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UN Chronicle. 1990 Dec; 27(4): p..A new Programme of Action aimed at advancing the world's poorest countries offers a "menu approach" for donors to increase their official aid to the least developed countries (LDCs), stressing bilateral assistance in the form of grants or highly concessional loans and calling on donors to help reduce LDC debt. The Programme was adopted by consensus at the conclusion of the Second United Nations Conference on the LDCs (Paris, 3- 14 September). The UN recognizes more than 40 developing countries as "least developed". Although individual nation's indicators vary, in general LDCs have a per capita gross domestic product (GDP) of approximately $200 a year, a low life expectancy, literacy rates under 20 per cent and a low contribution of manufacturing industries to GDP. Reflecting the emergence during the 1980s of new priorities in development strategy, the Programme of Action for the LDCs for the 1990s differs from the Action Programme adopted at the first UN Conference on LDCs held in 1981 in Paris. The new Programme emphasizes respect for human rights, the need for democratization and privatization, the potential role of women in development and the new regard for population policy as a fundamental factor in promoting development. Greater recognition of the role of non-governmental organizations in LDC development is also emphasized. (excerpt)
Family planning and maternal and child health in the World Bank's Population, Health and Nutrition Program.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 548-61.Since 1969, the World Bank has been involved in lending programs for population, health research, and policy formulation. The department designation has undergone changes. The population, health and nutrition (PHN) Department is now the Population and Human Resource Division (PHR) in Country Departments. There are now country PHR divisions supported by 4 technical regional units with PHN expertise. 2% of the entire Bank's lending supports population and health activities. Lending has gradually increased and projections for 1989 are $500 million for 10 projects. In addition, the Bank has been involved with policy dialogue: the Bank has helped to raise the issue of slowing population growth in sub-Saharan Africa through conferences, workshops, and information dissemination at all levels. The importance of their work is in developing an environment for creating demand for family planning and primary health care. More projects are in Africa, but more dollars are in Asia (e.g., India and Pakistan). Improving maternal-child health is more acceptable to Middle Eastern, Latin American, and African countries than focusing on fertility reduction per se. Initial programs centered on expanding basic health services; now it also includes improving efficiency, effectiveness, and rural outreach. Recommendations are to target population groups, improve client/private interaction, flexibility in implementation based on client feedback, and utilization of nongovernmental organizations (NGOs). In 1988, civil projects constituted only 10-40% instead of 40-80% of project resources. Sponsorship serves another function of PHN, including WHO's Reproductive Research Program, Safe Motherhood Conference in 1987 and initiatives, the Task Force for Child Survival, and increasing technical abilities of NGOs.
SOURCE. 1990 Jun; 2(2):14-7.Manchiet Nasser is the workplace of more than 10,000 Zabbaleen or garbage collectors, who collect an sort the household garbage of Cairo. Manchiet Nasser and 6 other settlements are part of one of the oldest and most extensive recycling operations in the world. This traditional system relies on donkey carts and thousands of small entrepreneurs who buy used materials. The Zabbaleen include 2 distinct groups. In the 1930s landless farmers, mainly Coptic Christians form Upper Egypt, began assisting the Wahis in garbage collection. The Wahis still administer the system, while the Zarrabs (or pig breeders) do most of the physical labor. The Zabbaleen have remained physically and socially on the fringes of society. In the early 1980s with over 10 million inhabitants, growing by 1000 more each day, Cairo's garbage was rapidly overtaxing the system. The Environmental Protection Company (EPC) includes representatives from both the Wahi and Zarrab communities. the EPC won a bid to mechanize part of Cairo's household garbage collection service. Their 20 trucks now cover 2 residential areas where 40 donkey carts once operated. The city also offered contracts to other private sanitation companies, which were given free access to city landfills for dumping. Up to 500 factories in Cairo alone use recycled polymers, which are about 1/2 as expensive. Full integration of the Zabbaleen into the municipal sanitation system will still take another 3-5 years. Improvements also began in Manchiet Nasser in the early 1980s as part of a large, urban upgrading program financed by a World Bank loan. With assistance from the Ford Foundation, Oxfam, and a number of Christian charities, schools and health clinics have opened, and hundreds of workshops are processing waste in Manchiet Nasser. Other Zabbaleen communities have requested similar assistance.
Washington, D.C., TvT Associates, MORE Project, 1990 Mar. , 26,  p. (USAID Contract No. DPE-3030-C-00-8167)A revitalized, nearly self-sufficient, factory-based contraceptive distribution project has existed in St. Lucia since the beginning of 1990. Seeded in 1981, with 1-year funding from the International Planned Parenthood Federation, the project was on shaky financial footing through the 1980s. The Family Planning Association (FPA) of St. Lucia, with the technical assistance of the Maximizing Results of Operations Research (MORE) project, has, however, turned the project into a viable distribution program financially-backed by factories employing almost 2,500 workers. This successful turnaround is due largely to the accomplishments of a MORE business consultant who made 2 field visits in 1989. In addition to helping the FPA expand the project, the consultant developed a business plan, and encouraged factory owners and business leaders to back the project. He held both individual meetings and a formal group presentation. The business plan, and activities and results of the field visits are presented in the report. The consultant found a 1-to-1 sales approach best in recruiting company members for the project, supports continued application of the formal presentation, suggests a hotel setting for business group meetings, and notes island-wide consensus for support of the project. Although not quite finalized, and expected to work on a restricted operating budget, the project's largest remaining obstacle is where to locate the nurse.
ADVANCES IN CONTRACEPTION. 1990 Sep; 6(3):169-76.Clinical trials of vaginal rings containing progestins or ethinyl estradiol and progestins by WHO, the Population Council and private firms are reviewed. Contraceptive steroids can be formulated into Silastic vaginal rings because they are released continuously from this material (zero-order kinetics). Vaginal rings have the advantage of avoiding the 1st pass effect on the liver, as well as self- administration, unrelated to the timing of coitus and regulation of withdrawal bleeding with removal for 7 days per cycle. The shell vaginal ring, with an inert core, a layer of Silastic containing the progestogen, and an outer Silastic layer is designed to regulate release by the thickness of the outer layer. The WHO tested rings releasing 200 mcg norethisterone/day resulting in too many menstrual side effects; and 50 mcg/day with too high a failure rate. A ring releasing 20 mcg levonorgestrel is expected to perform well. The Population Council designed rings releasing 152 mcg ethinyl estradiol and 252 mcg levonorgestrel, and 183 mcg ethinyl estradiol and 293 mcg levonorgestrel. These resulted in pregnancy rates of 2/100 woman years, and continuation rates of 50%, but unacceptably adverse lipid effects. Women discontinued for vaginal symptoms. Compared to a similar combined oral pill, the rings offered no advantage. WHO subsequently introduced a ring releasing 20 mcg levonorgestrel: efficacy was 3.8 and continuation over 50%. A new segmented ring with desogestrel is causing fewer androgenic effects and bleeding complaints. Another ring in current trials gives off 120 mcg desogestrel and 30 mcg ethinyl estradiol with no pregnancies and good acceptability in 100 women to date. Availability of Silastic material and quality control in manufacture are seen as obstacles to overcome for mass production of these vaginal rings.
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.