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In: The population debate: dimensions and perspectives. Papers of the World Population Conference, Bucharest, 1974. Volume I. New York, New York, United Nations, 1975. 573-97. (Population Studies, No. 57; ST/ESA/SER.A/57)WHO presented a discussion on health trends and prospects in relation to population and development at the World Population Conference in Bucharest, Romania, in 1974. Even though many countries did not have available detailed results of 1970 population censuses, WHO was able to determine using the limited available data that both developing and developed countries could still make substantial reductions in death rates. This room for improvement was especially great for developing countries. Infectious diseases predominated as the cause of death in developing countries, while chronic diseases and accidents predominated in developed countries. Life expectancy at birth in developing countries was lower than that in developed countries (48.3-60.3 years vs. 70 years). Any life expectancy gains were likely to be slower after 1970 than during the 1950-1970 period. WHO claimed that by 2000 almost all of the population in developing and developed countries could reach a life expectancy of 60-65 years and 75-80 years, respectively. WHO stressed the complex interactions among population growth, health, and socioeconomic development. Specifically, an improved health status for both individuals and communities would promote socioeconomic development which in turn appeared to reduce natural increase. Some experts have expressed concern that investment in health services spurs population growth because they reduce mortality. Yet the child survival hypothesis indicated that a reduced infant mortality precedes increased demand for family planning methods and subsequent fertility decline. WHO concurred with the hypothesis and advocated that primary health services and family planning are critical to socioeconomic development. Indeed, family planning services should be integrated with maternal and child health services.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
WORLD HEALTH. 1988 Jan-Feb; 10-11.In 1979 WHO invited its member states to participate in a global strategy for health and to monitor and evaluate its effectiveness using a minimum of 12 indicators. Members' 1982 implementation reports and 1985 evaluation reports form the basis for evaluating each measure. Indicators 1-6 have strong political and economic components in both developed and developing countries and are not complete. Indicator 7, for which rates of reply are satisfactory, asks whether at least 5 elements of primary health care are available to the whole population. The 8th gauge seeks information on the nutritional status of children, considering birth weight (a possible indicator of risk) and weight for age (a monitor of growth). Infant mortality rate and life expectancy at birth, indicators 9 and 10, are difficult to estimate in developing countries, and health services are not always kept informed of current estimates. Indicator 11 asks whether the literacy rate exceeds 70%; it can provide information on level of development and should emphasize literacy for women, for whom health information is critical. The last global measure yields information about the gross national product, which is not always the most recent, despite the trend of countries to publish their gross domestic product. Failure to make use of the best national sources, such as this, is one of several problems encountered by WHO's member states in collecting accurate data. Other problems include lack of universally acceptable definitions, different national accounting systems, disinterest of health authorities in economic matters, lack of staff, lack of financial resources in developing countries, and inadequately structured health system management. Each country must choose the most appropriate methods for collection of data. If an indicator cannot be calculated, the country is encouraged to seek and devise a substitute. WHO must produce more precise and reliable indicators. It must respond to requests for ways of improving or strengthening national systems.
Alternative approaches to meeting basic health needs in developing countries: a joint UNICEF/WHO study.
Geneva, World Health Organization, 1975. 116 p.Based on the failure of conventional health services and approaches to make any appreciable impact on the health problems of developing populations, this study examined successful or promising systems of delivery of primary health care to identify the key factors in their success and the effect of some of these factors in the development of primary health care within various political, economic, and administrative frameworks. In the selection of new approaches for detailed study, emphasis was placed on actual programs that are potentially applicable in different sociopolitical settings and on programs explicitly recognizing the influence of other social and economic sectors such as agriculture and education on health. Information was gathered from a wide range of sources; including members, meeting reports, and publications of international organizations and agencies, gathered country representatives, and field staff. The 1st section, world poverty and health, focuses on the underprivileged, the glaring contrasts in health, and the obstacles to be overcome--problems of broad choices and approaches, resources, general structure of health services, and technical weasknesses. The main purpose of the case studies described in the 2nd part was to single out, describe, and discuss their most interesting characteristics. The cases comprised 2 major categories: programs adopted nationally in China, Cuba, Tanzania, and, to a certain extent, Venezuela, and schemes covering limited areas in Bangladesh, India, Niger, and Yugoslavia. Successful national programs are characterized by a strong political will that has transformed a practicable methodology into a national endeavor. In all countries where this has happened, health has been given a high priority in the government's general development program. Enterprise and leadership are also found in the 2nd group of more limited schemes. Valuable lessons, both technical and operational, can be derived from this type of effort. In all cases, the leading role of a dedicated individual can be clearly identified. There is also evidence that community leaders and organizations have given considerable support to these projects. External aid has played a part and apparently been well used. Every effort should be made to determine the driving forces behind promising progams and help harness them to national plans.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
[The strategy of health for all in all its magnitude] Estrategia de salud para todos en toda su magnitud.
Boletin de la Oficina Sanitaria Panamericana. 1983 Oct; 95(4):361-6.Around 1970, interest in the concept of social justice began to be reflected in analyses of health systems in developing countries, and in the rapid acceptance and popularization of the goal of health for all by the year 2000, to be achieved through primary health care programs providing universal coverage. UN member states can maintain the impulse to provide universal health care by carrying out within their borders the health care policies collectively recommended by the UN General Assembly, aided by the World Health Organization (WHO) which has put aside the paternalistic policies of the past and which now seeks to assist nations in carrying out their own goals. 1 step in assuring that the goals will be met involves continual surveillance of the progress of implementation, which is to be reported in various meetings and conferences at regional levels and at the World Health Assembly in 1984. Identification of problems in implementation should not be interpreted as placing blame, but rather as signalling the need to search for common solutions to them. New principles in the use of WHO aid are that the member governments should assume responsibility for the application in their countries of the jointly agreed upon policies as well as the utilization of WHo resources reserved for that end, that WHO resources be used only for activities compatible with policies defined at the national and international levels; that WHO resources be used to achieve adequate planning and administration of the health infrastructure, with assistance from WHO; that individual countries participate in evaluation of WHO sponsored activities to assure the optimal use of resources; and that countries assume much greater responsibility for the use of WHO resources. Application of the new principles will require a new type of interaction with the various organs and personnel of WHO at different levels. External aid which requires excessive concentration on only 1 aspect of health care, such as immunization or control of some forms of diarrhea, is counterproductive and continues past tendencies to impose health goals and programs from outside.