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Maternal and Child Health. 2018 Sep 8;  p.Promoting exclusive breastfeeding (EBF) is a highly feasible and cost-effective means of improving child health. Regulating the marketing of breastmilk substitutes is critical to protecting EBF. In 1981, the World Health Assembly adopted the World Health Organization International Code of Marketing of Breastmilk Substitutes (the Code), prohibiting the unethical advertising and promotion of breastmilk substitutes. This comparative study aimed to (a) explore the relationships among Code enforcement and legislation, infant formula sales, and EBF in India, Vietnam, and China; (b) identify best practices for Code operationalization; and (c) identify pathways by which Code implementation may influence EBF. We conducted secondary descriptive analysis of available national-level data and seven high level key informant interviews. Findings indicate that the implementation of the Code is a necessary but insufficient step alone to improve breastfeeding outcomes. Other enabling factors, such as adequate maternity leave, training on breastfeeding for health professionals, health systems strengthening through the Baby Friendly Hospital Initiative, and breastfeeding counselling for mothers, are needed. Several infant formula industry strategies with strong conflict of interest were identified as harmful to EBF. Transitioning breastfeeding programmes from donor-led to government-owned is essential for long-term sustainability of Code implementation and enforcement. We conclude that the relationships among the Code, infant formula sales, and EBF in India, Vietnam, and China are dependent on countries' engagement with implementation strategies and the presence of other enabling factors.
Marketing of breast-milk substitutes: National implementation of the international code. Status report 2016.
Geneva, Switzerland, WHO, 2016.  p.This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) in and by countries. It presents the legal status of the Code, including -- where such information is available -- to what extent Code provisions have been incorporated in national legal measures. The report also provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Its findings and subsequent recommendations aim to improve the understanding of how countries are implementing the Code, what challenges they face in doing so, and where the focus must be on further efforts to assist them in more effective Code implementation.
Country implementation of the International Code of Marketing of Breast-Milk Substitutes: status report 2011.
Geneva, Switzerland, WHO, 2013.  p.Globally, breastfeeding has the potential to prevent 220 000 deaths among children under five each year. WHO recommends that all infants should be exclusively breastfed for the first six months of life, but actual practice is low (38%). The implementation and enforcement of International Code of Marketing of Breast-milk Substitutes and subsequent relevant Health Assembly Resolutions (the Code) are critical for an environment that supports proper infant and young child feeding and for the attainment of Millennium Development Goal 4 (reduce child mortality). This report summarizes the progress countries have made in implementing the Code. It is based on data received from WHO Member States between 2008 and 2010 and on information for 2011 from UNICEF. WHO recognizes ongoing progress being made in various countries since 2011, in terms of passing laws, strengthening existing laws or improving monitoring mechanisms. Updates will be included on an ongoing basis in the WHO Global database on the Implementation of Nutrition Action (GINA). In addition, WHO will publish status reports periodically.
Lancet. 2007 May 26; 369(9575):1773.A recent briefing paper by the charity Save the Children UK, and an investigation by the Guardian newspaper, highlight that inappropriate activities surrounding baby-milk formula marketing and promotion cannot be resigned to the pages of history. 25 years on from the introduction of the WHO International Code of Marketing Breast Milk Substitutes, food companies persist in their dubious practices, but in a more subtle manner than in their aggressive activities of 30 years ago. Most importantly, such practices are still responsible for the deaths of thousands of children. In 1970s, an international campaign against the food giant Nestle was responsible for eliciting such collective outrage that it led to one of the biggest public boycotts in corporate history. Subsequent international pressure resulted in the WHO code, which not only covers the marketing of infant formula, but also other commodities if promoted as partial or total breastmilk replacements. (excerpt)
Geneva, Switzerland, WHO, 2006. 11 p.The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code was formulated in response to the realization that poor infant feeding practices were negatively affecting the growth, health and development of children, and were a major cause of mortality in infants and young children. Poor infant feeding practices therefore were a serious obstacle to social and economic development. The 34th session of the World Health Assembly (WHA) adopted the International Code of Marketing of Breast-milk Substitutes in 1981 as a minimum requirement to protect and promote appropriate infant and young child feeding. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution". The Code advocates that babies be breastfed. If babies are not breastfed, for whatever reason, the Code also advocates that they be fed safely on the best available nutritional alternative. Breast-milk substitutes should be available when needed, but not be promoted. The Code was adopted through a WHA resolution and represents an expression of the collective will of governments to ensure the protection and promotion of optimal feeding for infants and young children. (excerpt)
BMJ. British Medical Journal. 2003 Jul 5; 327:3-4.One promising strategy is to market sanitation and handwashing as if they were consumer products like cars or shampoo. Consumers see the building of a toilet as a home improvement not as a health intervention. Equally they use soap to make hands look, feel, and smell good, not to prevent sickness. Public money could be spent on marketing hygiene and toilets, thus generating demand that can then be met by the private sector. The private sector also knows how to generate behaviour change through marketing. If consumer demand for hygiene and toilets can be stimulated with the help of the private sector, public funds can be liberated to support public infrastructure and to help the very poorest who cannot afford to adopt new technologies. This approach is being tested in six countries, where public-private partnerships between soap companies, governments, and agencies such as theWorld Bank aim to increase rates of handwashing with soap massively (www.globalhandwashing.org). (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 1994. ix, 92 p. (Technical Report No. 16)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to Viet Nam took place in 1993. This technical report presents a consensus of the findings and conclusions of that mission. After an executive summary and introductory chapter, which discusses population and family planning and the AIDS epidemic in Viet Nam, chapter 2 covers contraceptive requirements including longterm forecasting methodology, projected longterm contraceptive commodity requirements, short-term forecasting and requirements, and forecasting of condom requirements for HIV/AIDS prevention. Logistics management is considered next, with emphasis on public and private organizations which participate in contraceptive distribution, procurement, and allocation to outlets; the reception, warehousing, and distribution of contraceptives; warehousing regulations; the logistics management information system; and monitoring. Chapter 4 deals with contraceptive manufacturing and discusses the regulatory environment and quality assurance, condoms, IUDs, oral and other steroidal contraceptives, and related issues. The fifth chapter presents the role of NGOs and the private sector and discusses mass organizations, social marketing, and future private-sector options, opportunities, and constraints. A financial analysis provided in chapter 6 relays sources and use of funds, trends in financial contributions for 1985-2000, future funding requirements, and contraceptive cost implications for individuals. The final chapter considers condom programming for HIV/AIDS prevention with information given on current status and patterns; projected trends; the National AIDS committee; an overview of international donor assistance; major condom distribution channels and outlets, condom demand-generation activities, forecasting requirements for 1993-2002, and condom supply activities. A summary of key knowledge, attitude, and practice findings about AIDS and condoms is appended as is additional information on contraceptive requirements and condom programming for HIV/AIDS prevention. The report contains 17 tables and 1 figure, and 18 specific recommendations are made for the topics covered.
New York, New York, United Nations Population Fund [UNFPA], 1994. x, 122 p. (Technical Report No. 17)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to the Philippines took place in 1993. In the introductory chapter of this technical report, the Global Initiative is described and the Philippine Population Program is presented in terms of the demographic picture, the population policy framework, the Philippine Family Planning (FP) Program, STD/AIDS control and prevention efforts, and an overview of donor assistance from 1) the UNFPA, 2) USAID, 3) the World Bank, 4) the Asian Development Bank, 5) the Australian International Development Assistance Bureau, 6) the Canadian International Development Agency, 7) the Commission of the European Community, 8) the International Planned Parenthood Federation, 9) the Japanese International Cooperation Agency, and 10) the Netherlands. The second chapter presents contraceptive requirements including longterm forecasting methodology, projected longterm commodity requirements, condom requirements for STD/AIDS prevention, total commodity requirements for 1993-2002, short-term procurement projections, and projections and calculations of unmet need. Chapter 3 covers logistics management for 1) the public sector, 2) condoms for STD/AIDS preventions, 3) NGOs, and 4) the commercial sector. The fourth chapter is devoted to a consideration of private practitioners and a detailed look at the ways that NGOs relate to FP groups. This chapter also covers the work of NGOs in STD/AIDS prevention and coordination and collaboration among NGOs. Chapter 5 is devoted to the private commercial sector and includes information on social marketing, the commercial sector, and duties and taxes. The issues addressed in chapter 6 are contraceptive manufacturing and quality assurance, including the potential for the local manufacture of OCs, condoms, IUDs, injectables, and implants. The national AIDS prevention and control program, the forecasting of condom requirements for STD/AIDS prevention, and policy and managerial issues are considered in chapter 7. The last chapter provides a financial analysis of the sources and uses of funds for contraceptives including donated commodities, the private commercial sector, cost recovery issues, and regulations and policies, such as taxes and duties on donated contraceptives, which affect commodities. 5 appendices provide additional information on contraceptive requirements, logistics management and costs, the private commercial sector, condoms for STD/AIDS prevention, and a financial analysis. Information provided by the texts and appendices is presented in tables and charts throughout the report.
The International Code of Marketing of Breast-Milk Substitutes: synthesis of reports on action taken (1981-1990).
[Unpublished] 1990. 58 p. (WHO/MCH/NUT/90.1)The World Health Organization (WHO) adopted the international code of marketing of breast milk substitutes as a recommendation on May 21, 1981. Since then, the Director-General has reported on even years and in May 1993 on the status of the code's implementation. Cumulative information has been presented in reach report. Comprehensive report information is presented in this document to show steps relating to this recommendation taken by over 150 countries and territories over the past decade. Country action has taken place individually, collectively, regionally, and interregionally. The document covers the following: development of the draft international code; reporting on action giving effect to the code; action taken throughout the world giving effect to the principles and aim of the code; cooperation with parties relative to the appropriate marketing and distribution of breast milk substitutes; and summary of trends in action taken. The resolution and code are included in annexes.
[Unpublished] 1981 Aug 28. 222 p. (AID/LAC/P-085)The background, goals, projected activities and beneficiaries, financial requirements, and implementation plans for a Family Planning Outreach Project in Haiti are detailed. The project is intended to assist the Government of Haiti to establish a cost-effective national family planning program. Population growth continues to accelerate in Haiti, despite high infant and child mortality, significant emigration, and declining fertility. The government does not have an articulated population policy. Although family planning and maternal and child health services have been in existence since 1971, there is no effective access to these services. This project is viewed as a means of achieving a substantial and sustained reduction in family size and improving health status. It is also a means of strengthening the Haitian family so it can participate more directly in the national development process. The purpose of the project will be accomplished through the following activities: 1) improvement of the organization and management of the national family planning program; 2) improvement of the quality and quantity of maternal and child health and family planning services; 3) expansion of the participation of private and voluntary organizations, other governmental, and local community groups in service provision; 4) increase in the availability of contraceptives at reasonable prices through rural and urban commercial channels; and 5) formulation of appropriate population and family planning policies. By the end of the project, all government health facilities and 75% of private facilities will actively counsel and provide family planning services; integrated models of community health and family planning services will have been developed to serve 60% of the population; basic drugs and contraceptives will be available at reasonable subsidized prices throughout the country; and 25% of women ages 15-45 at risk of pregnancy will be continuing users of effective contraceptive methods. The project will be implemented by the existing infrastructure of private and public organizations, primarily by the Department of Public Health and Population and its Division of Family Hygiene. The US Agency for International Development (USAID) is providing US$9.615 million (54%) toward the estimated US$17.980 million cost of the 5-year project. An additional US$6.555 million (36%) will be provided by the Government of Haiti.
The role of the health sector in the development of national and international food and nutrition policies and plans, with special reference to combating malnutrition, 13th Plenary Meeting, 24 May 1978.
Geneva, WHA, 1978 May 24. 10 p. (WHA31.47/WHA34.22)The 31st World Health Assembly (WHA) has considered the Director General's report on the role of the health sector in the development of national and international food and nutrition policies and plans and endorses the functions of the health sector in this field. The WHA is convinced that malnutrition is 1 of the major impediments to realizing the goal of health for all by the year 2000, and that new approaches based on clearly defined priorities and maximum utilization of local resources are needed for a more effective action to combat malnutrition. The WHA recommends that Member States give the highest priority to stimulating permanent multisector coordination of nutrition policies and programs and to preventing malnutrition in pregnant women, lactating women, infants, and children by doing the following: 1) supporting and promoting breast feeding with educational activities to the general public, 2) legislative and social actions to facilitate breastfeeding by working mothers, 3) implementing the necessary promotional and facilitating measures in the health services and regulating inappropriate sales promotion of infant foods that can be used to replace breast milk, 5) ensuring timely supplementation and appropriate weaning practices and the feeding of young children with the maximum utilization of locally available and acceptable foods, and 6) conducting, if necessary, action oriented research to support this approach and the training of personnel for its promotion. Governments and multilateral and bilateral organizations and agencies are urged to support the proposed programs of research and development in nutrition through their technical and scientific institutions and workers and by financial contributions. A copy of the international code of marketing of breastmilk substitutes is included. The 11 articles of the code cover the following: aim and scope of the code, definitions, information and education, the general public and mothers, health care systems, health workers, persons employed by manufacturers and distributors, labelling, quality, and implementation and monitoring.
Report of the WHO/UNICEF Consultation on the National Production, Packaging and Distribution of Oral Rehydration Salts (ORS), Bangkok, January 23-26, 1979.
Geneva, Switzerland, WHO, 1979. 33 p. (ATH/79.1)The conclusions and recommendations reached by the participants at a joint WHO and UNICEF sponsored consultation on the national production, packaging, and distribution of ORS (oral rehydration salts) were presented. Also provided were separate country reports on the status of ORS production and distribution in Bangladesh, Costa Rica, Egypt, India, Indonesia, Mozambique, Pakistan, Philippines, and Thailand. The purpose of the consultation was 1) to identify the problems involved in national efforts to produce and distribute ORS and 2) to develop guidelines for the production, packaging, and distribution of the ORS. Oral rehydration therapy provides an effective method for treating all but the most serious types of diarrhoeal diseases and the treatment can be administered at home without medical assistance. Many countries are engaged in the production of ORS and at the present time there is considerable variation in the formulation, packaging, cost, and quality of the products. Recommendations were 1) the product should be packaged and identified as a drug in order to inspire confidence in the product; 2) national standards for the quality control of pharmaceuticals should be applied to the production of ORS; 3) eventually international standards for the formulation and quality control of ORS should be established; 4) bulk packaging of separate ingredients for use in large facilities is preferred; 5) efforts should be made to make ORS widely available especially in rural and isolated areas; 6) efforts should be directed toward developing a product with a long shelf-life; 7) all levels of health personnel should be trained in oral rehdyration therapy; and 8) evaluation of production and distribution systems should be promoted.
Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 645)In this report of the World Health Organization (WHO) Expert Committee on Specifications for Pharmaceutical Preparation, focus is on the following: 1) quality assurance in pharmaceutical supply systems; 2) revisions of the International Pharmacopoeia (methods of drug analysis, monographs for pharmaceutical raw materials, monographs for dosage forms, monographs for pharmaceutical aids); 3) international chemical reference substances for pharmaceuticals (reports from the WHO Collaborating Center, certificates, secondary reference substances, international cooperation, revision of guidelines); 4) quality requirements for oral dosage forms (tests for solid oral dosage forms, tests for liquid oral dosage forms, guidelines for in-process control of the manufature of some types of dosage forms); and 5) basic tests (basic tests for pharmaceutical substances, simple tests for the absence of gross degradation, basic tests for tablets and capsules, publication of basic tests). The Committee concluded that the term "quality assessment" was appropriate to the activities of governmental agencies who have been authorized to assess by inspection, surveillance and other means how closely manufacturers and distributers comply with drug quality requirements. Manufacturers are considered fully responsible for the quality of their products.
N.Y., United Nations Fund for Population Activities (1975) various pagingsAdd to my documents.
Action now toward more responsible parenthood worldwide. (Proceedings of the Tokyo International Symposium, Tokyo, April 4-7, 1977).
Tokyo, Japan, Japan Science Society, 1977. 578 p.The Tokyo International Symposium reviewed the progress made since 1974 in integrating population policies with socioeconomic development, with additional focus on needs of rural areas. It was discovered that even countries experiencing economic growth have still failed to provide basic human needs - health, nutrition, housing, education, and employment - and that in densely populated rural areas, and marginal districts of cities, fertility decline has been slow or nonexistant. New evidence presented at the symposium suggested that now a new stage of population history is approaching, characterized by falling birth rates and slackening of world population growth; nevertheless, rapid population growth in developing countries has not ended because 1) of the high proportion of young people in many countries and 2) the fertility rates of the poorest half of the population are 50% higher than the national averages. While projections of world population are being revised downward, world population is still likely to grow from its present 4 billion to 6 billion by the turn of the century. All agencies, official or private, need to emphasize development of cost-effective methods which the government may adopt after a successful pilot study that take into account the social values, religious beliefs, and customs in each country. The symposium urges that additional resources be made available for a broad range of new initiatives in the following areas: 1) to make the fullest range of family planning services available in rural areas and marginal districts of cities; 2) to expand the social and economic roles of women and to improve their status in other fields; 3) to educate adolescents and young adults about their reproductive behavior and to underscore the impact that premature parenthood would have on themselves, their families, and communities; 4) to integrate family planning with development activities; and 5) to encourage program design by affected populations.
Wida. 1997 Nov; (13):12-3.In Senegal, more than 20% of the female population in the Senegal River Valley, Upper and Lower Casamance, and the eastern part of the country have undergone female genital mutilation (FGM). Almost 80% of Toucouleurs and Mandés practice FGM, as well as about 60% of Peuhls and Diolas. Well-established in rural areas, FGM is also known in urban centers due to the high rate of rural exodus towards cities. Condemnable and open to challenge, FGM was never advised by Islam. UNIFEM celebrated International Women’s Day upon the theme of sexual mutilation by organizing film screenings, student sketches, and panel debates. Furthermore, on March 8, 1997, a major information and awareness campaign against FGM was launched in Senegal. UNIFEM will therefore support all associations and organizations fighting against the most gratuitous forms of violence such as FGM. This campaign particularly targets young people. In addition to awareness and education campaigns, public powers should become more involved in efforts against FGM, taking steps to completely eradicate the practice. Research should also be conducted into the scope and evolution of the practice across Senegal.
London, England, International Planned Parenthood Federation [IPPF], 2001 Jun. 28 p.This International Planned Parenthood Federation Advocacy Guide focuses on the application of advocacy to HIV/AIDS prevention. Specifically, this booklet concerns the protection of human rights to safeguard human dignity in the context of HIV/AIDS and to ensure an effective, rights-based response to HIV/AIDS. Other topics are promotion of male and female condom for dual protection against sexually transmitted disease/HIV/AIDS and unwanted pregnancy; and educating children and young people on sexual and reproductive health issues, including HIV/AIDS. It addresses advocacy for different groups of people at higher risk, such as the sex workers, injecting drug users, men who have sex with men, migrants and refugees, armed forces, and prisoners.
Globalization of tobacco marketing, research and industry influence: perspectives, trends and impacts on human welfare.
Development. 1999 Dec; 42(4):25-30.Presented is a study conducted by Derek Yach and Douglas Bettcher that examined how the globalization of tobacco marketing, trade, research, and industry influence is a major threat to public health worldwide. They showed how the tobacco industry operates as a global force buying influence and power in order to penetrate markets across the world. Industry strategists encourage homogenization and creation of a global shared culture and global tobacco industries. Tobacco industry members deny its addictive properties and poor health outcomes. Despite scientific evidence on addiction and health effects of tobacco, tobacco companies heavily invested on studying the best way to maintain and increase smoking rates. The WHO Director-General, with the support of the Tobacco Free Initiative and other organizations, has defined strategies to develop a global tobacco surveillance system, trends in tobacco related morbidity and mortality, policy and program interventions, and tobacco industry analysis. The analysis of tobacco industry documents and their wide dissemination, along with the epidemiological and economic evidence about the true impact of tobacco, will prevent the tobacco industry from gaining respectability. These actions, simultaneously local and global, could halt and eventually reverse trends currently underway.
Protecting breast feeding from breast milk substitutes. Royal college supports promotion of breast feeding. Authors reply [letter]
BMJ. British Medical Journal. 1998 Oct 3; 317(7163):950.Jacobs (of the Infant and Dietetic Foods Association) and Bronner (of the International Association of Infant Food Manufacturers) object to a peer-reviewed interagency study of widespread violations of the international code of the World Health Organization (WHO) regarding marketing of breast milk substitutes. They say that the study has been severely criticized, but provide no published peer-reviewed references in support of this. They say that the code does not apply to follow-on formulas, but the code specifically states that it applies to any product marketed to replace breast milk, partially or totally. They seek to avoid honoring the code by citing local regulations. Although not all components of the code are established in national legislation in many countries, the industry agreed to abide by the code when it was written in 1981. Marcovitch et al. state that the Royal College of Paediatrics and Child Health will support breast feeding with stronger measures and that they will not accept donations from formula manufacturers until receipt of a report from their ethics committee. However, they refused to join the interagency study because of concerns about research methodology. If the college fully supported the code, it should have joined the study and corrected the research methodology. The college research unit commenting on the methodology is funded by Nestle, which represents a conflict of interests.
Report from the Meeting on Changing Communication Strategies for Reproductive Health and Rights, December 10-11, 1997, Washington, D.C.
[New York, New York, Population Council, Health and Development Policy Project, . v, 85 p.The Working Group on Reproductive Health and Family Planning (FP) was convened by the Health and Development Policy Project and the Population Council in 1994 to help make US-supported international FP programs consistent with the Plan of Action of the International Conference on Population and Development. This document reports on a 1997 Working Group meeting on "Changing Communication Strategies for Reproductive Health and Rights." The first part of the report reviews changing communication strategies and offers a brief history of health communication. Part 2 presents results of a panel discussion about client-provider interactions, community participation, and the interface of client satisfaction and quality of health care. The third part summarizes a panel discussion on community mobilization and reproductive rights education strategies, including communication strategies for maternal health and rights in Bolivia; sex education in Latin America; IEC (information, education, communication), FP, and sexually transmitted diseases interventions; and a methodology for incorporating gender issues into community AIDS prevention programs. Part 4 contains papers from a panel on the mass media and social marketing that consider how to use the media as a tool for social change, a communication strategy to increase male involvement in FP in Zimbabwe, marketing the female condom in Zimbabwe, and the empowerment of women and youth in Nicaragua. The final sections present donors' perspectives, a summary of themes covered in technical group discussions, and appendices.
[Operations research in family planning programs] Investigacion operativa en programas de planificacion familiar.
In: Investigacion en planificacion familiar y servicios de salud, edited by Luis Sobrevilla, Mary Fukumoto. Lima, Peru, Consejo Nacional de Poblacion, 1984. 89-95.At the 1974 World Population Conference held in Bucharest, a World Plan of Action was adopted by 136 countries with the goal of controlling population growth. At the 1984 World Population Conference held in Mexico, many countries that previously supported pronatalist views started to promote family planning. China proposed to hold its population growth at 1200 million. Many African countries also adopted family planning programs. In the 1980s major changes occurred in strategies for the promotion of family planning. Community-based distribution, social marketing, and decentralized distribution schemes were tried. Community participation for promoting family planning was also undertaken. Operations research aided decision making and established links between health, nutrition, family planning, education, and employment. The family planning program could be divided into components such as organization (integration into health and nutrition programs, information about service users, the role of voluntary organizations); marketing (the increase of maternal age impacting demand, the choice between clinical or community distribution, social marketing or the combination of these); operations (the distribution of resources among different activities and among the three phases of the program, and personnel training for optimal resource use); and financing, budget, and control (budget controls for the stimulation of efficiency, the system of cost control in primary health centers, and the improvement of records). Operations research could also play a vital role in the design, implementation, and evaluation of different interventions.
[Breast feeding and the infant food industry: mutual respect as a form of collaboration (letter)] Lactancia materna e industria dietetica infantil: el respeto mutuo como forma de colaboracion.
ANALES ESPANOLES DE PEDIATRIA. 1993 Jun; 38(6):560-1.A letter from a pediatrician responding to comments on an earlier publication about breast feeding and the infant formula industry acknowledges the importance of having adequate preparations available for infants who for any reason cannot be breast fed. But some continuing advertising and marketing practices of the infant formula industry, along with inappropriate maternity ward routines and sociocultural changes, are jeopardizing the practice of breast feeding in rich and poor countries alike. The World Health Organization and UNICEF estimate that nutritional, infectious, and diarrheal diseases are more prevalent today than 20 years ago, and that abandonment of breast feeding is a factor in at least 1 million infant deaths each year. The nutritional problems caused by abandonment of breast feeding are not as drastic in developed countries, but some protections against allergies and infections are lost, as are the emotional bonding between the mother and infant. Furthermore, in developed countries the least advantaged groups are the least likely to breast feed. The World Health Organization General Assembly in 1974 called attention to the decline of breast feeding and requested member nations to promulgate laws regulating advertising and marketing of infant formula. A global campaign by health organizations and citizens' groups led to adoption by the World Health Organization in 1981 of an international code for marketing of milk substitutes. Various countries have subsequently adopted its measures, at least in part. Despite the code, bottle feeding continues to become more prevalent. A Spanish decree of 1992 established regulations for the wording and illustrations on infant formula containers and in advertising. A statement indicating the relative superiority of mothers' milk is required, and advertising of infant formulas is restricted to scientific publications. The wording may not imply that bottle feeding is equivalent to breast feeding. Advertising at points of sale, distribution of samples, and similar activities directed toward the consumer are prohibited. Health administrators are given responsibility for assuring that information on infant feeding provided to pregnant women and families is objective and coherent, and for limiting use of artificial preparations to infants requiring them. The World Health Organization/UNICEF August 1990 meeting established as goals for 1995 the establishment of multisectorial national committees on breast feeding, the guarantee that all maternity wards would establish routines support of breast feeding, the promulgation of measures to put into practice all articles of the international code for marketing of milk substitutes, and the approval of laws to protect the practice of breast feeding by working women. Although Spain's new legislation is an important step, much remains to be done.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 36 p. (USAID Contract No. DPE-5969-Z-00-7064-00)The Technologies for Primary Health Care Project (PRITECH) in Madagascar was begun in April 1992, in collaboration with the Ministry of Health (MOH), UNICEF, and WHO to reduce diarrhea-related morbidity and mortality in children under 5 years old. Consultants visited Madagascar in 1992 to plan PRITECH activities for 1993 and to analyze the oral rehydration salt (ORS) marketing situation. The ORS market assessment included a market analysis of pharmaceutical producers, distributors, and outlets. Key issues identified were the continuous supply, availability, accessibility, and correct use of ORS. Based on this assessment, preliminary marketing recommendations were to maintain local production by renegotiating agreements on the supply of raw materials and then to find a new and sustainable supply when demand outstrips supply in 1994. To develop a revised 1993 work plan and administrative arrangements for PRITECH activities, PRITECH consultants met with MOH officials, visited MOH facilities, and reported on collaboration efforts with UNICEF. In 1993, PRITECH will focus on the development of the National Control of Diarrheal Disease (CDD) program and establish 2 CDD Documentation Centers. PRITECH's original scope of work has been revised since 1992, but the 4 main objectives remain: 1) to increase the number of health care providers who can manage diarrheal disease and use ORS; 2) to develop an information, education, and communication (IEC) strategy; 3) to increase ORS demand, production, and availability; and 4) to increase the effectiveness and efficiency of the CDD program implementation. In the first quarter of 1993, PRITECH-supported MOH training activities included an IEC Strategy/ORS Promotion Plan Workshop, a Diarrhea Training Workshop, and third country training for CDD staff in Cameroon and Geneva. The administrative issues remaining to be settled before PRITECH start-up include: 1) procurement of vehicles (Jeep Cherokees), 2) establishment of a bank account, and 3) purchasing equipment, including photocopiers, a slide projector, overhead projector, computer, and printer. Plans for followup training include an IEC workshop and a Diarrhea Training Unit workshop. A revised calendar of activities, schedule of visits, list of people contacted, workshop participant lists, and delivery order scope of work description are presented.
In: Managing fast growing cities. New approaches to urban planning and management in the developing world, edited by Nick Devas and Carole Rakodi. Harlow, England, Longman Scientific and Technical, 1993. 102-31.Government management of urban land is intertwined with the operations of urban land markets, whose better understanding is necessary if government actions are to be more successful. Effective urban management is critical to achieving the proper functioning of urban areas in the developing world so that these areas can play their roles in the social and economic development of their people. Understanding the urban land market means understanding matters from both these approaches: the interplay of supply and demand and the economic cost and benefits, as well as the roles of the social agents in the production of land prices and the social costs and benefits involved. Planned land-use patterns, density regulations, the timing and location of new roads and water pipes, and taxes based on land values comprise the substance of a long tradition of urban growth management. Rapid urbanization steadily increases the numbers needing space and, therefore, engaged in the competition for land. Policies to determine ownership are usually directed at the needs of governments and the poor for land. Efforts to improve the housing conditions of low-income families through land policies have encountered some unexpected market effects. Corruption and favoritism were blamed, then the political necessity of satisfying the middle income groups, which are a pivotal support of governments in power. Urban managers attempt to determine the uses of land in order to improve the health and safety of the general public or to achieve policies of urban planning. The factors of the motives of policy interventions include: macro-level influences on land markets; past patterns of spatial development, which set the physical location and nature of new conversions from raw land to urban and from one urban use to another; the legal and social traditions of property relations; and, finally, the economic and social sectors involved in land transactions.
[Unpublished] 1990 May. , 12 p. (PRITECH Field Implementation Aid)Control of Diarrheal Disease (CDD) programs need to move more and more toward self-sufficiency. Thus they want a reliable supply of low cost, locally produced oral rehydration salts (ORS). 2 obstacles hinder the process: low demand and an inadequately developed pharmaceutical industry. It takes about US$200,000 to begin ORS production. In 1987, pharmaceutical plants in developing countries made 75% of all ORS produced. In Indonesia, for example, 12 private and parastatal manufacturers can produce ORS, but low demand is forcing some to decrease production. In Bangladesh, however, only 1 parastatal and 1 private company produces all ORS used in the country, but they cannot keep up with demand. Other developing countries producing their own ORS include Costa Rica, Tunisia, Zambia, Mali, Egypt, and Ghana. Any group that considers local ORS production must first examine various factors including an assessment of potential demand, the extent that diarrhea is treated with oral rehydration therapy (ORT), and the government's position on ORS production and distribution. The group should contact the local UNICEF office to gain its support and guidance. It should also work with WHO and Ministry of Health officials and speak with the chief pharmacist or head of the pharmacy board. This group also needs to consider economic factors such as pricing and costs of importing raw materials. It should also see to a detailed cost analysis and market research. The group also needs to determine production capability in the country which includes the ability of companies to adhere to the international Good Manufacturing Practices code. In the beginning of project development, the group must consider ORS promotion with ORS production, e.g., it should scrutinize the potential producer's record for marketing and organize field research. The group can obtain technical assistance from UNICEF, UNIDO, and USAID funded projects such as PRITECH, PATH, HEALTHCOM, and SOMARC.