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The role of community participation in development planning and project management. Report of a Workshop on Community Participation held in Washington D.C., September 22-25, 1986.
Washington, D.C., World Bank, 1988. x, 36 p. (EDI Policy Seminar Report No. 13)The role of community participation in development planning and project management is the subject of this report for the Economic Development Institute (EDI) of the World Bank. The report focuses on issues raised during policy seminars, specifically identifying emerging concerns and summarizing workshop activities. Community participation is defined, and the potential benefits and costs of community participation are discussed. The successful implementation of participatory approaches are examined, as well as EDI's role in community participation through training activities and regional seminars. Part of EDI's proposed strategies include developing modules for EDI training activities, regional seminars, developing teaching materials, and coordination with other agencies and organizations. Annexes provide a list of participants in the seminar, a workshop timetable, and a list of papers presented at the workshop.
Project agreement between the Employers Confederation of the Philippines (ECOP) and ILO/Labour and Population Team for Asia and the Pacific (LAPTAP).
[Unpublished] 1987.  p. (Project No. PHI/87/EO1)This project agreement between the Employers Confederation of the Philippines (ECOP) and the International Labor Organization (ILO)/Labor and Population Team for Asia and the Pacific (LAPTAP) continues support to the Population Unit of ECOP for an additional 2 years (July 1987-89). Economic uncertainties in the Philippines resulting from the past period of political turmoil necessitated this extension in ILO funding. After 1989, ECOP will absorb the population education officer into its regular staff. Continued funding of the ECOP program is based on several favorable factors, including the evident commitment of the ECOP directors to population activities, contact made with individual employers and business associations since 1985, and the production high-quality IEC materials. The long-term objective of this project is to promote smaller families through educational and motivational programs that emphasize the close relationship of family planning and living standards and to link such activities with existing health services at the plant level. Specific objectives are to disseminate information on family planning and family welfare to workers and to educate employers in the industrial sector about the relevance of family planning to labor force development. Project activities will include monthly seminars for employers and meetings with member associations of ECOP.
Oxford, England, Oxford University Press, 1988. , 86 p.The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
London, England, IPPF, 1987. ii, 27 p.Continuing the program directions adopted in the previous 1985-87 Plan, the 1988-90 Three Year Plan considers the need to sustain family planning associations (FPAs) in the roles and programs most suited to the needs of people in their countries. It is based on the experience of FPAs and is used selectively by them in the context of local priorities. Attention is directed to the objectives of each of the 7 action areas: strengthening the role and effectiveness of FPAs, the International Planned Parenthood Federation (IPPF), and other nongovernmental organizations (NGOs) in the planned parenthood movement; promotion of family planning as a basic human right; improving and expanding services for better family health; meeting needs of young people; women's development; male participation in family planning; and resource development. Strengthening management skills and program capacity at all levels of IPPF, including the opportunity for volunteer and staff development on a continuing basis needs to remain a priority. Specific objectives in this area include: intensifying understanding of the role of NGOs in family planning and promoting governmental, intergovernmental, and NGO collaboration in family planning activities; strengthening the contribution of volunteers; broadening community support and participation; and strengthening FPA capacity in the development, management, implementation, and evaluation of family planning programs. In the area of human rights, it is necessary to increase awareness and promote the exercise of family planning as a basic human right, to overcome obstacles to this objective, and to increase awareness of the interrelationship between people, resources, the environment, and development. IPPF still has an important pioneering role in demonstrating innovative, efficient, and cost-effective ways to expand the coverage of services whether through health-related service delivery systems or through other mechanisms such as social marketing. The Federation's Policy Statement on Meeting the Needs of Young People continues to provide the Federation with a broad framework for its efforts to work both for and with the younger generation. IPPF must maintain strong links with women's organizations and the women's development movement and provide technical assistance and support in the planning management and implementation of field programs. The Federation and other organizations must devote a more significant part of their resources to programs aimed at men. Strong international support for family planning continues to be essential, but increasing national self-reliance remains a key goal for IPPF.
[The Church, the Family and Responsible Parenthood in Latin America: a Meeting of experts] Iglesia, Familia y Paternidad Responsable en America Latina: Encuentro de Expertos.
Bogota, Colombia, CELAM, 1977. (Documento CELAM No. 32.)This document is the result of a meeting organized by the Department of the Laity of the Latin American Episcopal Council on the theme of the Church, Family, and Responsible Parenthood. 18 Latin American experts in various disciplines were selected on the basis of professional competence and the correctness of their philosophical and theological positions in the eyes of the Catholic Church to study the problem of responsible parenthood in Latin America and to recommend lines of action for a true family ministry in this area. The work consists of 2 major parts: 12 presentations concerning the sociodemographic, philosophical-theological, psychophysiological, and educational aspects of responsible parenthood, and conclusions based on the work and the meetings. The 4 articles on sociodemographic aspects discuss the demographic problem in Latin America, Latin America and the demographic question in the Conference of Bucharest, maturity of faith in Christ expressed in responsible parenthood, and social conditions of responsible parenthood in Peruvian squatter settlements. The 3 articles on philosophical and theological aspects concern conceptual foundations of neomalthusian theory, pastoral attitudes in relation to responsible parenthood, and pastoral action regarding responsible parenthood. 2 articles on psychophysiological aspects discuss the couple and methods of fertility regulation and the gynecologist as an advisor on psychosexual problems of reproduction. Educational aspects are discussed in 3 articles on sexual pathology and education, education for responsible parenthood, and the Misereor-Carvajal Program of Family Action in Cali, Colombia. The conclusions are the result of an interdisciplinary effort to synthesize the major points of discussion and agreements on principles and actions arrived at in each of the 4 areas.
[Unpublished] 1984 May 8. 31 p. (CE 92/12)This report shows how demographic information can be analyzed and used to identify and characterize the groups assigned priority in the Regional Plan of Action and that it is necessary for the improvement of the planning and allocation of health resources so that national health plans can be adapted to encompass the entire population. In discussing the connections between health and population characteristics in the countries of the region, the report covers mortality, fertility and health, and fertility and population increase; spatial distribution and migration; and the structure of the population. Focus then moves on to health, development, and population policies and family planning. The final section of the report considers the response of the health sector to population trends and characteristics and to development-related factors. The operations of the health sector must be revised in keeping with the observed demographic situation and the projections thereof so that the goal of health for all by the year 2000 may be realized. In several countries of the region mortality remains high. In 1/3 of them, infant mortality during the period 1980-85 exceeds 60/1000 live births. If measures are not taken to reduce mortality 55% of the population of Latin America in the year 2000 will still be living in countries with life expectancies at birth of under 70 years. According to the projections, in the year 2000 the birthrate will stand at around 29/1000, with wide differences between the countries of the region, within each of them, and between socioeconomic strata. High fertility will remain a factor hostile to the health of women and children and a determinant of rapid population growth. Some governments view the present or predicted growth rates as excessive; others want to increase them; and some take no explicit position on the matter. The countries would be well advised to assign values to their birthrate, natural increase, and periods for doubling their populations in relation to their development plans and to the prospects for improving the standard of living and health of their populations. An important factor in urban growth is internal migration. These migrants, like some of those who move to other countries, may have health problems requiring special care. Regardless of a country's demographic situation, the health sector has certain responsibilities, including: the need to promote the framing and adoption of population and development policies, in whose implementation the importance of health measures is not open to question; and the need to favor the intersector coordination and articulation required to ensure that population aspects are considered in national development planning.
Washington, D.C., World Bank, 1987 Feb. v, 37 p. (World Bank Discussion Papers 6)This paper reviews the experience of World Bank projects with community participation in the urban housing, health, and irrigation sectors. The analysis is based on a sample of 40 projects with potential for community participation and 10 successful projects without such community involvement. For the purposes of this review, community participation was defined as an active process with the following objectives: empowerment, building beneficiary capacity, increasing project effectiveness improving project efficiency, and project cost sharing. Community participation was introduced in 38% of the projects studied to increase effectiveness, but only 25% were able to implement it. 48% of the projects planned community participation for efficiency purposes, but only 35% translated it into specific activities. Cost sharing was the objective of 48% of the projects, but again, only 10% achieved some measure of success. Empowerment and capacity building emerged as relatively less important objectives in World Bank Projects. The primary organizational devices used in Bank projects to elicit community participation were user groups, community workers, and field extension workers of the implementing agency. User groups were formed mostly in irrigation projects; health projects relied primarily on outreach workers. The full potential of community participation could not be realized in some of these projects due to technological gaps, poor extension and supervision, lack of an intergrated set of serves, and an inability to implement critical project policies. Overall, it is suggested that community participation is an appropriate strategy when project objectives include empowerment and capacity building, the design of the project services calls for interaction among beneficiaries as a basis for identifying their needs, implementation of the project demands frequent dialogue and negotiation among beneficiaries, and users can manage a part of the project operations.
[Unpublished] 1985 Nov 19. Presented to the Executive Board, Seventy-seventh Session, Provisional Agenda Item 18. 20 p. (EB77/27)The Expanded Program on Immunization (EPI) has made major public health gains in the past decade. The central EPI strategy has been to deliver immunization in consonance with other health services, particularly those directed toward mothers and children. However, in the least developed countries and many other developing countries, it does not appear likely that national budgets will be sufficient by 1990 to support full immunization coverage on a sustained basis or that an adequate number of national managers can be assembled to staff effective programs. At the November 1985 meeting of the EPI Global Advisory Group, recommendations were made to accelerate global progress. These recommendations reflect optimism that the 1990 goal of reducing morbidity and mortality by immunizing all children of the world can be achieved, but also acknowledge that many fundamental problems of national program management remain to be resolved. 3 general actions needed are: 1) promote the achievement of the 1990 immunization goal at national and international levels through collaboration among ministries, organizations, and individuals in both the public and private sectors; 2) adopt a mix of complementary strategies for program acceleration; and 3) ensure that rapid increases in coverage can be sustained through mechanisms which strengthen the delivery of other primary health care interventions. The 4 specific actions needed are: 1) provide immunization at every contact point, 2) reduce drop-out rates between first and last immunizations, 3) improve immunization services to the disadvantaged in urban areas, and 4) increase priority for the control of measles, poliomyelitis, and neonatal tetanus. Continued efforts are also required to strengthen disease surveillance and outbreak control, reinforce training and supervision, ensure quality of vaccine production and administration, and pursue research and development.
The participation of the rural poor in development: releasing the creative energies of rural workers.
Geneva, Switzerland, ILO, . 55 p.This booklet provides an overview of the work of the International Labor Office (ILO) in the area of participation and rural development. The failure of many development projects is attributed to a failure to involve the rural poor in such efforts. An alternate approach involves making the poor participants in rather than passive recipients of the development process. The concept of people's participation is understood by the ILO to mean that the poor should have a say in the decsions that affect them, pool their efforts, share risks and responsibilities, and develop their own independent organizations. Specific measures discussed in this booklet that strengthen the particpation of the poor include workers' education activities, participatory training schemes, cooperative institutions, public works programs, and the involvement of women. In addition, the booklet sets forth 6 examples of this approach: betel production in Sri Lanka, Sarilakas ("own strength") in the Philippines, credit for the poor in Bangladesh, a storage cooperative in the Niger, fisherwomen in Brazil, and self-inquiry in Nicaragua.
Accelerated immunization programmes and CSDR: their meaning and broader implications for development [editorial]
ASSIGNMENT CHILDREN. 1985; 69-72:vii-xxvi.This editorial introduces a special issue of "Assignment Children" devoted to the theme of universal child immunization by 1990. Not only will this campaign significantly reduce morbidity and mortality from 6 childhood diseases, but it will also, through the experience of massive public participation, create conditions favorable for achieving development goals in areas other than health care. Immunization is a means for enabling those who have grasped the concept of protection of one's children to carry this effort into other areas for other goals. If families are to be empowered in this way, the knowledge and know-how held by the experts at the top must be melded with traditional knowledge and the wish of parents to protect their children from disease and death. The usual concept of development conveys ethnocentric and central power biases as well as a fragemented and sectoral approach. In contrast, accelerated immunization programs represent an example of action within a new development paradigm. This approach addresses not just symptoms, but fundamental causes of underdevelopment in the areas of health and survival. Although the underlying causes of poverty are only marginally affected by such campaigns, the validation of important goals of the majority of the population can release social energy and increase individuals' control over other aspects of their life.
Washington, D.C., Centre for Development and Population Activities, 1986 Apr. 14 p. (CEDPA Tenth Anniversary Lecture Series)This discussion of the role of women managers in family planning and population programs begins with an overview of the participation of women in development and population. It then directs attention to the need for women in management, increasing women's role in development programs, and changing attitudes about women's roles. 1 of the major achievements of the Decade for Women has been the recognition by most governments of the need to integrate women more fully into the process of national socioeconomic development. More and more governments are making a concerted effort to increase the participation of women and to integrate them into development. An area in which opportunities for women have not increased as much as they could is in management. The role and involvement of women in population and family planning are particularly important. Family planning programs in many areas of the world are directed to women, involve women, and are utilized by women, yet women are not in the policy-making or management position, deciding what should be done for them. In management, the 5 basic concerns are authority to make decisions, communication within organizations, the opportunity to introduce change, the productivity of the operation, and staff morale. The most important positions for women managers are at the policy-making and decision-making levels, but few women are at those levels in most developing country programs. Women's knowledge of local customs, norms, and needs can be used in designing programs and in selecting methods and services. Many programs now are designed, and family planning methods selected, without a clear understanding of the local situations or local customs. Women managers have the responsibility to educate others about how to design, implement, and evaluate programs and projects that are sensitive to the needs of women. Thus, the family planning sector in particular must involve women in all stages and levels of program design and implementation. The UN Fund for Population Activities (UNFPA) developed some guidelines on women, population, and development following the 1975 conference in Mexico inaugrating International Women's Year. The guidelines call for special attention to the needs and concerns of women and for participation of women in all stages and aspects of the UNFPA program. Since 1984, UNFPA has been examining how it can address the involvement of women in population programs and ways to improve the role and status of women. It tires to suppport projects in 2 major categories: projects aimed directly at improving the role and status of women by increasing their access to educational training and skills development and their participation in the community; and activities aimed at increasing the participation of women in all UNFPA-supported projects, which must be designed with consideration to the needs and concerns of women.
Washington, D.C, Pan American Health Organization, 1983. x, 145 p. (Scientific Publication No. 435)This document, prepared by the Pan American Health Organization (PAHO), reviews health in the Americas in the period 1905-47, provides a more detailed assessment of progress in the health sector during the 1970s, and then outlines prospects for the period 1980-2000 in terms of meeting the goal of health for all by the year 2000. The main feature of this goal is its comprehensiveness. Health is no longer viewed as a matter of disease, but as a social outcome of national development. Attainment of this goal demands far-reaching socioeconomic changes, as well as revision of the concepts underlying national health systems. It seems likely that the coming period in Latin America and the Caribbean will be characterized by intense urban concentration and rapid industrialization, with a trend toward increasing heterogeneity. If current development trends continue, the gap in living standards between urban and rural areas will widen due to sharp differences in productivity. Regionally based development planning could raise living standards and reduce inequalities. In the type of development expected, the role of social services is essential. It will be necessary to determine whether the objective is to provide the poor with access to services that are to be available to all or to provide special services for target groups. The primary health care strategy must be applicable to the entire population, not just a limited program to meet the minimal needs of the extreme poor. Pressing issues regarding health services in the next 2 decades include how to extend their coverage, increase and strengthen their operating capacity, improve their planning and evaluation, increase their efficiency, and improve their information systems. Governments and ministries must be part of effective infrastructures in which finance, intersectoral linkages, community participation, and intercountry and hemispheric cooperation have adequate roles. One of PAHO's key activities must be systematic monitoring and evaluation of strategies and plans of action for attaining health for all.
[Unpublished] 1981 Jun 19. 46 p. (A/36/215)The Advisory Committee for the International Youth Year, established by the General Assembly of the UN in 1979, met in Vienna, Austria, from March 30-April 7, 1981 to develop a program of activities to be undertaken prior to and during the UN designated 1985 International Youth Year; this report contains the draft program of activities adopted by the committee at the 1981 meeting. The activities of the International Youth Year will be undertaken at the national, regional, and international level; however, the major focus of the program will be at the national level. Program themes are development, peace, and participation. The objectives of the program are to 1) increase awareness of the many problems relevant to today's youth, (e.g., the rapid increase in the proportion of young people in the population; high youth unemployment; inadequate education and training opportunities; limited educational and job opportunities for rural youth, poor youth, and female youth; and infringements on the rights of young people); 2) ensure that social and economic development programs address the needs of young people; 3) promote the ideals of peace and understanding among young people; and 4) encourage the participation of young people in the development and peace process. Program guidelines at the national level suggest that each country should identify the needs of their young people and then develop and implement programs to address these needs. A national coordinating committee to integrate all local programs should be established. Specifically each nation should 1) review and update legislation to conform with international standards on youth matters, 2) develop appropriate educational and training programs, 3) initiate action programs to expand nonexploitive employment opportunities for young people, 4) assess the health needs of youth and develop programs to address the special health needs of young people, 6) transfer money from defense programs to programs which address the needs of young people, 7) expanding social services for youths, and 8) help young people assume an active role in developing environmental and housing programs. Activities at the regional and international level should be supportive of those at the national level. At the regional level, efforts to deal with youth problems common to the whole region will be stressed. International efforts will focus on 1) conducting research to identify the needs of young people, 2) providing technical assistance to help governments develop and institute appropriate policies and programs, 3) monitoring the program at the international level, 4) promoting international youth cultural events, and 5) improving the dissemination of information on youth. Young people and youth organizations will be encouraged to participate in the development and implementation of the program at all levels. Nongovernment agencies should help educate young people about development and peace issues and promote the active participation of youth in development programs. The success of the program will depend in large measure on the effective world wide dissemination of information on program objectives and activities. A 2nd meeting of the advisory committee will convene in Vienna in 1982 to assess progress toward implementing the adopted program. A 3rd and final meeting in 1985 will evaluate the entire program. This report contains a list of all the countries and organizations which participated in the meeting as well as information on program funding.
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.
[Unpublished] .  p. (XA/01472/00)The Regional Population Communication Unit for Africa, operational in Nairobi, Kenya in September 1974, and a sub-unit operational since 1977 in Dakar, Senegal, work closely with the population education office in Dakar and with other international, regional, and subregional organizations which are active in population, family planning research, rural development, women, youth, and educational matters. In the years ahead, the Regional Unit will concentrate its efforts on assisting individual member states in addition to activities at regional or subregional levels, which are considered by member states to have a multiplier effect. The Unit's main objectives include: to assist national governments in the development of their communication plans, policies, and projects in support of their population/family planning and overall development programs; to work out with regional and international organizations or agencies a practical and effective system of coordinating communication and education activities in support of population and development communication programs at the national, subregional, and regional levels; to develop regional and national institutions for training, research, and development of appropriate communication materials; and to establish a population communication clearinghouse to serve as an exchange center for population and development communication programs in the region. The immediate objectives are to assist member states in their quest for self sufficiency in the training and development of manpower in the field of population; to provide member states with technical support in the development of their population activities; to promote the exchange of information, experience, materials, and know-how in the region; to develop and evaluate innovative communication approaches, which could improve the performance of national programs; to develop, pretest, produce, and evaluate a variety of prototype educational materials for use at the national level; and to improve the capacity of the Regional Population Communication Unit to assist in providing advisory services to national governments. The Unit's program of activities concentrates on 4 areas at both national and regional levels -- training, research and studies, media development, and technical assistance and advisory services. The activities of the Unit are geared to provide support for existing projects and programs, study tours, regional specialized workshops, and seminars and participation in the training seminars and workshops. Training programs provided by the Unit include seminars, workshops, and conference on development support communication. The training strategy emphasizes training as a continuing activity.
Planned Parenthood and Women's Development. Experiences from Africa: Ghana, Kenya, Lesotho and Mauritius.
Nairobi, Kenya, International Planned Parenthood Federation, Africa Regional Office, 1985. , 54 p.This report, prepared as part of International Planned Parenthood Federation's (IPPF) Planned Parenthood and Women's Development (PPWD) program, analyzes selected program projects in Kenya, Mauritius, Lesotho, and Ghana. Projects were in the areas of income generation, community service provision, skill training, health education, and community issues. In all, over 40 projects have been assisted in Africa since the PPWD program was begun in 1977. Information on these projects, their activities, impact, and future needs is presented in tabular form. Members of the women's groups described are becoming outspoken advocates of family planning. Those who have limited their family size claimed to have more time to devote to self and family. Groups that have achieved high levels of acceptance of family planning methods attribute their success to the linkage of family planning and maternal-child health, family economics, nutrition, education, and future prospects. Community-based distribution of nonclinical contraceptives is viewed as a logical outgrowth of women's projects, and many group members are willing to be trained as volunteer motivators. In cases where PPWD funding periods have ended, Family Planning Associations have continued to support projects from their own resources. This is an encouraging trend, since the continuation and expansion of PPWD projects depends on groups being helped to become self-reliant, to seek government support for services, to develop strong leadership, and to link up with development plans for their areas. Revolving funds, rather than group grants, should be encouraged to extend the benefits of limited funding to more groups. Overall, the PPWD program has taken in Africa, and demands for expansion and further funding can be anticipated. It is important that the family planning objective remain central in these projects.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
New York, New York, UNFPA, 1984 May. xii, 156 p. (Report No. 67)A Needs Assessment and Program Development Mission visited the People's Republic of China from March 7 to April 16, 1983 to: review and analyze the country's population situation within the context of national population goals as well as population related development objectives, strategies, and programs; make recommendations on the future orientation and scope of national objectives and programs for strengthening or establishing new objectives, strategies, and programs; and make recommendations on program areas in need of external assistance within the framework of the recommended national population program and for geographical areas. This report summarizes the needs and recommendations in regard to: population policies and policy-related research; demographic research and training; basic population data collection and analysis; maternal and child health and family planning services; management training support for family planning services; logistics of contraceptive supply; management information system; family planning communication and education; family planning program research and evaluation; contraceptive production; research in human reproduction and contraceptives; population education and dissemination of population information; and special groups and multisectoral activities. The report also presents information on the national setting (geographical and cultural features, government and administration, the economy, and the evolution of socioeconomic development planning) and demographic features (population size, characteristics, and distribution, nationwide and demographic characteristics in geographical core areas). Based on its assessment of needs, the Mission identified mjaor priorities for assistance in the population field. Because of China's size and vast needs, external assistance for population programs would be diluted if provided to all provincial and lower administrative levels. Thus, the Mission suggests that a substantial portion of available resources be concentrated in 3 provinces as core areas: Sichuan, the most populous province (100,220,000 people by the end of 1982); Guandong, the province with the highest birthrate (25/1000); and Jiangsu, the most densely populated province (608 persons/square kilometer. In all the government has identified 11 provinces needing special attention in the next few years: Anhui, Hebei, Henan, Hubei, Hunan, Jilin, Shaanxi and Shandong, in addition to Guangdong, Jiangsu, and Sichuan.
New York, New York, Oxford University Press, 1985. 243 p.This report focuses on the contribution that international capital makes to economic development. While paying close attention to the events of the recent past, it also places the use of foreign capital in a broader and longer-term perspective. Using this perspective, the Report shows how countries at different stages of development have used external finance productively; how the institutional and policy environment affects the volume and composition of financial flows to developing countries; and how the international community has dealt with financial crises. A recurring theme of the Report is that countries in debt-servicing difficulties are not necessarily those with the largest debts or those that have suffered the biggest external shocks. The Report stresses that international flows of capital can promote global economic efficiency and can allow deficit countries to strike the right balance between reducing their deficits and financing them. A historical perspective on the role of international finance in economic development is presented, followed by an assessment of policies of industrial economies from the perspective of developing countries. The importance of developing countries' policies in deriving benefits from foreign capital is considered. Issues in managing capital flows are presented. The Report then discusses the main mechanisms through which foreign capital flows to developing countries. An overview of the international financial system and its relations with developing countries are presented. Issues in official development finance are examined. The evolving relationship between the developing countries and international capital markets is outlined. Possibilities for a bigger role for direct and portfolio investment in developing countries are examined. The Report concludes that the developing countries will have a continuing need for external finance. It demonstrates that many of the policies required to attract external finance and promote economic growth are either being implemented or planned already. A prosperous and stable world can become a reality if each country follows the route outlined.
[Health costs and financing and the work of WHO] Cout et financement de la sante et activities de l'OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):339-50.This discussion examines the international responses to issues and problems in the cost and financing of the health sector, focusing on the work of the World Health Organization (WHO). It describes the growth of attention to these concerns beginning in the 1970s, reviews methods and applications of financial analysis in greater detail, and summarizes progress to date and the agenda for work. Emphasis is on the developing countries, for they face the most urgent problems regarding costs and financing, and more attention is directed to their needs for support in this area. By the early 1970s it was clear that progress in health development particularly in the most underprivileged countries was unsatisfactory and that changes were needed if services were to have an appreciable impact on the health problems of developing populations. A major study conducted jointly by the UN Children's Fund (UNICEF) and WHO identified several of the critical problems associated with resources. The essential financial concerns requiring attention in connection with primary health service coverage, the need for more equitable distribution of existing resources for health and the priority of resources allocation to peripheral health services were examined in detail by a WHO Study Group on Financing Health Services which met in 1977. Among the problems of health finance, those of the overall lack of funds, the maldistribution of health resources, rising health care costs, and the lack of coordination were found to be particularly important. The Study Group concluded that, despite difficulties, it was possible to collect information of sufficient reliability for planners' needs and at a modest cost, even for the private sector. To help bring this about, it recommended that research centers and universities, in collaboration with national health authorities of their country, devote considerable attention to data collection methods. The reports, studies, and papers prepared at various meetings deal in general with specific aspects of health cost and financing. A major element, and evolving product, of the meetings and studies related to developing countries was a manual on financing health services, originally based on the recommendations of the 1st Study Group meeting. This draft document served as background material for a series of further meetings and was used to guide many of the country financing studies. A number of other health financing manuals were also developed between 1979-81. In its final published form the WHO manual attempts to be relevant to all developing countries. The manual describes health policies and their financial aspects and outlines techniques for data collection. If the recommendations of the 1st Study Group are compared with the achievements recorded thus far, the following facts come to light: many countries have undertaken surveys of health sector financing and resource allocation; increased interest in this subject has been shown by other international organizations; much progress has been made in the development and refinement of methodologies for collecting and using financial data; international activities and country studies have made it possible to provide reports for country leadership; and issues of financial planning and management often appear in medium and longterm plans.
Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
New York, UNFPA, 1985 Mar. viii, 68 p. (Report No. 70)The UN Fund for Population Activities (UNFPA) is in the process of an extensive programming exercise intended to respond to the needs for population assistance in a priority group of developing countries. This report presents the findings of the Mission that visited Burma from May 9-25, 1984. The report includes dat a highlights; a summary and recommendations for population assistance; the national setting; population policies and population and development planning; data collection, analysis, and demographic training and research;maternal and child health, including child spacing; population education in the in-school and out-of school sectors; women, population, and development; and external assistance -- multilateral assistance, bilateral assistance, and assistance from nongovernmental organizations. In Burma overpopulation is not a concern. Population activities are directed, rather, toward the improvement of health standards. The main thrust of government efforts is to reduce infant mortality and morbidity, promote child spacing, improve medical services in rural areas, and generally raise standards of public health. In drafting its recommendations, whether referring to current programs and activities or to new areas of concern, the Mission was guided by the government's policies and objectives in the field of population. Recommendations include: senior planning officials should visit population and development planning offices in other countries to observe program organization and implementation; continued support should be given to ensure the successful completion of the tabulation and analysis of the 1983 Population Census; the People's Health Plan II (1982-86) should be strengthened through the training of health personnel at all levels, in in-school, in-service, and out-of-country programs; and the need exists to establish a program of orientation to train administrators, trainers/educators, and key field staff of the Department of Health and the Department of Cooperatives in various aspects of population communication work.
Who Chronicle. 1984; 38(6):249-55.This article highlights the central features of the 5-Year Regional Plan of Action on Women in Health and Development, adopted by the Pan American Health Organization (PAHO) in 1981. Although the Plan does not mandate specific actions, it encourages certain activities and establishes an annual reporting system concerning these activities. The Plan recognizes that women's health depends upon numerous factors outside of medicine, including women's employment, education, social status, and accepted roles, access to economic resources, and political power. The low status of women is reinforced by the sexual double standard that makes women responsible for the reproductive process yet denies them the right to control that process. The Plan advocates an incremental approach, in which projects 1st focus on priority areas and groups and then expand to provide more general benefits. Programs exclusively for women are not advocated; encouraged, instead, is the integration of women's health and development activities into the mainstream of general activities promoting health. Among the areas targeted for action are the collection of statistics on women's health, women's nutritional problems, environmental health, maternal-child health services, screening for breast and cervical cancer, and family planning . Community participation is proposed as a good vehicle for local action and an essential tool in the campaign for health for all. Efforts must be made to enlist women's support in identifying community needs, planning health actions, selecting appropriate resources and personnel, establishing and administering health services, and evaluating the results. Overall, the Plan provides a solid basis upon which health authorities of the Americas can build.
Grassroots initiatives in developing countries and UNDP project planning and implementation. Summary and recommendations of the SID GRIS Policy Dialogue with UNDP in New York, 3-4 June 1983.
Development: Seeds of Change. 1984; 2:70-2.Some of the concepts of people-based development discussed at the SID GRIS Policy Dialogue are very important. Much benefit can be derived from exchanging information with staff and with resource people from the university sector, grassroots groups, or nongovernment organizations. In terms of field programs, it is important to know the country well to be able to identify and support those entities which benefit from support. Supporting a number of groups with a high potential for participatory development creates a critical mass. Once these grassroots grow, consumer organizations and certain government entities start interacting with one another in a country, and if enough participatory prone groups at different levels are supported a certain synergy is created, which over time builds up to become a dominant thrust in government. It is also important to establish criteria for those programs: what do they do for or with the poorest in the community; and what do they do for the most disadvantaged of disadvantaged groups, women and youths. Advocacy with governments is an obvious role for the UN, possibly by reinforcing those groups in government that are making progress so that they get a sense of reward, enough support through budgetary allocations, and are sustained because the outside world begins to look at them with a certain amount of admiration. There is a whole series of things that can be done in the program planning process to be more effective. It is very clear that local procurement is becoming much more significant. The decentralization of personnel and decision making has become more and more a fact of life in the UN International Children's Emergency Fund, where 75-80% of the staff are now based in the field. Decentralization must continue with more outposting of staff into smaller towns, because they interact with local government and encourage them to plan at that level with the people. There is a move to recruit more social scientists with the grasp of the social elements of development and participation, and more women professionals are also recruited. Staff development and training becomes very different. Grassroots development begins in one's own organization and making that come about can create tension. Budgeting becomes a significant area, and relations with national committees and donor governments require discussion and reeducation.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.