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  1. 1

    The roadmap for health measurement and accountability.

    World Bank; United States. Agency for International Development [USAID]; World Health Organization [WHO]

    [Washington, D,.C.], World Bank, 2015 Jun. [34] p.

    The Roadmap articulates a shared strategic approach to support effective measurement and accountability systems for a country’s health programs. The Roadmap outlines smart investments that countries can adopt to strengthen basic measurement systems and to align partners and donors around common priorities. It offers a platform for development partners, technical experts, implementers, civil society organizations, and decision makers to work together for health measurement in the post-2015 era. Using inputs and technical papers developed by experts from international and national institutions, the Roadmap was completed following a public consultation that received extensive contributions from a wide number of agencies and individuals from across the globe. (Excerpt)
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  2. 2
    Peer Reviewed

    Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process.

    Shen AK; Farrell MM; Vandenbroucke MF; Fox E; Pablos-Mendez A

    Health Policy and Planning. 2015 Jul; 30(6):687-95.

    As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.
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  3. 3

    The USAID | DELIVER project improves patient access to essential medicines in Zambia. Success story.

    John Snow [JSI]. DELIVER

    Arlington, Virginia, JSI, DELIVER, 2011 Feb. [2] p.

    Success story on a logistics system pilot project in Zambia that set out to cost-effectively improve the availability of lifesaving drugs and other essential products at health facilities.
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  4. 4

    Pandemic influenza A H1N1: Vaccination campaigns protect the most vulnerable populations in Togo. Photo and caption.

    John Snow [JSI]. DELIVER

    Arlington, Virginia, JSI, DELIVER, 2010 Dec. [2] p.

    During two countrywide vaccination campaigns, Togo's MOH immunized 10 percent of its most at-risk populations. Togo is one of 40 countries conducting a national H1N1 immunization campaign in collaboration with WHO and the USAID | DELIVER PROJECT.
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  5. 5

    Helping women understand contraceptive effectiveness.

    Shears KH; Aradhya KW

    Mera. 2008 Sep; iii-vi.

    When a woman chooses a contraceptive method, effectiveness is often the most important characteristic she considers. Knowing the risks and benefits of each method, including its effectiveness, is necessary for a woman to make a truly informed decision. Yet, many women do not understand how well various methods protect against pregnancy. Health professionals usually explain effectiveness by informing women of the expected pregnancy rates for each method during perfect use (when the method is used consistently and correctly) and during more typical use (such as when a woman forgets to take all of her pills). However, the World Health Organization (WHO) has recently endorsed a simple evidence-based chart that healthcare providers can use to help women understand the relative effectiveness of different methods -- a concept that is much easier for most people to grasp. Key points of this article are: 1) Clinicians play an important role in ensuring that women understand the concept of effectiveness -- a key element of informed choice; 2) Women are able to understand the relative effectiveness of contraceptive methods more easily than the absolute effectiveness of a particular method; and 3) A new chart that places the methods on a continuum from least to most effective can help health professionals better communicate about contraceptive effectiveness.
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  6. 6

    Malaria vaccine R & D: the case for greater resources.

    Moree M

    [Seattle, Washington], Program for Appropriate Technology in Health [PATH], Malaria Vaccine Initiative, [2002]. [2] p.

    Malaria kills more than one million people each year. In Africa, it is the leading cause of death among children under the age of five. Although prevention and treatment are crucial, a vaccine offers the greatest hope for controlling the disease. Despite malaria's tremendous social and economic impact, global spending for malaria vaccine research and development (R&D) is far less than the estimated $300 to $500 million required to advance one vaccine through the product development process. Industry-wide, the vast majority of vaccine candidates fail during development. To increase the odds of achieving a successful vaccine, malaria researchers must drive several candidates forward simultaneously. Given the urgency of the public health crisis, malaria vaccine R&D requires an aggressive development schedule--which will only be possible with a substantial increase in funding. (excerpt)
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  7. 7

    Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program. ACCESS. Year one annual report, 1 October 2004 - 30 September 2005.

    JHPIEGO. Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program [ACCESS]

    [Baltimore, Maryland], JHPIEGO, ACCESS, 2005 Oct. [50] p. (USAID Cooperative Agreement No. GHS-A-00-04-00002-00)

    The Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Program launched its mission to improve maternal and newborn health and survival in developing countries worldwide in July 2004, with program implementation beginning October 1, 2004. In its first year, ACCESS had three field-supported country programs; now—one year later— the Program has nine country programs, four Malaria Action Coalition (MAC) countries, and ongoing activities in another 16 countries worldwide. This rapid expansion of field-based programming reflects countries’ growing confidence and interest in ACCESS as they seek to reduce continued high rates of maternal and newborn mortality. Over the past year, ACCESS has become increasingly recognized as a global leader for policy and advocacy, technical expertise, and implementing evidence-based interventions and approaches in maternal and newborn health. Because ACCESS is implemented through such a rich partnership, the Program has demonstrated the technical and programmatic expertise to both advocate for and support the full range of maternal and newborn health care interventions from the household to the referral level. (excerpt)
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  8. 8

    Measuring the level of effort in the national and international response to HIV / AIDS: The AIDS Programme Effort Index (API). Summary report.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; United States. Agency for International Development [USAID]; Futures Group International. POLICY Project

    Geneva, Switzerland, UNAIDS, [2001]. 24 p.

    UNAIDS, USAID and the POLICY Project have developed the AIDS Programme Effort Index (API) to measure programme effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that programme effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programmes scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programmes received relatively high rating in all categories except care. The results presented here will be supplemented later in 2001 with a new component on human rights. (excerpt)
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  9. 9

    The USAID population program in Ecuador: a graduation report. [El Programa de USAID para la población de Ecuador aprueba su examen final. Informe]

    Coury JP; Lafebre A

    Washington, D.C., LTG Associates, Population Technical Assistance Project [POPTECH], 2001 Oct. [68] p. (POPTECH Publication No. 2001–031–006; USAID Contract No. HRN–C–00–00–00007–00)

    For nearly 30 years, the United States Agency for International Development (USAID) provided assistance for population, family planning, and reproductive health programs in Ecuador. Throughout the early years, USAID worked with both private and public sector institutions to establish a broad base for national awareness of and support for family planning and for the introduction of contraceptive services. USAID led all other donors in this sector in terms of financial, technical, and contraceptive commodity assistance. Upon reflection of the accomplishments of the USAID population program during these years and considering its most recent Strategic Objective of “increased use of sustainable family planning and maternal child health services,” it is apparent that the Agency was successful in this endeavor and has adequately provided for the graduation of its local partners, particularly those in the private sector, where USAID had directed the major focus of its assistance over the past decade. During the last and final phase of assistance, 1992–2001, the USAID strategy focused primarily on assuring the financial and institutional sustainability of the two largest local nongovernmental organizations (NGOs) that provide family planning services. USAID/Ecuador worked in partnership with the Asociación Pro-bienestar de la Familia Ecuatoriana (APROFE), which is the Ecuadorian affiliate of the International Planned Parenthood Federation (IPPF), and the Centro Médico de Orientación y Planificación Familiar (CEMOPLAF)—institutions that provide contraceptive and other reproductive health services. At the same time, in order to assure that the necessary tools were in place for future program monitoring, planning, and evaluation, USAID assistance was provided to the Centro de Estudios de Población y Desarrollo Social (CEPAR). (excerpt)
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  10. 10

    Epidemic preparedness and response in Africa: an epidemiological block approach. Summary report. AFRO / EMC epidemiological blocks.

    Academy for Educational Development [AED]. Support for Analysis and Research in Africa [SARA]

    Washington, D.C., AED, SARA, 2001 Mar. [20] p. (USAID Contract No. AOT-00-99-00237-00)

    Following a series of epidemics that occurred in 1995 and 1996 in several countries in West and Central Africa, the World Health Organization (WHO) Regional Office for Africa (AFRO) and the USAID Africa Bureau, Office of Sustainable Development (AFR/SD), decided to strengthen their cooperation on epidemic preparedness and response (EPR) throughout the continent. Many African countries lack drugs and other supplies for prompt and effective interventions to address epidemic outbreaks. Many country officials lack both awareness of the risk of epidemics and the capacity to effectively detect and manage them. In order to improve the situation, WHO/AFRO defined five groups of countries with similar epidemiological profiles, and created a political framework to facilitate inter-country collaboration within each of these epidemiological blocks. The Swiss Disaster Relief (SDR), the European Union (EU), and the U.S. Centers for Disease Control and Prevention (CDC) also joined the effort to strengthen capacity for EPR in West Africa. Almost four years later, AFRO and AFR/SD decided to organize a review and documentation of the epidemic preparedness and response program. The present summary report contains the findings and recommendations of this review. The report presents the epidemiological block approach used by WHO/AFRO to implement its Emerging and other Communicable Diseases Surveillance and Control (EMC) programs, and discusses the performance of the epidemiological teams in the West Africa Block (WAB) and Great Lakes Block (GLB). It discusses the availability and use of data for assessing trends in the incidence, mortality, and occurrence of outbreaks of epidemic-prone diseases — cholera and meningitis in particular. It concludes with a short discussion and recommendations for further efforts to strengthen capacities for epidemic preparedness and response in the Africa region. (excerpt)
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  11. 11

    Behavioral interventions for the prevention of sexual transmission of HIV. [Intervenciones conductuales para la prevención de la transmisión sexual del VIH]

    Institute of Medicine. International Forum for AIDS Research

    Washington, D.C., Institute of Medicine, International Forum for AIDS Research, [1992]. 8 p.

    The fourth meeting of the International Forum for AIDS Research was organized around three overall objectives: a) to consider a model for categorizing behavioral interventions; b)to share information about current behavioral intervention programs in which IFAR members are involved; and c) to foster discussion about the adequacy of present strategies. The meeting began with an analytical phase that explored aspects of methodology, followed with presentations on selected programs, and concluded with a generic case study exercise that highlighted different social scientific perspectives on producing change in human behavior. (excerpt)
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  12. 12

    Final report of an operations research project: "A Study to Increase the Availability and Price of Oral Contraceptives in Three Program Settings", Contract CI90.59A.

    Apoyo a Programas de Poblacion [APROPO]; Asociacion Pro-Desarrollo y Bienestar Familiar; Instituto Peruano de Paternidad Responsable [INPPARES]; Vecinos Peru; Futures Group. Social Marketing for Change [SOMARC]; Pathfinder Fund; Population Council. Operations Research and Technical Assistance to Improve Family Planning / Maternal-Child Health Services Delivery Systems in Latin America and the Caribbean [INOPAL]

    [Unpublished] 1991 Oct 10. [3], 32, [22] p. (PER-19; USAID Contract No. DPE-3030-Z-00-9019-00)

    In an effort to reach more clients while increasing self-sufficiency, a group of private and public agencies in Peru collaborated in 2 operations research (OR) studies. This OR project, which cost US $62,040, was affected by the action of the newly elected government which ended price controls and subsidies in August 1990 and resulted in changes in the spending habits of most Peruvian families. Sales of all oral contraceptives (OCs) fell from an average of 141,400 to 73,400 cycles/month, and sales of Microgynon in pharmacies fell from 76,400 to 38,000 cycles/month. The first OR study tested the use of community-based distributors (CBDs), Ministry of Health (MOH) facilities, and private midwives as contraceptive social marketing (CSM) outlets by adding the OC Microgynon (sold at pharmacy prices) to CBD programs and raising the price of the donated OC, Lo-Femenal, over time. Specific objectives were to determine 1) if total CBD sales increased with the method mix, 2) whether CBD from homes of small businesses was more effective, 3) if the new distribution of Microgynon would increase sales of the OC as a whole, and 4) the impact of Lo-Feminal price increases on sales and user characteristics. The study was carried out in 44 experimental and 44 control groups in Lima and 20 experimental and 21 control groups in Ica. Baseline data were obtained for December 1989-April 1990, and monthly sales were monitored during the 12 months from May 1990 to April 1991. Data were also obtained from surveys of dropouts and new Microgynon acceptors. It was found that the August 1990 price increase effectively destroyed the significant market penetration exhibited by Microgynon in the first 4 months of the study. Adding an affordable CSM brand to CBD programs will, however, increase sales and self-sufficiency, although the sale of donated OCs for around $0.30/cycle will reduce sales of the new brand by 20-40%. It was also found that most clients who dropped out because of side effects were less likely to be contracepting than those who dropped out because of cost, indicating a need for improved distributor counseling. The second study tested the price elasticity of demand for OCs in CBD programs by measuring the demand for Microgynon. Specific objectives were to determine 1) the level of Microgynon sales in MOH facilities, 2) the level of sales by nurse-midwives, 3) the number of Microgynon users who formerly used Lo-femenal from the MOH, and 4) the number of Microgynon users in MOH and nurse-midwife facilities who formerly obtained the OC from pharmacies. A demonstration project was carried out in the rural departments of Ayacucho and Huancavelica, the poorest areas of Peru. 4 MOH hospitals in 4 cities and 17 nurse-midwives participated. The hope was that the CSM products would mitigate the effect of stock-outs in the hospitals. It was found that no Microgynon was sold because of a reluctance to recommend it and other unfavorable study conditions (the necessity for separate accounting, the lack of stock-outs, the reluctance of the midwives to sell a contraceptive, and the decline in client purchasing power). Cost recovery in the MOH would be better served by charging a modest amount for donated contraceptives.
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  13. 13

    Latin American and Caribbean Region health care financing activities, 1982-1988. An annotated compilation. Draft.

    John Snow [JSI]. Resources for Child Health [REACH]

    [Unpublished] 1989 Mar. [2], 87 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    The Resources for Child Health Project (REACH) presents an overview of health care financing (HCF) activities in the Latin American and Caribbean regions for the period 1982-88. REACH is compiling regional health care financing initiatives, preparing detailed case studies of USAID health financing experiences in 3 countries, and developing a set of general guidelines to be used by health officers to identify opportunities for HCF activities. A draft version of the first of these components is presented and includes an updated annotated list of health finance activities, studies, and projects conducted in the region since 1982. The USAID approach to HCF as put forth in policy statements and other official documents is summarized; World Bank, Inter-American Development Bank, and Pan American Health Organization viewpoints are reviewed as well as social security issues and their relationships to HCF; and country overviews are provided under Caribbean, Central America, South America, and North America subheadings. Brief overviews of HCF activities for each country are given followed by summaries of individual activities funded by USAID and other organizations. Summaries indicate whether activities are public or private sector, main areas of emphasis, and describe content. Activity costs are also given for USAID-funded initiatives.
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  14. 14

    Public health goes private in Africa. Mosquito nets may become big business.

    Tarmann A

    Population Today. 2000 Feb-Mar; 28:[2] p..

    In sub-Saharan Africa, insecticide-treated materials (ITMs)--primarily mosquito nets or bed nets--have protected pregnant women and reduced mortality among infants and children. According to the WHO, the use of treated bed nets can reduce rates of severe malaria by an average of 45% and decrease childhood mortality rates between 25% and 35%. Since the nets and insecticide have proven so effective that access to them furthers public health, the WHO, UN Children's Fund, and the US Agency for International Development (USAID) have committed in the distribution of ITMs. The international donors have also supported the public sector and nongovernmental organizations in selling health products and services at affordable prices and motivating people to use them. However, Will Shaw, director of international public health with the Academy for Educational Development (AED), pointed out several limitations of donor-funded ITM programs. Hence, under a cooperative agreement with USAID, AED will work with the S.C. Johnson company and other international and local partners on the Africa NetMark regional project, promoting the commercial distribution of ITMs.
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  15. 15

    Saving women's lives, protecting women's health. U.S. global leadership in family planning.

    United States. Agency for International Development [USAID]

    Washington, D.C., USAID, 2000 Apr. 12 p.

    This paper documents the US global leadership in family planning in response to the challenge of saving women’s lives and protecting women’s health. Backed by a strong bipartisan consensus in Congress, the US support for voluntary family planning and related health programs in developing countries began in the 1960s. Since then, profound changes have occurred in reproductive behavior throughout most of the world. The other programs include enabling couples to make reproductive choices and enhancing quality of life and development. In addition, the US government provides family planning assistance to developing countries through the Agency for International Development, and the UN Population Fund. These partnerships seek to: provide comprehensive assistance; integrate family planning and other reproductive health services; expand access to services through partnerships with nongovernmental organizations; focus on quality care and the battle against HIV/AIDS; save women's lives by replacing abortion with contraception; and empower women through integrated approaches. Despite the above initiatives, special efforts are needed to expand access to those needing the family planning services in both public and private sectors.
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  16. 16

    Quality of care in family planning service delivery. A survey of cooperating agencies of the Family Planning Services Division, Office of Population, U.S. Agency for International Development.

    Hardee-Cleaveland K; Norton M; Calla C

    [Unpublished] 1992 Apr. v, 39, [50] p.

    The purpose of this report was to provide information to the Family Planning Services Division of the Office of Population, Agency for International Development on approaches to the quality of care of eight of its cooperating agencies (CAs); namely, Association for Voluntary Surgical Contraception, Cooperative Assistance Relief Everywhere, Center for Development and Population Activities, Enterprise, International Planned Parenthood Federation/Western Hemisphere Region, Pathfinder, Family Planning Services Expansion and Technical Support project, and Social Marketing for Change project. The report addresses questions on the following areas: CA definition of quality of care, approaches to assessing quality, success stories, constraints to quality of care, future activities, and their recommendations regarding quality of care. The overall approaches of quality assurance fall into four categories: grass roots, medical/management monitoring, information and training, and method/stage of program approach. The approaches to assessing quality of care that are developed by each CA are often complementary. Some of the major constraints to quality of care include lack of understanding of client-oriented services, provider bias, and restrictive government policies. Estimated resources devoted for quality of care was between 5 and 30%. In terms of the future of the quality of care, all CAs would like to increase levels and approaches, and try new approaches and activities in the area of quality of care.
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  17. 17

    [Workshop on quality assurance of salt iodinization programs, October 1996] Atelier en matiere d'assurance de la qualite des programmes d'iodation du sel, Octobre 1996.

    John Snow [JSI]. Opportunities for Micronutrient Interventions [OMNI]; Program Against Micronutrient Malnutrition

    [Arlington, Virginia], JSI, OMNI, 1997 May. [6], 37 p. (USAID Contract No. HRN-C-00-93-00025-08)

    Despite the considerable progress which has been achieved in establishing salt iodination programs with the goal of covering broader populations in more countries, salt produced for eventual human consumption tends to be either over- or underiodized. To resolve that problem, quality assurance systems need to be created and implemented to ensure that the iodized salt being produced and consumed meets certain key standards. This workshop grew out of the ideas and efforts of salt producers, governmental decision-makers, and program and organization managers seeking to evaluate the essential elements of such quality assurance systems and to recommend which steps should be taken. The 27 workshop participants from several different fields and organizations therefore examined production problems, sales monitoring concerns at both the wholesale and retail levels, standards and their application, laboratory analyses, and policy development. Workshop participants came from South Africa, Bangladesh, Canada, Denmark, Eritrea, the US, Ghana, Guatemala, India, Pakistan, Holland, Philippines, Tanzania, and Thailand. Recommendations are presented.
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  18. 18

    The immunisation programme in the Caribbean.

    Irons B; Smith HC; Carrasco PA; de Quadros C

    CARIBBEAN HEALTH. 1999 Oct; 2(3):9-11.

    The Directing Council of Pan American Health Organization approved a resolution concerning the formal inauguration of the Expanded Programme on Immunization (EPI) in the Americas in October 1977. Subsequently, the EPI entered full implementation in those countries that were members of the Caribbean Epidemiology Center (CAREC) during 1978-80. All 19 CAREC Member Countries (CMC) were conducting routine immunization with diphtheria, pertussis, tetanus, poliomyelitis, measles and BCG vaccines by 1980. The establishment of the program in these countries resulted in focused activities, including training and the development of operational guidelines. Health education has been primarily used to encourage mothers to have their children vaccinated at optimum age, and to advise parents and guardians about adverse reaction to vaccines. Great efforts have been made in immunization coverage in all the CMCs for the six vaccine preventable diseases. The eradication of poliomyelitis, the interruption of measles transmission (8 years measles-free), and the implementation of strategies for the elimination of rubella and CRS have presented many challenges to public health practitioners in the region. The success of all these initiatives is a reflection of the deep commitment and strong partnerships, which have been developed between the governments, health practitioners, and people of the region. Moreover, technical and financial support from both international agencies and service clubs played a major role in the success of the program.
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  19. 19

    Sustainability of the FP-MCH program of NGOs in Bangladesh. Future Search Workshop, July 15-18, 1995, Centre for Development Management, Rajendrapur, Bangladesh.

    Fowler C

    Dhaka, Bangladesh, Pathfinder International, 1995. [10], 38, 51 p. (USAID Cooperative Agreement No. 388-0071-A-00-7082-10)

    This report summarizes the activities of a workshop held July 15-18, 1995, in Bangladesh, on the sustainability of Bangladesh's family planning/maternal-child health (FP/MCH) program among nongovernmental organizations (NGOs). The workshop included representatives of the FP/MCH program, donor agencies, USAID cooperating agencies (CAs), NGOs, family planning clients, and technical experts (64 individuals). The aim was to determine a common vision of sustainability by 2010; to identify common features of this vision; and to identify Action Plans that stakeholders might adopt to ensure the actualization of the vision. The report includes a summary, introduction, objectives, inaugural session notes, technical presentations on USAID's vision, lessons learned from sustainability initiatives in Latin America, sustainability planning approaches and tools, and a future search workshop on sustainability. Stakeholders' evaluations of the workshop were listed in about 16 different statements. The appendices include the agenda, the list of participants, the national vision, USAID's vision, lessons learned from international settings and applicability to Bangladesh, tools to help plan for sustainability, and the workshop evaluation form. Many of the lessons learned were applicable to Bangladesh, with the exception of the question of appropriateness of charging all clients. The Quality-Expansion-Sustainability Management Information System and Management Development Assessment Tool were developed with staff from USAID's CAs in Bangladesh. Eight stakeholders participated in the Future Search Workshop and prepared Action Plans which are included in the appendix. The main features were lower donor dependency, community participation, and cost recovery. Promising features included quality of care, income generation, women's empowerment, collaboration, strengthening management skills, and endowment funds.
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  20. 20

    Indonesia trip report, September 1994.

    Frere JJ

    Arlington, Virginia, Partnership for Child Health Care, 1994. [3], 10, [4] p. (BASICS Trip Report; BASICS Technical Directive: 000 IN 00 011; USAID Contract No. HRN-6006-C-00-3031-00)

    A World Bank-supported BASICS project will respond to the government of Indonesia's request to improve the public provision of health care. An informal agreement existed between BASICS, the World Bank, and the Indonesian Ministry of Health to conduct a joint visit to Indonesia during the preparation of the Bank's Health Project IV. That visit was conducted between September 21 and October 8, 1994, and included several field trips to East Java, East Nusa Tengara, West Kalimantan, and Central Java. The technical note included in this report considers some possibilities of the expansion of the private sector in modern Indonesia. The provision of specialized health services to remote areas, the support of training activities, the stimulation of behavioral changes, and ensuring quality assurance for the private sector are discussed. The technical note also emphasizes the need to look beyond the health center especially since the current systems often fail to address basic health needs. Many opportunities exist for BASICS to play an important role in Indonesia, but it is unclear how many resources USAID/Jakarta will have to invest in child survival activities. The anticipated modest size of resources will probably restrict BASICS activities to the private sector, the district level, and potentially operations research activities. Ongoing research into urban health is a promising area. Most of the possible lines of action concerning support to the private sector are outlined in the technical note.
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  21. 21

    Medical education in the context of diarrheal disease control.

    Northrup RS

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1993 Jul. 20 p. (PRITECH Issues Paper No. 1; USAID Contract No. DPE-5969-A-00-7064-00)

    In the 1980s, Technologies for Primary Health Care [PRITECH] was involved in control of diarrheal diseases (CDD) projects that stressed oral rehydration therapy in many developing countries. In the mid 1980s, CDD training added diarrhea training units in teaching hospitals to train medical students in correct diarrhea case management. The World Health Organization (WHO) had developed a special case management course and supportive teaching materials for trainers and trainees that included hands-on training but not follow-up of the trainees. WHO and USAID worked with PRITECH to develop practical learning diarrhea-related activities and teaching materials for medical schools in developing countries. PRITECH introduced the activities from the medical education package in Pakistan, Indonesia, and the Philippines prior to 1988. It set up a pilot projects of the full package in the Philippines and Indonesia. WHO/CDD recommended revisions to the package in 1992. The major revision was adding a detailed workshop guide for national level workshops in introduce faculty to the new materials. The revised package was piloted in Vietnam, Nigeria, and India. In 1986, WHO and PRITECH/Sahel Office embarked on improving the diarrhea-related curriculum of nursing schools in the Sahel countries of Africa. Nursing teachers taking part in a workshop helped develop competency-based modules. These modules include an epidemiological overview and clinical concepts, treatment and prevention of diarrheal, disease, appendix (cholera), application of health education techniques to CDD programs, elements of a national program to combat diarrheal diseases, and a field training workbook and teacher's guide. 16 of 21 nursing schools in the Sahel are using them. The nursing curriculum provides for follow-up visits to CDD programs. The medical schools' teaching program needs to consider various issues, e.g., CDD medical education in an integrated context. Recommendations for donors concludes this summary report.
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  22. 22

    The Board allocates funds for 1994 programs during its meeting in New York last June.

    FORUM. 1993 Dec; 9(2):38.

    The Board of Directors of the International Planned Parenthood Federation (IPPF) Western Hemisphere Region (WHR) met June 24-26, 1993, in New York to decide how much each of 38 family planning associations would receive as their budgets to fund programs in 1994. A total of $18,656,900 was allocated to grant receiving associations and the WHR regional office. The Board allocated funds on the basis of consideration of the following elements: the analysis of associations' input by program and financial advisors; comments from volunteers; group discussion of each association; and a detailed review of information provided by the IPPF regional office staff from its Red Book of 3-year working plans of all regional family planning association members. A series of options were also presented to mitigate the negative impact of expected funding reductions by the IPPF and USAID.
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  23. 23

    Technical support to the Expanded Program on Immunization, Ecuador.

    Steinglass R

    [Unpublished] 1989. [4], 16, [27] p. (USAID Contract No. DPE-5927-C-00-5068-00)

    The Ministry of Public Health (MSP) and external agencies participating in Ecuador's Expanded Program on Immunization (EPI) decided in 1987 that a field-oriented supervisor was needed to help improve the implementation of immunization service delivery at operational levels. Dr. Jose Litardo was therefore retained as EPI Field Coordinator to offer technical support including 2 short-term visits annually from REACH headquarters. The 1st visit was January 11-22, 1989, during which detailed discussions were had with USAID, the Ministry of Public Health (MSP), PAHO, and UNICEF staff; a 3-day field trip within Cotopaxi Province also took place so that EPI supervisory techniques could be demonstrated, strengths and weaknesses in the EPI identified, and recommendations formulated. It was found that the MSP needs technical, managerial, administrative, and logistic support for its EPI at provincial and canton health area levels as it continues to extend its regionalization of health services. More personnel like the REACH EPI Field Coordinator will be needed. It was also found that the program has been slack in meeting routine demand for immunization services; the prevention of neonatal tetanus has been overlooked relative to other EPI target diseases; many norms in use Ecuador do not reflect internationally accepted WHO EPI policies; third doses of vaccine are not completed before age 12 months in many areas; and training in the management and supervision of the cold chain is needed. REACH supports the MSP's decision to assign Litardo to Esmeraldas in 1989. Recommendations are provided on regionalization, delivery strategies, EPI norms, monitoring immunization coverage, supervision, the cold chain, and research.
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  24. 24

    AID to restore support to pop groups shunned under Reagan and Bush.

    WASHINGTON MEMO. 1993 Aug 24; (13):3, 4.

    US Congressional action on family planning (FP) foreign assistance and the directives of the new director of USAID are summarized. Brian Atwood, USAID Director, reported to Congress that the administration supported a restoration of funding (nonsupport has occurred since 1985) to the UN Population Fund (UNFPA), International Planned Parenthood (IPPF), and the WHO Human Reproduction Program (HRP). Support would be provided through a reallocation of $30 million in fiscal 1993 USAID money. UNFPA would receive $14.5 million, IPPF $12 million, and HRP $3.5 million. UNFPA funding would be allocated from funds included in the House-approved foreign aid appropriations bill, H.R. 2295 for fiscal 1994. UNFPA would be required to account separately for US funds and would not be allowed to direct any money to China; funding would be received by September 30. The UN Development Program would periodically report on China's population program. The US plans to pressure UNFPA to withdraw UNFPA funding from China, if significant improvement is not made in their FP operation. Population assistance funding for 1994 is still in the Foreign Operations Subcommittee of the Senate Appropriations Committee. Authorization was approved by the Senate Foreign Relations Subcommittee on International Economic Policy for $400 million to USAID and $50 million for UNFPA, with the provision that US funding to UNFPA will be reduced in fiscal 1994 if UNFPA funds to China exceed $9.7 million. The bill included the preceding year's restriction that the Permanent Representative of the US to the UN General Assembly must approve the bill before disbursement of funds to UNFPA. The House version had been previously (June 30) approved in the State Department authorization bill. A provision was also included requesting Clinton administration reports on revision of foreign assistance, a reduction by 20 of the number of countries receiving foreign aid, and approving 4 basic objectives for the poorest countries (sustainable economic growth, increasing democratic participation, attention to global issues, and responding to humanitarian needs). Another funding bill was introduced in the Senate (S.1096) with a similar one in the House (H.R. 2447) to set a goal of $11 billion for FP funding by the year 2000 and a 1994 fiscal authorization level of $725 million.
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  25. 25

    House vote on Hyde changes dynamic of Congressional abortion debate.

    WASHINGTON MEMO. 1993 Jul 27; (12):1-2.

    US Congressional action is summarized for actions taken on abortion amendments and abortion funding amendments during the month of July 1993. The Hyde Amendment was passed in the House on July 1, 1993; by a margin of 255 to 178; the Senate version will be voted on in August. The amendment was a victory for anti-abortion supporters, because it limited coverage of abortions under Medicaid to cases involving only life endangerment, rape, or incest. Both sides of the abortion debate were energized by the vote. The national Campaign for Abortion and Reproductive Equity (CARE) was launched on July 13 through support from a coalition of 130 organizations and Representatives Maxine Waters, Cynthia McKinney, and Nita Lowey. CARE aims to restore federal funding of abortion services for poor women and others using federally funded health care. The Freedom of Choice Act (FOCA) leaves abortion funding and parental involvement to the discretion of individual states. FOCA was characterized by Senator Carol Moseley-Braun, who withdrew her sponsorship of the bill, as not meeting the needs of the "marginalized, disrespected, and ignored population." 4 other Democratic women senators followed suit and promised to very strongly oppose all efforts to restrict abortions through amendments to appropriations bills. Senate appropriations bills were also considered during July. On July 15 the Senate Veterans Affairs (VA) Committee defeated an amendment that would have barred the use of federal funds for abortion services at VA hospitals, except in cases of rape, incest, or the saving of maternal life. Senate Committee members John Rockefeller and Tom Daschle contributed to the bill's defeat. Federal employee health insurance plans will continue to ban the coverage of abortion services due to passage by the Subcommittee on Treasury, Postal Service, and General Government. An amendment introduced by Senator Bond to allow abortions in cases of rape, incest, or risk to maternal life was adopted by a 3-to-2 vote. The Bond amendment was defeated in the full committee on July 22. It will be voted on in the full Senate soon, along with foreign aid bills restricting abortions for Peace Corps volunteers and providing funding for UNFPA and USAID.
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