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In: Conference for Identification of Unmet Needs in Family Health Care in Anglophone Africa, 1979, London. Report of the Conference. [London, ICM and USAID, 1979]. 5 p..In this report of the Conference for Identification of Unmet Needs in Family Health Care in Anglophone Africa, meeting in London in 1979, objectives were reviewed and shortcomings of health care were outlined. Objectives included the following: giving leaders the opportunity to state their unmet needs in their own country in the field of maternal and child health and family planning; identifying the role of rural health personnel within such programs; and recommending individual midwives capable of implementing in-country programs aimed at meeting the needs. Adequate financial resources were considered to be the primary constraint against development of comprehensive health care services. Generally, there were insufficient facilities to meet the needs of the populations and overcrowding was often encountered. Maldistribution of facilities and services brought a concentration of available care in the urban areas and deficiencies in the rural areas. The scope of maternal and child health care in most countries left room for improvement. Health education, with emphasis on community participation, had been begun in many countries but required strengthening. Every country delegate thought that their health services were unduly concentrated in the urban areas and that the rural areas were neglected. No country had sufficient health personnel at any level, and equipment was scanty and frequently out-of-date. There was a growing realization of the need for the involvement of the community in all aspects of health care delivery. Points highlighted during discussions following presentations included approaches to establishing primary bealth care projects, with the identification, training and utilization of village level workers who were selected by the villages and who would work in their villages following training. The wide variety of care provided by traditional birth attendants highlight the need for training to be based on a spot description of the tasks they would be expected to perform. There were family planning programs in all of the countries, and the majority involved the midwives in some aspect of the program.
London, England, International Confederation of Midwives, 1978. 425 p.This document provided a summary of the activities from 1973-June 1978 of the International Congress of Midwives and of the International Federation of Gynecology and Obstetrics and International Congress of Midwives Joint Study Group. These activities were undertaken with a USAID grant. During these years, 12 Working Parties were held in various African, Asian, and Latin American countries. The purpose of the Working Parties was 1) to exchange information of the training and utilization of midwives and traditional birth attendants and 2) to develop recommendations for expanding the role of midwives and traditional birth attendants in the delivery of maternal and child care and family planning services through legislative changes, through the development of training programs, and through broadening contacts with other health organizations. The International Congress of MIdwives determined the host country for each of the Working Parties. The governments of all participating countries were invited to send 2 delegates to the Work Party and to present a country report at the meeting. This document provided a summary of the proceedings, the country reports from the particpating countries, and the conclusions and recommendations made by the participants for each of the 12 Working Parties. Follow up visits were made to participating countries by staff members of the International Congress of Midwives in order to ascertain if the recommendations were being implemented and to offer assistance, if necessary. The results of these follow up visits were also provided.
Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
Summary and evaluation report: Program Year 2, July 1, 1973 - June 30, 1974, Contract Aid/La-707 (Regional).
Washington, D.C., Development Associates, . 28 p.An evaluation of a project to provide training and academic programs in family planning, demography, and population studies to Latin American and Caribbean grantees from July 1, 1973-June 30, 1974, finds the project met or surpassed most of its goals. 775 grantees were recruited in 27 countries and trained in the U.S., Puerto Rico, Canada, and 9 Latin American countries; the original goal was 500 grantees. 66% (491) of the short-term grantees participated in programs in their own or other Latin American countries; 34% (253) were in the U.S. or Puerto Rico. 30 were enrolled in academic and other long-term programs. 735 were trained in 48 groups ranging from 2-55 in size; 10 received individual instruction. A change of Mexican government policy allowed grantees from that country. Brazilians received grants through a relaxation of the prohibition against Title 10 activities. Grants to Uruguay, Argentina, and Chile were drastically reduced because of their governments' lowered priorities for population and family planning. At Harbor General Hospital, Los Angeles, a long-range program for training paraprofessionals as family planning specialists was begun and included in-country, follow-up technical assistance. Development Associates (DA) has trained 4 groups of nurse-midwives in Spanish at its Denver Family Planning Training Center since November, 1973.
INTERNATIONAL JOURNAL OF GYNAECOLOGY AND OBSTETRICS. 1979; 17(2):102-4.A brief summary of the historical development of the International Confederation of Midwives (ICM) and a review of the organization's recent activities was presented. Efforts to develop an international association of midwives began in 1922. The 1st World Congress of Midwives was held in 1954 and since that time the Congress has met once every 3 years. National midwife associations from 51 countries belong to the ICM. The goals of the organization are 1) to improve the knowledge, training, and professional status of midwives; 2) to promote improved maternal and child care in member countries; and 3) to further information exchange. Since 1961 the ICM and the International Federation of Gynecology and Obstetrics have cooperated in a joint study of midwife training and practice. In 1966 the study group completed its 1st report on the status of maternal care around the world and made a number of recommendations for improving the training of midwives and for establishing uniform licensing requirements. It soon became apparent that these problems could not be dealt with on a worldwide basis, and 12 working parties in different regions were established to investigate the problem at the local level and also to make recommendation in regard to providing family planning services in the context of maternal and child health programs. Each working party has a Field Director who seeks to implement the recommendations of the group. Field Directors have also arranged seminars in reproductive health for rural health workers and especially for traditional birth attendants. The ICM also works in cooperation with the European Economic Community, WHO, IPPF, and several other international agencies. The activities of the working parties have received financial support from USAID.
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.
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.
IPPF Situation Report, June 1973. 10 p.The Indonesian Planned Parenthood Association (IPPA) was founded in 1957 and pioneered family planning services. It made little headway duri ng the pronatalist Sukarno regime, but in 1967 the present government announced an intensive family planning program and the IPPA was named as an implementing unit in 1971. 2 primary roles now are the training activities for fieldworkers and the development of community education and motivation programs. This complements the national mass media program. In 1970 the government took over all clinics except those in the Outer Islands (the islands outside Java, Bali, and Madura). The IPPA runs 150 clinics in the Outer Islands, is responsible for all supplies and maintenance, and has a number of model clinics in Java and Bali. The Community Education program has 8 components: speakers bureau, family planning clubs, mobile audiovisual units, exhibitions, tr aditional media, special events, local mass media support, and evaluatio n. In 1971 the 'ippa trained 2951 people; in 1972 this was increased by 25%. In 1973 the target is training 3000 fieldworkers with 16 centers for training and 16 field demonstration areas. An agreement with the U.N. Fund for Population Activities/International Development Association (UNFPA/IDA) will provide for building, equipping, and staffing. The research and evaluation function is also expanding to complement government activities. The government program aims to train 20,250 medical and paramedical personnel over 5 years and medical schools have incorporated the teaching of population and family planning. Government allowances are being curtailed for all children over 3 for government workers. An active clinic program aims to set up 1200 fully equipped and 1250 moderately equipped facilities by 1973. An active media campaign has been launched and for the 1st time in the population field the UNFPA and the IDA are helping to finance a project to expand a family planning program and broaden its activities. This su pport will provide for physical facilities, technical assistance, training, motivation, evaluation, research, and population education.
IPPF Situation Report, February 1974. 6 p.Laos has been so torn by war and continuing waves of refugees that i t has been difficult to provide basic medical services to the population . In 1969 Laos had 53 medical doctors, 40 of whom were foreign instructors at the School of Medicine, 676 practical nurses, and 400 trained midwives. Before 1971 the government was opposed to family planning. A study commission in that year, however, examined population growth problems and recommended support for family planning. The voluntary association had been formed in 1966 and had sent representatives to international workshops. After the change in government attitude, the association has actively acted to distribute family planning supplies to villages, train midwives as motivators, and give additional training to public health center heads, home economists, medical assistants, and refugee village heads. The governmental emphasis is on better spacing of births rather than limitation. It took over operation of 7 association clinics in 1973 and now helps provide contraceptive services. The association still has 5 fixed and 6 mobile clinics. A refugee pilot program which opened in 1971 now has a permanent building and a full-time rural midwife. The association also stresses influencing opinion leaders through lecture forums, pamphlets, radio commercials, and film shows. Information and Education teams were formed to conduct 2-3 day seminar-lectures in other provinces to diverse groups like village headmen, town influentials, teachers, and other leaders. Many foreign groups have provided assistance, supplies, training, and other aid. WHO is helping with the integration of family planning into the nursing and midwifery curricula in the schools of Laos.
Studies in Family Planning. 1972; 3(7):151-156.In Thailand the family planning program is integrated into health services. During 1971 there were 404,187 new acceptors, the majority of which chose the pill since they are prescribed by midwives and are available in more than 3500 centers. The number of pill acceptors increased from approximately 8800 per month to more than 30,000 after auxiliary midwives were officially authorized to prescribe oral contraceptives. In 1972 a pilot program was started to train paramedical personnel to insert IUDs. In 1971 12-month continuation rates were 75% for the IUD (with the majority of women expelling them having reinsertions), 65% for the pill, with more than 20,000 sterilizations. A major effort will be made during 1972 to introduce vasectomy more widely. More than 80% of acceptors are from rural areas, with 90% having less than 4 years of education. Postpartum acceptors accounted for 16% of the national program. Since 85% of all deliveries occur at home, the postpartum concept should be adapted to these women. In a 1970 followup survey of 2597 acceptors in the 3 largest cities, among IUD users, expulsions were negatively correlated and removals positively correlated with age; pregnancies were 3%. Pills were more widely accepted than IUDs in all age groups, and younger women definitely preferred them. The source of family planning information was: husband, 47%; health personnel, 38%. It is estimated that 144,000 couple years of protection were provided in 1971, and 393,000 in 1972 -- 3% and 8% respectively of married women of reproductive age. Cost of the program is estimated to be US$.08 per capita or US$7.00 or $8.00 per acceptor. The greatest problem has been lack of effective supervision at the field level. The usefulness of family planning field workers is being studied.
IPPF Situation Report, May 1972. 5 pAll the demographic statistics and the cultural, economic, and geogr aphical situation of the Republic of Vietnam are presented. The history of interest in family planning and the current personnel of the Vietnamese Association for the Protection of Family Happiness are presented. Conservative Catholic opinion considers family planning activity controversial. Contraception is widely practiced by those who can afford to pay for it and the practice is considered private, not open to government interference. The government is showing increasing i nterest in the question of population. Current educational, clinic, training, and research activities are summarized. International organizations providing aid are enumerated.