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The level of effort in the national response to HIV / AIDS: the AIDS Program Effort Index (API), 2003 round.
Washington, D.C., USAID, 2003 Dec.  p.The success of HIV/AIDS programs can be affected by many factors, including political commitment, program effort, socio-cultural context, political systems, economic development, extent and duration of the epidemic , and resources available. Many programs track low-level inputs (e.g., training workshops conducted, condoms distributed) or outcomes (e.g., percentage of acts protected by condom use). Measures of program effort are generally confined to the existence or lack of major program elements (e.g., condom social marketing, counseling and testing). To assist countries in such evaluation efforts, several guides have been developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the United States Agency for International Development (USAID) and other organizations (see, for example, “Meeting the Behavioural Data Collection Needs of National HIV/AIDS and STD Programmes” and “National AIDS Programs: A Guide to Monitoring and Evaluation of HIV/AIDS Programs”). However, information about the policy environment, level of political support, and other contextual issues affecting the success and failure of national AIDS programs has not been addressed previously. (excerpt)
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.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
[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.
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.
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.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
American Universities Field Staff Reports. East Africa Series. 1971; 10(2):1-15.Kenya was one of the 1st sub-Saharan countries to develop a national family planning program and has made considerable progress in promoting contraception; however, the program is beset with many staffing, administrative, and political problems. In 1965 the government requested the Population Council to conduct a demographic survey in Kenya and to develop recommendations for establishing a family planning program. The Ministry of Health subsequently instituted most of these recommendations and established 220 family planning clinics in various facilities across the nation. The program receives funding and other forms of assistance from a large number of outside organizations and relies on a large number of foreign advisors for planning, operating, andevaluating the program. One of the major problems confronting the program is the lack of strong and consistent program support from high level government officials. Many officials fear that they will lose political support if they issue strong family planning directives. This lack of commitment weakens the program at all levels and reduces the effectiveness of the educational component of the program. Other problems include 1) inadequate coordination and communication between the various organizations which contribute to the program; 2) internal conflicts between medical and administrative personnel; 3) high reliance on foreign advisors who tend to be insensitive tolocal issues and concerns; and 4) an insufficient number of staff personnel. Despite these problems the outlook for family planning in Kenya is good. Future funding is assured, staff increases are contemplated, and plans call for less reliance on foreign personnel.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
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.
INTERNATIONAL JOURNAL OF GYNAECOLOGY AND OBSTETRICS. 1979; 17(2):102-4.A brief summary of the historical development of the International Confederation of Midwives (ICM) and a review of the organization's recent activities was presented. Efforts to develop an international association of midwives began in 1922. The 1st World Congress of Midwives was held in 1954 and since that time the Congress has met once every 3 years. National midwife associations from 51 countries belong to the ICM. The goals of the organization are 1) to improve the knowledge, training, and professional status of midwives; 2) to promote improved maternal and child care in member countries; and 3) to further information exchange. Since 1961 the ICM and the International Federation of Gynecology and Obstetrics have cooperated in a joint study of midwife training and practice. In 1966 the study group completed its 1st report on the status of maternal care around the world and made a number of recommendations for improving the training of midwives and for establishing uniform licensing requirements. It soon became apparent that these problems could not be dealt with on a worldwide basis, and 12 working parties in different regions were established to investigate the problem at the local level and also to make recommendation in regard to providing family planning services in the context of maternal and child health programs. Each working party has a Field Director who seeks to implement the recommendations of the group. Field Directors have also arranged seminars in reproductive health for rural health workers and especially for traditional birth attendants. The ICM also works in cooperation with the European Economic Community, WHO, IPPF, and several other international agencies. The activities of the working parties have received financial support from USAID.
In: Raphael, D., ed. Breastfeeding and food policy in a hungry world. New York, Academic Press, 1979. p. 277-285Pregnant Indian women and nursing mothers are often deficient in absorbable iron, folic acid, vitamin A, vitamin C, and calcium. These nutrients combined in an oil base with a protein fortificant could be marketed as a medicine. Project Poshak and the Kasa project are two maternal-child-health nutrition programs in which breastfeeding, solid food weaning and preschool child care were emphasized. Nontribal Hindu women have many dietary strictures during pregnancy which contribute to anemia and protein vitamin deficiency. Poshnak project influenced other projects, including national feeding programs, special nutrition programs, and take-home food and child care services. Traditional child rearing practises have outlasted modern agricultural production. The delayed introduction of supplements to the breastfeeding child and female child neglect continue despite availability of nutritional food.n unexpected result of both projects was that acceptance of birth control and family planning greatly increased.
Washington, D.C., Family Health Care, Inc., May 31, 1977. 132 p.Current demographic characteristics for SAHEL countries are presented along with a health delivery strategy based on a distributive philosophy and linking health activities with other development efforts. Resource allocation is proposed within a village-based system, integrating the following components: 1) nutrition; 2) village water; 3) environmental sanitation; and 4) communicable disease control. Investment in a health services infrastructure is anticipated to be a factor in socioeconomic development. Improved health should stimulate labor productivity, enhance the role of women, and increase survival, hence population growth and development. Health services at the village level will be divided into 4 levels: arrondissement, cercle, regional, and national. Specific action recommendations proposed are: 1) organization of a permanent health group to investigate and disseminate information to member countries of SAHEL and to examine experiences in other countries; 2) sponsorship of a ministry-level conference to implement health strategy recommendations; 3) enhancement of health policy, planning, and resource allocation capabilities by development of policy and planning infrastructures by donor organizations, which would also provide training; and 4) incorporation in the next 3- or 5-year plan of SAHEL countries village-based health systems.
Egypt, USAID. 1978 March; 82.A review of Egypt's population/family planning policy and assessment of the current population problem is included in a multi-year population strategy for USAID in Egypt, which also comprises: 1) consideration of the major contraints to expanded practice of family size limitation; 2) assessment of the Egyptian government's commitment to fertility control; 3) suggestions for strengthening the Egyptian program and comment on possible donor roles; and 4) a recommended U.S. strategy and comment on the implications of the recommendations. The text of the review includes: 1) demographic goals and factors; 2) assessment of current population efforts; 2) proposed approaches and action for fertility reduction in Egypt; and 4) implication for U.S. population assistance. Based on analysis of Egyptian population program efforts, the following approaches are considered essential to a successful program of fertility reduction: 1) effective management and delivery of family planning services; 4) an Egyptian population educated, motivated and participating in reducing family size; 5) close donor coordination; and 6) emphasis on the role of women.
Studies in Family Planning. September 1978; 9(9):235-237.The National Family Planning Coordinating Board (BKKBN) of Indonesia began a program of expansion of services in mid-1977. On Java and Bali there are 25,000 contraceptive resupply posts. In the 10 outer-island provinces where program services began in 1973-74 village family planning volunteers work in 4000 communities. The BKKBN has been conducting intensive training programs for community leaders to manage local fertility programs since 1977. The major responsibility for maintaining family planning acceptors will be transferred from government agencies to local organizations. The total family planning budget for fiscal year 1975-76 was U.S. $25.5 million, 50% of which came from the Indonesian government and 50% from donor agencies, including USAID. USAID provided 34 million monthly cycles of oral contraceptives in 1976. Indonesia will be able to supply most of its own contraceptives by 1983-84. The number of family planning service points for all of Indonesia have increased to 1.8/1000 married women in 1976 to 3.8/1000 in 1978. These should increase to 5.4/1000 by 1982.
Washington, D.C., IOM, April 1978. (Report NO. IOM-78-03) 81 pFindings and recommendations are presented of a study conducted by the U.S. Institute of Medicine's Committee on International Health in response to a 1977 congressional request to determine opportunities, if any, for broadened federal program activities in areas of international health. The study committee urged that the U.S.: 1) assist less developed countries to strengthen their own capacity to deal with their health problems; 2) work collaboratively with host country organization; 3) make realistic and sustained commitments to international health proejcts; and 4) coordinate activities with international agencies such as the World Health Organization. An examination of statutory policy and organizational framework now used by the U.S. government in international health programs led the committee to identify 4 major problems that must be resolved: 1) inadequate access by the government to major U. S. sources of health science expertise; 2) skimpy support of research and development on major health problems in developing countries; 3) scattered agency responsibility for decisions on international health activities; and 4) inadequate organizational arrangements for policy development. The committee makes 3 general recommendations for reassignment of responsibilities to resolve the problems.
.. Washington, D.C., U.S. General Accounting Office, June 23, 1977 65 p. (ID-77-3)Although the population policy of Ghana stresses integration of population control with national development policy, little actual integration has occurred. Development efforts encouraging small families will be more actively supported by USAID in the future. Ghana's high birth rate (3%) impedes social and economic development. As the mortality rate falls, the growth rate rises. The results of population growth include increased food imports, crowded health facilities, and a smaller number of eligible students in school. More than 70% of the people live in rural areas; 60% employment is in agriculture. Experience in the Danfa project showed family planning was more acceptable to rural people when integrated with other medical services.
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.
Washington, D.C., U.S. Government Printing Office, March 22, 1976. 56 pA report of the staff survey team of the Committee on International Relations, whose review had the objectives of assessing the opportunities, challenges and obstacles to the introduction of effective family planning programs and population control programs into the West African environment, evaluates several aspects of U.S. development assistance programs in West Africa including: 1) population/family planning programs; 2) the Senegal River Basin project; and 3) reimbursable development programs in Nigeria. Population planning activities are reviewed for Nigeria; Ghana; Sierra Leone; Ivory Coast; Upper Volta; Senegal; and the International Planned Parenthood Federation (IPPF). It is concluded that despite the clear requirement for most nations in West Africa to curb high population growth rates if economic development is to be facilitated, little or nothing is being done in the countries visited. Information is provided for each country on family planning and population projects and organizations; sources of aid and funding; and health services available, concluding with a summary and comment. The Senegal River Basin project is reviewed, concluding that alternate strategies of fulfilling the U.S. pledge to the long-term development of the Sahel be thoroughly explored. Information provided on reimbursable development programs in Nigeria includes: 1) summary of findings; 2) program background; 3) Nigeria as an AID "graduate"; 4) Nigerian economic planning; 6) reimbursable development programs; and 7) staffing.
African Population Newsletter. 1976 Jun; (21):10-11.A new 7-year program -- Strengthening Health Delivery Systems -- has been launched to provide better health care for 20 central and West African countries. The program is funded by the Agency for International Development (AID) and draws on advice provided by the World Health Organization and regional governments and health ministries. Patterned after earlier AID-sponsored smallpox, measles control, and vaccination programs, this program aims to improve local health delivery systems, ease the shortage of trained health personnel, provide maternal and child health care, and expand health, nutrition, and immunization services to rural areas.
Washington, D.C., U.S. Government Printing Office, June 1976. (Syncrisis, The Dynamics of Health No. 18) 149 pThere 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.
A Framework for Evaluating Long-Term Strategies for the Development of the Sahel-Sudan Region. Annex 2. Health, Nutrition, and Population. A final report, September 1, 1973 through December 31, 1974
Cambridge, Massachusetts, Massachusetts Institute of Technology, Center for Policy Alternatives, December 31, 1974. Contract AID/afr-C-1040. 315 pThis report on the health-care system of the Sahel-Sudan characterizes it as fragmented and severely understaffed. There is inequitable distribution of health resources, with a strong tendency toward urbanization. The largest, inappropriately so, fraction of available resources goes to curative medicine; investment in preventive medicine is recommended as cost effective. Improvements in health require improvements in nutrition, water supply, waste disposal, public health programs, hygiene, education, and transportation; in addition, health-care delivery systems must be improved. A vaccination program for measles will reduce child mortality but will also expand the dependency ration and further strain available resources geared to younger aged persons. The principle recommendations for improving health care are: 1) integration of all components of the system; 2) improvements in monitoring disease; 3) reorientation of the system toward preventive medicine; 4) emphasis on mother-child care; 5) use of all communications media in health education; and 6) strengthening of health education to amplify health-care delivery. The low average population density in this region means that demographic issues have not been of overriding concern. The present stagnation of economic development, high rate of unemployment, prevalence of undernutrition, and dependence on foreign aid suggest that under current circumstances population is in excess of the optimal land-population ratio. The present average population growth rate of 2.2%/year, together with the fact that nearly half of the total population is below 15 years of age, means that the population will double in 32 years or less unless the growth rate falls. Some pronatalist laws have been changed.
Syncrisis: the dynamics of health. An analytic series on the interactions of health and socioeconomic development. VI. Haiti.
Washington, D. C., U.S. Government Printing Office. November 1972. (Syncrisis: The Dynamics of Health, No. 6) 42 pIn 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.
Syncrisis: the dynamics of health. An analytic series on the interactions of health and socioeconomic development. V. El Salvador.
Washington, D.C., U.S. Government Printing Office, October 1972. (Syncrisis: The Dynamics of Health, No. 5) 53 pThis brief overview focuses on the basic health situation in El Salvador. An attempt is made to point to the interactions between health and other sectors in the hope that this will influence others to think in the direction of multisector influences. The 3 main health problems in El Salvador relate to nutrition, health services, and sanitation. There is a tremendous burden placed on a society by a weak and ill population, and this is especially true in El Salvador where over 1/2 the children are malnourished and simple childhood diseases are often fatal. However, there seem to be no government or other programs to alleviate this problem, and nutrition is only dealt with in relation to adult literacy programs. Improvement of the nutritional status of the population would benefit the health and well being of the population. Regarding the availability of health services, some form of health facility is available to 85.6% of the population, but over 1/2 these facilities are not permanently staffed. There are, however, more sophisticated facilities which are fairly evenly distributred throughout the country. Deaths which are not certified by a physician are at a high of 65%, indicating that medical care was not available at or near the time of death for the majority of those dying. The country has a good transportation system; there are not any obvious cultural barriers to seeking modern medical care, and yet the people of El Salvador, young and old alike die from a lack of care. It is encouraging that in the area of sanitation there is at least much activity. Poor sanitation is 1 of the basic underlying causes for a large percentage of the diseases, and until this problem is resolved, the country will continue to experience preventable diseases.