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Eradication of indigenous transmission of wild poliovirus in the Americas. Plan of action, July 1985.
[Washington, D.C.], PAHO, 1985 Jul. 26 p. (EPI-85-102; CD31/7 Annex II)The Pan American Health Organization (PAHO) appointed a Technical Advisory Group (TAG) which met in July 1985 to plan eradication of wild poliovirus in the Americas by 1990 by immunization and surveillance. The strategies to be adopted are mobilization of national resources; vaccine coverage of 80% or more of the target population; surveillance to detect all cases; laboratory diagnosis; information dissemination; identification and funding of research needs; development of a certification protocol; and evaluation of ongoing program activities. The expanded immunization program (EPI) will be organized at the country level by setting up National Work Plans, with inventories of resources and identification of participating agencies and donors, under the guidance of national EPI offices. The TAG will be composed of a core of 5 experts on immunization, with additional consultants as needed, meeting quarterly, semi-annually or annually to review progress and publish recommendations. Regional EPI offices will coordinate eradication activities between the Ministries of Health, the 10-11 epidemiologists/technical advisors in each country and all agencies affiliated with the PAHO. Support personnel will be available at the sub-regional and regional level, including support virologists to assist the laboratory network. Appendices are attached showing estimated costs for regional and regional personnel, vaccines, laboratories, and program activities, predicting that the effort will pay for itself 2.3 times over by 2000.
Chandigarh, India, Punjab Nutrition Development Project, 1974. 115 p.The primary goal of the Punjab Nutrition Development Project was to develop a plan of delivering supplementary foodstuffs to pregnant and nursing women, infants, and children up to age 11. The project was assisted by CARE and was led by an anthropologist, a pediatrician, a nutritionist, and a statistician who worked with a supportive staff from the government. Research was undertaken in 4 main areas: nutritional assessment and diet surveys; studies of community participation, sociocultural aspects of malnutrition and midday meals programs; development of local foods; and organizational and administrative aspects. The following specific studies were conducted: nutritional assessment of preschool children of Punjab; diet survey of preschool children, pregnant and lactating women; chandigarh study of privileged children; nutritional assessment of primary school children; sociocultural aspects of malnutrition in Punjab; nutrition knowledge level of village leaders and their opinions regarding the formation of local health/nutrition teams; a study of the midday meals program with special emphasis on the role of the teacher; comprehensive study of food processing and marketing; food formulations feasibility studies; bulk food consumption by preschool chidlren; feeding programming through community participation; prototype food preparation center; and, evaluation of the midday meals program.
NURSING STANDARD. 1994 Jul 6-12; 8(41):18-20.On May 23, 1993 after years of colonization and oppression Eritrea was a free country. From 1961 to 1991 an armed struggle was fought against the occupying Ethiopian forces. Health has always been on the agenda of Eritrean Peoples' Liberation Front (EPLF). From 1970 onwards they set up clinics with mobile teams to encompass primary health care and health education. In hospitals, health centers and stations there is a shortage of qualified staff, a lack of transportation for referral of patients and in some places inadequate drug supply. The main causes of morbidity and mortality are malaria, malnutrition, diarrheal diseases, respiratory infections, tuberculosis, and vaccine preventable diseases. 30% of neonatal deaths are thought to result from tetanus. Anemia, multiple, closely spaced pregnancies, and complications of child birth contribute to maternal mortality. Economic difficulties, food insecurity, and limited access to safe water exacerbate health problems faced by the Eritreans. Over a million people sought refuge in neighboring countries or in the West. Christian Outreach has been involved with Eritrean refugees in Sudan since 1986, providing health care in a camp on the Sudan/Eritrea border. Hospital, out-patient and maternal and child health facilities were provided along with comprehensive community care and health education. Training courses for the Eritrean health workers have been established to encompass all aspects of primary health care. The Ministry of Health of Eritrea is to promote a system of primary health care throughout Eritrea by the extension of rural health services, the prevention and control of disease, and promotion of community involvement. The goal is the promotion of child survival and development, maternal well-being and the improvement of overall access to health services. The school of nursing will provide courses to allow barefoot doctors to upgrade their training while training civilians as nurses, midwives, and health assistants. The aim is to provide one health station for every 10,000 people instead of the current 72,000.
In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 114-20. (ST/ESA/SER.R/128)The paper addresses: 1) national population principles and objectives; 2) the population dimension of national development policy; 3) national population programs; 4) the rationale, opportunities and needs for external donor support; and 5) processes for population program needs assessment based on the work of one bilateral donor, the United Kingdom Overseas Development Administration. The population dimension to national development policy formulation is most important in relation to policies on: 1) provision of social services (health, education, family planning); 2) environment; 3) development planning and resource allocation; 4) poverty alleviation; 5) labor force and human resource development (youth employment, child labor); 6) social security for the elderly; and 7) the status of women. A population program establishes the strategies to implement the national population policy. Effective family planning programs recognize diverse needs for contraception (youth adults, couples wishing to space their children, those who have completed their families). Ready access to family planning can be achieved through: 1) integrating family planning into clinic-based maternal and child health services; 2) community-based activities; and 3) the retail sector using social marketing. Other population activities include effective dissemination of data including population education in schools. United Kingdom development donor assistance and wider development policies includes: 1) public expenditure rationalization for structural adjustment; 2) civil service reform; 3) health system restructuring; and 4) decentralization. External assistance would include: 1) technical assistance, using local and international expertise; 2) training, in-country and overseas; 3) supplies, including contraceptives; 4) renovation of the existing health infrastructures; and 5) local costs, such as salaries. For donors, one model is the UNFPA program review and strategy development process.
BRITISH JOURNAL OF GENERAL PRACTICE. 1990 Aug; 40(337):341-4.In spite of Vietnam's 40-year history of war, infant mortality rate of 50-60/1000 live births in urban areas, life expectancy of 55 years for women and 61 years for men, growth rate of 21.5/1000 population and population totaling 61-66 million in 1986, the health status of the Vietnamese, is better than the mean for all African countries and no worse than developing countries with a GNP per head greater than Vietnam's US 210. The incidence of infectious disease remains high for both adults and children, with malaria leading for adults and diarrheal disease for children as well as malnutrition due to dietary insufficiency. Air pollution, poor sanitation, and chemical pollution of water supplies pose a serious threat to health in Saigon, as do dioxin-related diseases in the surrounding countryside. A decentralized government hospital service with health centers in all communities provides 1 doctor for every 18,000 population. This system is criticized for lack of attention to socioeconomic conditions or diet. The health care strategy developed in 1986 targets the following goals for 1990: adequate nutrition, drinking water, essential drugs, and sanitation as well as more extensive immunization, family planning services, and home treatment of illness. Along with the 3000 community health centers, community health workers provide basic treatment and health education from their homes. Although the health system is paternalistic, vital provisions of salts and sugars for combating diarrhea, and A and D supplements and food are given to the poor. Dr. Duong Quynh Hoa's pediatric research institute, children's hospital, and new medical school are principally concerned with the development of socioeconomic conditions where the doctor is only 1 among many collaborating to improve the quality of life. One pediatric center project, for example, has been successful in promoting the active participation of people in an environmental hygiene program, a clean drinking water program, immunization efforts, and a diarrhea control program funded through UNICEF, WHO, and French and British charities. Investment is being sought from developed countries for economic development and food aid.
LINKS. HEALTH AND DEVELOPMENT REPORT. 1991 Fall; 8(3):11-2.The authors respond to Tony Dajer's critique of their study concerning the trend in Nicaraguan infant mortality and its possible explanations. It is pointed out that the sharp decline in Nicaragua's infant mortality in the mid-1970s is an intriguing phenomenon, since it began to occur at a time of economic slump, civil disturbance, and under a government that gave low priority to the social sector. It is contended that a number of factors (among them the Managua earthquake) prompted the government to shift its allocation of resources from hospital-based health care in the capital city to ambulatory health care throughout the country. After the revolution, the Sandinista government continued this process. Dajer's characterization of USAID-funded clinics as "notoriously ineffective" is rejected; arguing that although operating under overt political guidelines, these projects are well-advised by experts. Dajer's question as to the importance of health care within the Sandinista government is considered. It is maintained that the revolution was not fought in order to reduce infant mortality, and that health was not the primary concern of the Government of National Reconstruction. It was the international solidarity movement, not the Sandinista government, which focused so intently on infant mortality, hoping to find good news to report. The issue of health care had the added advantage of being politically noncontroversial. It is also maintained that since the mid-70s, the country's health policy has remained stable, despite the radical changes in government because the international arena helps determine national health policy.
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.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
In: Management information systems and microcomputers in primary health care, edited by Ronald G. Wilson, Barbara E. Echols, John H. Bryant, and Alexandre Abrantes. Geneva, Switzerland, Aga Khan Foundation, 1988. 17-20.A wide array of issues must be addressed if the development and use of management information system (MIS) and microcomputers are to improve management of primary health care (PHC) programs and increase the equity and cost-effectiveness of PHC. These issues include: specification of the purpose and objectives of MIS at community and district levels; distinquishing types of information required; the understanding of organizational issues that must be resolved as a result of introducing MIS; the practical definition of the most useful indicators of program effectiveness and efficiency; the specification and monitoring of data collection, compilation, and analysis requirements and procedures; procedures for generating and using processed MIS data and management information; the PHC program's capacity to absorb technological innovations; and personnel requirements. The need for improved data systems must be recognized. Data quality and systematic flow of information must be ensured from the field level upwards, and minimum information requirements need to be defined. The success of any MIS is heavily dependent on feedback of the data collected. Unless staff at all levels of a PHC program understand the importance of the data they are collecting, the value and use of the information system will be negligible. Examples of the Egyptian government's National Health Information System and the role of the World Bank are used to show how MIS and microcomputer can be introduced and used in PHC.
Social Science and Medicine. 1987; 25(6):615-20.It is expected that community involvement in health policy be not only cost-effective but also the best way of providing comprehensive solutions to public health problems. Over 50 years of experience in India show that public enthusiasm does tend to wane after a short period of time, but efforts continue to be made. Governmental and other organizations and UN agencies have been active in promoting the concept of community involvement. The best that can be expected is that people will come forward voluntarily to participate in public health programs formulated by governments and other agencies. Generally, however, public cooperation has to be sought and participation motivated. There is little support for coercive measures. Community participation is often hampered by a wide range of factors including: difficult terrain; inegalitarian social structure; the tendency to depend on others to look after one's needs; and the absence of an understanding of healthful conditions and practices. Also, bureaucrats and medical professionals often consider community involvement an interference. Nevertheless individuals and organizations are everywhere engaged in experiments in such involvement, and certain Indian projects have provided valuable insights which may be of use in other developing countries.
Health aspects of population dynamics: report by the Director-General to the 21st World Health Assembly.
[Unpublished] 1968 Apr 24. 8 p. (A21/P and B/9)Add to my documents.
International Journal of Health Services. 1985; 15(2):275-99.Until the mid 1960s, Latin American health system reflected the skewed distribution of wealth in the region: most health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. For many countries, however, the 1964 Pan American Health Organization's (PAHO) efforts to introduce health planning, intended as a 1st step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Guatemala, however, was and remains an exception. Its technocrats have proven unable to plan effectively; no single entity is responsible for health sector planning, and the 5-year plans have come to consist of disjointed mini-plans, each reflecting the aims, desires and goals of a particular vested interest group or institution. The Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies such as the InterAmerican Development Bank, USAID, UNICEF, Kreditanstaldt and PAHO, which have conceptualized, promoted, designed, built and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed additive reform. The government of Guatemala's own commitment to these outside agency funded projects is reflected in the recurrent shortfall of current or operating funds, and in the rapid depreciation of facilities. Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these additive reforms will not last.
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.
A national approach to health service management information services. The work of the English Steering Group on Health Services Information.
[Unpublished] 1984. 23 p. (WHO/HS/NAT.COM/84-387)In February 1980 the Secretary of State for Social Security appointed the joint National Health Service/Department of Health and Social Security Group on Health Services Information to conduct the 1st comprehensive review of national health services (NHS) management information services since the inception of the NHS. The 1st report presents the Group's conclusions and recommendations about the information required by management regarding clinical facilities and departments in hospitals and the patients using them. In due course this report will be followed by reports on information about community services, paramedical services, personnel, finance, patient transport services, dental service, and other areas of interest. The Steering Group's approach to its task has been based on the requirement to collect data because they are essential for operational purposes. The Group also aims to establish a series of minimum data sets, covering the major areas of management activity in the NHS, to provide the information needed by a district health authority and its officers to manage health services, and to actively influence the allocation of services. The Group began with a review of existing data systems. Working groups were established to investigate hospital facilities used by consultant medical staff, laboratory and scientific services, paramedical services, community health services, health service personnel, health service management accounting, and patient transport services. The smooth implementation of recommendations requires training of the staff responsible for data collection. In formulating proposals, focus has been on the information required by a district health authority and its officers. It is believed possible to identify a minimum set of data which should be used in all districts and that the data should be collected largely as a byproduct of operational procedures. The approach to information for management postulates that the needs of the district tier of the NHS are paramount. In developing the district minimum data set, the working groups paid particular attention to the following characteristics of data: relevance; timeliness; and ability to be collated with data from other sources. Statistical information about the clinical services in a district is drawn from activity data, health services personnel data, and financial data. The major areas of clinical work can be categorized as services provided on hospital premises, off hospital premises, and in or for the community. This report is a synthesis of the recommendations of the 2 working groups which have reviewed the data required about the activity of: the services provided on hospital premises (except radiotherapy); the services provided in consultant outpatient clinics; the services provided in day care facilities; and the services related to a registrable birth. Recommendations are summarized.
[Perinatal assistance of a basic level in Latin America in 1978: description of projects under execution in 1978] Asistencia perinatal a nivel primario en areas rurales de America Latina en 1978: descripcion de proyectos en ejecucion en 1978.
Montevideo, Uruguay, Centro Latinoamericano e de Perinatalogia y Desarrollo Humano, 1979 Feb. 128 p. (Publicacion Cientifica del C.L.A.P. No. 790.)This report investigates the status of maternal-infant services in the rural areas of 18 Latin American countries, and presents statistics on fetal, infant, and maternal mortality in the same countries. Methods and types of personnel used for the attention of pregnancy and delivery are described, together with recommendations for improvements from such international organizations as WHO and PAHO. The important role of practical midwives in all Latin American countries is stressed, as is the need for their training, especially for what concerns the identification of high risk pregnancies. The report includes a brief description of programs already implemented in 14 countries, and compares them to similar ones existing in the U.S., Holland, Nigeria, Tanzania, Thailand, China, and Ethiopia. The report concludes with recommendations from the Latin American Center for Perinatology and Human Development on simplifying perinatal care in Latin American countries.
[Washington, D.C., American Public Health Association, 1979.] 110 p. (Contract AID/pha/C-1100)This reports the Third Evaluation of the Thailand National Family Program and was prepared by the entire joint Thai-American evaluation team. The summary of findings states that the NFPP has successfully achieved its target to date. The population growth rate will reach the goal of 2.1% per annum set by the Fourth Economic and Social Development Plan. It was further recommended that if the record of achievement is to be maintained through the Fifth 5-year plan (1982-6), increasing levels of support are needed both from the government and international donors. Further recommendations state that the National Family Planning Program (NFPP) should continue to focus its efforts on all regions of the country, including Bangkok. The NFPP should prioritize those georgraphic areas and segments of the population where family planning acceptance is low and/or availability of information and services are not fully developed. Targets should be set in terms of a combination of new and continuing acceptors in the next 5-year plan. Greater emphasis should be given to management and supervision at the village and health center levels. The international donor community should give full recognition to the necessity of maintaining a level of direct support for the NFPP to assist the Royal Thai Government (RTG) in achieving the goals of the Fifth National Economic and Social development Plan (1982-6). The RTG and donor agencies should continue to support public and private sector activities in voluntary sterilization.
Delhi, D.K. Publishing House, . 130 p.The population program of India was examined from a descriptive analytical perspective. The organizational layout was examined and methods of operation were scrutinized from the standpoint of program policy. The 8 chapters of the monograph deal with the following: management and population; role of public administration; family planning system; an appendage of health; the law of sinecure and success; international assistance; population mangement; resume and results. The systems concept is a useful approach to the job of management, for it provides a framework for visualizing internal and external environmental factors as an integrated whole. The systems concept also permits recognition of the proper place and function of subsystems. Public administration in India suffers from several problems: 1) too many levels and positions to effect any rapid program decision and implementation; 2) too many boards and committees with vague or obscure duties and lack of responsibility on the part of any single individual or group; control orientation; and 4) generalist administration.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 39-44.The International Labor Organization's (ILO) conventions and recommendations that apply exclusively to women are of 2 main types: promotional and protective. The protective standards are concerned with providing them with the special protection they need because of their sociological and social function of maternity. Maternity protection is most important for both working mothers and society as a whole. This is becoming a more significant problem because of the increase in the number and proportion of women. The protection of working women in connection with their role as mothers was dealt with in 2 ILO conventions, the Maternity Protection Conventnion and the Maternity Protection Convention (Revised), and 2 recommendations. The 1919 instrument was ratified by 28 States and the 1952 instrument by 17 States (on January 1, 1977). The ILO policy on maternity protection is that maternity must be recognized as a social function and the protection of this function must be recognized as a basic human right. In relation with maternity, women and men require full and free access to information and facilities concerning family planning and the right to decide on family size and the spacing of births. The 1919 Convention provides that the working woman be allowed time to nurse her child. In a large majority of countries, rules provide for rest periods to allow a mother to feed her child during working hours. A number of legislations stipulate explicitly that the pauses for feeding must be allowed in addition to the normal rest periods. The 1952 Recommendation refers to the establishment of facilities for nursing or day care.
London, England, International Confederation of Midwives, 1978. 425 p.This document provided a summary of the activities from 1973-June 1978 of the International Congress of Midwives and of the International Federation of Gynecology and Obstetrics and International Congress of Midwives Joint Study Group. These activities were undertaken with a USAID grant. During these years, 12 Working Parties were held in various African, Asian, and Latin American countries. The purpose of the Working Parties was 1) to exchange information of the training and utilization of midwives and traditional birth attendants and 2) to develop recommendations for expanding the role of midwives and traditional birth attendants in the delivery of maternal and child care and family planning services through legislative changes, through the development of training programs, and through broadening contacts with other health organizations. The International Congress of MIdwives determined the host country for each of the Working Parties. The governments of all participating countries were invited to send 2 delegates to the Work Party and to present a country report at the meeting. This document provided a summary of the proceedings, the country reports from the particpating countries, and the conclusions and recommendations made by the participants for each of the 12 Working Parties. Follow up visits were made to participating countries by staff members of the International Congress of Midwives in order to ascertain if the recommendations were being implemented and to offer assistance, if necessary. The results of these follow up visits were also provided.
[Unpublished] 1980. Presented at the Annual Meeting of the Population Association of America, Denver, Colorado, April 10-12, 1980. 34 p.The Calabar Rural Maternal and Child Health/Family (MCH/FP) Project ran from July 1975 to December 1980 funded by the Cross River State Government Ministry of Health with assistance from the Population Council (New York) and the UN Fund for Population Activities. Calabar met the following requirements: it is rural; population between 200,000-500,000; family planning and maternal and child health is integrated from the top level of administration to the delivery of services to the clients; the target population is all women who deliver within the area and their children up to 5 years; services are at levels that can be expanded to larger areas of the country; and attention is given to evaluation of both health benefits and results of family planning services. As a model of health care delivery services to be used throughout the developing world, maternal health services are most important because the level of preventable deaths is highest in preschool children and in women at childbirth and MCH is the most appropriate an effective vehicle for introducing family planning. At the end of the Calabar Rural MCH/FP Project, the office will be closed but the services will continue under the direction of the local governments in Cross River State. 6 health centers and 1 hospital served 275 villages. Knowledge of contraception was low but positively associated with education.
WHO CHRONICLE. 1980 Feb; 34(2):47-52.The Council for International Organizations of Medical Sciences (CIOMS) devoted their 1979 conference to the subject of economics and health policy. The discussions were held in 4 main sessions: 1) economic context of health problems and services; 2) economic aspects of health service manpower and technology; 3) financial implications of health services organization; and, 4) conclusions on requirements for future research and policy. Summaries stressed the importance of primary care and the need for prudent use of advanced technologies to control rising health costs. In spite of great differences between free market and centrally planned economies, the trend is toward a convergence of all health care systems. Agreement was reached on the fundamental importance of socioeconomic factors in determining health status; need to eliminate waste and improve cost-effectiveness, including more downward delegation of tasks (paramedical personnel and midwives); and the principle of equal distribution of services in populations. Research is needed into the effects of financing and remunerations in developing countries, cost-effectiveness of health care procedures, better matching of skills to tasks, socioeconomics developments in improving health.
In: International Labor Office. Family planning in industry in the Asian region. Pt. 3. Field experiences. 1st edition. Bangkok, Thailand, ILO Regional Office for Asia, 1979 Jun. 55-67.Rapid population growth on the large Indian tea plantations, where people are afforded an economic security they seldom leave, first became a problem in the 1940's when infant morbidity and disease began to decline because of the conquest of malaria. The campus-style environment and system of medical and welfare services, as stipulated by the Plantation Labour Act, makes the rendering of family planning services quite easy. The Indian Tea Association's family planning program began in 1957; by 1963 the birth rate had dropped to 38.6/1000 from 43.4/1000 in 1960. Services are free; methods are by choice; cash incentives are granted those who accept sterilization. The United Planters' Association of Southern India began its family planning/health programs in 1971 on 3 estates. The program, known as the No Birth Bonus Scheme, was initiated after a series of 3 surveys and enacted a deferred incentive for motivating employees. The program was extended until 250,000 workers were covered under the Comprehensive Labour Welfare Scheme. The organizational structure includes liaison with State medical and health services and the District Health and Family Welfare officials of the Central Government. CLWS also has support from the Family Planning Association of India, which provides backup clinical services.
In: International Labor Office. Family planning in industry in the Asian region. Pt. 3. Field experiences. Bangkok, Thailand, ILO Regional Office for Asia, 1979 Jun. 1-9.The per capita income in Bangladesh is $72 per year; the infant mortality rate is 140/1000. The rate of literacy is 24%. Family planning and population policy is one of the government's first priorities. The Population Planning Unit in the Directorate of Labour implements and coordinates all population activities in the labor sector. 3 pilot projects are being conducted with the technical and financial aid of ILO/UNFPA and IDA/IBRD: 1) Family Planning Motivation and Services in Industry and Plantation; 2) Population Education and Training for Labour Welfare Officers, Trade Union Officials, and Personnel; and, 3) Pilot Project for Population Planning in the Organized Sector. The government allows 3 days leave with full pay for those workers orspouses who undergo sterilization. Some industrial managements give additional benefits: housing, bonuses, medical care, education, and employjent opportunities to spouses. The long range objectives of the projects are to support the national program; facilitate the use of existing medical services; and to promote the concept of providing family planning services as part of other labor welfare services. The immediate objectives are to create an awareness of the population problem and family planning methods among industrial and plantation workers and encourage small family norms; and, to use existing services for family planning.
In: Bloch LS, ed. The physician and population change: a strategy for Africa, the Middle East and Europe. Bethesda, Maryland, World Federation for Medical Education, 1979 Mar. 149-67.The family planning program in Pakistan began in 1953 with the formation of the Family Planning Association of Pakistan. In 1960 the Second 5-Year Plan allocated 30.5 million rupees and attempted to provide services to 600,000 couples. The 1965 Plan attempted to reduce the crude birth rate from 50/1000 to 40/1000. 148.2 million rupees was allocated and indigenous midwives were incorporated into an autonomous 3-tiered administration with the district the main unit of operation. This program was the most successful, and the basic structure continues unchanged, with the addition of a "Continuous Motivation System" which has male-female teams assigned to local areas who contact clients and prospective clients. Population education has been introduced into school curricula. The 5th Plan hopes to deliver more services to rural areas. All MCH centers are involved in motivation, education, and providing contraceptives. Family planning clinics have been set up in established hospitals. Paramedical personnel man clinics in rural areas where services include family planning, MCH, and treatment of minor ailments. In 1978 the population of Pakistan was 75.6 million; the crude birth rate was 43.6, the death rate, 13.6. The sex ratio is 876 females to 1000 males. Approximately 19% of women are in the reproductive age group. The maternal mortality rate is 6.0/1000 females giving birth; the infant mortality rate is 115/1000 live births.
World Health. 1979 Aug-Sep; 6-9.The United Nations General Assembly adopted and proclaimed in their Universal Declaration of Human Rights that everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services. Also, motherhood and childhood are entitled to special care and assistance. Under certain conditions in developing countries food is not available for each child or adult to receive minimum requirements. Women often labor long hours in the field, which, coupled with the responsibility of family raising, leaves them tired and susceptible to disease affecting the entire family. 1975 was offically declared the International Year of the Woman by the United Nations. The objectives were equality of men and women, women's full involvement in societal development, and women's contributions to world peace. Economic development has become the top priority in the last 2 decades, but development cannot be accomplished by unhealthy individuals. The World Plan of Action of 1975 calls for governments to pay special attention to women's special health needs by provideng prenatal, postnatal, and delivery services; gynecological and family planning services during the reproductive years.