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London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
BMJ. British Medical Journal. 1993 Sep 18; 307(6906):729-30.The former Minister of Health responds to an earlier, inaccurate article about the dispute between some emergency ward physicians and the public sector in Chile. Even though the economy appears to be healthy, 38% of the population are poor. Chile has had a longterm social policy addressing socioeconomic problems in health and in education, resulting in impressive health indicators (e.g., in 1990, 97% immunization rate for children under 5 years of age. The Pinochet regime whittled away at the strong national health service, however, including a large reduction in staff in the mid-1970s and a 40% reduction in expenditures (and a response to the economy adjustment crisis). These actions became time bombs which exploded in May 1990, 2 months after the inauguration of the 1st democratically chosen president in years. The health unions and, later, physicians asked for higher wages. In late 1992, the government increased salaries by 35% in real terms and 100% in nominal terms. Between 1990 and 1993, 6000 people, which included 1200 physicians for rural areas, were added to the public sector staff. The government increased investment in equipment (around 10,000 pieces of equipment, including 10 CAT scans) and in infrastructure by 240%. 190 public hospitals are undergoing repair and renovation. 2 small hospitals have opened. 4 large regional hospitals are scheduled for completion in 1993 and 1994. During the 3 years of democracy, the public sector budget increased 50% in real terms. The World Bank has provided assistance for a health sector reform project to meet the challenges that accompany the demographic and epidemiologic transition, transitions from a planned to a market economy and from dictatorship to democracy, a cultural transition, and behavioral changes. Politicians and physicians do not necessarily support reforms, however, sometimes resulting in changes in ministers, such as the author of this article.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
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.
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.
WHO CHRONICLE. 1980; 34(1):20-3.In order to fulfill the goal of "health for all by the year 2000," the countries of Southeast Asia must be encouraged to establish comprehensive drug policies. This would remedy the present situation where access to life-saving drugs and essential drugs is limited and national health resources are wasted on less important medicines. The comprehensive drug policy could streamline every aspect of the pharmaceutical and supply system, ensuring high quality, safety and efficacy of the drugs. Each country's ministry of health should coordinate the program with aid from the WHO Regional Committee. Technical cooperation among the countries of the region is essential and establishment of eventual self-sufficiency with respect to essential drugs is encouraged. Traditional medicine and traditional medical practitioners should be integrated into the existing institutional system. Training of traditional practitioners in the preventive and promotive aspects of primary health care would improve the existing system. Since there is a lack of pharmacists in the region, the training of additional pharmacists should be a priority item in any new comprehensive drug program.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
Problems of distribution, availability, and utilization of agents in developing countries. A. Industry perspectives.
In: Institute of Medicine. Division of International Health. Pharmaceuticals for developing countries. (Conference proceedings, Washington, D.C., January 29-31, 1979) Washington, D.C., National Academy of Sciences, 1979. (IOM-79-001) p. 211-227A spokesman for the drug industry emphasizes that the health and well-being of the peoples of the developing world are far more dependent on political and economic decisions than on scientific and technological developments. The following tables provide evidence for the superiority of private sector drug distribution vs. public: 1) leading therapeutic classes by sales through retail pharmacies in selected developed and developing markets (e.g., all of Latin America together consumes less antidiabetic drugs than Holland); 2) national expenditure on health as a percentage of gross national product (i.e., GNP; in general, developed countries spend 5-8% of GNP on health care, of which 10-20% represents expenditure on drugs; whereas in low-income countries drug expenditure rarely rises to 2 U.S. dollars and often accounts for up to 50% of total health care); 3) distribution of public finance in selected developing countries (1975); 4) health care and development aid provided by major donor nations (1976); 5) structure of aid to health in capital aid only; 6) comparative rankings of the leading 10 therapeutic classes in selected developing countries; and 7) patent protection for pharmaceuticals in selected developing countries. It is pointed out that policies which restrict activities in multinational corporations, especially patent and trade name restrictions, have resulted in a heavy pull-out of multinationals from participation in drug delivery in developing countries. This is seen as further debilitating the already woeful, by industry standards, state of public sector health care delivery in developing nations.
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.
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.
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.
In: Fukutake, T. and Morioka, K., eds. Sociology and social development in Asia. Tokyo, University of Tokyo Press, 1974. p. 39-60The history of the development of a population policy in Ceylon is given. Ceylon has a high rate of growth due to a declining death rate and a high steady birthrate. A continuing economic crisis has been aggravated by the high birthrate, and the unemployment rate is over 12%. Increased food production has been inadequate, and welfare policies have limited funds available for productive investment. The Family Planning Association (FPA) in Ceylon was founded in January 1953 and has received financial support from several sources, most importantly from the Swedish International Development Authority. In the 3 plans during 1955-1965 emphasis has been laid on the relation between economic development and population growth. The Sirimavo Bandaranaike Government's Short-Term Implementation Programme of 1962 stated the urgency of the economic problem and its connection with the rate of population growth. From 1965 the Government of Ceylon made family planning an official responsibility. Family planning work was taken over by the Dept. of Health. The FPA has devoted itself to the dissemination of propaganda on family planning. Official policy on family planning has tended to become ambivalent because of a charge that family planning could turn the ethnic balance against the Sinhalese. In April 1971 there was an insurrection that threatened the existence of the government, and realizing it was due to unemployment, living costs, and fragmentation of land, the Government incorporated a note that facilities for family planning among all groups are essential.
How many people? A Symposium. Foreign Policy Association, 1973. (Headline Series No. 218) p. 7-15. December 1973The progress of the family planning and population control movements are traced with particular regard to the significant role played by early volunteer organizations like the International Planned Parenthood Federation (IPPF) which was formed in 1952 by the National Family Planning Associations of India, the U.S., Britain, Hong Kong Germany, Holland, Sweden and Singapore. Global recognition of the population problem has been fostered in part by the universal trend toward urbanization, the sharp reduction in maternal and child deaths, the gradual improvement in the status of women, and other social changes which created a demand for better living conditions. The current trend toward assessing national development prospects in terms of social objectives represents a merger between demographic policy and family planning programs. This union between the public and private sector is largely due to the efforts of voluntary family planning groups who have sought to demonstrate that provision of birth control services and education would result in individual efforts to control fertility. Pioneers like the IPPF lobbied and forced action on the evidence that family size and population growth are related integrally to the social and economic progress which the UN and national governments were trying to create. In the mid-60s, the UN officially recognized the efforts of volunteer agencies and within 2 years, the World Health Organization, the International Labor Organization, UNESCO, UNICEF and the Food and Agriculture Organization acknowledged the contribution of family planning to their own efforts to improve living standards. By 1965, family planning had been introduced in 92 countries and governments committed to population control numbered 10. The IPPF has received increased funding from the U.S., Britain and Sweden to supplement their aid to emerging voluntary organizations which are still dependent on private funding. Governments rely on the private sector during their early experiments with national services as well as on the efforts of the voluntary movement to get services fully utilized. Public and private sector activities tent to become mutually supportive. No voluntary association has been able to develop a nationwide clinic service alone. Government involvement provides essential public health facilities. Family planning organizations, in continuing roles as catalyst and pressure group, can be vital to emerging national programs, and can assist governments with problems of training, administration, distribution and coordination which are essential to the efficient delivery of services.
Country Profiles. 1972 Oct; 19.The estimated population of Iran in 1972 was 31,000,000, with an estimated rate of natural increase of 3.2% per year. In 1966 61% of the population lived in rural areas, male literacy was 41% and female literacy 18%. Coitus interruptus is the most common form of contraception used in Iran, followed by condoms. Because of the rapid rate of population growth, the government has taken a strong stand in support of family planning. The Ministry of Health coordinates family planning activities through the Family Planning Division. Contraceptive supplies are delivered free of charge through clinics. The national family planning program also is involved in postpartum programs, training of auxiliary personnel, communication and motivation for family planning population education, evaluation and research. The overall goal of the program is to reduce the growth rate of 2.4% by 1978, and to 1% by 1990.
In: Martinez Manautou J, ed. The demographic revolution in Mexico 1970-1980. Mexico City, Mexican Institute of Social Security, 1982. 17-97.Provides summaries of Mexican demographics, with tables showing annual growth rate (1900-1980), demographic growth rates, crude birth and mortality rates, life expectancy at birth by sex (all for 1940-1980), marital status of women and average age at 1st union (1979), rural and urban population with age distribution (1940-1980), fertility rates overall and broken down by urban and rural groups (1971-1979) and specific age groups (1971 and 1979). Discusses population policy development which has changed from formally pronatalist in the 1940s to a gradual realization of the need for slower growth. Relevant laws and regulations are briefly noted. Policy is viewed in the context of international movements (notably the World Action Plan for Population). The National Plan for Family Planning is summarized and placed in the context of overall development and planning and coordination of overall health services. Organizations within the health sector which provide family planning services are briefly described. The coordination of the national family planning program is based organizationally on the general sense of family planning in 3 dimensions: health, demography, and family and community development; it has 2 types of general objectives: intrinsic, at the family level, and extrinsic, at the social level. Family planning activities are developed according to multidisciplinary, micro and macrosocial, and coordinated activity perspectives. The organization of the coordination office of the national program and the composition of the National Plan are detailed, including establishment of common bases for family planning, coordinated intrasectoral programming, and participation of international organizations.