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  1. 1
    066097

    Contraceptive source and the for-profit private sector in Third World family planning. Evidence and implications from trends in private sector use in the 1980s.

    Cross HE; Poole VH; Levine RE; Cornelius RM

    [Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991. [63] p.

    Estimates by Family Health International and UNFPA predict that the annual cost of modern family planning in meeting the target overall contraceptive prevalence level of 52% will be between $5-9 billion by the year 2000. The number of couples using modern methods of contraception will increase dramatically in future years, incurring great cost to donors, governments, and users. Urbanization, rising incomes, and higher education levels are generally seen as positive factors in permitting an expanded private sector role in the provision of modern contraceptives, providing an alternative source to donor and government programs. The for-profit concerns within the private sector of developing countries, were studied using available 1978-89 data from 26 countries to examine private family planning sources of contraceptives. Also, hypothetical determinants of private family planning use are established and their interrelationship with the use of for-profit family planning services, is investigated. Contrary to result expectations, it was found that use of the major provider for-profit private sector is declining in the face of rising incomes, urbanization, and better education. Government services are crowding out the private sector. Additionally, results indicate a strong user desire for longer-term methods. Full comprehension of the private sector and the factors governing choice of contraceptive source should lead to more effective use of donor and government funding in efforts to achieve set population objectives. Policy and program development will more accurately reflect social needs. Policy implications of the results are discussed.
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  2. 2
    062986
    Peer Reviewed

    Global health, national development, and the role of government.

    Roemer MI; Roemer R

    AMERICAN JOURNAL OF PUBLIC HEALTH. 1990 Oct; 80(10):1188-92.

    Health trends since 1950 in both developed and developing countries are classified and discussed in terms of causative factors: socioeconomic development, cross-national influences and growth of national health systems. Despite the vast differences in scale of health statistics between developed and developing countries, economic hardships and high military expenditures, all nations have demonstrated significant declines in life expectancy and infant mortality rates. Social and economic factors that influenced changes included independence from colonial rule in Africa and Asia and emergence from feudalism in China, industrialization, rising gross domestic product per capita and urbanization. An example of economic development is doubling to tripling of commercial energy consumption per capita. Social advancement is evidenced by higher literacy rates, school enrollments and education of women. Cross-national influences that improved overall health include international trade, spread of technology, and the universal acceptance of the idea that health is a human right. National health systems in developing countries are receiving increasing shares of the GNP. Total health expenditure by government is highly correlated with life expectancy. The view of the World Bank and the International Monetary Fund that health care should be privatized is a step backward with anti-egalitarian consequences. The UN Economic Commission for Africa attacked the IMF and the World Bank for promoting private sector funding of health care stating that this leads to lower standards of living and poorer health among the disadvantaged. Suggested health strategies for the future should involve effective action in the public sector: adequate financial support of national health systems; political commitment to health as the basis of national security; citizen involvement in policy and planning; curtailing of smoking, alcohol, drugs and violence; elimination of environmental and toxic hazards; and maximum international collaboration.
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  3. 3
    109688

    Employment-based family planning programs. L'emploi et le planning familial.

    Rinehart W; Blackburn R; Moore SH

    Population Reports. Series J: Family Planning Programs. 1987 Sept-Oct; (34):921-51.

    Family planning services through the workplace is an idea that is attracting more attention, benefit's workers, employers, and nations. Large manufacturers and plantations in India first offered family planning to workers in the 1950s. Now also in Indonesia, the Philippines, Thailand, South Korea, Turkey, Egypt, Kenya, and elsewhere, many large companies have added family planning to other health services. In some Latin American countries social security systems have added family planning for many workers. Many different groups, including compaines, labor unions, government-sponsored social marketing programs, and the military, run employment-based programs. Services are offered in workplace clinics, through referrals, in free-standing facilities, in social security hospitals, and in community clinics. Funding comes from employers, governments, unions, family planning associations, and USAID. The most effective programs offer supplies and services as well as information, offer them directly at the workplace, and use worker-volunteers to distribute pills and condoms. Successful programs require the full support of company management. Favorable cost-benefit projections can show managers that offering family planning makes financial sense and contributes to employee health.
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  4. 4
    034685

    Brazil.

    Population Crisis Committee [PCC]

    Washington, D.C., Population Crisis Committee, 1985 Dec. 8 p. (Status Report on Population Problems and Programs)

    In 1985 Brazil's new civilian government took a potentially significant step towards political commitment to a national population program by appointing a national Commission for the Study of Human Reproductive Rights and by accepting large-scale external assistance to implement a nationwide maternal and child health program intended to include family planning services. Brazil's traditional pronatalist policy has been undergoing a change since 1974 and family planning is now viewed as an indispensable element of Brazil's development policy. Several laws which had long impeded the growth of family planning services have been revised or repealed. It is no longer illegal to advertise contraceptives, but abortion is only allowed in restricted circumstances. Approval for voluntary sterilization is easier to obtain. Brazilians who practice family planning obtain services primarily through commercial channels or the private sector. The government and private family planners are faced with a major problem of organizing family planning services for rural areas and the vast city slums. The estimated cost of a national family planning program for Brazil is between US$221 million for 1990 and US$182 to US$324 million for the year 2000. The various aspects of the government program are discussed. The private sector was instrumental in introducing family planning to Brazil. A private non-profit organization was established by a group of physicians to encourage the government to develop a national family planning program and to inform the public about responsible parenthood. This organization (BEMFAM) was given official recognition by the federal government and a number of states and declared a public convenience. Another organization (CPAIMC) was established to provide maternal and child health care in poor urban areas. The sources of external aid, accomplishments to date and remaining obstacles are discussed. Sources of external aid include: UNFPA, USAID, IPPF, the Pathfinder Fund and Columbia University's Center for Population and Family Health (CPFH). A change in popular and official pronatalist attitudes has been effected.
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  5. 5
    033841

    General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.

    United Nations Fund for Population Activities [UNFPA]

    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.
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  6. 6
    267369

    Population: from Bucharest to Mexico and beyond. Poblacion: de Bucharest a Mexico y mas alla.

    Nobbe C

    Tellus. 1984 Jul; 5(2):8-11, 25-8.

    Since the formulation of the World Population Plan of Action (WPPA) in Bucharest in 1974, about 80% of governments have endorsed family planning and fertility control. There has been a growing awareness by governments that population planning must be an integral part of general policy formulation. This article describes the issues of central concern to the 1984 International Population Conference in Mexico, highlighting those which result from new global developments over the past decade. Immigration, particularly by exiles and refugees from political persecution, are contributing much more to population instability than foreseen by the WPPA. Internal migration and massive population shifts from rural to urban areas are of increasing concern to governments in developing nations. In developed countries, there has been an emergence of anxiety over zero population growth. The role of privately sponsored programs for population control is much less prominent, as governments take more responsibility for formulating population policy. A report from a meeting of 90 such nongovernmental organizations held in 1983 was reluctantly accepted as an official document at the conference in Mexico. The Canadian Task Force on Population has identified 5 issues of special concern: status of women, the environment, aging, immigration, and family planning. The Task Force includes among its objectives the encouragement of a comprehensive population policy for Canada, focussing both on Canada's special concerns and on its place in the global community. For example, acid rain and improper soil conservation are threatening Canada's status as one of the few viable "bread baskets" for the world. The growing bulge in the population over age 65 will impose economic strain in the future. Sex education for adolescents in inadequate, with only 1/2 of Canadian schools addressing sex and sexuality in the curriculum.
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  7. 7
    267011

    On a national drug policy for Bangladesh.

    Islam N

    Tropical Doctor. 1984 Jan; 14(1):3-7.

    On April 27, 1982 the Ministry of Health of the government of Bangladesh, set up an 8-man expert committee to evaluate all the registered pharmaceutical products presently available, and to formulate a draft National Drug Policy. Objectives are: 1) to provide support for ensuring quality and availability of drugs; 2) to reduce drug prices; 3) to eliminate useless, nonessential, and harmful drugs from the market; 4) to promote local production of finished drugs; 5) to ensure coordination among government branches; 6) to develop a drug monitoring and information system; 7) to promote the scientific development and application of unani, ayurvedic, and homeopathic medicines; 8) to improve the standard of hospital and retail pharmacies; and 9) to insure good manufacturing practices. 16 criteria were agreed on as guidelines for evaluating the drugs on the country's market. Drugs in Bangladesh have been classified into 3 categories. The 1st is drugs that are positively harmful. They should be banned immediately and withdrawn from the market. There are 265 locally manufactured drugs and 40 imported drugs in this category. The 2nd, drugs to be slightly reformulated by eliminating some of their requirements. There are 134 drugs in this category. The 3rd is drugs that do not conform to 1 or more of the 16 criteria/guidelines. There are over 500 drugs in this category. The new drug policy will produce a saving of 800 million taka (US $32.4 million). Drug supply in Bangladesh is a problem. The public sector distributes 20% of the total. In the private sector, drugs are supplied through import and local production. Investment for research by the pharmaceutical companies is essential. The principles laid down by the International Federation of Pharmaceutical Manufacturers Associations for the supply of good medicine needs to be put into practice.
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  8. 8
    798195

    An assessment of population and family planning in the Caribbean.

    Carlson BD

    [Washington, D.C.], American Public Health Association, 1979 Mar 7. 42 p. (Contract AID/pha/C-1100)

    The needs and opportunities in population and family planning in the Caribbean region are assessed. Focus is on the general setting (regional profile, economic situation, education, health, basic constraints and regionalism), observations and recommendations (population policy, international donor support, community-based distribution, voluntary sterilization, commercial retail sales, status of women, management, regional cooperation), selected regional institutions (government and non-government organizations), and international donor agencies. In general the governments in the Caribbean are supportive of family planning programs, and, except for Belize and Guyana, most of the countries have a national family planning program. Although there is tacit or direct support for family planning and an increasing application of demographic variables in the planning and development of socioeconomic programs, there is no clear indication that the governments understand or recognize the implications of rapid population growth. Except for the United Nations Fund for Population Activities and International Planned Parenthood Federation and World Bank population projects in Jamaica and Trinidad, the international donor community has provided only modest, sporadic and ad hoc support for population and family planning in the Caribbean. In the Caribbean the needs and opportunities for community-based distribution are markedly different from those existing in other countries.
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  9. 9
    681113

    Population and family planning in Malaysia.

    Saunders L; Perkin G

    Bangkok, Thailand, March 1968. 28p

    The government of Malaysia has initiated a highly visible, high prio rity family planning program to supplement private family planning efforts in accelerating the decline in birthrates and in promoting the health of families. Because increases in economic production were barely able to meet increase in population, the need for reducing the birthrates in East and West Malaysia became apparent. In 1953, private Family Planning Associations were established and eventually there was one such association in each state. By 1966, these private efforts were providing contraceptive services and supplies through 166 clinics. These associations also sponsor a variety of public information and education activities. In 1966 the government launched a family planning program by passing the Family Planning Act and creating the National Family Planning Board (NFPB). The ultimate aim of the government is to incorporate family planning into an overall health service program. The NFPB is presently a semi-autonomous organization with its own professional staff and clinics and manned by its personnel within the Ministry of Health. The responsibilities of the Board are to establish and administer clinics and distribute funding, conduct social and biological research concerning birth control acceptance and methods, and evaluate the effectiveness of family planning programs. The four divisions of the board include: 1) Administrative Division; 2) Service and Supply Division, whose duties include training new personnel; 3) Research Evaluation and Planning Division; 4) Information Division. The government clinics will be attached to existing government health facilities with priority going to establishing facilities in urban areas. International agencies are supporting the program with contraceptive supplies, technical assistance and training. With the acc eptance of the major ethnic groups and no political or religious opposition and enthusiastic government support, the program is a model for other developing countries.
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  10. 10
    025935

    Co-financing.

    United States. Agency for International Development [USAID]. Bureau for Program and Policy Coordination

    Washington, D.C., Agency for International Development, 1983 May. 16 p. (A.I.D. Policy Paper)

    Cofinancing is a useful method of development finance that offers the potential for increasing the effectiveness of the US Agency for International Development's (USAID) resources by broadening the scope of investment opportunities beyond those that are within its singular capacity. Cofinancing is any formal arrangement under which USAID loan and/or grant funds are associated with funds from one or more different sources (private or public) outside the borrowing country to finance a particular program. Cofinancing may be used to leverage USAID resources with those of the external private sector as well as to facilitate the transfer of skills and technology. The Development Assistance Committee (DAC) of the Organization for Economic Cooperation and Development (OECD) has viewed cofinancing primarily in the context of its ability to improve the quality of assistance (additionality). Multilateral Development Bank (MDB) participation in USAID-sponsored cofinancing arrangements should generally be in the form of at risk lending as a means of enhancing the prospects for additionality over the medium to longer term. While USAID in appropriate conditions is willing to provide relief, it will not generally link its loans to those of other cofinancing participants through the use of mandatory cross-default clauses but may use optional cross-default clauses in the case of private lenders. In addition to advantages in the application of development assistance resources, cofinancing offers the potential for enhancing the effectiveness of USAID's policy dialogue with the respective less developed countries (IDCs). Although cofinancing has a number of potential advantages, particular care should be exercised to insure that cofinancing does not become an end itself, but rather remains a mechanism among other alternatives to be utilized when it represents the most efficient application of USAID resources in the context of the development objectives of country-specific strategies.
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  11. 11
    048852

    Report on the evaluation of UNFPA assistance to population education projects executed by the ILO in Nepal: NEP/74/PO1--population education in the organised sector and NEP/77/PO2--population education through panchayats, cooperatives and training institutions (November 1982).

    Kobes J; Matthews P; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Dec. vi, 61, [7] p.

    2 projects financed by the the United Nations Fund for Population Activities (UNFPA) and implemented by the Nepalese Government with the International Labor Organization (ILO) as the executing agency are reviewed. The projects are assessed, conclusions drawn and recommendations made in terms of the achievement of the country level project objectives, training and educational activities undertaken, and information education and communication (IEC) materials produced for population education projects, the to which projects have been integrated into relevant country level programs and into Maternal-Child health/Family Planning (MCH/FP) programs, the strategies used and the impact on the various target populations. Part I deals in general with the immediate objectives of the projects; part II goes into more detail on project plans, implementation and achievements. The basis of the Population Education in the Organization Sector project was the development of worker motivators who would promote family planning. The overall plan was for seminars to arouse awareness, support and commitment at the national level, regional seminars for local managements, regional tripartite and plant bipartite committees to develop and sustain local awareness, to encourage practical management support at the local level. The project was carried out successfully in terms of the original plan and work schedules. However, there were deficiencies in the original project design (e.g., combining the industrial sector, the cooperative sector and women under 1 project); objectives were not well formulated and little attention was paid to them after the project started. Review and evaluation aspects of the management of the project were neglected and follow-up was thus deleteriously affected. Recommendations focus on attempts to consolidate and institutionalize the achievements of the project. The target groups of the 2nd project were the leaders and officers in the Department of Cooperatives and in the Ministry of Panchayat and Local Development, the members of cooperative societies and community leaders. The project was designed to contribute to the implementation of the national population program by institutionalizing the provision of population education on a continuing basis to rural families through the work-related training network of the named organizations. For the most part, the objectives for the cooperative sector have been met: a significant number of cooperative officers are more aware of population issues and population education is part of the staff's regular curriculum. Many quantitative targets were met. However, some of the qualitative aspects of activities could be improved and the commitment to the population education program by the Cooperative Department must be translated into manpower and budgetary allocations that will provide the necessary means for continued activity.
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  12. 12
    048858

    Report of the evaluation of UNFPA assistance to population education projects executed by the ILO in India: IND/74/PO7, IND/78/PO6, IND/78/PO7 and IND/79/P12 (February 1983).

    Valdivia L; Roque F; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Dec. vii, 82, [6] p.

    Independent, in-depth evaluations at the United Nations Fund for Population Activities (UNFPA) are undertaken to provide timely, analytical information for decision-making within UNFPA and to provide one of the inputs that enable the Executive Director to meet the requirements of accountability to the Governing Council. The main focus of this report is on conclusions and recommendations. Part I summarizes the main conclusions and recommendations which are addressed primarily to UNFPA and the executing agency. Part II goes into more datail on the projects being evaluated and the conclusions and recommendations are addressed primarily to the government and the executing agency. The evaluation covers 4 population education projects in India. It is part of a comprehensive evaluation study of selected population education projects executed by the International Labour Organization (ILO) in the Asia and Pacific Region. The 1st project reviewed, Population Education in the Organized Sector, is mainly concerned with the development of prototype training and information, education and communication (IEC) materials for use in the organized sector, the adaptation of these materials into regional languages for distribution, and in motivational/training activities for the organized sector. The 2nd project concerns cooperation of management and workers in population education and welfare activities in the industrial sector. It is designed to enlist the participation of a greater number of employers in providing family planning education, motivation and services to their workers and their families. The 3rd project shares the same service orientation, focuses on the industrial sector and is designed to enlist the participation of employers in the provision of family planning education, motivation and services for their workers and their families. Finally, the 4th project evaluated is the Tripartite Collaboration for Promotion of Family Welfare Activities in the Organized sector. Its principal aim is to provide family welfare education to textile workers and their families. Its major assumption is that the key role in persuading workers to accept family planning services is played by the union. These projects are assessed, conclusions drawn, and recommendations made in terms of the institutionalization and integration of population education programs with other relevant programs, achievement of population education objectives, training activities, including curricula and IEC materials, and impact upon target audiences. The methodology for the evaluation and the reporting procedures are included in an appendix.
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  13. 13
    118854

    Report on the evaluation of UNFPA assistance to the Swaziland family planning programme.

    Ryder B; Burton J; Frieiro L

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1982 Dec. xi, 44, [10] p. (Project SWA/75/P01)

    The long range objective of this project (1976-1981) was to improve and enhance the health and welfare of mothers and children, especially in rural areas. In assessing Project achievements and the degree to which progress toward the long term objective has been accomplished, the Evaluation Mission found that the immediate objectives had, to a large degree, been met within the general framework of the Ministry of Health's (MOH) development program. Service delivery points in governmental, mission private and industrial/plantation health facilities are now widely distributed throughout Swaziland. The integration of preventive and curative is clearly in place in the rural health clinics and health centers. Analysis of service statistics data indicates that a large % of pregnant women attend antenatal clinics. Family planning services are now offered in 86 clinics with 27,094 clinic attendances recorded for 1981. The pill is the most popular method, followed by condoms, injectables and IUDs. An adequate though incipient health education program is functioning. The MOH strengthened the health infrastructure for, and has in place a program of, maternal child health (MCH) and family planning (FP). The strong points of the program are the government's commitment to MCH/FP, the general strategy, the training component, the number and quality of staff involved in service delivery, the number of service delivery points and the system of recruitment and the employment of Rural Health Motivators (RHM). Weak points, which appear to have hindered a more effective program performance, are planning and management, the lack of solid socio-anthropological knowledge to base, the lack of a focal point for FP, supervision at all levels and the lack of monitoring and evaluation which, if properly undertaken, could have led to changes and adjustments in the program. Future activities supported by the United Nations Fund for Population in the organization and management of family planning activities within the MCH program and within other government and voluntary organizations. UNFPA should help the government prepare a new proposal for UNFPA assistance to family planning activities in the country and should consider supporting supervision and training activities.
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