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FRONT LINES. 1987 Sep; 27(8):8-9, 11.The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.
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.
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.
World Health Forum. 1983; 4(2):157-61.In developing countries, the delivery of basic health care services is often hampered by communications problems. A pilot project in Guyana, involving 2-way radio in 9 medex (medical extension) locations, was funded by USAID (United States Aid for International Development). A training manual was prepared, and a training workshop provided the medex workers with practical experience in using the radios. The 2-way radios have facilitated arrangements for the transport of goods, hastened arrangements for leave, and shortened delays in correspondence and other administrative matters. Communication links enable rural health workers to treat patients with the advice of a doctor and allow doctors to monitor patient progress. Remote medex workers report that regular radio contacts with their colleagues have lessened their sense of isolation, boosted their morale, and helped build their confidence. 1 important element of the project was the training given to the field workers in proper use of the radio and in basic maintenance. Another key to the success of the system appears to be the strength and professionalism of the medex organization itself. Satellite systems may eventually prove to be the most cost effective means of providing rural telephone and broadcasting services and may also be designed to include dedicated medical communications networks at very little additional cost.