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[Unpublished] 1990 May.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.
Integrating oral rehydration therapy into community action programs: what role for private voluntary organizations?
Washington, D. C., CEFPA, 1980. 42 p.A workshop, sponsored by the Centre for Population Activities, the National Council for International Health, and the Pan American Health Organization, meet in 1980 to discuss the use of ORT (oral rehydration therapy) in health and development programs and to determine how private and voluntary organizations could be encouraged to become involved in efforts to extend ORT availability. ORT is a technique for reducing dehydration in patients suffering from prolonged diarrhea. Diarrhea related dehydration is a serious problem among children in developing countries, especially among malnourished children. In 1975, 5 million children under 5 years of age died from diarrhea in Latin America, Africa, and Asia. The therapy consists of administering a solution of sodium chloride, sodium bicarbonate, potassium chloride, glucose, and water to the patient in order to balance the composition of body fluid. Initially the solution had to be administered intravenously at a treatment center; however, the solution can now be administered orally to mildly or moderately dehydrated patients by the patient's family in the home setting. The solution is given to the patient frequently and amount is determined by the patient's thirst for the solution. Packets containing enough dry ingredients to mix with 1 liter of water are now available. These packets can be centrally or locally manufactured. The solution can be mixed at health centers upon request, or the packets can be distributed directly to family members who are then taught how to mix and administer the solution. Various community action programs can incorporate an ORT component. Personnel in these community action programs, working at all organizational levels, should receive training in ORT. Community workers should receive intensive training so that they in turn can teach families in the community to use the therapy. The programs should use all available communication channels to send out accurate messages about ORT. The program should also organize the distribution of the packets and develop evaluation procedures for the ORT program component. WHO, UNICEF, USAID, and the National Council for International Health provide various forms of assistance to governments or to private and voluntary organizations interested in developing ORT programs.
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.
WHO CHRONICLE. 1980; 34(1):20-3.In order to fulfill the goal of "health for all by the year 2000," the countries of Southeast Asia must be encouraged to establish comprehensive drug policies. This would remedy the present situation where access to life-saving drugs and essential drugs is limited and national health resources are wasted on less important medicines. The comprehensive drug policy could streamline every aspect of the pharmaceutical and supply system, ensuring high quality, safety and efficacy of the drugs. Each country's ministry of health should coordinate the program with aid from the WHO Regional Committee. Technical cooperation among the countries of the region is essential and establishment of eventual self-sufficiency with respect to essential drugs is encouraged. Traditional medicine and traditional medical practitioners should be integrated into the existing institutional system. Training of traditional practitioners in the preventive and promotive aspects of primary health care would improve the existing system. Since there is a lack of pharmacists in the region, the training of additional pharmacists should be a priority item in any new comprehensive drug program.
WHO Chronicle 33(7-8):267-274. July-August 1979.The 350 participants at the 32nd World Health Assembly, held in Geneva from May 11-17, 1979, discussed ways to promote technical cooperation among developing countries (TCDC) and factors which act as constraints to TCDC. The participants agreed that strategies must be developed at the national, regional, and global level and recommended that 1) each country adopt a national health policy and establish an information system with exchange facilities; 2) areas in which regional cooperation is to be vigorously sought are in the manufacture and quality control of drugs, information exchange, and the development of research facilities and training of health personnel; and 3) WHO is to act as a promotor and coodinator for TCDC activities, help develop and facilitate information exchange, and encourage the drug industry to supply drugs on a nonprofit basis to TCDC programs. Constraints on TCDC included 1) the unfounded fear that the TCDC approach will delay the development of self-reliance for 3rd world countries; 2) the lack of administration facilities and structures needed for regional and national coordination; 3) various legal, financial, and political factors which inhibit cooperation; 4) language barriers; and 5) a lack of knowledge about the resources and capabilities available in each country which could be shared by others. Financing of TCDC projects will be done primarily through allocations in the national budgets in each of the developing countries and multinational financing. Funds from UN programs and from other organizations interested in promoting TCDC principles must be sought.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
Problems of distribution, availability, and utilization of agents in developing countries. A. Industry perspectives.
In: Institute of Medicine. Division of International Health. Pharmaceuticals for developing countries. (Conference proceedings, Washington, D.C., January 29-31, 1979) Washington, D.C., National Academy of Sciences, 1979. (IOM-79-001) p. 211-227A spokesman for the drug industry emphasizes that the health and well-being of the peoples of the developing world are far more dependent on political and economic decisions than on scientific and technological developments. The following tables provide evidence for the superiority of private sector drug distribution vs. public: 1) leading therapeutic classes by sales through retail pharmacies in selected developed and developing markets (e.g., all of Latin America together consumes less antidiabetic drugs than Holland); 2) national expenditure on health as a percentage of gross national product (i.e., GNP; in general, developed countries spend 5-8% of GNP on health care, of which 10-20% represents expenditure on drugs; whereas in low-income countries drug expenditure rarely rises to 2 U.S. dollars and often accounts for up to 50% of total health care); 3) distribution of public finance in selected developing countries (1975); 4) health care and development aid provided by major donor nations (1976); 5) structure of aid to health in capital aid only; 6) comparative rankings of the leading 10 therapeutic classes in selected developing countries; and 7) patent protection for pharmaceuticals in selected developing countries. It is pointed out that policies which restrict activities in multinational corporations, especially patent and trade name restrictions, have resulted in a heavy pull-out of multinationals from participation in drug delivery in developing countries. This is seen as further debilitating the already woeful, by industry standards, state of public sector health care delivery in developing nations.
WHO Chronicle 33(6):203-208. June 1979.The Action Programme on Essential Drugs is an internationally-sponsored program of technical cooperation which was started by the World Health Orgnaization (WHO). The Program aims to: 1) strengthen national capabilities of developing countries in selecting, supplying, distributing, and using essential drugs; 2) strengthen local quality control and production, where possible, of such drugs; and 3) provide essential drugs and vaccines to developing countries. Drugs considered essential will differ from 1 country to another depending on available medical personnel and prevalent diseases. In the next several years, development of primary health services will go concurrently with development of pharmaceutical supply systems adapted to the specific needs of the country's population. Technical cooperation should be facilitated through international assistance. Current activities of the Program in each of the WHO regions are summarized.
CBFPS (Community-based Family Planning Services) in Thailand: a community-based approach to family planning.
Essex, Connecticut, International Council for Educational Development, 1978. (A project to help practitioners help the rural poor, case study no. 6) 91 pThis report and case study of the Community-Based Family Planning Service (CBFPS) in Thailand describes and evaluates the program in order to provide useful operational lessons for concerned national and international agencies. CBFPS has demonstrated the special role a private organization can play not only in providing family planning services, but in helping to pioneer a more integrated approach to rural development. The significant achievement of CBFPS is that it has overcome the familiar barriers of geographical access to family planning information and contraceptive supplies by making these available in the village community itself. The report gives detailed information on the history and development of the CBFPS, its current operation and organization, financial resources, and overall impact. Several important lessons were learned from the project: 1) the successful development of a project depends on a strong and dynamic leader; 2) cooperation between the public and private sectors is essential; 3) the success of a project depends primarily on the effectiveness of community-based activities; 4) planning and monitoring activities represent significant ingredients of project effectiveness; 5) a successful project needs a sense of commitment among its staff; 6) it is imperative that a project maintain good public relations; 7) the use of family planning strategy in introducing self-supporting development programs can be very effective; 8) manning of volunteer workers is crucial to project success; and 9) aside from acceptor recruitment in the short run, the primary purpose of education in more profound matterns such as childbearing, womens'roles in the family, and family life should also be kept in mind. The key to success lies in continuity of communication and education.