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[Washington, D,.C.], World Bank, 2015 Jun.  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)
The USAID | DELIVER project improves patient access to essential medicines in Zambia. Success story.
Arlington, Virginia, JSI, DELIVER, 2011 Feb.  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.
Arlington, Virginia, JSI, DELIVER, .  p. (Policy Brief)Driven by the increasing demand for and popularity of family planning, increasing population size, and changing demographics with more couples entering their fertile years, the financing requirement for contraceptives has become increasingly onerous. Strategies to finance contraceptives include expansion of the donor base; increased use of cost recovery, including revolving drug funds; greater use of the private sector; and direct government financing of contraceptive procurement. None of these is mutually exclusive, and to ensure contraceptive security, most countries are likely to use some or all of these approaches, and many others. Evidence suggests that many governments are beginning to finance contraceptive procurement using national resources, but limited data are publicly available regarding the global extent of this financing. This brief details the findings of a survey of the extent to which national governments of developing countries are using national resources to finance contraceptive procurement. The brief examines the different types of financing used, some of the benefits of this type of financing, and some of the issues it raises. Hopefully, this study can be repeated to track spending and will spur more rigorous efforts to measure this practice. (excerpt)
Arlington, Virginia, Management Sciences for Health [MSH], Center for Pharmaceutical Management, Rational Pharmaceutical Management Plus Program, 2001. iv, 9 p. (USAID Contract No. HRN-A-00-00-00016-00)As part of its contribution to USAID’s SO5—reduce the threat of infectious diseases of major public health importance, the Rational Pharmaceutical Management (RPM) Plus program is providing technical support to the national Tuberculosis (TB) program in Vietnam through the SO5 ID/TB Activity 3: Conduct TB drug procurement training in Vietnam. The RPM Plus assistance will facilitate Vietnam’s procurement of TB drugs under a secured World Bank project. Thomas Moore of RPM Plus and Hugo Vrakking of Royal Netherlands Tuberculosis Association (KNCV) traveled to Vietnam to conduct the training course. The Ministry of Health (MOH) has recently reorganized its procurement department, devolving procurement activities to respective vertical programs such as Tuberculosis, Malaria, and Hematology. Course participants (listed in Annex 1: Proceedings of the Training Workshop—Vietnam) are members of the management committee of the national TB program (NTP). All are expected to play some part in the procurement of TB drugs. (excerpt)
Lancet. 2003 Oct 4; 362(9390):1152-1153.By AIDS day 2002, HIV/AIDS in Africa had killed 20.4 million and infected 29.4 million people. This number of deaths is seven times that in the Nazi holocaust, and it approaches the death toll associated with transatlantic slave trading. Treatment for AIDS includes monitoring of disease progression, psychosocial support, provision of adequate nutrition, teaching healthy living and survival skills, prophylaxis and treatment of opportunistic infections, and antiretroviral treatment. Such holistic treatment can now be provided at an all-inclusive cost of about US$600 dollars per year. Yet most African countries and donors still judge this amount to be too costly. The cost of not treating a person with AIDS includes the loss of output of each patient; loss of income of care-givers; cost of treatment in homes, clinics, and hospitals; funeral costs; death and survivor benefits; and the cost of orphan care and support. These costs are met by patients, families, employers, governments, and society at large. On economic grounds alone treatment should be provided for all those for whom the present value of expenses exceeds the cost of not giving treatment. Results of several studies show that this situation is now true for many classes of people and workers. The issue has become not whether we can afford to treat, but whether we can afford not to. Here, I review imagined obstacles and faulty arguments against large-scale treatment programmes, and show that unwillingness to pay is the main reason for inaction. (excerpt)
Foreign aid, democratisation and civil society in Africa: a study of South Africa, Ghana and Uganda.
Brighton, England, University of Sussex, Institute of Development Studies [IDS], . 28 p. (Discussion Paper No. 368)The 1990s have seen increased interest on the part of Western governments in funding civil society in Africa in an attempt to promote the continent's democratisation process. This discussion paper examines how a range of foreign donors has developed civil society initiatives in Ghana, Uganda and South Africa. All three countries form part of the new generation of African states that are seen as turning their back on decades of authoritarian rule, instead embracing open government and open economies in productive 'partnerships' with the West. After defining what donors mean by 'civil society', this discussion paper is divided into two main sections. The first section identifies who the major foreign donors to civil society are in Ghana, Uganda and South Africa. It examines the relative importance and differences in approach of the United States, Germany, the World Bank and the Like-minded Group of donors (the Nordic countries, the Netherlands and Canada). The second major section discusses the broad objectives of donors in African countries. The study found that civil society organisations committed to the promotion of liberal democracy and economic liberalism are the most popular with donors. The paper concludes that although assistance to civil society is relatively small, and is directed at a very particular section of civil society, in each of these societies it funds some of the key actors involved in influencing economic policy and defining the content of democracy. (author's)
New York, New York, United Nations Population Fund [UNFPA], 1994. x, 122 p. (Technical Report No. 17)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to the Philippines took place in 1993. In the introductory chapter of this technical report, the Global Initiative is described and the Philippine Population Program is presented in terms of the demographic picture, the population policy framework, the Philippine Family Planning (FP) Program, STD/AIDS control and prevention efforts, and an overview of donor assistance from 1) the UNFPA, 2) USAID, 3) the World Bank, 4) the Asian Development Bank, 5) the Australian International Development Assistance Bureau, 6) the Canadian International Development Agency, 7) the Commission of the European Community, 8) the International Planned Parenthood Federation, 9) the Japanese International Cooperation Agency, and 10) the Netherlands. The second chapter presents contraceptive requirements including longterm forecasting methodology, projected longterm commodity requirements, condom requirements for STD/AIDS prevention, total commodity requirements for 1993-2002, short-term procurement projections, and projections and calculations of unmet need. Chapter 3 covers logistics management for 1) the public sector, 2) condoms for STD/AIDS preventions, 3) NGOs, and 4) the commercial sector. The fourth chapter is devoted to a consideration of private practitioners and a detailed look at the ways that NGOs relate to FP groups. This chapter also covers the work of NGOs in STD/AIDS prevention and coordination and collaboration among NGOs. Chapter 5 is devoted to the private commercial sector and includes information on social marketing, the commercial sector, and duties and taxes. The issues addressed in chapter 6 are contraceptive manufacturing and quality assurance, including the potential for the local manufacture of OCs, condoms, IUDs, injectables, and implants. The national AIDS prevention and control program, the forecasting of condom requirements for STD/AIDS prevention, and policy and managerial issues are considered in chapter 7. The last chapter provides a financial analysis of the sources and uses of funds for contraceptives including donated commodities, the private commercial sector, cost recovery issues, and regulations and policies, such as taxes and duties on donated contraceptives, which affect commodities. 5 appendices provide additional information on contraceptive requirements, logistics management and costs, the private commercial sector, condoms for STD/AIDS prevention, and a financial analysis. Information provided by the texts and appendices is presented in tables and charts throughout the report.
Latin American and Caribbean Region health care financing activities, 1982-1988. An annotated compilation. Draft.
[Unpublished] 1989 Mar. , 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.
Population growth problem in developing countries: coordinated assistance essential, Report to the Congress of the United States by the Comptroller General.
Wash., D.C., GAO, 1978 Dec. 91 p.This document argues that a formal coordinating mechanism should be established to oversee the increasing bilateral and multilateral assistance funds being channeled into population activities in developing countries. Effective coordination is needed, according to the General Accounting Office, to ensure that funds are applied to the highest priorities, to maximize efficiency of country programs, and to take advantage of opportunities of cost reduction. The report is based on visits to 6 countries including Bangladesh, Costa Rica, Jamaica, Nigeria, Tanzania, and Thailand, and interviews with U.S. ambassadors, AID mission directors, officials of donor organizations and host governments, and visits to headquarters of voluntary organizations and the 3 principal donors of population assistance. Viewpoints of the officials and agencies contacted and provisions for coordination within country programs are described. In-country coordination was found to consist largely of informal discussion among field representatives, officials of several voluntary organizations warned that overdeveloped coordination would be counterproductive, and officials of AID, the World Bank, and UNFPA, the main donors, felt that obstacles in the way of greater coordination were many. The GAO was unable to identify instances of unproductive duplication.
Conflict Prevention and Post-Conflict Reconstruction: Perspectives and Prospects, April 20-21, 1998, Paris, France.
Washington, D.C., World Bank, Social Development Department, Post-Conflict Unit, 1998 Aug. 44 p.As part of a global workshop series on the transition from war to peace, the World Bank Post-Conflict Unit, in collaboration with the World Bank's Paris Office, held a workshop focusing on conflict prevention and post-conflict reconstruction in Paris, France, April 20-21, 1998. The meeting involved two distinct but interrelated efforts to bring together existing thinking about the area of post-conflict reconstruction. The first day was dedicated to exploring ways that development assistance and private investment can address the root causes of conflict. The second day of the Paris conference was planned as a follow-up to an October 1997 conference sponsored by the US Agency for International Development's Office of Transition Initiatives. The 1997 conference brought together donor agencies' newly-created post-conflict offices, with the aim of gaining a clearer vision of how governments and multilateral organizations are moving forward to address the operational needs that have emerged since the end of the Cold War.
HINDU. 1999 Apr 19; 4.The successful experiences of Tamil Nadu (TN) in the control and prevention of HIV/AIDS provides vital clues for the second phase of the Rs. 1,150-crore World Bank-funded national AIDS control program which will begin in July. The National AIDS Control Organization (NACO) is looking at TN for concrete answers in several areas before it composes its guidelines for the second phase. Key areas of focus in the second phase will be high-risk groups, control of STDs, people living with AIDS, communication structures and blood safety. NACO and the funding agency has been impressed by TN s method of mobilizing NGOs in the massive anti-HIV/AIDS campaign and its handling of the cost of the care. In addition to the Tamil Nadu State AIDS Control Society (TNSACS), the AIDS Prevention and Control Project of the Voluntary Health Services (supported by USAID) also contributed to the impressive performance of this State.
Report from the Meeting on Changing Communication Strategies for Reproductive Health and Rights, December 10-11, 1997, Washington, D.C.
[New York, New York, Population Council, Health and Development Policy Project, . v, 85 p.The Working Group on Reproductive Health and Family Planning (FP) was convened by the Health and Development Policy Project and the Population Council in 1994 to help make US-supported international FP programs consistent with the Plan of Action of the International Conference on Population and Development. This document reports on a 1997 Working Group meeting on "Changing Communication Strategies for Reproductive Health and Rights." The first part of the report reviews changing communication strategies and offers a brief history of health communication. Part 2 presents results of a panel discussion about client-provider interactions, community participation, and the interface of client satisfaction and quality of health care. The third part summarizes a panel discussion on community mobilization and reproductive rights education strategies, including communication strategies for maternal health and rights in Bolivia; sex education in Latin America; IEC (information, education, communication), FP, and sexually transmitted diseases interventions; and a methodology for incorporating gender issues into community AIDS prevention programs. Part 4 contains papers from a panel on the mass media and social marketing that consider how to use the media as a tool for social change, a communication strategy to increase male involvement in FP in Zimbabwe, marketing the female condom in Zimbabwe, and the empowerment of women and youth in Nicaragua. The final sections present donors' perspectives, a summary of themes covered in technical group discussions, and appendices.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 11-23.Rapid assessment procedures (RAP) grew explosively in the 1980s in the social investigation of development work, with four main trends to be distinguished: 1) fast repertoire enrichment with new and imaginative procedures; 2) application of RAP in new sectors through content-adaptation and cross-fertilization (rapid rural appraisal by Chambers); 3) geographic broadening in both elaboration and application of RAP (from Sussex, England, to Thailand, Kenya, and India); and 4) the growing shift from technique to substance. There has been compelling demonstration of RAP's potential for changing and improving the planning of development. RAP can increase the planners' ability to put people first in the development projects. Furthermore, a decade of RAP work has launched some social sciences on a path of methodological retooling. Some major development agencies (the World Bank, USAID, ODA) have started to use RAP. The World Bank has been striving to promote the use of sociological/anthropological investigation methods for generating social information needed in projects. The RAP field work of a medical anthropologist who had received a 2-year contract from USAID to conduct research in Swaziland within a water-borne disease project illustrates the value of RAP. He questioned the lengthy sample survey and carried out an informal study of the health beliefs and behavior among traditional healers and rural health motivators. Within 6 months he collected sociocultural information and specific health-related data which led to significant improvement in the public health network via cooperation between traditional and modern health practitioners. The epistemological risks of RAPs result from the limitations intrinsic to the procedures themselves: accuracy, representativeness, cultural appropriateness, and subjectivity. The extrinsic risks are an improper contextual place or weight within the research strategy. These limitations can be overcome by professional training of RAP practitioners. Nevertheless, RAPs are not a universal cure for gaps in social information, and long-term social research is still essential.
Arlington, Virginia, Partnership for Child Health Care, 1994. , 10,  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.
ECONOMIC AND POLITICAL WEEKLY. 1994 Aug 20; 29(34):2,201-4.The aim of US-promoted population policies is maintaining and securing the economic and political dominance of capitalist states. Governments of developed countries blame overpopulation in developing countries for destroying the planet and those of developing countries blame overconsumption, waste, and industrial pollution in the capitalist countries to be responsible. Developed countries and the UN profess that population control is in the interests of development and for the sake of women's rights. Many women's groups protest planned and already existing population policies and bear witness to the suffering women from developing countries experience, raising the question of choice of these policies. Sexism served as the smokescreen behind which US strategies of population control were implemented. The concept of sustainable development is also used to advance population policies in developing countries. Developed countries use this concept to maintain the status quo, agricultural countries as such, cash crop economies, dependency on food, foreign aid, and loans and to continue their exploitation in developing countries. USAID, UNFPA, and the World Bank are the major moneylenders for population control. The US targets Africa for population control because it produces 90-100% of four minerals vital to US industry. The new phase of capitalist development has shifted the state's role from its function as a nation state to facilitator of global capital. Population control policy, national security laws, and anti-trade union laws are used to create a docile and immobile pool of labor. The World Bank, the IMF, and the WTO, through their structural adjustment policies, provide the infrastructure to implement population policies and targets. Population policies focusing on targets take control away from women. People in developing countries will not accept these population policies until they have control of their lives. They need assurance of child survival and to be in a position to plan their future. The population control lobby now uses deception to thwart resistance.
ECONOMIST. 1994 Jan 7; 53-6.The intricacies of aid distribution and the impact on the environment are discussed in this article. Topics include routine environmental impact assessments (EIAs), the procedures for determining aid recipients, the interaction between national and local governments and donors, the impact of structural adjustment plans, and criticisms of the Global Environment Facility (GEF) managed by the World Bank. Aid programs have been criticized for not taking environmental impact into consideration in project planning; for increasing the wealth of the recipient country's elite or professional classes; and for improving foreign technologies and changing established practices. There is also a unifying position: promotion of sustainable development regardless of economic growth. The arguments center on whether a project assured sustainable development or nor or whether the environment was good for aid. Nongovernmental organizations (NGOs) are in pivotal positions in environmental and development planning. In the US, NGOs act as watchdogs for "ungreen" activities of multilateral development banks. Their influence has positively affected activities of US AID, which routinely carries out EIAs. In 1989, the World Bank followed suit and now produces an annual environmental report. Most multilateral donors consider environmental impact at present. The objection now is that the EIAs stifle development or that development good may only be achieved with environmental harm. The way aid is given has been affected. Development programs that add an environmental component are easily accepted; for instance, a "run of the mill" power plant proposal with a strategy to improve air quality is likely to have support. There is more aid than the supply of projects. Collaborative projects are common. Capacity building is being encouraged, and investments are being made not in feasibility studies for waste disposal schemes but in designing management systems. Environmental policy must involve governments in determining priorities and developing environmental plans. Biodiversity plans are required, if the country signed the convention on biodiversity, for instance. Donor restrictions from above or secret UN project endorsements are not always well received in recipient countries; World Bank policies have indirectly impacted on the environment.
In: Institutions for the earth: sources of effective international environmental protection, edited by Peter M. Haas, Robert O. Keohane, and Marc A. Levy. Cambridge, Massachusetts, MIT Press, 1993. 351-93. (Global Environmental Accords)This paper describes the political forces which have shaped the agendas and policy formulation of international population institutions (IPI) as well as their institutional characteristics and outputs. It also assesses the contributions of IPIs to national population policy formulation and implementation. During the almost three decades during which IPIs have existed, important exogenous changes have occurred in North-South and East-West relations as well as in the domestic politics of key countries involved in population issues. Although population as an issue has remained somewhat insulated from the large-scale changes in the international political and economic order, the impact of such changes on the preferences and resources of governmental and nongovernmental actors has nonetheless been evident in the decision-making forums of IPIs. There have also been changes and developments in the relevant science and technology as well as in the institutional structures and procedures of the IPIs themselves, which over time have influenced the formation of actors' preferences. IPIs are examined over the following three phases of their history: 1965-1974, the period of rapid growth in IPIs under leadership from the US and other Western donor countries; 1974-1984, a period of greater accommodation to the preferences of developing countries; and 1984-1991, a period marked by conflict over IPIs and a search for new sources of support, especially from the transnational environmental movement. A major challenge for IPIs in this recent period has been adapting to the withdrawal of the US government from participation in the UN Population Fund and the International Planned Parenthood Federation in response to domestic political pressure from individual and group lobbies against women's right to abortion.
[Unpublished] 1992 Apr 2. iv, 37,  p. (PN-ABL-448)The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.
Washington, D.C., Futures Group, Options for Population Policy, 1993 Feb. , 24 p. (Policy Paper Series No. 2)While in 1960, 9% of 415 million married women of reproductive age in less developed countries were using some form of fertility control, by 1990, the proportion had increased to 51% of 716 million women. Contraceptive use has expanded most in East and Southeast Asia and in Latin America. There has been also progress in South Asia, the Middle East, and North Africa. China accounts for over 40% of current users in the developing world. An approach to strategic planning at the sector level is outlined. OPTIONS for Population Policy II is a 5-year project funded by the Office of Population of the USAID. The goal of the project is to help USAID-assisted countries formulate and implement policies that address the need to mobilize and effectively allocate resources for expanding family planning (FP) services. The titles of the working papers published as part of an ongoing Policy Paper Series focusing on various aspects of operational policy in FP include: 1) Assessing Legal and Regulatory Reform in FP; 2) Strategic Planning for the Expansion of FP; 3) Policy Issues in Expanding Private Sector FP; 4) Communicating Population and FP Information: Targeting Policy Makers; and 5) Cost Recovery and User Fees in FP. Sector-level strategic planning is a 5-step process: 1) assessment of the current situation in the population/FP sector and examination of future prospects in the sector; 2) identification of the alternative program approaches that could be employed to achieve stated goals and objectives; 3) review and ranking of these programs for the selection of the one which best suits the needs and conditions of the country; 4) commitment by the decision makers to an action plan to implement the chosen program expansion strategy; and 5) agreement on arrangements for monitoring and periodic evaluations of programs.
NETWORK. 1993 May; 13(4):22-4.Social marketing is a strategy which addresses a public health problem with private-sector marketing and sales techniques. In condom social marketing programs, condoms are often offered for sale to the public at low prices. 350 million condoms were sold to populations in developing countries through such programs in 1992, and another 650 million were distributed free through public clinics. The major donors of these condoms are the US Agency for International Development, the World Health Organization, the UN Population Fund, the International Planned Parenthood Federation, the World Bank, and the European Community. This marketing approach has promoted condom use as prevention against HIV transmission and has dramatically increased the number of condoms distributed and used throughout much of Africa, Latin America, and Asia. Donors are now concerned that they will not be able to provide condoms in sufficient quantities to keep pace with rapidly rising demand. Findings in selected countries, however, suggest that people seem willing to buy condoms which are well promoted and distributed. Increasing demand for condoms may therefore be readily met through greater dependence upon social marketing programs and condom sales. Researchers generally agree that a social marketing program must change for 100 condoms no more than 1% of a country's GNP in order to sell an amount of condoms equal to at least half of the adult male population. Higher prices may be charged for condoms in countries with relatively high per-capita incomes. Since prices charged tend to be too low to cover all promotional, packaging, distribution, and logistical management costs, most condom distribution programs will have to be subsidized on an ongoing basis.
In: To cure all hunger. Food policy and food security in Sudan, edited by Simon Maxwell. London, England, Intermediate Technology Publications, 1991. 191-206.Targeting on grounds of equity, cost, or minimizing interference fails to consider whether targeting is politically possible. In the case of the USAID-sponsored famine-relief and emergency food aid operation in Darfur, western Sudan, in 1985, the expressed intention of target this relief was not fulfilled. The target group received inadequate amounts of relief grain owing to the lack of targeting by area councils within Darfur, and the lack of targeting within area councils. After severe rainfall failures in 1982, 1983 and 1984, large numbers of people in western Sudan faced severe food shortage, abnormal migrations, and increased risk of destitution. USAID, the principal donor for relief operations to western Sudan in 1984-85, approved 82,000 metric tons (mt) of relief grain for western Sudan in September 1984, and then a further 250,000 mt in late 1984 and early 1985. The target population for the first 41,000 mt of relief sorghum was the neediest one-fourth later, the neediest one-third. A USAID document provided estimates of people and the way the area councils conceived sheltering throngs of the target group. There was 153,141 seriously affected in Kutum area council, 102,907 in Mellit, and 507,348 in Geneina representing around 25% of Darfur's population, the size of the target group envisaged for the first 41,000 mt of relief grain. USAID made concessions to the Darfur regional government allowing South Darfur a higher proportion of early allocations than need dictated. Save the Children Fund experienced serious difficulties with the local contractor to distribute food from area-council level. Aid agencies and donors need to consider how targeting is to be accomplished and how to confront influential local players with interests contrary to such targeting. Allocations of relief grain could be made on the assumption that targeting will be only partially achieved; and through alternative forms of relief.
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.
Vulnerability and resiliency: environmental degradation in major metropolitan areas of developing countries.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 107-52. (World Bank Discussion Papers 168)The main factors contributing to vulnerability to natural and man-made hazards and the implications of environmental degradation for large urban areas in the developing world are outlined. Many high-risk metropolitan areas in developing countries are projected to have populations of over 10 million by the year 2000; including Baghdad, Bangkok, Beijing, Bombay, Buenos Aires, Cairo, Calcutta, Dhaka, Delhi, Jakarta, Istanbul, Karachi, Manila, Mexico City, Rio de Janeiro, Sao Paulo, Shanghai, and Teheran. Water depletion and quality is a looming issue. In Thailand water demand for the area of Bangkok will increase from 2.8 million cubic meters per day in 1987 to 4.1 million by 1997, and to 5.2 million by 2007. Only 2% of the population of Bangkok is connected to the sewer system. In Calcutta there are 3 million people in settlements which have no systematic means of disposing human wastes. Fertilizers have had a severe negative impact on the environment. Among the cities which have polluted their coastlines are Alexandria, Dakar, Guayaquil, Karachi, Panama City, and Valparaiso. Montevideo and Rio de Janeiro have polluted beaches. The Torrey Canyon, the Exxon Valdez and the Gulf War each focused world attention on marine oil pollution that stems from tanker operations, refineries, and offshore oil wells; from the disposal of industrial and automotive oils; and from industrial and motor vehicle emissions. Because of inappropriate sitting, hundreds of people were killed by mudslides in Rio de Janeiro in 1988, in Medellin in Colombia in 1987, and in Caracas in 1989. In Guatemala, 65% of deaths in the capital following the 1976 earthquake occurred in the badly eroded ravines around the city. The production of greenhouse gases will lead to a rapid warming of the biosphere sometime in the next century, changed rainfall patterns, altered paths of ocean currents, and rising sea levels. A World Bank study recommends for country responses 1) to focus on particular environmental problems; 2) to concentrate on vulnerable populations using vulnerability analysis; and 3) to focus on government intervention strategy.
[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.
Inventory of population projects in developing countries around the world, 1988/1989: multilateral organization assistance, regional organization assistance, bilateral agency assistance, non-governmental organization and other assistance.
New York, New York, UNFPA, . , 932 p.The UNFPA periodically releases a publication listing population projects supported and/or operated by various organizations. This publication also has basic demographic data and each country's population policy. The 16th edition covers the period from January 1, 1988 to June 30, 1989. The first section reviews all the countries' programs and makes up the bulk of the publication. Each division in this section begins with demographic data, followed by the government's views about population growth, specifically as it affects mortality and morbidity; fertility, nuptiality, and family; spatial distribution and urbanization; international migration. Each division next examines the population projects and external assistance. The second section examines regional, interregional, and global programs. The regional programs are divided into Africa, Asia and the Pacific, Latin America and the Caribbean, Middle East and Western Asia, and Europe. The next section lists published information sources including those used to compile the country, regional, interregional, and global reports. Other sources include periodic publications from various agencies and organizations which provide current information about population, addresses to obtain additional information, and a listing of UNFPA representatives (names, addresses, and telephone numbers) in the field. The Inventory concludes with a detailed index.