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UN Chronicle. 1990 Dec; 27(4): p..A new Programme of Action aimed at advancing the world's poorest countries offers a "menu approach" for donors to increase their official aid to the least developed countries (LDCs), stressing bilateral assistance in the form of grants or highly concessional loans and calling on donors to help reduce LDC debt. The Programme was adopted by consensus at the conclusion of the Second United Nations Conference on the LDCs (Paris, 3- 14 September). The UN recognizes more than 40 developing countries as "least developed". Although individual nation's indicators vary, in general LDCs have a per capita gross domestic product (GDP) of approximately $200 a year, a low life expectancy, literacy rates under 20 per cent and a low contribution of manufacturing industries to GDP. Reflecting the emergence during the 1980s of new priorities in development strategy, the Programme of Action for the LDCs for the 1990s differs from the Action Programme adopted at the first UN Conference on LDCs held in 1981 in Paris. The new Programme emphasizes respect for human rights, the need for democratization and privatization, the potential role of women in development and the new regard for population policy as a fundamental factor in promoting development. Greater recognition of the role of non-governmental organizations in LDC development is also emphasized. (excerpt)
FOOD POLICY. 1990 Dec; 15(6):518-24.Faced with balance of payment problems, declining commodity prices, and a corresponding reduction in foreign exchange earnings, Nigeria implemented a structural adjustment program in 1986. This step was taken in response to encouragement from the International Monetary Fund and the World Bank, and was aimed to accomplish the following: find the true value of the official currency; overcome public sector inefficiency through improved public expenditure and parastatal rationalization; reschedule medium- and long-term debt to relieve debt burden; and encourage net foreign capital inflow while limiting foreign loans. Implementing and adhering to these macroeconomic adjustment policies has brought unprecedented inflation, lower real earnings, and increased malnutrition among lower income sectors of the population. The poor have suffered diminishing access to nutritious foods. Conscribed access to food and compromised nutritional status will most likely persist into the 1990s unless corrective policies are adopted. Appropriate policy would aim to increase the poor's access to food and limit population growth.
Washington, D.C., United States Agency for International Development, 1990 Jul. x, 21 p. (A.I.D. Program Evaluation Discussion Paper No. 31)This report examines the critical issues involved in continued donor support for development finance institutions (DFI) based on a review of donor experience and explores the effectiveness of DFI as "intermediaries for targeting credit to priority sectors, the long-term sustainability of DFI in developing countries and the contribution of DFI to the development of financial markets." The key question is whether DFI can mobilize local resources and supply long-term credit to priority groups in developing countries. This report is based on the work of the Development Assistance Committee (DAC) of the Organization for Economic Cooperation and Development which established an Expert Group on AID Evaluation representing 9 major donors and covering the period from 1975 to the late 1980's. Despite several examples of DFI programs positively affecting credit availability and private sector growth (Korea, Pakistan, Costa Rica, Indonesia, and Tanzania) the consensus was the DFI reach very few target groups because of: 1) eligibility requirements to get credit; 2) transaction costs of credit; and 3) interest rates charged to sub-borrowers. DFI have not become sustainable intermediaries because of poor financial performance due to: 1) the inability of DFI to mobilize domestic savings and to operate as "full-fledged" financial institutions; 2) restrictions and prohibitions (interest rate ceilings and legal/contractual prohibitions) making them specialized as opposed to a decentralized operation; and 3) a management capability that cannot compete in a "complex economic environment." Lastly, DFI have been unable to contribute to financial market developments in developing countries due to financial policy measures limiting DFI from offering new financial services. Changes should be directed at donors that could increase the efficiency and performance of DFI in the future.
Social Science and Medicine. 1990; 31(6):639-48.Sub-Sahara Africa (SSA) has gone from "classical colonialism to neocolonial debt bondage." this article traces SSA's deterioration from a master-servant relationship during colonialism to the present-day "hybrid of decay and anarchy" from which people's health status and health services in the region are being asphyxiated by the debt crisis. The tragedy facing the continent is a carryover from colonialism SSA remains dependent on outside multinational forces that continue to determine her policies, extract her natural wealth, and minimally invest in the SSA region. This continued "cola-colonization" or external control of SSA has resulted in the "catastrophic" decline of most of SSA's social and economic institutions reflecting the collapse in the economies of the West. By the end of 1986, SSA owed US $200 billion or 45% of its GDP--growing to over US$600 million by the year 2000. By 1990 all SSA countries had to accept structural adjustment policies (SAP's) imposed by the International Monetary Fund and the World Bank to monitor cuts in Government public spending, remove subsidies, trade liberalization and currency devaluation all leading to "tragic declines" in the standard of living. Health services in SSA also originated from colonialism and today remains dependent on the home government's. One of the major carry-over's is the urban/rural disparity; 70% of SSA's population is rural yet most health services and providers are in the urban areas contributing to higher infant mortality rates (2-5 times) in the rural areas. The debt crisis has compounded the magnitude of the lack of health services for the majority of people. Shortages exist for all essential drugs and equipment while social services and institutions have deteriorated, aggravating the already low health status in the region. SAP's have increased starvation, epidemics and the brain drain. Perhaps there is a need for a "Marshall Plan" to help SSA out of its underdevelopment.
In: Population policy: contemporary issues, edited by Godfrey Roberts. New York, New York/London, England, Praeger, 1990. 179-91.The primary role of the World Bank is to assist Third World governments in the economic and social development process. Given the World Bank's view that reductions in fertility and mortality will lead to improvements in productivity, GNP growth, and maternal-child health, its population activities are focused on encouraging governments to adopt fertility decline as a national development objective and on providing loans for implementing population programs. The Bank's sector work, including country economic reports and population sector analyses, has been most ambitious in countries where there was no population policy or program, especially sub-Saharan African countries. Even in pronatalist countries, this sector work has been instrumental in leading to an open discussion of population issues. In other countries, such as Indonesia, the Bank's population sector work has been instrumental in helping governments to develop and implement a population program. Through the World Bank's access to the highest levels of government and its links to a wide range of ministries, it is in a position to influence governments by providing information about the seriousness of the population problem. In Africa, this type of dialogue has been facilitated through a series of regional senior policy and management-level seminars. The Bank is further able to shape policy development through its involvement in project identification and implementation. In recent years, Bank-funded projects have placed greater emphasis on management, institution building, demand-generation activities, and involvement of the private sector in service delivery. In the area of research, the Bank's current priority is the internal efficiency of alternative policy and program strategies. Evaluations have identified the policy dealogue that links population issues with other aspects of development as the World Bank's most effective role.
Lancet. 1990 Jul 7; 336(8703):56-7.In response to The Lancet's April 14 editorial on structural adjustment and health in Africa, it is surprising that the World Bank report did not include maternal mortality as a yardstick for monitoring health standards in Africa: maternal mortality seems to be a better index of social and economic development than perinatal or infant mortality. Obstetric performance was reviewed in parts of Nigeria after the introduction of the structural adjustment program (SAP). In the 1970's and early 1980's the Nigerian economy was buoyant, thanks to petroleum exports, but when oil prices slumped the government was forced to introduce SAP. As a result most of the costs that had been borne by the government were gradually passed on to individuals, of all the sectors affected health seems to have been the hardest hit. Looking at factors that might have been responsible for the rising maternal mortality rate in the Zaria area of Northern Nigeria, it was found that between 1983 and 1988 there had been no significant change in the numbers of obstetricians and obstetric residents at the Ahmadu Bello Teaching Hospital; there was a slight rise in the number of midwives. However, the number of deliveries in 1988 was only 46% of the figure for 1983, and the proportion of obstetric admissions that were complicated more than tripled. Maternal deaths at the hospital numbered 48 per year in 1983-85 and 75 in 1988, an increase of 56%. These changes in obstetric indices may not be unrelated to financial policies in hospital care. In 1983 all aspects of maternity care at the hospital were free. In 1985, following the reduction in government subsidy, fees were introduced for some services, leading to a fall in the number of pregnant women attending the hospital. By 1988 patients were asked to pay for their treatment; with the mean interval between admission and surgery increasing significantly and contributing to the high maternal morbidity and mortality rates in Zaria. (Full text modified)
New York, New York, Oxford University Press, 1990. xvii, 423 p.This text on international health covers historical and contemporary health issues ranging from water distribution systems of the ancient Aztecs to the worldwide endemic of AIDS. The author has also included areas not in the 1979 version: the 1978 Alma Ata conference on primary health care, infant and maternal mortality, health planning, and the role of science and technology. The 1st chapter discusses how each population movement, political change, war, and technological development has changed the world's or a region's state of health. Next the book highlights health statistics and how they can be applied to determine the health status of a population. A text on international health would be incomplete without a chapter on understanding sickness within each culture, including a society's attitude towards the sick and individual behavior which causes disease, e.g. smoking and lung cancer. 1 chapter features risk factors of a disease that are found in the environment in which individuals live. For example, in areas where iodine is not present in the soil, such as the Himalayas, the population exhibits a high degree of goiter and cretinism. Others present the relationship between socioeconomic development and health, e.g., countries at the low socioeconomic development spectrum have low life expectancies compared to those at the high socioeconomic end. An important chapter compares national health care systems and identifies common factors among them. An entire chapter is dedicated to organizations that provide health services internationally, e.g., private voluntary organizations. 1 chapter covers 3 diseases exclusively which are smallpox, malaria, and AIDS. The appendix presents various ethical codes.