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Washington, D.C., U.S. Agency for International Development, 1982 Sep. 14 p. (A.I.D. Policy Paper)Population growth has been a major inhibitor of self-sustaining economic development in less developed countries. The individual and familial costs in terms of impaired maternal health, poor living conditions and child and infant malnutrition are high. Effective utilization of family planning services tends to accompany progress in other developmental sectors, such as, health, education, employment and urbanization. Family planning programs are an essential part of US development assistance, which seeks to achieve 2 objectives through the Agency for International Development (AID): to enhance opportunities for voluntarily choosing family size and spacing births, and to encourage population growth which is consistent with economic growth. AID support for family planning services is based on 2 principles: voluntarism and informed choice. AID support has been provided for supplies, health worker training, outreach program research, development of new contraceptive methods and improvement of existing methods, and dissemination of information and education to individuals and governments. Successful programs tend to develop in countries with a strong governmental commitment, an appropriate infrastructure, and a population receptive to the concept of family planning. Legislation has prohibited the use of AID monies for abortion services and involuntary sterilization. Only contraceptives approved by the Food and Drug Administration are provided to recipient countries, as well as information and education on natural family planning. In countries where acceptance or use of modern contraceptives is inhibited by lack of improvement in basic socioeconomic opportunities, AID seeks to coordinate developmental activities and assist governments in policy development. The private voluntary sector, often the initial supplier of family planning services, also receives AID support, as do local institutions that play an important role in service delivery. An important component of AID assistance is the transfer of scientific and technical knowledge to less developed countries implementing family planning programs.
Population and Development Review. 1982 Jun; 8(2):423-34.Since the mid-1960s, the US government has played a major role in influencing population policies worldwide through its assistance programs and through its activities on international forums discussing population matters. The 2 memoranda excerpted below represent probably the clearest and most authoritative articulation by the Executive Branch of the US government international population policy now on public record. (These memoranda were recently declassified officially since they were originally issued as confidential documents.) The 1st document reproduced is the Executive Summary of the U.S. National Security Council Memorandum (NSSM 200), issued on December 10, 1974 under the title "Implications of worldwide poulation growth for U.S. security and overseas interests." The 2nd document, a follow-up to the 1st item, is National Security Decision Memorandum 314, issued on November 26, 1975, by Brent Scowcroft, then President Gerald Ford's Assistant for National Security Affairs, to the Secretaries of State, Treasury, Defense, Agriculture, Health, Education, and Welfare, and to the Administrator of the Agency for International Development. (author's modified)
Science. 1982 Jul 30; 217(4558):424-8.The record of the U.S. Food and Drug Administration's (USFDA) actions regarding Depo-Provera, a medroxyprogesterone acetate, as an injectable contraceptive and the international implications are reviewed. In September 1982 a special panel of scientists began deliberations to recommend whether Depo-Provera should be approved for use as an injectable contraceptive. The U.S. Agency for International Development (USAID) has been asked by developing countries to furnish the drug but will not export drugs that are not approved by USFDA. More than 80 countries have approved the drug. Advocates for USFDA approval include the Upjohn Company (manufacturer of the drug), World Health Organization, International Planned Parenthood Federation, Population Crisis Committee, and the American College of Obstetrics and Gynecology. The opposition includes the Health Research Group affiliated with Ralph Nader, the National Women's Health Network, and several right-to-life groups. Hesitation by USFDA is related to laboratory animal studies which suggest that Depo-Provera is a potential human carcinogen. Upjohn conducted a 7 year study with 16 beagles and a 10 year study with Rhesus monkeys; both of the test animals developed more tumors than the controls. Questions were raised about using the animals since the response of these two species to the drug and the human response are not necessarily comparable. Limited approval has been recommended twice by expert advisory committees in 1974 and 1975, but USFDA refused both times. It is suspected that Korea, Taiwan, Egypt, Jordan, and Yemen reversed their approval as a result of the latest USFDA rejection. This final decision will have major economic and social implications and will assume international importance.
New York, UNFPA, 1982. 339 p. (Population programmes and projects v.1)This expanded guide to population assistance describes a variety of organizations and agencies which are not funding or donor agencies in the usual sense but which offer different services that developing countries might need. Information is included on fields in which assistance can be provided, types of assistance provided, restrictions on types of assistance, channels of assistance reporting requirements, how to apply for financial assistance, and addresses. 4 major types of sources are included: Multilateral Organizations and Agencies, Regional Organizations and Agencies, Bilateral Organizations and Agencies, and Nongovernmental Organizations. This guide also lists some regularly issued journals, bulletins, and newsletters in the field of population including address, frequency of issue, and subscription cost. Organizations and individuals in developing countries may request a free copy from Jack Voelpel, UNFPA, Room 1902, 220 East 42nd Street, New York, New York, 10017, USA.
[Unpublished] 1982. Presented at Conference on Financing Health Services in Developing Countries, Washington, D.C., June 13-16, 1982. 3 p.Focus in this presentation is on cost-effectiveness trends and comparisons among contraceptive social marketing programs. Social marketing programs require brand name products. Over time sales increase and costs/couple years of protection decrease. Advertising becomes less important and there are more customers. In 1981, excluding funds from donor organizations, the costs per couple years of protection for most programs was under $10. In 1981 the US Agency for International Development (USAID) spent $7.2 million on social marketing. In theory, the price charged could be increased to cover all expenses so the project can become self-sufficient. One possibility is to reduce the cost of packaging. Another possibility is to raise prices, cut the cost of commodities (e.g., buy from India), cut project margins for distributors, cut advertising, or fire managers. Yet, it would still be difficult to meet all project costs. Alternatives are the following: continue indefinitely with donor financing; use system to sell profitable items; and get local government to finance deficit.
[Unpublished] 1982. 19 p.The Integrated Population and Development Planning project (IPDP) has led to many diverse activities in 22 countries. The project consists of technical assistance, training, and research which have been evaluated insofar as each contributes to the objectives of the project. One part of the evaluation examines the Mauritania Human Resources Planning Model, Thailand Cost Benefit Analysis, the relationship between IPDP and The Futures Group, the role of the African Regional Office in Lome, Togo, and the quality of staffing of the IPDP; the 2nd part deals with project management issues. The following recommendations are made: 1) future activities should be concentrated in no more than 10 countries, 2) a special workshop should be convened to reexamine the entire issue of population and development policy, particularly as it related to sub-Saharan Africa, 3) future conferences should be planned as workshops or as short courses and be oriented towards mid-level staff, 4) no new research should be solicited, 5) technical assistance should be available not only to ministries of planning but to other ministries as well, 6) mini-courses should be developed in computer science, demography, statistics, and the economics of population in host countries, and individuals sent to short-term courses in the region or, if preferable, in the U.S., 7) the IPDP core staff should be maintained at its 1981/82 strength over the remaining term of the project, 8) present activities should be continued and adequately financed so that real impact on population policy may be achieved, and 9) the US Agency for International Development/Washington Contract Office should review internal procedures to expedite contractor requests for consultant approval.
[Child health in Chile and the role of the international collaboration (author's transl)] Salud infantil en Chile y el rol de la colaboracion internacional.
Revista Chilena de Pediatria. 1982 Sep-Oct; 53(5):481-90.Assuring the rights sanctioned by the UN Declaration on the Rights of Children requires the participation of the family, community, and state as well as international collaboration. Health conditions in Chile have improved significantly and continuously over the past few decades, as indicated by life expectancy at birth of 65.7 years, general mortality of 9.2/1000 in 1972 and 6.2/1000 in 1981, infant mortality of 27.2/1000 in 1981. Although the country has experienced broad socioeconomic development, due to inequities of distribution 6% of households are indigent and 17% are in critical poverty. The literacy rate in 1980 was 94%, but further progress is needed in environmental sanitation, waste disposal, and related areas. Enteritis, diarrhea, respiratory ailments, and infections caused 60.4% of deaths in children under 1 in 1970 but only 37.8% in the same group by 1979. Measures to guarantee the social and biological protection of children in Chile, especially among the poor, date back to the turn of the century. Recent programs which have affected child health include the National Health Service, created in 1952, which eventually provided a wide array of health and hygiene services for 2/3 of the population, including family planning services starting in 1965; the National Complementary Feeding Program, which supervised the distribution in 1980 of 25,195 tons of milk and protein foods to pregnant women and small children; the National Board of School Assistance and Scholarships, which provides 300,000 lunches and 750,000 school breakfasts; and programs to promote breastfeeding and rehabilitate the undernourished. Health services are now extended to all children under 8 years in indigent families. Bilateral or multilateral aid to health services in Chile, particularly that offered by the UN specialized agencies and especially the World Health Organization, Pan American Health Organization, and UNICEF, have contributed greatly to the improvement of health care. The Rockefeller, Ford, and Kellogg Foundations have contributed primarily in the areas of teaching and basic and operational research. Aid from the US government assisted in the development of health units and in nutritional and family health programs. The International Childhood Center in Paris rendered educational aid in social pediatrics. (summary in ENG)
Demography. 1982 Nov; 19(4):429-38.The Presidential Address at the Annual Meeting of the Population Association of America (PAA) outlines the effects of the current political climate on the field of demography. First, government cutbacks have forced many experienced demographers to leave government service; moreover, austerity measures have produced a decline in the quality of data collected, a loss of geographic coverage, diminished access to data, and curtailed dissemination of results. Of major concern to demographers is the recent decision to reduce the size of the Current Population Survey and the National Health Interview Survey. Second, support for basic data collection and analysis from international agencies, including the US Agency for International Development (USAID) and the World Bank, has been reduced. The United Nations Fund for Population Activities (UNFPA) has been reluctant to follow through with technical assistance for data processing of the 1980-81 censuses it helped to launch. The future status of population policy centers located in planning ministries in numerous countries is also in doubt. Countries in sub-Saharan Africa, where there is an acute need for more accurate information, have been hardest hit by cutbacks in research. A 3rd area of concern involves the intellectual foundations of population policy. Revisionist writings, asserting that the effect of population growth on development is at best indeterminate, are on the upswing. Research in the field of population is further threatened by the dramatic growth of antiscience religious groups. As these groups grow in political influence, funds for population research will be increasingly vulnerable. PAA is considering affiliation with the Consortium of Social Science Associations, a coalition which has been involved in efforts to forestall cuts in federal research funding. It is concluded that continuous efforts are required to maintain conditions under which the field of demography can flourish.
Washington, D.C., USAID, Bureau for Program and Policy Coordination, 1982 Dec. 13 p. (A.I.D. Policy Paper)Human resources development, necessary for the growth of overall productivity and efficient use of human capital, is a longterm process that is integral to all aspects of national development. Broad agreement exists among development agencies that assisting countries to establish more efficient systems of education, to control their recurrent cost and administrative burdens, and to relate them more effectively to employment opportunities and trained manpower needs are essential components of effective development strategies. The development strategies of the US Agency for International Development (USAID) stress efforts to raise levels of basic education and relate technical training to employment opportunities as adjuncts of programs to apply science and technology to development efforts, rely on market mechanisms and the private sector to stimulate economic development, strengthen institutions important in development processes, and reinforce efforts of local leaders to address their development problems and administer local resources. Schooling for children aged 6-14, vocational education and functional skills training for adolescents and self-employed adults, and technical skills training for wage employment are among USAID priorities. USAID policy is to focus 1st on problems of resource utilization and internal efficiency, in the expectation that such an approach will lead over time to improved access and more broadly based distribution of educational opportunities. Most nonenrolled children or those whose educational experience is cut short by grade repetition, examination failure, or dropout, are poor, rural, or female, and those who are all 3 usually have the least opportunity. Measures are thus needed to increase the proportions of children who successfully complete at least primary schooling. USAID will focus its assitance to educational and training systems on increasing the efficiency of educational resource utilization, increasing the quantitative and qualitative outputs of training and educational investments, and increasing the effectiveness of the educational and training systems to support economic and social development goals. USAID will seek to promote the participation of communities in the establishment and maintenance of schools and the involvement of employers in the implementation ot technical training programs.
Washington, D.C., Agency for International Development, 1982 May. 24 p. (A.I.D. Policy Paper)Inadequate budgeting for recurrent costs is a serious problems in many less developed countries (LDC). The problem is defined and analyzed and recommendations are made in reference to the way US Agency for International Development (USAID) Missions should respond to the problem. Recurrent costs are costs that recur throughout the lifetime of a project, e.g., road maintenance costs, teacher's salaries, and medical supplies for clinics. If a project such, as a road, generates sufficient money, or output, it is usually more profitable for a country to budget for the recurring costs of maintaing the road rather than to use the money for investing in a new project with initial costs, i.e., high investment and fixed costs. The output from the road would probably be greater than the output from the new project because of these high initial costs. When a country does not allocate money for recurring costs for existing projects, which have potentially high outputs, the country is defined as having a recurring cost problem. Many LDCs recipients are experiencing serious economic crises due to adverse international market conditions Thes countries will find it increasingly difficult to allocate money to cover the cost of maintaining USAID projects. There are 3 major reasons why LDCs have recurring cost problems. 1st, donor policies often contribute to the problem because the generally restrict funding to capital investment and refuse to cover recurring costs in the mistaken belief that it is better to use funds for growth rather than consumption, that it promotes self-reliance on the part of the recipient country, and that the recipient country will be more committed to the project if they have to maintain it. 2nd, policies in recipient countries are sometimes responsible for recurring cost problems because 1) the countries fail to raise adequate revenues, 2) they misallocate funds for political reasons or for services they cannot afford to provide, and 3) they are straddled with poorly designed projects that have high recurring costs but small outputs. Procedures are suggested for determining whether a country currrently has a recurrent cost problem and for assessing whether a country will develop a recurrent cost problem in the near future. Solutions to the problem are 1) allocation of a greater proportion of the countries revenues to recurrent costs, 2) reducing investment in new projects, 3) increasing revenues, and 4) ensuring that recurrent costs are kept to a minimun in any new projects. Appropriate USAID responses depend on the cause, USAID Missions should persuade the country to undertake reforms. If a LDC refuses to modify its poliies, USAID should consider reducing the level of assistance to that country. If the LDC's policies are appropriate but there is still a recurrent cost problem, USAID Missions should consider funding some of the recurrent costs.
Washington, D.C., Agency for International Development, 1982 May. 8 p. (A.I.D. Policy Paper)The Task Force of the US Agency for International Development (US AID) sets forth the overall objectives, policy decisions, and programming implications for food and agricultural assistance funded from Development Assistance, Economic Support Fund, and PL 480 budgets. The objective of US food and agricultural assistance is to enable developing countries to become self-reliant in food through increased agricultural production and greater economic efficiency in marketing and distribution of food products. Improved food consumption is gained through expanded employment to increase purchasing power, increased awareness of sound nutritional principles, and direct distribution of food from domestic or external sources to those facing severe malnutrition and food shortages. Policy elements to accomplish these objectives include 1) improving country policies to remove constraints on food production; 2) developing human resources and institutional capabilities, including research on food and agriculture problems; 3) expanding the role of private sectors in developing countries and private sector in agricultural development; and 4) employing available assistance instruments and technologies in an integrated and efficient manner. A sound country policy framework is fundamental for agricultural growth and should 1) rely on free markets, product incentives, and equitable access to resources; 2) give priority to complementary public sector investments that complement and encourage rather than compete with private sector growth. Private and voluntary organizations (PVOs) can also offer low-cost approaches to agricultural development that take local attitudes and conditions into account. Under appropriate conditions, US AID will finance a share of recurrent costs of food and agricultural research, education, extension or related institutions, provided that policy and institution frameworks assure effective utilization and the country is making maximum and/or increasing domestic resource mobilization efforts.
Summary: field trip report, Agency for International Development, Sri Lanka, (Colombo, Kalutara, Kandy and Nuwara Eliya), July 14 to August 2, 1982.
[Unpublished] 1982. 19 p.This report, prepared for the US Agency for International Developement (USAID), provides a description and assessment of the 4 social marketing programs operating in Sri Lanka, an inventory of the program's current contraceptive supplies, an estimate of the programs' supply requirements for 1983-85, and several recommendations for improving social marketing activities in the country. The assessment was made during a brief visit to Sri Lanka in the summer of 1982. Supply requirements were difficult to assess since there is little coordination between the programs. The programs are supplied by a variety of donor organizations, and record keeping is inadequate in some programs. The 4 programs are operated by 1) the Family Health Bureau (FHB) of the Ministry of Health, 2) the Family Planning Association of Sri Lanka (FPASIL), 3) Population Services International (PSI), and 4) Community Development Services (CDS). The FHB program sells oral contraceptives (OCS) and condoms. During 1983-85, most of the program's supplies are expected to be obtained form the UN Fund for Population Activities. The FPASIL program was initiated in 1974 and distributes 10 brands of condoms and 3 brands of OCS. The program receives supplies from the International Planned Parenthood Federation and USAID. The PSI program trains Ayurvedic practitioners to distribute OCs and condoms. Most of the contraceptives are distributed free of charge but some are marketed. The program obtains its supplies from the FHB stocks and distributes them to the practitioners via the postal system. The Community Development Service is a privately run organization which conducts a variety of projects including the marketing of OCs and condoms through health workers and Ayurvedic practitioners. The program is supplied by several donors and is currently requesting condoms from USAID. Detailed information on the program is unavailable; however, it appears that the program overestimated its contraceptive needs for 1983. Between 1975-82, the proportion of married women of reproductive age relying on traditional methods increased from 17%-25%, the proportion relying on sterilization increased from 13%-17%, and the proportion using other modern methods increased from 11%-13%. In 1982, the proportion using OCs was 2.64% and the proportion using condoms was 3.19%. The marketing programs distribute primarily condoms and OCs. Estimated USAID delivery requirements for 1983 included 3,500,000 condoms for the FHB and FPASIL programs and 700,000 cycles of OCs for the FPASIL program. Requirements for 1984 could be estimated only for the FPASIL program and included 800,000 OC cycles and 8,500,000 condoms. The Ministry of Health should commission an outside review of all social marketing activities to identify appropriate and complementary functions for the 2 major programs (FPASIL and FHB) and a local review of the Ayurvedic practitioner training and distribution programs of CDS and PSI. Condoms provided by USAID for the FHB and CDS programs should differ in brand and packaging from those marketed by FPASIL. The progrms' service statistics and logistics should be improved. Research should be undertaken to identify factors contributing to the increase in the use of traditional contraceptive methods and to explore why only minimal increases in the use of modern contraceptives have occurred since 1975. Consideration should be given to setting up a central warehouse for stocking the nation's contraceptive supplies. All programs would then obtain their supplies from this central facilities. USAID assistance would be available for implementing a number of these recommendations.
Washington, D.C., U.S. Agency for International Development, May 1982. 12 p. (A.I.D. Policy Paper)Estimates indicate that 600 million people in less developed countries (LDCs) are in danger of not getting enough to eat. This policy paper reviews the justifications for US investment in improving nutrition in LDCs and sets out some policy guidelines for USAID programs. The objective of the nutrition policy is to maximize the nutritional impact of USAID's economic assistance. The policy recommendations are to place the highest priority on alleviating undernutrition through sectoral programs which incorporate nutrition as a factor in decision making. This can be effected through identifying projects based upon analysis of food consumption problems; this is especially appropriate in formulating country development strategies, especially in the areas of agriculture, rural development, education and health. USAID will give increasing attention, through research, analysis, experimental projects, and programs, to improve the ability to utilize the private sector whenever feasible to implement the policy, and to target projects to at-risk groups with the design of overcoming or minimizing constraints to meeting their nutritional needs. It will also monitor the impacts of development projects and strengthen the capacity of indigenous organizations to analyze and overcome nutrition problems.
Pasadena, California, Population Communication, . 9 p. (A Population Communication Report)This report provides short summaries of the discussions of the Population Communication sponsored meeting on the subject of fertility incentives and disincentives. The meeting's purpose was to review the current status of incentives and disincentives and to determine what donors and governments could do in designing and implementing programs. The following were among the topics covered by various participants: the urgent need for incentives; the UN Fund for Population Activities (UNFPA) analytical study of incentives; the World Bank and incentives; the US Agency for International Development Policies (AID); the Population Crisis Committee (PCC) guidelines for community incentives; research guidelines for incentives; the 1 child family goal of the People's Republic of China; the Indian experience with incentives; the Indonesian incentive program; the approach of the Philippines to incentives; the Bangladesh experiment with incentives; the Singapore Incentive Program; the Thailand Community Incentive Program; and the status of incentive programs in fertility control. Ambassador Marshall Green spoke on the need for increased focus on incentives and disincentives in population policies and programs, stressing that there are a great number of possibilities for action. The World Bank in its Indonesia III Population Project provides financing for community incentive schemes. AID has confined its incentive payments to providers of services and to some degree, the cost to acceptors, e.g., transportation. PCC has recently funded the Thailand community incentive program and will consider support for trials of the community incentive approach in other settings in Asia, Africa, and Latin America. According to Henry P. David, Director of the Transnational Family Research Institute, incentive programs should be voluntary and noncoercive, with full consideration given to local cultural conditions and the expressed needs of the community for quality of life improvements. Since the inception of the family planning program in 1951, incentives have been a part of Indian policy. Incentives and disincentives have not attracted much interest in the Philippines. There have been a few small pilot studies, but little has been done to determine how these could be implemented on a wider scale. Lenni W. Kangas reports that the lack of measurement tools no longer needs to be a major impediment to mounting community incentive efforts.