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ASIA-PACIFIC POPIN BULLETIN. 1991 Jun; 3(2):7-11.George Walmsley, UNFPA country director for the Philippines, discusses demographic and economic conditions in the Philippines, and present plans to revitalize the national population program after 20 years of only modest achievements. The Philippines is a rapidly growing country with much poverty, unemployment and underemployment, uneven population distribution, and a large, highly dependent segment of children and youths under age 15. Initial thrusts of the population program were in favor of fertility reduction, ultimately changing to adopt a perspective more attuned to promoting overall family welfare. Concurrent with this change also came a shift from a clinic-based to community-based approach. Fertility declines have nonetheless grown weaker over the past 8-10 years. A large gap exists between family planning knowledge and practice, with contraceptive prevalence rates declining from 45% in 1986 to 36% in 1988. Behind this lackluster performance are a lack of consistent political support, discontinuities in program implementation, a lack of coordination among participating agencies, and obstacles to program implementation at the field level. The present government considers the revitalization of this program a priority concern. Mr. Walmsley discusses UNFPA's definition of a priority country, and what that means for the Philippines in terms of resources nd future activities. He further responds to questions about the expected effect of the Catholic church upon program implementation and success, non-governmental organization involvement, the role of information and information systems in the program, the relationship between population, environment and sustainable development, and the status of women and its effect on population.
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.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
[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.
[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.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
[Operational sequence for the implementation of a subregional food and nutrition strategy] Secuencia operativa para la implementacion de una estrategia subregional de alimentacion y nutricion.
In: Lineamientos de una estrategia Andina de alimentacion y nutricion [by] Junta del Acuerdo de Cartegena. Grupo de Politica Technologica. Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos. Lima, Peru, Junta del Acuerdo de Cartagena, Grupo de Politica Technologica, Proyectos Andinos de Desarollo Technologico en el Area de los Alimentos, 1983. 143-74.This article outlines and diagrams a recommended operational sequence for implementation of food and nutrition strategy for the Andean region. The multisectorial strategy envisioned by the planners would involve the supply and demand for foods; basic health, environmental sanitation and educational services; and food information and technology. The integrated, multisectorial nature of the strategy requires policies, plans, and programming designed to facilitate harmonious development of all the necessary elements within the 5 Andean countries. The proposed methodology for operationalizing the strategy is based on a systems focus which covers all aspects of production, processing, distribution, final consumption, and technoeconomic policies for food and nutrition. Because the food and nutrition strategy is more than a production program, its design should identify interrelations between the availability and prices of foods, external commerce, industrial trends, food commerce and distribution, and food consumption in adquate quantities by the entire population. A basic service component for health should also be included for the Andean population because of its relationship to nutritional aspects. The suggested instrument for operationalizing the systems focus is the "Methodology for Evaluation andprogramming of Technological and Economic Development of Production and Consumption Systems" developed by the Andean Projects for Technological Development Food Group for the Group for Technological Policy of the Cartagena Accord. The methodology consists of a manual and a "Model of Numerical Experimentation", which permits identification of system components, calculation and evaluation of relevant aspects of each production factor, and design and selection of development alternatives. The Model of Numerical Experimentation" allows simulation of goals for satisfaction of needs, exports of final products, import substitution, different production technologies, commercial margins, subidies, customs duties, taxes and exchange rates and related variables. Various food production systems have already been studied using the methodology in each of the 5 Andean countries. It is recommended that implementation of aspects of the food and nutrition strategy involving food production and consumption proceed in 8 operational sequences: 1) characterization of the current industrial, agroindustrial, and fishing economy 2) identification and selection of basic foods and/or strategies 3) representation and quantification of each of the selected systems 4) evaluation of each system and intersystem relationship 5) identification and selection of systems of production of alternative foodstuffs 6) proposal for a national and regional food system 7) concerted development programming for the regional food system and 8) design of mechanisms of evaluation and follow-up.