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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.
HEALTH POLICY AND PLANNING. 1992 Dec; 7(4):364-74.The Director of WHO's Regional Office for Africa presents a health development framework based on the primary health care (PHC) concept. the government should review national health policies, national health strategies, and national heath services to resolve basic issues. Then it should define the framework for health development by breaking down the goal into operational target-oriented subgoals for individuals, families, and communities, by creating health districts as operational units, and by organizing support for community health. Once this framework has been decided, the government should use it to restructure the national health systems. At the district level, health and development committees, helped by community health workers, and district health teams would be responsible for community health education and activities. The provincial health offices would oversee district activities, select and adapt technologies, and provide technical support to communities. A board would manage the provincial hospitals (public, private, and voluntary). These hospitals would work together to organize secondary medical care programs. A public health office wold link them with the provincial health centers. Other sectors would also be involved, e.g., departments of education and water. The national health ministry would set national policies, plans, and strategies. A suprasectoral health council would coordinate cooperation between universities and other sectors and external agencies. National capacity building would involve establishing management cycles of health development, using national specialists as health advisors, and placing health as a priority in development. To implement this framework, however, the government needs to surmount considerable structural economic, and social obstacles by at least decentralizing and integrating health and related programs at the local level, fostering a national dialogue, and promoting social mobilization.
INTERNATIONAL NURSING REVIEW. 1991 Mar-Apr; 38(2):31.A brief report summarizes issues and concepts discussed by participants from Malawi, Tanzania, and Zambia at the 2nd ICN/WHO intercountry conference in Lusaka, Zambia. Broadly discussing nursing care of people with HIV/AIDS and their families, counseling and case/family support should be considered major components of local initiatives in Africa. While local constraints must be recognized in diagnosing, counseling, caring for, and supporting cases and families, programs may also build upon community strengths. Present official health services are often unable to accommodate the needs of all patients with HIV/AIDS. Participants therefore examined innovative, new home-based approaches to care and case/family support. Examples of community-based support programs tailored to meet local needs are mentioned. The role of counseling in both case/family support and for behavioral change is also voiced. A multidisciplinary approach carried out by open, flexible, and understanding personnel is required. Nurses must provide clinical care to cases while also working to facilitate behavioral change.
Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.
New York, United Nations Fund for Population Activities, July 1981. 181 p.This report for UNFPA (United Nations Fund for Population Activities) on Colombia's Maternal and Child Health and Population Dynamics (MCH/PD) program was prepared by an independent team of consultants which spent 3 weeks in Colombia in February 1980 reviewing documents, interviewing key personnel and observing program services. The report consists of 8 chapters. The 1st describes the terms of references of the evaluation mission. The 2nd chapter provides background information on Colombia and identifies some of the principal environmental factors that affect the program. Chapter 3 describes the organizational context within which the program operates. The chapter also includes a discussion of the UNFPA funding and monitoring mechanism and how that affects program planning and operations. Chapter 4 is a description of the program planning process; goals, strategies and objectives, and of the UNFPA and government inputs to the program between 1974-1978, the period under review. A large part of the report is devoted to describing and assessing each program activity. Chapter 5 consists of descriptions of management information; maternal care; infant, child and adolescent care; family planning; supervision; training; community education; and research and evalutation studies. Chapter 6 is an analysis of the program's impact on: maternal morbidity and mortality; infant morbidity and mortality; and fertility. Chapter 7 summarizes the Mission's conclusions and lists its recommendations. The final chapter deals with the Mission's position in relation to the 1980-1983 proposal. Appendices provide statistical data on medical activities, contraceptive distribution and use, content of training courses, target population, total expenditures, and norms for care, as well as organizational charts, individuals interviewed, and UNFPA assistance to other agencies in Colombia. (author's modified)
[Unpublished] 1979. Paper prepared for the Technical Workshop on the Four Country Maternal and Child Health/Family Planning Projects, New York, Oct. 31-Nov. 2, 1979. (Workshop Paper No. 2) 10 p.An integrated health care system which combined the maternal/child health with other services was undertaken in the Yozgat Province of Turkey from 1972-77. The objective was to train midwives in MCH/FP and orient their activities to socialization. The first 2 years of the program was financed by UNFPA. 52 health stations were completed and 18 more are under construction. The personnel shortage stands at 33 physicians, 21 health technicians, 30 nurses, and 67 midwives. Yozgat Province is 75% rural and has about a 50% shortage of roads. The project was evaluated initially in 1975 and entailed preproject information studies, baseline health practices and contraceptive use survey, dual record system, and service statistics reporting. The number of midwives, who are crucial to the program, have increased from an average 115 in 1975 to 160 in 1979. Supervisory nurses are the link between the field and the project managers. Their number has decreased from 17 to 6. Until 1977 family planning service delivery depended on a handful of physicians who distributed condoms and pills. The Ministry of Health trained women physicians in IUD insertions. The crude death rate in 1976 was 13.2/1000; the crude birth rate was 42.7/1000. The crude death rate in 1977 was 14.8/1000; birth rate, 39.9/1000. Common child diseases were measles, enteritis, bronchopneumonia, otitis, and parasitis.
In: Martinez Manautou J, ed. The demographic revolution in Mexico 1970-1980. Mexico City, Mexican Institute of Social Security, 1982. 17-97.Provides summaries of Mexican demographics, with tables showing annual growth rate (1900-1980), demographic growth rates, crude birth and mortality rates, life expectancy at birth by sex (all for 1940-1980), marital status of women and average age at 1st union (1979), rural and urban population with age distribution (1940-1980), fertility rates overall and broken down by urban and rural groups (1971-1979) and specific age groups (1971 and 1979). Discusses population policy development which has changed from formally pronatalist in the 1940s to a gradual realization of the need for slower growth. Relevant laws and regulations are briefly noted. Policy is viewed in the context of international movements (notably the World Action Plan for Population). The National Plan for Family Planning is summarized and placed in the context of overall development and planning and coordination of overall health services. Organizations within the health sector which provide family planning services are briefly described. The coordination of the national family planning program is based organizationally on the general sense of family planning in 3 dimensions: health, demography, and family and community development; it has 2 types of general objectives: intrinsic, at the family level, and extrinsic, at the social level. Family planning activities are developed according to multidisciplinary, micro and macrosocial, and coordinated activity perspectives. The organization of the coordination office of the national program and the composition of the National Plan are detailed, including establishment of common bases for family planning, coordinated intrasectoral programming, and participation of international organizations.
In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 281-9.It is now widely recognized that there is great potential in traditional medicine to contribute to primary health care, specially in developing countries. Such a potential is due not only to the wide acceptance of these systems at the community level but also to their simple, inexpensive, non-toxic, and time-tested remedies for the alleviation of disease and disability. In order to contribute usefully to primary health care, these systems must be functionally integrated into the country's health system. A thorough study should therefore be made of the prevailing traditional systems in their entirety--the type of system, the available manpower, the existing training programs, including any linkage to the official health services and the budgetary requirements. The identification of areas of health care to which these systems can contribute effectively and problems relating to their further development also require scrutiny. A list of recommendations given by WHO in 1979 for the development of traditional medicine are given. These include: manpower planning, the development of traditional medicine programs at the community level, and the identification of research priorities (drug research, the characteristics of traditional practitioners, integration programs, and cost effectiveness of traditional remedies and practices). An additional area of research suggested is the effectiveness of traditional remedies against chronic diseases for which there are no satisfactory treatments in modern medicine. WHO has been actively promoting traditional medicine as an integral part of primary health care through its technical cooperation programs with member states. In the last few years, a useful program to encourage visits of teams from different countries to China has been carried out in collaboration with the United Nations development program. The emphasis of WHO's programs are on coordinated and integated efforts to foster traditional systems and to maximize their usefulness towards the attainment of health for all.