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Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
The adaptability of international development agencies: the response of the World Bank to women in development.
In: Women, international development, and politics: the bureaucratic mire. Updated and expanded edition, edited by Kathleen Staudt. Philadelphia, Pennsylvania, Temple University Press, 1997. 136-150.The following analysis will focus on four matters: first, a brief history of WID (women-in development) in the World Bank; an explanation of WID policy adoption based on the bank's professional and technical expertise and on its organizational structure; third, the bank's interaction with external actors, and fourth, internal strategies of change followed by change advocates. The data are derived from the author's interviews with the World Bank staff, internal memoranda and documents, and publications by and on the World Bank. (excerpt)
Oxford, England, Oxford University Press, 1990. xix, 136 p.The Commission on Health Research for Development is an independent international consortium formed in 1987 to improve the health of people in developing countries by the power of research. This book is the result of 2 years of effort: 19 commissioned papers, 8 expert meetings, 8 regional workshops, case studies of health research activities in 10 developing countries and hundreds of individual discussions. A unique global survey examined financing, locations and promotion of health research. The focus of all this work was the influence of health on development. This book has 3 sections: a review of global health inequities and why health research is needed; findings of country surveys, health research financing, selection of topics and promotion; conclusions and recommendations. Some research priorities are contraception and reproductive health, behavioral health in developing countries, applied research on essential drugs, vitamin A deficiency, substance abuse, tuberculosis. The main recommendations are: that all countries begin essential national health research (ENHR), with international partnership; that larger and sustained international funding for research be mobilized; and that larger and sustained international funding for research be mobilized; and that international mechanisms for monitoring progress be established. The book is full of graphs and contains footnotes, a complete bibliography and an index.
INTEGRATION. 1990 Apr; (23):4-11.Since 1976, the Integrated Family Planning and Parasite Control (IP) has been conducted by the Population and Community Development Association (PDA) through the financial support of the Japanese Organization for International Cooperation in Family Planning (JOICFP). Family planning was integrated with other activities starting with parasite control and then environmental sanitation. In 1976, PDAs activities were focused on a community-based delivery (CBD) system for contraception in rural Thailand. In the IPs first years, the PDA conducted mass treatment campaigns using both the local plant "maklua" and modern medicines. Various motivational activities were included, such as letting children see the parasites under a microscope. Many villagers showed up for treatment. Later, however, they were reinfected and failed to get further treatment. Since 1981, the major emphasis of the IP rural program has been to push building of latrines and improved water resources. PDA has started a major project for safe storage of rainwater. Some 11,300 liter bamboo-reinforced concrete rainwater storage tanks are being built in northeast Thailand. Giant water jars for rainwater catchment with a 2000-liter capacity are produced. The financing of PDAs environmental sanitation construction activities is unique. Villagers pay back the cost of the raw materials of the tank, latrine, or jar they received. Repayments go into a revolving fund which can be lent to other families. Peer pressure has made repayment levels approach or exceed 100% in target districts. Villagers are trained to produce the casings, bricks, and other things needed for building. Individuals from building crews are selected and given special training in construction techniques and are taught the potential health benefits of each activity. These people become village sanitation engineers. Villagers can engage in income-generating activities and receive technical assistance from the PDA. The IP has taken on a community participation approach. The PDAs Family Planning (FP) Health Checkup Program is the urban version of the IP. In 1989, the PDA sold 11,109 cycles of pills and 2100 packages of 3-piece condoms through FP volunteers based in 459 enterprises. These FP volunteers also tell their co-workers about parasite control and other issues that they learned from the annual refresher courses. The PDA also does school health checkup services. The PDA generated funds to keep the programs ongoing. The Thai government actively supports the work of the nongovernmental organizations.
In: Workshop on the Integration of AIDS Related Curricula into Family Planning Training Programs, Quality Hotel, Arlington, Virginia, May 10-11, 1988. Documents, distributed by The Family Planning Management Training Project [FPMT] of Management Sciences for Health [MSI] Boston, Massachusetts, Management Sciences for Health, The Family Planning Management Training Project, 1988 May.  p..Current objectives in the fight against AIDS are focused on reducing transmission. International cooperation must be guided by principles including allowing the World Health Organization and participating governments, not donors, to determine policy; work done in developing countries must achieve the same standards as in the US; relationships between health and population programs, donor agencies and governments must be characterized by cooperation, not competition; and flexibility is necessary to respond to new information. Sensitivity is essential, as the control of AIDS involves personal issues, and the diagnosis of AIDS has profound implications. Surveillance is essential to detect and control infection and to guide public policy. As few infections currently result from medical injection, interventions have focused on the difficult problem of modifying sexual behavior, with little success. Social research is essential to determine means of behavior modification and to evaluate their efficacy. A brief history of the AIDS epidemic, as well as a summary of its epidemiology are provided. Efforts to control the spread of AIDS and to care for victims are draining the resources of basic health care programs, interfering with the delivery of primary health care. The extra demands that will be placed on family planning programs, including the shift in emphasis to barrier methods will strain these programs. WHO is currently undertaking a global effort to reduce morbidity and mortality from HIV infections and prevent transmission. Its strategies focus on preventing sexual, blood borne and perinatal transmission, therapeutic drugs against HIV, vaccine development, and helping infected people, and society, deal with the illness. Other agencies which have developed programs are USAID, the DHHS and the Centers for Disease control in the US.
NUFUSBILIM DERGISI/TURKISH JOURNAL OF POPULATION STUDIES. 1987; 9:63-73.From the perspective of the UN Fund for Population Activities, Turkey has a population problem of some magnitude. In 1987 the population reached 50 million, up from 25 million in 1957. Consistent with world trends, the population growth rate in Turkey declined from 2.5% between 1965-73 to 2.2% between 1973-84; it is expected to further decrease to 2.0% between 1980 and 2000. This is due primarily to a marked decline of the crude birthrate from 41/1000 in 1965 to 30/1000 in 1984. These effects have been outweighed by a more dramatic decline in the death rate from 14/1000 in 1965 to 9/1000 in 1984. Assuming Turkey to reach a Net Reproduction Rate of 1 by 2010, the World Bank estimates Turkey's population to reach some 109 million by the middle of the 21st century. The population could reach something like 150 million in the mid-21st century. Some significant progress has been made in Turkey in recent years in the area of family planning. Yet, some policy makers do not seem fully convinced of the urgency of creating an ever-increasing "awareness" among the population and of the need for more forceful family planning strategies. Government allocations for Maternal and Child Health and Family Planning (MCH/FP) services continue to be insufficient to realize a major breakthrough in curbing the population boom in the foreseeable future. Most foreign donors do not consider Turkey a priority country. It is believed to have sufficient expertise in most fields and to be able to raise most of the financial resources it needs for development. The UNFPA is the leading donor in the field of family planning, spending some US $800,000 at thi time. Foreign inputs into Turkey's family planning program are modest, most likely not exceeding US $1 million/year. Government expenditures are about 10 times higher. This independence in decision making is a positive factor. Turkey does not need to consider policy prescriptions that foreign donors sometimes hold out to recipients of aid. It may be difficult for foreign donors to support a politically or economically motivated policy of curtailing Turkey's population growth, but they should wholeheartedly assist Turkey in its effort to expand and improve its MCH/FP services. Donors and international organizations also may try to persuade governments of developing countries to allocate more funds to primary education and to the fight against social and economic imbalances. Donors should continue to focus on investing in all sectors that have a bearing on economic development.
Washington, D.C., World Bank, 1984. 36 p. (International Conference on Population, 1984; Statements)In his address to national leaders in Nairobi, Kenya, Clausen expresses his views on population growth and development. Rapid population growth slows development in the developing countries. There is a strong link between population growth rates and the rate of economic and social development. The World Bank is determined to support the struggle against poverty in developing countries. Population growth will mean lower living standards for hundreds of millions of people. Proposals for reducing population growth raise difficult questions about the proper domain of public policy. Clausen presents a historical overview of population growth in the past 2 decades, and discusses the problem of imbalance between natural resources and people, and the effect on the labor force. Rapid population growth creates urban economic and social problems that may be unmanageable. National policy is a means to combat overwhelmingly high fertility, since governments have a duty to society as a whole, both today's generation and future ones. Peoples may be having more children than they actually want because of lack of information or access to fertility control methods. Family planning is a health measure that can significantly reduce infant mortality. A combination of social development and family planning is needed to teduce fertility. Clausen briefly reviews the effect of economic and technological changes on population growth, focusing on how the Bank can support an effective combination of economic and social development with extending and improving family planning and health services. The World Bank offers its support to combat rapid population growth by helping improve understanding through its economic and sector work and through policy dialogue with member countries; by supporting developing strategies that naturally buiild demand for smaller families, especially by improving opportunities in education and income generation; and by helping supply safe, effective and affordable family planning and other basic health services focused on the poor in both urban and rural areas. In the next few years, the Bank intends at least to double its population and related health lending as part of a major effort involving donors and developing countries with a primay focus on Africa and Asia. An effective policy requires the participation of many ministeries and clear direction and support from the highest government levels.
UNFPA and the resident representatives: a continuing relationship, statement made at the Global Meeting of UNDP Resident Representatives, Tunis, Tunisia, 12 July 1980.
New York, N.Y., UNFPA, . 10 p. (Speech Series NO. 55)This statement outlines the dimensions of the population problem and UNFPA's goals for its resolution. Aiding UNFPA in the execution of its programs are the UNDP Resident Representatives. To facilitate the work of the Resident Representatives in those countries where projects are directly executed, UNFPA has provided and will provide administrative and clerical support, whenever possible. UNFPA posts Field Coordinators to assist the Resident Representatives, and, increased cooperation has developed as a result. It is urged that the representatives and coordinators inform and assist each other in those activities where a combined effort would be to the mutual benefit of all concerned. At the headquarters level, in order to avoid duplication and for reasons of economy, efficiency and better coordination, UNFPA will continue to avail itself of administrative services of UNDP headquarters, including personnel, travel, financial processing (including computer time) and other services in the amount of US$300,000. There will be no charge for this arrangement.
Health and Population: Perspectives and Issues. 1982 Jan-Mar; 5(1):23-33.A new discipline, health economics, which reflects the relationship between the health objective procuring adequate health care and the financial resources available, is becoming increasingly important. The WHO definition of health, that health is a "state of complete physical, mental and social well being and not merely the absence of disease or infirmity," is criticized for not lending itself to direct measurement of the health of the individual or community. This concept should include consideration of the process of being well as well as the absence of disease. It must also recognize that services to promote health, to prevent, diagnose and treat disease and rehabilitate incapacitated people must be included in the concept. For economic analysis purposes, health services can be classified into medical care, public health services and environmental public health services. It is suggested that the cost of education and training of medical personnel and medical research should be included in computing the cost of health services. In defining economic concepts many factors including capital and current costs, and depreciation must be considered. In addition all health economists have differentiated the direct cost of sickness including cost of prevention, detection, treatment, rehabilitation, research, training, and capital investments from indirect costs which include loss of output to the economy, disability and premature death. Using these concepts, some understanding of cost trends, cost accounting, cost benefit analysis and cost efficiency analysis should be made available in the medical curriculum and for health administrators so that health management can be more standardized and effective. (summary in HIN)
[Unpublished] 1981. Paper prepared for the International Workshop on Cost-Effectiveness Analysis and Cost-Benefit Analysis in Family Planning Programs, St. Michaels, Maryland, Aug 1981. 7 p.The object of this analysis of indirect cost rates of organizations providing technical assistance in population is to measure operating efficiency. With incomplete and unchecked data on a single Project X, a pattern was discovered. Indirect costs were lowest for 2 state universities and a nonprofit population specialist, mid-range for other universities, and highest for agencies working primarily on government contracts. The approach of this study would be limited even with better data. Some of the limitations are 1) it calculates costs only, not cost-effectiveness; 2) salaries, caliber and skills of personnel are not considered; 3) no 1 project's budget can be a fair test of efficiency for organizations best suited for different types of projects; 4) sources of support which may reduce overhead are not accounted for; 5) types of work provided by indirect costs may vary; 6) treatment of consumable commodities varies among organizations; 7) no distinction is made between various types of excluded subcontracts. There are 2 disturbing considerations involved in deciding whether or not to try to refine this methodology: 1) if comparison of a single budget item is unreasonable, how can complex programs be compared? 2) What are the implications of the increase in control of the donor agencies over budgeting, hence management processes of funding recipients?