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Science and Technology for Development: Prospects Entering the Twenty-First Century. A symposium in commemoration of the twenty-fifth anniversary of the U.S. Agency for International Development, Washington, D.C., June 22-23, 1987.
Washington, D.C., National Academy Press, 1988. 79 p.This Symposium described and assessed the contributions of science and technology in development of less developed countries (LDCs), and focused on what science and technology can contribute in the future. Development experts have learned in the last 3 decades that transfer of available technology to LDCs alone does not bring about development. Social scientists have introduced the concepts of local participation and the need to adjust to local socioeconomic conditions. These concepts and the development of methodologies and processes that guide development agencies to prepare effective strategies for achieving goals have all improved project success rates. Agricultural scientists have contributed to the development of higher yielding, hardier food crops, especially rice, maize, and wheat. Health scientists have reduced infant and child mortalities and have increased life expectancy for those living in the LDCs. 1 significant contribution was the successful global effort to eradicate smallpox from the earth. Population experts and biological scientists have increased the range of contraceptives and the modes for delivering family planning services, both of which have contributed to the reduction of fertility rates in some LDCs. Communication experts have taken advantage of the telecommunications and information technologies to make available important information concerning health, agriculture, and education. For example, crop simulation models based on changes in temperature, humidity, precipitation, wind, solar radiation, and soil conditions have predicted outcomes of various agricultural systems. An integration of all of the above disciplines are necessary to bring about development in the LDCs.
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
AIDS ANALYSIS AFRICA. 1995 Jun; 5(3):9-10.Cameroon participated in World Health Organization (WHO)-coordinated global AIDS control efforts for about 10 years, when the HIV/AIDS epidemic was just beginning in Cameroon. The government established a National AIDS Committee and AIDS Control Service to provide information on prevention of HIV/AIDS. The National AIDS Program was donor-oriented, donor-driven, donor-sustained, and donor-sustaining. It failed, as illustrated by a strong increase in HIV seroprevalence between 1989 and 1992 from 60 to 1304 cases. The donors then abandoned Cameroon. Government officials did not decentralize the program, largely because they believed that districts and communities are incapable of understanding HIV/AIDS-related issues and of managing money from donors. Since the primary health care (PHC) system broke down, it was impossible to integrate HIV/AIDS control activities into PHC, needed for program sustainability. The government did not commit financial resources to the national AIDS program. When donors first provided monies to Cameroon, the economy was strong. 10 years later, a politically and economically unstable situation prevails in Cameroon. WHO has recalled all its staff in Cameroon. The donors often attached conditions that hurt HIV-infected persons. The European Union did not implement a project to train laboratory technicians in the screening and diagnosis of AIDS because of problems encountered with its blood banking and its youth projects, also in Cameroon. Both of these projects have ended. The USAID Office closed in 1994 with about three months' notice, allegedly due to clashes with the Cameroon government. Not all persons working with the funding agencies have totally abandoned Cameroon, however. The government needs to be more concerned about its people and allocation of resources. As Cameroon struggles with its problems, HIV/AIDS is increasing in Cameroon.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27,  p.In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991.  p. (USAID Contract No. DPE-5969-Z-00-7064-00)Representatives from several nongovernmental organizations visited Uganda in February-March 1991 to help the Control of Diarrheal Disease (CCD) program bolster its ability to advance case management, training, and supervision of health care professionals. Specifically, the team focussed its activities on determining a strategy to create a national level diarrhea training unit (DTU) centered around case management for medical officers, interns and residents, medical students, and nurses. Similarly, it participated in developing a strategy for training traditional healers in diarrhea case management and for inservice training for health inspectors (preventive health workers). The team presented a generic model for a training/support system to the DTU faculty and CDD program manager. The model centered on what needs to be done to ensure that the local clinic health worker manages diarrhea cases properly and instructs mothers effectively to manage diarrhea. Further, in addition to comprehensive case management, content included interpersonal communication at all levels supplemented by supervision and training skills. It encouraged a participatory approach for training. In addition, it strongly encouraged the DTU faculty and CDD program staff to follow up on training activities such as supporting trainees and reinforcing skills learned in the training course. The team met with relevant government, university, and donor representatives to learn more about existing or proposed CDD activities. Further, the CDD program asked team members to assist informally in the surveyor training session for the WHO/CDD Health Facilities Survey. The team also spoke to WHO/CDD staff about its plans and future activities. WHO/CDD was concerned that training in interpersonal skills not weaken the quality of training in diarrhea case management.
Child survival and development toward Health for All: roles and strategies for Asia-Pacific universities.
ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH. 1989; 3(2):118-28.The child survival and development movement in relation to universities in the Asia-Pacific region were the subject of recent discussions of medical practitioners and academics. There are 14 million deaths of children that could be avoided if they could benefit from immunizations, pure water, sanitation, nutrition, and oral rehydration therapy. Also there is a large loss of physical and mental ability. Many international agencies have helped improved children's health and survival, and life expectancy has risen 40% in the last 40 years. In countries such as China, India, Pakistan, Thailand, and Indonesia there has been an exceptional achievement in child survival and development. In many developing countries health services have been patterned after western medical systems that promote treatment rather than prevention. Universities' role in relation to these problems has been the conducting of research, providing instruction, education, and training. The areas of success are in vaccine development and mass communications research. New roles can be taken in technical assistance and introduction of technology in planning and evaluation. There are also possibilities in the pooling of information and resources to help in child survival and development. In long range strategies and roles, universities can use conventional methods. In midrange areas the universities can use new modes and share and interact with governments and international organizations. In the short term they can use the less conventional methods and follow the leadership of the international organizations. In short term, universities can provide help in planning of national campaigns, provide resources, and participate in evaluations of campaigns. In the mid-range they can be involved in joint initiatives in operations research, specialized training, and clinical trials. In the long range universities are best suited to conventional research, training, laboratory science and technology development.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care, 1988. 51,  p. (USAID Contract No. AID/DPE-5927-C-00-3083-00)Personal interview, site visits to Regions VII and VIII (Philippines), and record reviews were the principal methods used to evaluate the Oral Rehydration Therapy (ORT) component of the Primary Health Care Financing (PHCF) Project designed to increase the use of oral rehydration therapy as a primary preventive measure against diarrheal death among infants and young children. The project is designed to increase ORT utilization through a 2-pronged approach which creates demand for ORS products through training physicians, nurses, midwives, and health educators in the public and private sectors; and information, education, and communication campaigns to promote ORT among the public. The most serious concern regarding clinical training was the poor quality of case management observed in regional, provincial, and district hospitals. There seems to be no national plan or budget for the production of print materials to support IEC program activities. A wide disparity was found between projected demand and actual use of ORS, called ORESOL. The present distribution practices of the Department of Health translate to oversupply or nonavailability of ORS. Private sector pharmaceutical firms take a limited/traditional approach to product distribution, and commercial distributors capable of reaching the rural population should be identified and encouraged to market ORS.
[Unpublished] 1988 May 21. 18 p. (NCIH 15th Annual International Health Conference; Papers)This address covers the 3 phases of National Primary Health Care (PHC) Implementation in Nigeria from 1975 to the present. The concept for the implementation of the 1st phase was to build and equip health centers, then train and post health workers to the facilities. No attempt was made to involve the community, use appropriate health technology, or set up management systems (such as referrals, supplies, monitoring, and evaluation of the delivery system). In short, at the end of the planned period, nowhere in the Federation were services, as described in the Alma Atta Declaration, being delivered. Between 1980 and 1985, because of the failure of the Basic Health Services Scheme, the Federal Ministry of Health abandoned any attempt to set up a PHC system and began the implementation of vertical systems of health care. Within the Ministry, groups attached themselves to particular agencies, leading to severe fragmentation of the Ministry. The Ministry as a whole had ceased to pursue the goals of PHC and adopted new objectives agreeable to each donor agency. Since 1985, the present Nigerian administration has aimed at establishing local government by local government, with the nation's PHC system incorporating the existing vertical programs. The considerable resources available through many AID agencies, international organizations, and governments need to be harnessed to achieve Nigeria's goals. Nigeria must therefore be clear as regards what these are and how to achieve them, bearing in mind that most of these agencies and organizations have their mandates and objectives limiting the activities in which they may engage.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
[Unpublished] 1984. v, 25 p.This meeting was sponsored by the World Health Organization (WHO) with Dr. Wayne S. Stinson participating at WHOs request. The objectives of the informal consultation were: 1) to strengthen national capabilities for undertaking the costing of preimary health care and for the utilization of results for development and management; 2) to exchange experiences on the costing of PHC in different countries; 3) to discuss methodologies used for data collection at the PHC center; and 4) to make recommendations for future work. This consultation is one in a series of costing and financing meetings held by WHO since 1970. The most recent meeting prior to 1983 was an interregional workshop on the cost and financing of primary health care, held in Geneva in December 1980. Papers distributed at that meeting (which have not yet been published) suggest a need for greater understanding of costing principles and technical refinement of methodologies. Judging by the papers presented at the Nazareth workshop, costing efforts have greatly improved since 1980. Representatives from the following countries participated in the Nazareth workshop: Argentina, Botswana, Columbia, Thiopia, Gambia, Kenya, Lesotho, Malawi, Sierra Leone, Sri Lanka, Swaziland, Tanzania, Thailand, Uganda, and Zambia. Some of these reported costing studies. This report consists of a narrative description of the meeting itself followed by a commentary on some of the issues raised. There is then a discussion of Arssi Province and Ethiopia as a whole based on a 1-day field trip. Finally recommendations are given regarding the United States Agency for International Development's (AID's) further PHC costing efforts.
Grass roots, herbs, promoters and preventions: a reevaluation of contemporary international health care planning. The Bolivian case.
Social Science and Medicine. 1983; 17(17):1281-9.In evaluating a United States Agency for International Development (USAID) project in Bolivia, the author argues that the program unwittingly contributed to the situation that created Bolivia's political problems. A 5-year pilot project which covered 39 villages and colonies in the Montero district in the state of Santa Cruz began in 1975 and was completed in 1980. In 1980 the project was "deobligated" when all but essential economic aid to Bolivia was halted following a political coup. The pilot project was based on 1) community participation through health care; 2) a referral system from health post of the promotor to the center with an auxiliary nurse midwife, to secondary and tertiary care in hospitals by physicians; 3) an emphasis on preventive medicine; and 4) the use of traditional medicine along with other therapy by the promotor. Although these concepts sound appropriate, they are in fact derived from contemporary thought in advanced industrial societies. The assumptions about social reality that are inherent in these plans actually misconstrue Bolivian society. The unintended consequences of the project actually diminish rural health care. A difference between the Western health planner's conception and the Bolivian conception--of community, of effective referral systems, of preventive and indigenous medicines--can have the effect of producing a health care program that has little resemblance to what was originally intended. The Bolivian elite actually manipulated the USAID health care programs through hegemony in the villages. The Jeffersonian concept of community is not applicable in Bolivia where resources are only exchanged through personal contacts. In villages of multiple class or ethnic groups or both or in villages with close ties or histories of ties with larger, more cosmopolitan groups, multiple different interests exist. These work against each other to prevent the very cooperation envisioned by the health care programs. The author suggests that developed countries should consider native ideologies, native social relations, and indigenous medicine more sensitively in design.
Washington, D.C., U.S. Dept. of Health, Education, and Welfare, Office of International Health, 1978 Aug. 288 p. (Contract No. TAB/Nutrition/OIH RSSA 782-77-0138-KS)The most rapidly growing category of health assistance is the development of low cost health delivery systems which integrate health services, family planning, and nutrition interventions. It has been shown that the perception of improved child survival due to better health and nutrition is a precondition to the acceptance of family planning on the part of the rural poor in developing countries. In 1977, 27% of AID health funds went to integrated low cost health delivery systems and in 1979 the figure was 43% with Africa receiving the largest proportion (1/3) of the funds. This volume summarizes 39 AID projects based on information contained in AID Project Identification Documents and Project Papers. 2/3 of the projects summarized target the population of a region or subregion in the country rather than the population as a whole; the assumption here is that if the value of low cost rural health delivery can be demonstrated in a part of a country it will be extended to other regions.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.