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World Bank Task Force on Accelerating the Development of an HIV / AIDS Vaccine for Developing Countries. HIV vaccine industry study, October-December 1998. Draft.
[Unpublished] 2000 Mar 20. 13 p.Industry’s decision to invest in the development of a vaccine is a function of the risks and uncertainty of “cracking the science” to develop a viable product and the promise of the future market and revenue stream. Although vaccines have proven to be one of the most cost-effective intervention available to control disease with measles, polio, Diphtheria-Pertussis-Tetanus, BCG and tetanus toxoid 5 vaccines preventing 3 million deaths per year in developing countries, they represent less than 2% of the total pharmaceutical market. The availability of these vaccines to the world is dependent on the capacity and pricing decisions of industry. Development of new vaccines against diseases such as HIV/AIDS, malaria and tuberculosis will also depend on the investment decisions of industry. Unfortunately, investment in the development of these high priority new vaccines is low. Understanding industry’s perception of the risks and potential returns for specific vaccines is essential for public sector agencies such as the World Bank. With this information, the Bank and other partners can work with agencies and private industry to develop new strategies which “push” the development of these priority products by reducing the cost or risk of investment or “pull” them by providing market incentives. In April 1998, the World Bank created a Bank-wide AIDS Vaccine Task Force to explore the market failure resulting in under-investment in an HIV/AIDS vaccine. The Task Force commissioned a study by Mercer Management to understand the biotechnology, vaccine and pharmaceutical industries’ perspectives on R&D investment in an HIV vaccine for developing countries. The study was conducted during the fall of 1998 and was co-funded by the International AIDS Vaccine Initiative (IAVI). (excerpt)
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992.  p.External donors provided plenty of funds to nongovernmental organizations (NGOs) in developing countries, hoping the governments would eventually support a national family planning (FP) policy. Lower levels of funding for population programs caused external donors to force NGO FP programs to become self-sustaining. Yet, it is likely to be difficult for them to improve the quality of services, expand coverage, and increase program sustainability all at the same time. External donors consider the 35-50% contraceptive prevalence rates that NGO FP programs are achieving to represent the early stages of sustainability at which time they divert funds to government programs. This loss of funds shifts the NGO program's focus from poor women to income-generation, made possible by targeting middle and upper income women. When diversion of funds resulted in a decline of contraceptive prevalence rates in Sri Lanka and stagnant rates in Pakistan and the Philippines. FP programs in Sri Lanka, Pakistan, and the Philippines first provided physician-controlled, reversible, clinical methods. Those in Sri Lanka and the Philippines next provided contraceptives through a widespread rural community-based distribution system. Pakistan held mass sterilization campaigns to address rapid population growth and high fertility. The management system of the national FP program in Sri Lanka is slow, and disruption of service delivery and supply systems is common Physician-trained nonphysician FP workers and the vertical national health and population sectors caused the stagnation in the public sector. The Philippines has trouble implementing public policy-based FP programs.
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.
[Unpublished] 1992 Apr 2. iv, 37,  p. (PN-ABL-448)The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.
POPULI. 1993 Jun; 20(6):6-7.The UN Population Fund (UNFPA) assists population programs and activities in 140 countries, with field offices in 95 countries and country directors in 59. Its staff of 801 worked last year on a budget of US $225 million. An evaluation of the Fund's operations was sponsored by the official development agencies of Canada, Finland, and Germany in 1992 and early 1993. Conclusions are based upon reviewed documents, interviews, meetings, and case studies of programs in Bangladesh, Bolivia, Brazil, Egypt, Indonesia, Kenya, and Senegal. Generally, the Fund has succeeded in establishing credibility and promoting population as a critical development issue, but its close ties and dependence upon the sanctions and participation of host governments have kept the Fund from maximizing the potential of nongovernmental organizations (NGO) and the private sector to implement projects. Projects are either supported because of government pressure or are not executed by the best executing agencies; only very limited project execution is conducted through the private sector of NGOs. The Fund should instead encourage competition among UN agencies, NGOs, and private companies interested in executing projects. The Deputy Executive Director agrees with these findings, but holds that their relationship with governments is the result of the UN requirement that the Fund work at the invitation of and through host governments. UNFPA-supported country programs have also relied too heavily on other UN agencies to execute projects which have suffered from poor project management and inadequate and/or poor technical support. Moreover, the evaluation revealed that the UNFPA is overextended and should emphasize helping countries which have already tried to move forward with their population programs. Countries should demonstrate need for assistance in addiction to the proper attitude and practices.
Washington, D.C., World Bank, 1993. vii, 103 p.The World Bank has conducted an assessment of the performance of family planning (FP) programs in developing countries. The first part examines their contributions and costs. It concludes that FP programs have played a key role in a reproductive revolution in these countries. Specifically, all developing regions have experienced a transition to lower fertility (e.g., in the last 20 years, fertility has fallen 33%), resulting in lower infant, child, and maternal mortality. One chapter looks at experiences in East Asia, South Asia, Latin America, and sub-Saharan Africa. World Bank staff use research to present a broad summary of what methods and characteristics achieve effective programs. The book addresses other social development interventions that contribute to a lasting reproductive revolution. Despite the positive results of FP programs, maternal mortality in developing countries is still much higher (10 times) than it is in developed countries and 25% of married women in developing countries report an unmet need for FP. Government commitment to FP programs needs to be strengthened and donor support should keep up with needs to expand successful FP programs. FP programs can satisfy these needs if they provide quality services, including a solid client focus, effective promotion, and strong encouragement of the private sector to increase their participation. Indeed, program quality must be the top priority. Strategic management of FP programs is also crucial. Programs need to integrate and coordinate effective promotion of FP, e.g., social marketing, with other activities.
Lot quality assurance sampling techniques in health surveys in developing countries: advantages and current constraints.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1991; 44(3):133-9.Costly, time-consuming, traditional survey methods usually provide information only at national or regional levels. Information from the health center and community levels is, however, also of interest particularly in managing and directing supervisory activities. An industrial method is described with practical applications for conducting health surveys to monitor health programs in developing countries. This lot quality assurance sampling (LQAS) methodology was developed in industry for quality control, and allows the use of small sample sizes when surveying small geographical or population-based areas. The paper describes the method, explains how to build a sample frame, and how to conduct the sampling necessary for field application of LQAS. Sampling unit selection for health program monitoring is described in detail. Simple- and double-sampling schemes are discussed, as well as interpretation of survey results and the planning of subsequent rounds. Constraints limiting use by health planners are explored with suggestions provided on modes of overcoming obstacles through future research.
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.
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
Management information systems in maternal and child health / family planning programs: a multi-country analysis.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):19-30.Management and information systems (MIS) in maternal and child health were surveyed in 40 developing countries by trained consultants using a diagnostic instrument developed by UNFPA and the Pan American Health Organization (PAHO). The instrument covered indicators of input (physical infrastructure, personnel, training, finances, equipment, logistics), output (recipients of services, coverage, efficiency), quality, and impact, as well as frequency, timeliness and reliability of information. The consultants visited national and 2 provincial level administrative and service points of public and private agencies. Information on input was often lacking on numbers and locations of populations with access to services. In 15 countries data were lacking on personnel posts filled and training status. Logistics systems for equipment and supplies were inadequate in most areas except Asia, resulting in shortfalls of all types of materials and vehicles coinciding with idle supplies in warehouses. Financial reporting systems were present in only 13 countries. Service outputs were reported in terms of current users in 13 countries, but the proportion of couples covered was unknown in 25 countries. 2 countries had cost-effectiveness figures. Redundant forms duplicated efforts in half of the countries, while data were not broken down at the usable level of analysis for decision-making in most. Few African countries had either manual or computer capacity to handle all needed data. Family planning data especially was not available to draw the total picture. Often information was available too late to be useful, except in Portuguese speaking countries. Even when quality data existed, managers were frequently unaware of it. It is recommended that training and consultancies be provided for managers and that these types of surveys be repeated periodically.
[Unpublished] 1984 Jul. , 193 p.As of 1984, Lebanon had not yet formulated a clear and specific population policy because laws existed against contraception and political differences among the various ethnic groups also existed which culminated in a civil war. Nevertheless the government condoned the creation of the Lebanese Family Planning Association (LFPA) in August 1969 and its activities. The government also helped spread family planning through its own institutions such as the Ministry of Health and the Office of Social Development. Further some of LFPA's staff members have been part of the government itself. LFPA conducted a survey in June 1975 in Zahrani in rural south Lebanon and it showed that the people wished to limit their fertility, but could not since birth control was not available. Therefore LFPA established the 1st Community Based Family Planning Services Program in Zahrani which later spread to other villages. Wasitas (field workers) served as the major means of providing birth control and information to the women. They emphasized child spacing. The wasitas also served as a major adaptive and indigenous agent of social change and development. Initially they underwent intensive training lasting at least 1 week, but in 1979, LFPA hosted annual 1 month training sessions. The wasitas use of traditional communication methods resulted in not only an increase of contraceptive use, but also in meeting the elemental needs of the women for psychological comfort and self reliance. In some instances, however, some wasitas resorted to deception in encouraging the most uneducated women to use birth control because of strong incentives, e.g., the wasita received 50% of the money earned for the sale of each contraceptive. LFPA needed to reassess those measures which lead to possible encroachment of the dignity and freedom of choice of the women villagers.
Evaluation of the regional advisory services in population education and communication in Sub-Saharan Africa of FAO, the ILO and UNESCO, 1978-1982.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Jun. iv, 64 p.This evaluation was conducted to assess alternative modes of providing regional population education and communication (PEC) advisory services in the African Region in the future, in addition to assessing past performance of existing projects. In the absence of specific and measurable project objectives, as well as uniform, reliable and comparative data for the different projects included in this evaluation, it was not possible to determine exactly the quantity and quality of the achievements of the regional advisory projects over the period under review. Nevertheless, it is concluded that the achivements had been relatively limited, partially because of inherent difficulties associated with the provision of advisory services in the region (e.g., distances, inter-and intra-country communication problems) but more so because of weaknesses in the formulation and implementation of the regional advisory projects. These weaknesses include: 1) differing views on the part of the Executing Agencies and the United Nations Fund for Population Activities (UNFPA) about the functions of the regional advisors which underlie the rather vaguely defined functions presented in the project documents; 2) insufficient planning of the regional advisory teams' activities; and 3) recruitment difficulties which led to vacancies and high turnover as well as to the hiring of partially qualified advisors. Furthermore, the present arrangement for the delivery of regional PEC advisory services, e.g., separate agency teams and advisors located in different countries, impedes the effective delivery of services because the advisors under this arrangement cannot function as 1 team. It is recommended that the functions of the regional PEC advisors in Africa be concentrated on assistance to country project formulation, advice on country project management and systemenatic particiaption in country project monitoring and evaluation. Recommended regional PEC advisory services are 1 team for PEC in the non-formal sector and another team for population education in the formal sector. Other recommendations deal with the role of Headquarters vis a vis regional follow-up and monitoring/supervision of regional advisors, other in-country activites and need for resident country advisors.