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Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1989. , 19,  p. (USAID Contract No. AID/DPE-5969-Z-00-7064-00)A social marketing consultant sponsored by the US Agency for International Development visited the Philippines to assist in boosting oral rehydration solution ORS commercialization. The task includes following up on current ORS commercialization efforts in analyzing proposals from companies for strategies on rural distribution, promotion, pricing, and introduction scheduling as requested by the Department of Health (DOH) and to develop a plan of action that will lead to a final selection of companies and to develop the terms of reference for working relationship between the DOH and the selected companies. The 6 companies contacted were divided into 2 groups, 1 that insisted on using ORESOL exclusively, and those willing to use ORESOL as a generic name. All the advantages for the selected companies as well as the disadvantages for each, was weighted. Other factors considered were the political environment within the pharmaceutical market and the timing of the ORESOL launch. To provide DOH with the best objective decision, the Keptner-Tregoe decision making technique was used. This process showed an advantage to use the open market companies. An action plan outlining specific tasks to be done, responsibilities of various parties, and the dates of completion is described.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
Agenda. 1980 Mar; 3(2):8-11.Although the baby formula controversy continues, an important step toward resolving the issue was undertaken recently at an international conference of industry representatives, physicians, and nutritionalists, sponsored by WHO and UNICEF. At the conference, industry spokesmen agreed to ban all infant formula advertising which discourages breast-feeding and to ban all promotional activities in hospitals. Opponents pointed out that 1) the success of the ban is dependent on voluntary compliance and 2) the conference failed to address the issue of whether baby formulas were completely inappropriate for use in many developing countries. Conference participants also agreed 1) to stress the contraceptive value of breast-feeding; 2) to promote the use of contraceptives which do not interfere with lactation; 3) to promote nutritional education and the granting of longer maternity leaves to working women. In line with these recommendations AID has initiated a project aimed at helping countries expand and develop maternal health and nutritional program. As part of the project, AID will help the American Public Health Association develop a clearinghouse for infant and child nutritional information and will lend assistance to a number of organizations which plan to develop nutritional training programs. AID will also assist a number of organizations in their investigation of infant formula marketing practices and will help the Department of Agriculture develop and market local weaning foods.
Washington, D.C. American Public Health Association, 1975. 16 p. (APHA Assgn. No. 1100-020)A commercial contraceptive distribution program in Bangladesh, funded by USAID and contracted by Population Services International (PSI) was evaluated upon completion of the market testing phase of the operation. The evaluation team reported that the program was generally in compliance with the contract, made a number of recommendations for modifying both the program and the contractual agreement, and offered suggestions for USAID drafting of similar contracts in the future. The evaluation team recommended that the prices should not be so high as to reduce sales but high enough to permit future price setting flexibility, to inhibit smuggling, to enhance the identification of the product as a quality item, to discourage the use of the product for other purposes, and to insure the self-reliance of the program in the future. All pills should be packaged as soon as possible to insure sanitary handling. A timetable for covering the distribution network should be submitted promptly so that distribution and promotional efforts can be coordinated. Expanding the program by adding new administrative units each month was considered an inappropriate approach in a small country. Instead efforts should be made to promote national coverage within 1 year. No decision should be made at this time on whether or not a non-profit organization should be established for carrying on the program after PSI phases out. Additional funds should be allocated for market research and for promotional activities and allocations for consumer attitudinal surveys should be reduced. A foreign advisor shoud be hired to help coordinate the distribution phase since it is difficult to hire a qualified local person given governmental salary restrictions. In reference to the establishment of contract guidelines for future distribution projects in developing countries, the team recommended against the development of a uniform contract. A flexible contract tailored to the needs of the specific country was viewed as more appropriate. The development of a technical marketing plan should not be a contract requirement. USAID should determine the most appropriate form of packaging for the contraceptives and then use this form of packaging in all future distribution programs.
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.
Honolulu, Hawaii, East-West Communication Institute, May 1977. (A synthesis of Population Communication Experience Paper No. 3) 84 pThe extent to which conferences and meetings have been involved in the development of the meetings have been involved in the development of the population/family planning field and particularly in the development of communication as a component of population/family planning programs is examined. Significant international, regional, and problem-oriented meetings that have taken place during the last decade are reviewed in terms of their purpose, subject matter, sponsorship, and impact on world awareness and national policies and programs. Topics covered include the roles of various agencies and organizations which organize fund conferences related to population communication, conferences with and for the mass media, conferences and meetings as components of specific projects, and the development of meetings on the national level. A detailed case study of a conference is presented to show how conferences are planned, conducted, and evaluated, and to identify desirable and undesirable aspects of conference management. An overall look at conferences and identification of their positive elements and their major shortcomings, by presenting guidelines for conference planners and managers, and by assessing trends and alternatives for population/family planning conferences in the future, is included.(AUTHORS', MODIFIED)
Bellagio Conference Paper. 1973 Apr 5; 18.The 2 basic subdivisions of population research are social science research and biomedical research. A global strategy for social science research would include the following priorities: 1) birth rates and their major components should be measured annually at the national level; 2) facilities should be available to do sample surveys of acceptors of birth control and of the whole population of child-bearing age, thus enabling programs to be evaluated; 3) the relationship between economic factors and demography should be studied. Country-specific data is needed if it is to be useful, and in a few countries, the entire biosocial system should be analyzed over time to see how certain variables influence reproduction. Biomedical research is grossly underfunded and not given the status it deserves in the medical communit y. FDA requirements for the approval of a new contraceptive would cost pharmaceutical companies $8 million - $30 million to undertake the required studies, and pharmaceutical companies might not be willing to proceed unless part of the developmental costs are defrayed. There are 5 major programs in the public sector which fund research to develop new birth control methods -- 1) the Population Research Program of USAID (1972 expenditure of $9.9 million); 2) the contraceptive development program of the Center for Population Research of USNICHD (1972 expenditu re of $10.41 million); 3) the WHO Expanded Programme of Research, Develo pment and Training in Human Reproduction (1972 expenditure of $1.23 mill ion for contraceptive research); 4) the International Committee for Contraceptive Research of the Population Council (1972 expenditure of $1.7 million; 5) ICARP. Clinical studies of new methods have included research on prostaglandins, methods for the regulation of sperm migration and survival, improved methods of female sterilization, and the Copper T IUD. Despite some declines in public funding levels for contraceptive research, the private sector has shown little inclination to support such research. Of the 22,000 foundations in the U.S. only the Scaife, Ford, and Rockefeller Foundations have a large role in supporting research in the population field.
Costa Rican Demographic Association (Asociacion Demografica Costarricense (ADC): the coupon system controversy.
Managua, Nicaragua, Instituto Centroamericano de Administracion de Empresas, 1973. 43 p. (INCAE Management Case No. 9-575-601)This case study was developed as a teaching tool for administrative family planning personnel. The Costa Rican Demographic Association (ADC) assumed responsibility for the distribution of oral contraceptives (OCs) through commerical outlets in a program started by Alberto Gonzalez. Gonzalez had organized a rural distribution system of OCs by recruiting local women to sell OCs to friends and relatives at reduced prices. The number of women involved grew so rapidly, Gonzalez, who was a founder of ADC and its first Executive Director, expanded the distribution system to urban areas. In 1964, however, stiff opposition to the distribution system was made by the College of Pharmacists, for OCs were being sold at greatly reduced prices through noncommerical outlets. After difficult negotiation, the College agreed, in 1967, to allow the ADC to import and distribute contraceptives providing a pharmacist supervised the distribution, a doctor's prescription was obtained, and the ADC disburse OCs in pharmacies. The latter provision forced ADC to abandon its highly successful system of individual distributors. Instead, a woman had to go to a clinic, obtain a doctor's prescription as well as a blue (minimal charge) or green (no charge) coupon and then find an authorized outlet to purchase the OCs at a reduced price. The pharmacist had to keep special inventories and maintain a coupon system in order to obtain credit from ADC. ADC had to make sure inventories were maintained and that proper controls were placed on the distribution process. By 1971, 233,309 cycles of OCs were distributed through the coupon system. Nonetheless, questions were raised by USAID and other organizations about control procedures and pricing. It was suggested that it might be more convenient for the patient if the clinics themselves could assume the responsibility of supplying OCs to patients.
Population Reports. Series A: Oral Contraceptives. 1974 Apr; (1): p.This report provides data on worldwide distribution of oral contraceptives (OCs) over the last decade. Marketing figures and information on government and international distribution programs were provided by AID, the Swedish International Development Authority, UNICEF, and IPPF. It is noted that in at least 5 developed countries (Canada, Australia, West Germany, the Netherlands, and New Zealand) 25% or more of all women aged 15-44 are regularly purchasing OCs from pharmacies. If women receiving supplies from family planning programs are included, the U.S. and the United Kingdom are now close to the 20% level. The highest usage rate is in the Netherlands where nearly 30% of the fecund women bought OCs regularly in 1972 and 37% in the first half of 1973. The hazards of OCs publicized in 1969 and 1970 caused noticeably reduced purchases. In Australia 15-22% of the women taking OCs discontinued their use following adverse reports. By 1971 when further evaluations put earlier warnings into a more reassuring perspective and lower dosage formulations became available, sales in developed countries substantially exceeded previous levels.
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.
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.
The private sector, the public sector, and donor assistance in economic development: an interpretive essay.
[Washington, D.C.], U.S. Agency for International Development, 1983 Mar. 52 p. (A.I.D. Program Evaluation Discussion Paper No. 16)A retrospective view of the ways in which the public policy of host countries coupled with the actions of donors have led to the growth of a vital private enterprise economy in less developed countries (LDC) is provided for the Agency for International Development (AID). Efforts are concentrated on examining the recent development history of 4 countries: Malawi, Cameroon, Thailand, and Costa Rica. These examinations contain a great deal of information on the process of economic development, the role of private enterprise production activities, the importance of free and competitive markets, and the possibilities of donor intervention to affect the speed and direction of economic development. The studies have revealed that free and competitive markets are efficient institutions for allocating resources, yet governments frequently intervene. In all of the countries studied, economic policy and economic ideology seem unconnected to the existing political system. Donors wishing to encourage private sector growth find themselves in an anomalous situation. Interventions need to be chosen to address contraints but little is known about the constraints inhibiting the growth of proprietal, entrepreneurial, and managerial firms. As a donor, one's role should be to facilitate the expression of the creative energies within the private sector by working with host governments on ways both can provide needed help and reduce unneeded hindrances to market activities.