procedure, and continuous supervision in collaboration with non-professional health workers.
Washington, D.C., U.S. Dept. of Health, Education, and Welfare, Office of International Health, 1978 Aug. 288 p. (Contract No. TAB/Nutrition/OIH RSSA 782-77-0138-KS)The most rapidly growing category of health assistance is the development of low cost health delivery systems which integrate health services, family planning, and nutrition interventions. It has been shown that the perception of improved child survival due to better health and nutrition is a precondition to the acceptance of family planning on the part of the rural poor in developing countries. In 1977, 27% of AID health funds went to integrated low cost health delivery systems and in 1979 the figure was 43% with Africa receiving the largest proportion (1/3) of the funds. This volume summarizes 39 AID projects based on information contained in AID Project Identification Documents and Project Papers. 2/3 of the projects summarized target the population of a region or subregion in the country rather than the population as a whole; the assumption here is that if the value of low cost rural health delivery can be demonstrated in a part of a country it will be extended to other regions.
Impact of population assistance to an African country: Department of State, Agency for International Development. Report to the Congress by the Comptroller General of the United States
U.S. General Accounting Office. Comptroller General, Washington, D.C., United States, 1977. (ID-77-3) v, 65 p.Add to my documents.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
In: Current problems in obstetrics and gynecology, Vol. 5, No. 6, edited by John M. Leventhal. Chicago, Illinois, Year Book Medical Publishers, 1982. 4-41.This article addresses the medical aspects of population growth, with specific focus on a demographic overview, population policies, family planning programs, and population issues in the US. The dimensions of the population problem and their implications for social and economic development are reviewed. The world's response to these issues is discussed, followed by an assessment of what has been accomplished, particularly as it relates to the record of national family planning programs in developing countries. The impact of population growth on such issues as education, available farm land, deforestation, and urban growth are discussed. Urban populations are growing at an unprecedented rate, posing urgent problems for action. From a public health perspective, data are reviewed which demonstrate that having children at short intervals (2 years) or at unfavorable maternal ages (18 or 35) and/or parity (4) has a negative impact on maternal, infant and childhood morbidity and mortality, particularly in developing countries. Increasing the age of marriage, delaying the 1st birth, changing and improving the status of women, increasing educational levels and improving living conditions in general also are important in reducing population growth. Probably the most important, but most controversial intervention, has been the development of national family planning programs aimed at increasing the public's access to modern contraceptive and sterilization methods. India was the 1st country to declare a formal population policy (in the 1950s) with the goal of reducing population growth. Currently, close to 35 countries have formal policies. The planned parenthood movement, with central support from the London office of the International Planned Parenthood Federation (IPPF), has played a most important role in making family planning services available. 2 population issues in the US today are reviewed briefly in the final section: teenage pregnancy and the changing age structure.