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  1. 1

    The social impact of cost recovery measures in Zimbabwe.

    Nyambuya MN


    Since the International Monetary Fund/World Bank Economic Structural Adjustment Program (ESAP) in Zimbabwe was adopted in 1990, health care and education costs have escalated, and many people fail to get these services owing to poverty. The post-independence era in Zimbabwe witnessed a tremendous growth in education and health with many schools, colleges, hospitals and clinics built, professional staff employed, and a general expansion in demand. Nevertheless, the question of drug shortages and ever-increasing health care costs were not addressed. A deficient transport network, the increases in drug prices, the exodus of professional staff, the devaluation of the Zimbabwe dollar, and the cost recovery measures endangered the right to acceptable health care. The social service cutbacks adopted by the government in education will deepen poverty. After independence, the Zimbabwean education system had a free tuition policy at primary school levels. Now that the government reintroduced school fees, a generation of illiterate and semi-illiterate school dropouts will grow up. The social implications of this include increases in crime, prostitution, the number of street kids, the spread of diseases, and social discontent, which are the symptoms of a shrinking economy. As a result of the cost recovery measures, school enrollment in rural areas has gone up. Some urban parents have been forced to transfer their children to rural schools. Higher education also suffers, as government subsidies to colleges and universities have been drastically curtailed. The budgetary cuts have grave repercussions for teaching and research, as poor working conditions and low morals of lecturers and students become prevalent. Most wage-earning Zimbabweans' living standards have deteriorated as the cost of living continues to escalate, coupled with the cost recovery measures in the name of ESAP.
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  2. 2
    Peer Reviewed

    Establishment of primary health care in Vietnam.

    Birt CA

    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.
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  3. 3

    Health trends and prospects in relation to population and development.

    World Health Organization [WHO]

    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.
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  4. 4
    Peer Reviewed

    Manpower issues in Saudi health development.

    Searle CM; Gallagher EB

    New England Journal of Medicine. 1983 Fall; 61(4):659-86.

    In this examination of Saudi Arabia's health care accomplishments, it is argued that the World Health Organization's primary health care model is not the most appropriate for Saudi Arabia and countries like it. Saudi Arabia's health care policy is closely linked to its very rapid emergence as a new and distinctive society. Whereas most developing countries export physicians, Saudi Arabia imports them because the demand for physicians services cannot be met by the supply of indigenous physicians. Saudi health care development is very different from that of most of the third world. Although the country does have a great deal of western technology, Saudi Arabia seems to be following a different course of development from both the third world and the West. Unlike the West, the cost of medial technolgoy is not a problem for Saudi Arabia. Rather, it solves the problem of how to allocate its oil wealth to maintain political stability. The Saudis intend to make the best health care available to all its citizens; they are very concerned about the effect of modern technology on tradition. Therefore, the selection of technology is based on its cultural compatability, rather than on its costs. Primary care may be more technological and specialized than in the West. In Saudi Arabia primary health care may eventually be delivered entirely by specialists, rather than by general or family practitioners. The Saudis are expected to develop a health care system that will meet their particular needs. As with Saudi Arabia itself, health care is experiencing unprecedented change. Thus, the emerging Saudi system will be unique and innovative. Some of its accomplishments will be adopted by other developing countries; Western countries may look to Saudi Arabia as a natural laboratory of health care experimentation.
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  5. 5
    Peer Reviewed

    A case study in the administration of the Expanded Programme of Immunization in Nigeria.

    Jinadu MK

    Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.

    The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
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  6. 6

    Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.

    Reynolds J; Belmar R; Rodriquez-Trias H; Segovia J; Frieiro L

    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)
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  7. 7

    Lactation, fertility and the working woman.

    Jelliffe BD; Jelliffe EF; Sai FT; Senanayake P

    London, International Planned Parenthood Federation, 1979. 163 p.

    Focus in the proceedings of the joint International Planned Parenthood Federation and the International Union of Nutritional Sciences Conference on lactation, fertility, and the working woman is on the following: 1) perspectives of the International Planned Parenthood Federation (IPPF) and the International Union of Nutritional Sciences (IUNS); 2) lactation and infertility interaction; 3) United Nations appraoches; 4) the social context (breastfeeding and the working woman, breast feeding in decline, and women's liberation and breastfeeding); and 5) case studies for the countries of France, Egypt, Ghana, Scandinavia, Chile, Indonesia, Lebanon, Yugoslavia, Singapore, and Sri Lanka. Breastfeeding supplies nutrition specifically adapted to the human infant's needs, mother/child interaction important to emotional development, and biological birth spacing resulting from maternal hormonal changes brought about by sucking. Over the last 50 years, there has been a marked decline in breastfeeding, originally in industrialized countries. Since the end of World War 2, there has been a decline in breastfeeding in developing nations. Recent scientific research has shown increasing evidence of the unique value of human milk and breastfeeding for infants in industrilized countries and developing areas. As women have become more emancipated, conflicts have arisen between their biological family reproductive role and their role as salaried workers outside the home.
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  8. 8

    The promotion and development of traditional medicine: report of a WHO meeting.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1978. 41 p. (Technical Report Series No. 622)

    A WHO meeting to study the promotion and development of traditional medicine was held in late 1977. Traditional medicine concepts and its place in health care are discussed. The fact that traditional medicine consists of a great deal more than the use of medicinal plants is illustrated with discussions of indigenous medical systems from various countries. Much of traditional medicine has been shown to have intrinsic value. It should be evaluated and its efficacy, safety, and availability improved. This should be done because the use of traditional medicine is the surest means of achieving total health care coverage of the world population, using safe, acceptable, and economical means, by the year 2000. The meeting discussed methods of integrating traditional medicine and traditional medical practitioners into the national health care systems of developing nations. Examples of such integration from various countries are cited. Manpower in this area can best be developed by utilizing and retraining, if necessary, existing personnel, including TBAs (traditional birth attendants). Research priorities in the field will vary with cultural settings. The various possible research approaches are illustrated with case studies.
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  9. 9

    Yozgat MCH/FP Project: Turkey country report.

    Coruh M

    [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.
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  10. 10

    Future prospects of family planning in India: some emerging issues.

    BOSE A

    In: Seminar on India's Population Future, Bombay, 1974: Proceedings. Bombay, International Institute for Population Studies, 1975. pp. 59-71

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  11. 11

    Economic policies and program selection in international nutrition problems.


    Paper presented at the 106th Annual Meeting of the American Public Health Association, Los Angeles, California, October 15-19, 1978. 12 p

    Indications are that nutrition status is more important than health services in reducing the level of mortality, especially infant mortality, in a society. International aid agencies and government planners must integrate nutrition considerations into general development thinking. The World Food and Nutrition Survey conducted by the National Academy of Sciences in the U.S. in 1977 pointed out nutrition-related areas for future research and governmental attention. There are 2 main methods for government intervention regarding nutrition: 1) nutrition intervention through such programs as food subsidies to raise actual nutrition levels; and 2) inclusion of nutrition concerns in general development plans, e.g., agricultural planning, income redistribution, and food distribution systems. The question of funding such programs and the technique of enlisting community initiatives and organization are discussed. Direct intervention may be necessary until the long-range development plans begin to have nutrition-related effects.
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  12. 12

    Islamic Republic of Pakistan.

    Furnia AH

    Washington, D.C., U.S. Government Printing Office, June 1976. (Syncrisis, The Dynamics of Health No. 18) 149 p

    There is no sector of Pakistani life which more graphically reflects the great sacrifice it took to make Pakistan a viable state than the health sector. Malaria, tuberculosis, and cholera continue to constitute threats to health. Gastrointestinal, infectious, and other parasitic diseases continue to contribute substantially to morbidity and mortality. These diseases are exacerbated by extremely primitive water supplies and waste disposal, bad housing, nutritional problems, and an increasingly heavy population growth. Public health resources to cope with these conditions have not previously been available. Pakistan's poor helth environment appears to result from widespread infectious and communicable diseases, poverty, and sociocultural attitudes which inhibit improving the environment, and ineffective policies administered by limited numbers of inadequately trained health workers, affecting both the urban poor and the rural population. In the latest 5-year plan, the 5th, 1975-1980, there is increasing attention to health. Regarding family planning, it has been suggested that the government has finally begun to recognize that urgent and dramatic steps are necessary to reduce Pakistan's population growth rate. The government has adopted a policy of using conventional contraceptives as the most acceptable method of contraception in Pakistan. A program of distributing the oral contraceptive without medical or paramedical constraints had been instituted, and the government has undertaken to subsidize the distribution of th oral contraceptive and the condom through some 50,000 outlets at 2.5 cents per monthly supply.
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  13. 13

    The population situation in the region and the family planning and population programme.

    Sodhy LS

    In: International Federation of Medical Student Associations (IFMSA). Standing Committee on Population Activities (SCOPA). Proceedings of the Asian Regional Workshop on Population, Singapore, June 15-22, 1975. Singapore, Asian Regional Workshop on Population, (1975). p. 5-13

    The fertility rate of a country is closely interrelated with social and economic goals; increases in population can nullify any improvements made in either sector. The relationship between the fertility rate and the family unit is also profound. The overall quality of family life deteriorates if numbers exceed resources. The hazards of high fertility to maternal and child health are also great. Asians have long been aware of the dangers of overpopulation and in the past few decades have used family planning as a prime means of fertility control. Efforts to arrive at solutions to the population problem have been made on an inter national and a national level. At the national level, government and vo luntary agencies encourage the acceptance and practice of family planning. Government programs are based on demographic objectives within development planning and aim to reduce fertility to achieve development. For voluntary organizations fertility reduction is a by-product of achievement of family welfare and well-being through planning. Voluntary organizations, generally family planning associations, have been able to remove the stigma attached to birth control in many instances because they are generally community based and oriented and have stimulated local involvement. National family planning associations are coordinated and supported at the international level by IPPF. 3 major factors have been found to encourage fertility reductions; economic progress, valuing children as individuals and not as economic assets, and elevating the status of women. Education of adults and children toward an awareness of population issues and responsible parenthood is a necessary part of any family planning program. The scope of such programs is extremely broad and may encompass legal as well as voluntary measures to reduce fertility; in any case, the participation of medical professionals is vital to the success of any program. In the area, Singapore, Hong Kong, Korea, Taiwan, and Japan have been successful in lowering fertility. The number of new acceptors for the region increased from 2.7 million in 1972 to 3.4 million in 1973, a significant rise but not a sufficient one. It is increasingly apparent that it requires about 10 years to get the annual growth rate of a country down 2 percent and another 10 to get it down to 1.5 percent, and further, that such reductions go hand in hand with economic development.
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  14. 14

    Syncrisis: the dynamics of health. An analytic series on the interactions of health and socioeconomic development. VI. Haiti.

    Beamer LG; Gangloff LJ; Gauldfeldt FI

    Washington, D. C., U.S. Government Printing Office. November 1972. (Syncrisis: The Dynamics of Health, No. 6) 42 p

    In Haiti, both the small, literate, urban, elite and the isolated, illiterate, Vodoun-practicing rural peasantry have been adversely affected by the economic decline and stagnation of this once-rich French colony. For nearly a century and a half it has been virtually isolated. Vital statistics are extremely unreliable, but special surveys indicate that infant mortality is at least 150/1000 live births (180-200 according to 1 survey) and mortality among children aged 1-4 is 33/1000. Diarrheal diseases, tetanus, respiratory infections, intestinal parasites, and the common childhood diseases all play a part. 70% of children aged 5 show signs of malnutrition and 10% show 3rd degree malntrition. After age 5 chances of survival improve although intestinal and perhaps malarial parasites will permanently stunt physical development. A mass yaws program and a mass antimalarial program show public willingness to accept public health measures. Rough estimates place annual growth at 2-2.5%. Since virtually all the island is engaged in subsistence farming, this will soon put unbearable pressure on resources. As it is, Hati is the poorest country in the Americas and 1 of the poorest in the world. Since family patterns stress the desirability of a large number of children to work the land and prove masculinity, the situation promises to get worse. Large numbers of young people have tried to emigrate, but other countries in the area do not want large numbers of Haitians coming in to compete with their own unskilled work forces. High illiteracy, poor communications, rural isolation, and a formerly pronatalist government with only recent commitment to family planning all hamper efforts in this direction. 2 major projects are currently operating with foreign funds: a 2-year U.N. Special Population Fund pilot project in Port-au-Prince and a Unitarian Universalist Service Committee pilot project. In addition, a USAID-Funded, CARE-administered community help project in northwest Haiti includes family planning services. Popular acceptance has been encouraging.
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  15. 15

    The family planning movement and population control.

    Henderson J

    How many people? A Symposium. Foreign Policy Association, 1973. (Headline Series No. 218) p. 7-15. December 1973

    The progress of the family planning and population control movements are traced with particular regard to the significant role played by early volunteer organizations like the International Planned Parenthood Federation (IPPF) which was formed in 1952 by the National Family Planning Associations of India, the U.S., Britain, Hong Kong Germany, Holland, Sweden and Singapore. Global recognition of the population problem has been fostered in part by the universal trend toward urbanization, the sharp reduction in maternal and child deaths, the gradual improvement in the status of women, and other social changes which created a demand for better living conditions. The current trend toward assessing national development prospects in terms of social objectives represents a merger between demographic policy and family planning programs. This union between the public and private sector is largely due to the efforts of voluntary family planning groups who have sought to demonstrate that provision of birth control services and education would result in individual efforts to control fertility. Pioneers like the IPPF lobbied and forced action on the evidence that family size and population growth are related integrally to the social and economic progress which the UN and national governments were trying to create. In the mid-60s, the UN officially recognized the efforts of volunteer agencies and within 2 years, the World Health Organization, the International Labor Organization, UNESCO, UNICEF and the Food and Agriculture Organization acknowledged the contribution of family planning to their own efforts to improve living standards. By 1965, family planning had been introduced in 92 countries and governments committed to population control numbered 10. The IPPF has received increased funding from the U.S., Britain and Sweden to supplement their aid to emerging voluntary organizations which are still dependent on private funding. Governments rely on the private sector during their early experiments with national services as well as on the efforts of the voluntary movement to get services fully utilized. Public and private sector activities tent to become mutually supportive. No voluntary association has been able to develop a nationwide clinic service alone. Government involvement provides essential public health facilities. Family planning organizations, in continuing roles as catalyst and pressure group, can be vital to emerging national programs, and can assist governments with problems of training, administration, distribution and coordination which are essential to the efficient delivery of services.
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  16. 16

    Human fertility and national development: a challenge to science and technology.

    United Nations. Department of Economic and Social Affairs

    New York, United Nations, Department of Economic and Social Affairs, 1971. 140 p

    This report was prepared as a working document for the use of the United Nations Advisory Committee on the Application of Science and Technology to Development in devising its recommendations to the UN Economic and Social Council on the application of science and technology to population problems. The study is primarily organized around the analysis of the levels and trends of high fertility rates and their impact (along with other demographic factors) upon the development process and the life and well-being of individual, families, and the community. Consequently, the religious, cultural and social factors influencing fertility patterns and reproductive behavior in the developing countries are analyzed in detail. 2 chapters are devoted to the organizational, logistical, and motivational aspects of establishing family planning programs as part of development planning. A proposed 5-year program for expanded UN activities in the population field, together with a description of the possible development of population programs under UN aegis, are also described.
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  17. 17

    Iran (Profile).

    Friesen JK; Moore RV

    Country Profiles. 1972 Oct; 19.

    The estimated population of Iran in 1972 was 31,000,000, with an estimated rate of natural increase of 3.2% per year. In 1966 61% of the population lived in rural areas, male literacy was 41% and female literacy 18%. Coitus interruptus is the most common form of contraception used in Iran, followed by condoms. Because of the rapid rate of population growth, the government has taken a strong stand in support of family planning. The Ministry of Health coordinates family planning activities through the Family Planning Division. Contraceptive supplies are delivered free of charge through clinics. The national family planning program also is involved in postpartum programs, training of auxiliary personnel, communication and motivation for family planning population education, evaluation and research. The overall goal of the program is to reduce the growth rate of 2.4% by 1978, and to 1% by 1990.
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