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Belize City, Belize, Ministry of Health, 1984. , 54 p. (EPI/84/003)An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
[Institutions of youth promotion and services in La Paz, Bolivia: an analytical-descriptive study] Las instituciones de promocion y servicio a la juventud en La Paz, Bolivia. Un estudio analitico-descriptivo.
La Paz, Bolivia, Centro de Investigaciones Sociales, . 104 p. (Estudios de Recursos Humanos No. 8)This work presents the results of an evaluation of 30 institutions in La Paz, Bolivia, which offer recreational, nonformal educational, training, and sports programs to young people. The 1st chapter provides theoretical background on the psychological, social, and sexual problems and tasks of adolescents in modern societies. The 2nd chapter briefly discusses the roles of the family, friendships, and organizations in the development of adolescents, and briefly describes the goals, programs, and financing of 17 of the 20 organizations studied. 21 of the 30 had formal legal status. 16 of the organizations were public and 13 were private. 7 were national in scope and 15 had international ties. 2 were for women only, 23 were for both sexes, and 5 included children. The primary program objectives were educational in 11 cases, cultural in 8, and sports and religious in 5 cases each. 24 of the organizations reported that they fulfilled their objectives and 5 that they possibly did so. 9 of the organizations had vertical patterns of authority, 16 had horizontal, and 5 had other types. 26 reported that their personnel were qualified. 21 were financed by member contributions, 5 by donations, and 1 by parental contributions. 21 reported that attendance was normal and 5 that there was little participation or interest among members. None of the organizations provided more than very superficial sex education programs, although 26 organizations indicated their belief that sex education is important. 12 of the organizations had professionals on their staffs and 17 had volunteers only. 19 reported they had sufficient manpower and 2 that they did not. The material resources of the organizations were scarce; only 6 had their own meeting places. 15 relied on financing by members, 8 had governmental help or received donations from nonmembers, and 4 had international assistance.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
Report on the evaluation of UNFPA assistance to the civil registration demonstration project in Kenya: project KEN/79/P04.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. xi, 36 p.Kenya established a compulsory vital statistics and civil registration system in 1963 and it was extended nationwide in phases until it covered the whole country by 1971. Serious under-registration of births and deaths however, has persisted. In order to improve registration coverage, the government submitted a proposal to UNFPA to support experimentation with ways to promote registration in some model areas. The original project document included 4 immediate objectives: the strengthening of the civil registration system in the model areas including the creation of a new organizational structure, the training of project personnel and the decentralization of registration activities; the improvement of methods and procedures of registration through experimentation; the collection of reliable vital statistics in the model areas; and, the establishment of a public awareness program on the need for civil registration to ensure the continuation and extension of the new system. Of the 4 objectives of the project, 2 have been achieved--the strengthening of civil registration in the model areas and the improvement of methods and procedures of registration. The major deficiency during the project period was the lack of required staff in the field. The primary feature which distinguishes the project is that traditional birth attendants and village elders become key persons at the village level and act as registration informants after receiving training. The strong points of the project are the high quality of technical assistance provided by the executing agency, the close collaboration among various government departments, and the choice of project strategy and model area. Recommendations have been made to correct the problems of a lack of key personnel at the head office and in the field, and the expansion of registration to new areas before consolidation was completed in the old areas.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
[Unpublished] 1984. v, 37,  p.This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
Geneva, Switzerland, WHO, . 16 p.This report discusses the important place of women in health and development as perceived by WHO and as formulated in various World Health Assembly resolutions, particularly those concerned with the UN Decade for Women. Underlying all objectives is that of increasing knowledge and understanding about how the various socioeconomic factors that make up women's status affect and are affected by their health. The aim of WHO's Women, Health and Development (WHD) activities, is the integration or incorporation of a women's dimension within on-oing programs, specifically as part of "Health for All" strategies. Chief among WHD objectives and groups of activities are the improvement of women's health status, increasing resources for women's health, facilitating their health care roles and promoting equality in health development. Overall WHD activities stress the importance of data on women's health status, the dissemination of this and related information, and the promotion of social support for women. The WHD component of ongoing WHO programs focuses mainly on managerial and technical support to national programs of maternal-child health/family planning care. The present report also includes an update on the incorporation of women's issues within WHO's on-going programs in human reproductive research, nutrition, community water supply and sanitation, workers' health, mental health, immunization, diarrheal diseases, research and training in tropical diseases and cancer. Women's participation in health services is discussed mainly within the context of primary health care and is based on their role as health care providers. The results of a multi-national study initiated in 1980 on the topic of women as health care providers should be ready in early 1984 and are expected to contribute a basis for further action.