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[Mali: report of mission on needs assessment for population assistance] Mali: rapport de mission sur l'evaluation des besoins d'aide en matiere de population.
New York, New York, Fonds des Nations Unies pour la Population, 1988. x, 67 p. (Rapport No. 95)The UN Fund for Population Activities sent a 2nd needs assessment to Mali in September 1985. Mali is a vast Sahelian country, characterized by vast deserts. Only 16.8% of the population is urbanized. Mali is essentially agricultural. The 3rd 5-year development plan covered the years 1981-1985. Population factors do not occupy the place they deserve in development planning in Mali. Recommendations for population and development planning include forming an organization to promote population policy and territorial resource management. Recommendations on data collection include creating a national coordinating committee for demographic statistics, analyzing census data from 1976 and planning for the census of 1987, and reorganizing the vital statistics system. The mission recommends the creation of a national organization to coordinate research activities in the country. Recommendations on health and family planning services include examining bottlenecks in the national health system, redistributing health personnel, and improving planning and administration. The mission recommends extending the educational system in Mali. Materials on population must be included in educational materials. Facts on the condition of women and their participation in economic life are insufficient. The mission recommends the creation of a section for women in the Ministry of State to gather social, economic, and demographic information on women.
[Cape Verde: report of mission on needs assessment for population assistance] Cap-Vert: rapport de mission sur l'evaluation des besoins d'aide en matiere de population.
New York, New York, Fonds des Nations Unies pour la Population, 1988. ix, 66 p. (Rapport No. 93)The Un Fund for Population Activities sent a mission to Cape Verde in 1986 to evaluate their need for population assistance. Small and densely populated, Cape Verde is a poor country which counts on large amounts of international assistance for economic and social development. Demographic data has been collected in Cape Verde for a long time, but it is necessary to improve data collection so that the results can be better used by the government to plan demographic policy. The census of 1990 will be the 2nd one since independence. The big problems of Cape Verde constitute fertility and migration. Institutional support for the Direction Generale de la Statistique will help them take charge of a national system of data collection. In development planning, the mission recommended 2 projects; 1) the support of the organization Unity for analyzing existing data, and 2) a scheme of national territorial resource management. The mission recommends financing a research program to promote national development. The health situation in Cape Verde is better than that of many African countries. However, there are still many public health problems, such as infectious diseases, malnutrition, high fertility, a lack of health education programs, and insufficient health personnel and training for them. Therefore, the mission recommends decentralization of health services, health education, taking advantage of popular organizations, prenatal care, training for traditional midwives, preventive health measures for children, oral rehydration therapy for diarrhea, and family and sex education. Information, education, and communication activities are extremely limited. To extend the integration of women in the process of development, the mission recommends collecting statistics on women, especially in work and employment, and developing productive activities for women.
Updated guidelines for UNFPA policies and support to special programmes in the field of women, population and development.
[Unpublished] 1988 Apr. , 8 p.The United Nations Fund for Population Activities (UNFPA) has been mandated to integrate women's concerns into all population and development activities. Women's status affects and is affected by demographic variables such as fertility, maternal mortality, and infant mortality. Women require special attention to their needs as both mothers and productive workers. In addition to integrating women's concerns into all aspects of its work, the Fund supports special projects targeted specifically at women. These projects have offered a good starting point for developing more comprehensive projects that can include education, employment, income generation, child care, nutrition, health, and family planning. UNFPA will continue to support activities aimed at promoting education and training, health and child care, and economic activities for women as well as for strengthening awareness of women's issues and their relationship to national goals. Essential to the goal of incorporating women's interests into all facets of UNFPA programs and projects are training for all levels of staff, participation of all UNFPA organizational units, increased cooperation and joint activities with other UN agencies, and more dialogue with governmental and nongovernmental organizations concerned with the advancement of women. Specific types of projects to be supported by UNFPA in the period ahead are in the following categories: education and training, maternal health and child care, economic activities, awareness creation and information exchange, institution building, data collection and analysis, and research.
PAHO Bulletin. 1988; 22(4):416-29.This article, which is a summary of a World Bank policy study, states that the characteristics and performance of health sectors vary tremendously in developing countries. In most cases, the sector faces three main problems: insufficient spending on cost-effective health activities; internal inefficiency of public programs; and inequity in the distribution of benefits from health services. It is argued that each of these problems is due in part to the efforts of governments to cover the full costs of health care for everyone from general public revenues. Proposed policy reforms include: charge users of government health facilities; provide insurance or other risk coverage; use nongovernmental resources effectively; and decentralize government health services. However, it was pointed out that further analysis is needed on these proposed reforms.
Arlington, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1988 Sep. , 99,  p. (USAID Contract No. DPE-5927-C-00-5068-00)Building upon smallpox and measles immunization campaigns originally supported by USAID, the Centers for Disease Control, and the World Health Organization, the African region Combatting Childhood Communicable Diseases (CCCD) Project began providing immunizations, oral rehydration therapy for children with diarrhea, and malaria prophylaxis services in 1982. The project was approved in September, 1981, for spending of $47 million through fiscal 1988, and was designed to be implemented through existing publicly operated health service delivery systems with recipient CCCD project countries helping to finance recurrent costs and providing human resources for project implementation. Accordingly, almost all country project agreements were written to ensure that country governments would provide financial support for activities through direct budget allocations, user fees, or some combination of the 2. Regular analyses of service provision were also agreed upon. The development and implementation of user fees have taken place, but the overall theoretical financial strategy has yet to be met in any country project. This document discusses financing achievements and what more is needed to ensure longer term project financial sustainability. Sections review country-specific agreements to spell out original USAID/country terms on financing components; consider the capacity of CCCD project governments to finance recurrent costs in their respective macroeconomic contexts; present highlights of a review of CCCD project financing activities; summarize an evaluation of alternative health financing options; give conclusions of analyses on the financial sustainability of CCCD project activity; and make recommendations for future USAID CCCD project support with respect to financing and economics.
Mexico City, Mexico, MEXFAM, 1988 Feb. , 10 p.During 1987 the Mexican Federation for Family Planning (MEXFAM) continued developing its programs following the same orientation as in the previous year, but at a slower pace intended to achieve a greater degree of consolidation. A permanent mechanism for qualitative evaluation was arranged with the Mexican Institute for Social Studies, an external organization. Work was initiated in 4 new states, bringing the total to 26 of Mexico's 32 states. Activities were suspended in Yucatan because new information revealed that fertility rates were relatively low. MEXFAM does not seek to provide massive family planning coverage but rather to act as a catalyst for family planning activities. MEXFAM is expanding its program of "community doctors", in which it assists young medical school graduates to establish practices in underserved urban areas. In a similar program, "affiliate doctors", physicians already established in their communities, receive technical assistance and materials to begin offering family planning services. During 1987, MEXFAM initiated the "Young People" program to provide sex and family planning education to young people under 20 in schools, clubs, and recreation centers. Various films were made to provide sex education to the Young People program. They were well received in Mexico and some were broadcast in other countries. In 1987, 382,328 new users were served, compared to 174,634 in 1986. 73% of the new users were in MEXFAM programs and the rest were in collaborative programs. Mexico's deteriorating economic situation in 1987 was reflected in increasing resource scarcities for public health organizations. The broad geographic distribution and remoteness of some MEXFAM programs pose a serious challenge for control and supervision. Programs have been grouped into logistic centers with responsibility for supervision assigned on a regional basis. MEXFAM is making great efforts to improve its record system, adapt it to International Planned Parenthood Federation requirements, and make it compatible with the Ministry of Health record system. A certain amount of confusion is anticipated in 1988 as workers become accustomed to new record formats. User payments are the main source of local revenues for MEXFAM. Given Mexico's poor economic situation, the prospects for an increase in local donations are poor, but efforts to raise funds locally are continuous. 4 new external donors were added in 1987. The International Planned Parenthood Federation continues to be the main source of funds. 87% of MEXFAM funds were directly spent on projects and 13% on administration and general services in 1987.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 6-10.The global acquired immunodeficiency syndrome (AIDS) epidemic has, in fact, been comprised of 3 successive epidemics. The 1st of these epidemics is infection with human immunodeficiency virus (HIV), which has already affected 5-10 million people worldwide. The 2nd epidemic, following the 1st but with a delay of several years, is the epidemic of AIDS and other related conditions. By September 1987, a total of 59,563 cases of AIDS had been reported to the World Health Organization (WHO) from 123 countries. However, given the reluctance of some countries to report AIDS and underrecognition of the syndrome, WHO believes the actual number of global AIDS cases is closer to 100,000. 10-30% of HIV-infected persons appear to develop AIDS within a 5-year period, suggesting that 500,000-3 million new cases of AIDS will emerge during the next 5 years. The 3rd epidemic is the wave of economic, social, and political reaction to the 1st 2 epidemics. Since AIDS most often affects individuals in the most economically and socially productive age groups, it can be expected to have a devastating effect on social and economic development in Third World countries. In areas where 10% or more of pregnant women are infected with HIV, projected gains in infant and child health anticipated through child survival initiatives will be cancelled out. AIDS is also having a devastating effect on the health care system in Third World countries as AIDS patients consume limited supplies of drugs, require costly diagnostic tests, and occupy limited numbers of hospital beds. Fear and ignorance about AIDS has threatened free travel between countries and open international exchange and communication. WHO believes the spread of AIDS can be stopped, but only through a sustained, longterm commitment that extends beyond the boundaries of individual countries. AIDS control will require both committed national AIDS programs and strong international leadership, coordination, and cooperation.
Washington, D.C., PAHO, 1988 Jul. v, 117 p. (Official Document No. 221)The global economy continued to adversely affect member countries' health programs and activities in 1987. For example, Latin American and Caribbean countries lost >$US28 billion in 1987 and from 1982-1987 they lost $US130 billion. At the same time, the percentage of adolescents and elderly in the total population increased tremendously, the numbers of people experiencing chronic and disabling diseases also increased while infectious and parasitic diseases still posed challenges for the health community, and the number of urban poor continued to grow. In 1987, to help member countries deal with the everchanging health needs of their populations, PAHO focused on population groups and geographic regions and within these defined areas concentrated on specific diseases. For example, PAHO worked with member governments to formulate, implement, and evaluate policies and programs on the health of adults. Specifically, diseases and conditions emphasized in adult health included cardiovascular diseases, cancer, diabetes mellitus, accident prevention, and the prevention, treatment, and rehabilitation of alcoholism and drug abuse. Other emphases were maternal and child health and family planning and those diseases and conditions associated with the population. Additionally, PAHO continued with special programs and initiatives to maximize its role as a catalyst and to mobilize national and international resources in support of activities aimed at selected health priorities. Some of these initiatives included the Expanded Program on Immunization, the Emergency Preparedness and Disaster Relief Coordination, and the Caribbean Cooperation in Health. In addition, each country's PAHO activities have been summarized.
1987 report by the Executive Director of the United Nations Population Fund. State of world population 1988. UNFPA in 1987.
New York, New York, UNFPA, 1988. 189 p.Of major significance to the United Nations Fund for Population Activities (UNFPA) in 1987 was the fact that the world's population passed the 5 billion mark in that year. Although population growth rates are now slowing, the momentum of population growth ensures that at least another 3 billion people will be added to the world between 1985-2025. This increasing population pressure dictates a need for development policies that sustain and expand the earth's resource base rather than deplete it. Successful adaptation will require political commitment and significant investments of national resources, both human and financial. It is especially important to extend the reach of family planning programs so that women can delay the 1st birth and extend the intervals between subsequent births. Nearly all developing countries now have family planning programs, but the degree of political and economic support, and their effective reach, vary widely. In 1987, UNFPA assistance in this area totalled US$73.3 million, or 55% of total program allocations. During this year, UNFPA supported nearly 500 country and intercountry family planning projects, with particular attention to improving maternal-child health/family planning services in sub-Saharan Africa. As more governments in Africa became involved in Family planning programs, there was a concomitant need for all types of training programs. Other special program interests during 1987 included women and development, youth, aging, and acquired immunodeficiency syndrome (AIDS). This Annual Report includes detailed accounts of UNFPA program activities in 1987 in sub-Saharan Africa, Arab States and Europe, Asia and the Pacific, and Latin America and the Caribbean. Also included are reports on policy and program coordination, staff training and development, evaluation, technical cooperation among developing countries, procurement of supplies and equipment, multibilateral financing for population activities, and income and expenditures.
INDOCHINA ISSUES. 1988 Jan; (78):1-7.A campaign promoting "1 or at most 2 children" was launched officially in 1982 in Vietnam, a country which ranked 12th most populous in the world in 1987, with the 7th largest annual growth rate. Although major municipalities have registered less than 1.7% annual growth rates, in rural areas, particularly in the southern provinces, the growth rate ranges from 2.3-3.4%; 80% of the population resides in such locales. In April 1986, the Hanoi City People's Committee issued regulations designed to encourage the practice of birth control. Cash awards were offered to couples with only 1 child and payments for sterilization after the birth of a 2nd child. The birth of a 3rd child triggers higher maternity clinic charges, and an escalating scale of birth registration fees has been introduced to discourage failure to practice family planning. The most significant statistic to emerge from the birth control program is the gradual increase in the number of family planning acceptors over the past 5 years, slightly over 1 million couples estimated in 1981 to 4.5 million acceptors estimated for 1987. Between 1981-87 there was more than a doubling of acceptors for sterilization and IUD insertion. The IUD is used by 75% of couples practicing birth control, followed in popularity by the condom. Agencies in a UN triumvirate with special population concerns in Vietnam include the UN Fund for Population Activities (UNFPA), the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO). In the 3 years preceding 1987, several new UNICEF-supported public information projects were implemented, including the creation of an extensive maternal and child care network. This network was used to train cadres from the Women's Union as family planning motivators. In mid-1986, an experimental and innovative pilot project on "family life" or "parenting information" was initiated by UNICEF, UNFPA, and the Vietnamese Committee for the Protection of Mothers and the Newborn (CPMN). The desired growth rate of 1.1% by 2000 will have to rely on a variety of current program innovations. Surveys now being conducted in various regions of Vietnam reveal attitudinal problems in promoting smaller families. A survey of the members of 300 farming cooperatives in various areas of Vietnam in 1986 found that 60% of those questioned believed that the more children they had the better it would be for their family economy. Cooperative Vietnamese and UN efforts, particularly the innovative surveys and field research, represent valuable approaches, but considerable need remains for improvement in birth control knowledge and application and in the means to reduce child morbidity and mortality rates.
ISSUES IN SCIENCE AND TECHNOLOGY. 1988 Winter; 4(2):43-8.Without a medical miracle, it seems inevitable that the Acquired Immune Deficiency Syndrome (AIDS) pandemic will become not only the most serious public health problem of this generation but a dominating issue in 3rd world development. As a present-day killer, AIDS in developing countries is insignificant compared to malaria, tuberculosis, or infant diarrhea, but this number is misleading in 3 ways. First, it fails to reflect the per capita rate of AIDS cases. On this basis, Bermuda, French Guyana, and the Bahamas have much higher rates than the US. Second, there is extensive underreporting of AIDS cases in most developing nations. Finally, the number of AIDS cases indicates where the epidemic was 5-7 years ago, when these people became infected. Any such projections of the growth of 3rd world AIDS epidemics are at this time based on epidemiologic data from the industrialized rations of the north and on the assumption that the virus acts similarly in the south as it does in the US and Europe. Yet, 3rd world conditions differ. Sexually transmitted diseases usually are more prevalent, and people have a different burden of other diseases and of other stresses to the immune system. In Africa, AIDS already is heavily affecting the mainstream population in some nations. Some regions will approach net population declines over the next decade. How far their populations eventually could decline because of AIDS is unclear and will depend crucially on countermeasures taken or not taken over the next 1-2 years. In purely economic terms, AIDS will affect the direct costs of health care, expenses which are unrealistic for most 3rd world countries. Further, the vast majority of deaths from AIDS in developing countries will occur among those in the sexually active age groups -- the wage earners and food producers. Deaths in this age group also will reduce the labor available for farming and industry. AIDS epidemics also may have significant effects on foreign investment in the 3rd world as well as negative effects on tourism. The global underclass will be disproportionately affected by AIDS as the blacks and Hispanics already are in New York and Miami. Thus far, the reaction of donor countries to the World Health Organization's (WHO) appeal for funds to fight the battle against AIDS has been excellent. The global strategy of WHO places priority on national campaigns, but none of the national campaigns will be effective unless linked to similar actions in other nations to form a vigorous international program. The US has a special responsibility to provide international leadership on AIDS. The US is the world leader in AIDS research and has the bulk of the virus research capacity. Further, no country can come close to matching US experience in dealing with AIDS through "safe sex" education campaigns.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 13 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The World Health Organization's (WHO's) Control of Diarrheal Diseases Program (CDD) is seeking ways to prevent diarrhea and has identified breastfeeding as an important factor. CDD has developed activities in both its research and services components. In the research component, results from recent studies, some of which received support from the program, have shown the strong protective effect of breastfeeding against diarrheal morbidity and mortality. Exclusively breastfed infants are at lower risk of experiencing diarrhea than infants who are partially breastfed, and those who are partially breastfed are at lower risk than those who are not breastfed. Breastfeeding, which also may reduce the severity of the diarrheal illness, has a powerful effect on the risk of diarrhea-associated death. CDD's priorities for research support in the area of infant feeding were reviewed at an April 1988 meeting. Further research that the program feels is needed falls into 2 broad categories: trials of hospital and community-based interventions that aim to promote exclusive breastfeeding in the 1st 4-6 months of life; and evaluation of approaches for implementing tested breastfeeding promotion interventions in the context of national diarrheal disease control programs. CDD's services component has as its basic responsibility collaboration with countries in developing national control programs. It applies the results of research and involves activities in planning, oral rehydration solution (ORS) supply, training, communication, monitoring, and evaluation. It is in the area of training that specific recommendations on breastfeeding have been made. These recommendations are outlined. The training courses are being used to train approximately 5000 supervisory and management staff a year. The program plans to monitor the effectiveness of the training and develop future activities based on that information.
CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
INTERNATIONAL HEALTH NEWS. 1988 Apr; 9(4):4-5.In the effort to realize Universal Child Immunization by 1990, an active search is underway to find ways to raise immunization coverage levels. The World Health Organization's (WHO) Expanded Program on Immunization (EPI) has developed excellent systems that develop such program components as supply management, equipment maintenance, disease surveillance, clinical practice, and supervision. Program performance has shown a steady improvement over the years in those countries which have adopted such systems, yet the trend has not been as marked as expected. Coverage levels in many countries have remained below 60%, and figures show a "dropout" with the multi-dose vaccines. The dropout figures suggest that parental acceptance of immunization is difficult to sustain throughout the entire series, which is spread over the first 9 months of life. To reduce dropout and boost coverage levels still further, recent program directions have emphasized social mobilization to increase the public response to immunization. It is tempting to conclude that with the implementation of improved management systems the final success will come from persuading parents to avail themselves of immunization services, but field reports suggest that this may not be the case. Health records show missed immunizations despite numerous visits to clinics, suggesting widespread problems in the implementation of the WHO systems. A combination of causes seem to ensure that children attending with their mothers do not get immunized, including errors and omissions on the part of field staff which reduce the chances for immunizations by families making return visits to the clinics. Few programs incorporate immunizations in daily practice. In a series of immunization coverage surveys conducted recently in 1 African country, the most striking fact was that the limitations of the data collected meant that the calculated contribution of clinical error could only be a gross underestimation of true clinical error contribution. This suggests that social mobilization to improve clinical attendance is likely to be ineffective until problems with the provision of services have been solved, but improving services has the potential to increase coverage levels as well as the potential to motivate parents to bring their children to the clinics.
Technical Working Group D report: government and donor support for breastfeeding in health and health-related programs.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 3 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The focus of the working group was to design a general strategy for government and donor support for breastfeeding promotion in health-related and other nonmaternity health programs. As a start, it is important to examine the reasons why government and donor agencies accept or reject programs to support. 3 steps must be followed for governments to accept breastfeeding: statistics showing declines in breastfeeding within the country need to be gathered; the benefits to the country of promoting breastfeeding would have to be demonstrated; and the link between increased breastfeeding and the decrease in child morbidity and mortality also would have to be demonstrated along with the fact that breastfeeding promotion programs can be done. Both economic arguments and data are necessary. For donor agencies to accept and promote breastfeeding enthusiastically, the benefits of breastfeeding should be shown to be synergistic with benefits from other donor priorities. 2 particular gaps in breastfeeding promotion that would be likely to garner donor support are training and communications. Regional centers for breastfeeding information, advanced training, even newsletter publication would be invaluable. Further, donor agencies could support projects like a review of textbooks and the effective distribution of donor publications.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988]. 7 p.. (USAID Contract No. DPE-3040-A-00-5064-00)The US Agency for International Development (USAID) and the Institute for International Studies in Natural Family Planning are at work to find ways to remove barriers to family planning breastfeeding promotion efforts. Barriers include lack of or conflicting measures of program success along with lack of information on the breastfeeding/fertility relationship. The 2 organizations have taken the following steps to assist family planning organizations to increase their promotion and support of breastfeeding: identify current activities and potential barriers to breastfeeding promotion; develop guidelines for breastfeeding support and promotion; assess feasibility and impact of the guidelines; and disseminate the guidelines. Much remains to be done to integrate family planning and breastfeeding. The keys to success are: generating and communicating information which can be used readily by both the population and health policymakers in family planning programs; developing and disseminating guidelines and prototype materials which can be adapted to program needs; identifying, implementing, and evaluating programmatic ways to promote breastfeeding in community and clinical settings; and involving the population community -- at the local, national, and international levels, and in research, service delivery, policy, and training -- in an ongoing dialogue about the relationship of family planning and breastfeeding.
In: The global impact of AIDS. Proceedings of the First International Conference on the Global Impact of AIDS, co-sponsored by the World Health Organization and the London School of Hygiene and Tropical Medicine, held in London, March 8-10, 1988, edited by Alan F. Fleming, Manuel Carballo, David W. FitzSimons, Michael R. Bailey, Jonathan Mann. New York, New York, Alan R. Liss, 1988. 329-34.A study of 30 national Acquired Immune Deficiency Syndrome (AIDS) programs and control plans suggests an auspicious beginning in the effort to mobilize an array of organizations focusing on AIDS prevention and control. The Global Program on AIDS (GPA) of the World Health Organization has assisted National AIDS Committees in over 100 countries to develop short-term plans (6-18 months) or longterm plans (3-5 years) for AIDS prevention and control. Information and education programs are a key element of each plan. In its effort to support these programs, the Global Program on AIDS maintains a worldwide profile of the scope and impact of information and education programs to combat AIDS. To prepare an analytical frame of reference for this profile, 30 national AIDS Prevention and Control Plans were studied to identify recurring target audiences and collaborating institutions. 10 plans were included from countries in Sub-Saharan Africa, 5 plans from the Americas, 5 from the Middle and Near-East, 5 from Asia, and 5 from the Pacific Region. 21 of these plans describe their countries as having a low prevalence of AIDS and HIV infection. All plans include explicit efforts to inform the public about AIDS, how HIV infection is transmitted, and how HIV infection is not transmitted. Some plans specifically call for information, testing, and counseling services and the marketing of the services to encourage their use. All plans recognize the media as important channels for information and all plans give a high priority to the AIDS-related education of health sector personnel. In all plans, prostitutes and their clients and attendees of Sexually Transmitted Disease (STD) clinics are important. Homosexual and bisexual men are included in virtually all plans where heterosexual transmission is not verified as the dominant mode of transmission. Where HIV prevalence is low and where traveling across national boundaries for work or pleasure is common, travelers are identified as an important target audience. A table presents the channels of institutional influence most frequently included in plans, in addition to health and formal educational systems. These include national and local political organizations, church organizations, family planning associations, employer and employee groups, and leading public and private agencies. 22 plans include the provision of condoms and discuss a variety of institutional mechanisms for their distribution.
Non-governmental organisations, AIDS and the institutional memory: experiences from the League of Red Cross and Red Crescent Societies.
In: The global impact of AIDS. Proceedings of the First International Conference on the Global Impact of AIDS, co-sponsored by the World Health Organization and the London School of Hygiene and Tropical Medicine, held in London, March 8-10, 1988, edited by Alan F. Fleming, Manuel Carballo, David W. FitzSimons, Michael R. Bailey, Jonathan Mann. New York, New York, Alan R. Liss, 1988. 271-6.The challenge is to ensure that nongovernmental organizations (NGOs) involvement with Acquired Immune Deficiency Syndrome (AIDS) strengthens existing programs and that the lessons learned from these ongoing activities, i.e., the institutional memory, strengthen and direct involvement with the AIDS pandemic. An involvement with the AIDS pandemic draws attention to the many difficult issues already facing NGOs, including: how to "move something up the agenda" without allowing it to take over; how to develop general policies and strategies and ensure consistency of NGO messages, while at the same time being sensitive to local needs and conditions; how to "coordinate" without being seduced by the aphorism that "to coordinate is good but to control is best;" and how to find a balance between proactive and reactive. In addition, AIDS has posed some problems that most NGOs have not had to confront with other health programs: the importance of being sensitive about language; the importance of specifically involving people with high risk behaviors and those who are HIV positive or have AIDS; the importance of trying to do something despite the ostrich position taken by some governments; and the importance of both taking a stand against discriminatory practices that affect people's health and of counteracting the discrimination that is released by this disease. An attempt was made within the League of Red Cross and Red Crescent Societies to use institutional memory in response to the AIDS pandemic. With the support of several donor National Societies, workshops for Red Cross and Red Crescent Societies were organized in Europe and Africa with the aim of informing and motivating them, generating commitment, exchanging experiences and ideas, and developing general policies and strategies. An information pack also was sent to all National Societies, containing basic information about AIDS and including some ideas about what can be done. Using the information gained from these workshops, a Resolution on AIDS was drafted and adopted at General Assembly held at the end of last year. At the same time, effective formal and informal communication and coordination both within the Federation and outside were developed. Finally, during this initial phase, basic information and advice was developed for delegates. In 1988, workshops will be run for the Caribbean and Latin American National Societies, and efforts will be made to assist National Societies in organizing and conducting national workshops and developing short and mid-term plans.
[Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. 7 p.In most developing countries, particularly those in Africa and the Caribbean, equal numbers of women as men are affected by the acquired immunodeficiency syndrome (AIDS) and have the potential to infect their fetuses. Thus, any consideration of the AIDS problem in developing countries must give serious attention to women and children. Current research suggests a perinatal transmission rate of 30-40% and there is concern that AIDS-related pediatric deaths will undermine child survival efforts in countries that have begun to reduce infant and child mortality rates. A number of clinical issues that are now poorly understood require immediate research so that findings can be incorporated into AIDS prevention strategies. Among these issues are: the impact of pregnancy on progression of human immunodeficiency virus (HIV) infection to AIDS; factors that affect an HIV-infected mother's chance of infecting her fetus; the safety of breastfeeding; immunization; the relationships between HIV infection and various contraceptives; and the potential impact of HIV infection on fertility. The extent and nature of the social and financial impact of AIDS at the family and community levels must also be better understood. In the interim, UNICEF has proposed 6 programmatic approaches to prevent women from becoming infected, to prevent perinatal transmission, and to address the AIDS-related needs of women and children. 1st, traditional birth attendants should be trained in AIDS prevention measures and provided with supplies to ensure infection control. 2nd, women must be able to receive consistent, appropriate advice from both maternal-child health workers and family planning staff about contraception and their future health. 3rd, the issue of counseling for women should be broadened beyond that associated with routine prenatal HIV screening. 4th, AIDS education efforts for school-age children must be expanded. 5th, more attention should be given to the social service needs of AIDS-infected women and children. And 6th, there is an urgent need to improve protocols and treatment facilities for those affected with HIV and AIDS.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1988; 66(2):143-54.Through a review of the work on the control of poliomyelitis carried out under the auspices of the World Health Organization (WHO) during the past 20 years, the importance of international collaboration is shown. Because of efforts in planning and coordinating, the production and control of the Sabin strains of the live oral vaccine provide safe, reliable, and potent vaccines. The cooperative efforts have included working not only with national control laboratories but with poliomyelitis vaccine producers in many countries. In the early 1970s, a Consultative Group of WHO became active. Their initial efforts included an extensive epidemiological study in 13 interested countries. Later, the group saw to studying the reliability of the marker tests used in the intratypic differentiation of poliovirus stains of different origins. Additionally, they saw to standardizing tests for the neurovirulence of vaccine lots, including analyzing and recording results, and to ensuring that adequate supplies of vaccine will be available for the next 200 years. After 15 years of continual surveillance of vaccine-associated cases by WHO epidemiologists and clinicians, the findings show the following: Type 1 live poliovirus vaccine is almost never implicated in postvaccination paralysis; type 2 strain occasionally causes of paralysis in contacts of the vaccine, and type 3 strain causes most of the few cases of postvaccine paralysis. The occurrences of the cases from type 2 and 3 strains remains an enigma. Current research of the group suggests an even more effective vaccine may become available in the future.
In: Women's health and apartheid: the health of women and children and the future of progressive primary health care in Southern Africa, edited by Marcia Wright, Zena Stein and Jean Scandlyn. New York, New York, Columbia University, 1988. 84-9.There is a large discrepancy between maternal mortality rates in developed and developing countries, with maternal mortality as a leading cause of death of young women in poor countries. There has been renewed interest in maternal mortality among international agencies and major foundations quite recently. Women and children form up to 2/3 of the population of many developing countries, and over 1/2 of primary health care resources are devoted to maternal and child health programs. Nevertheless, little of this is directed at maternal mortality; most goes to immunization, oral rehydration for diarrhea, monitoring children's growth, and promoting breastfeeding. While some of the international health community attribute the long neglect of maternal mortality to not knowing the extent and severity of the problem before, prior data existed demonstrating the alarmingly high rates. Low maternal mortality in the West may have distracted attention from the international problem. Sexism may have been a major factor, as even today efforts to reduce maternal mortality need to be justified in terms of the implications for the family, children and society as a whole. The reasons for the current concern are not clear, but may relate to an interest in concrete issues after the United Nations Decade for Women, or real surprise in the international community once the problem was pointed out. As various agencies rush to establish maternal mortality programs, it is imperative to evaluate which approaches will be really effective. Critical evaluation of programs is necessary to capitalize on the current interest.
[Unpublished] 1988 Dec 9. Paper presented at The Northeastern Regional meeting of The National Council for International Health (NCIH) co-sponsored by the Center for Population and Family Health of the Columbia University School of Public Health, at the Kellog Conference Center, Columbia University, New York City, December 8-9, 1988. 7 p.To specify the integration of AIDS policies with existing family planning associations around the world, the International Planned Parenthood Federation (IPPF) gave a policy speech at the Dec. 1988 Northeast Regional Meeting of the NCIH. The speech had a dual purpose. One was to outline the best way to deal with a centralizing problem like AIDS by using a decentralized system like IPPF. The second was to answer 5 questions posed by the meeting which were: how do individual government and agency AIDS policies fit in with global AIDS policies?, how does the publication of new data impact policy formation?, how are priorities determined as in treatment vs. prevention?, what are the linkages between family planning, population, and AIDS programs?, and have examples of other health policies been helpful in the formulation of AIDS policies? IPPF policy is to direct a centralized special unit to integrate with existing family planning work and not displace it. This unit would collect and distribute information, discuss ideas, provide technical assistance in developing programs, and channel necessary funds. The emphasis is that the programs would be done by family planning workers who are all nationals, and therefore the best to relate to and work with their own people. 2 publications have been released by IPPF called 'Preventing A Crisis' and 'Talking AIDS' which concentrate on teaching associations and field workers how to treat subjects with dignity and respect while dealing with situations that are relevant to them and their community.
Kuala Lumpur, Malaysia, ICOMP, 1988 Jan. vi, 68 p.1987 has proven to be a most successful year for the International Council on Management of Population Programs (ICOMP). Membership expanded to 61 -- program managers 34, heads of management institutes 12, associate members 9, and honorary members 6. 6 workshops were held in 1987, 4 devoted to population program management and 2 in the area of women's programs. The UN Fund for Population Activities (UNFPA), South Asian Management Program (SAMP) is being executed in a timely manner. ICOMP also executed a management training program for Vietnam at the request of the UNFPA. Training activities were conducted in Vietnam, and study tours of the ASEAN region were conducted. Other activities in 1987 included the study tour of China, the ongoing research activities under the community participation project, and various international activities. The 1987 Financial Report and Accounts shows that ICOMP has reached its financial target of US$1,000,000. The actual income for 1987 was US$1,014,602. The various activities of the year are detailed.
New York, New York, United Nations Population Fund, 1988. xi, 850 p. (Population Programmes and Projects Vol. 2.)The purpose of this 14th edition of the INVENTORY is to show, at a glance, by country, internationally-assisted projects funded, inaugurated, or being carried out by multilateral, bilateral, and non-governmental and other agencies and organizations during the reporting period. The time frame for this edition is for projects carried out during the period from 1 January 1986 through 30 June 1987. Whenever possible, projects that may have been funded prior to 1986 and that were still being carried out in 1986/1987 are shown. The entry for each country includes 1) demographic facts, 2) government's views regarding population, and 3) assistance organized by type of organization. The basic source of demographic data for individual countries is the "World Population Prospects, Estimates and Projections As Assessed in 1984," United Nations, New York, 1986, except for some island countries and/or territories for which no updated information was available and information was provided from other sources. The basic sources of information for the government's views regarding population is the Population Division and its publication, POPULATION POLICY BRIEFS: THE CURRENT SITUATION IN DEVELOPING COUNTRIES AND SELECTED TERRITORIES, 1985. The dollar value of projects or total country program is given where such figures were available.
IPPF MEDICAL BULLETIN. 1988 Apr; 22(2):2-3.The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.