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  1. 1

    [Lessons learned concerning water, health and sanitation. Thirteen years of experience in developing countries. Updated edition. Lecciones aprendidas en materia de agua, salud y saneamiento. Trece anos de experiencia en países en desarrollo. Edicion actualizada.

    Camp Dresser and McKee International. Water and Sanitation for Health [WASH]

    Arlington, Virginia, WASH, 1993. [175] p. (USAID Contract No. 5973-Z-00-8081-00)

    As this latest edition of "Lessons Learned" informs us, sustainable development in the water and sanitation sector is not just the construction of an installation or the installation of a hand pump, but the way in which these interventions help people improve their quality of life. More importantly, we see that sustainable development promotes change: change in the way in which power is distributed and technologies are spread. The issue of participation is explored in this report through an analysis of associations of donors, governments, non-governmental organizations, and private for-profit companies. The notion of the association imposes certain responsibilities on the beneficiary governments and their communities. (excerpt)
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  2. 2

    Tanzania assessment: Program for Permanent and Long-Term Contraception, November 1-12, 1993.

    Tanzania. Ministry of Health. Family Planning Unit; Uzazi na Malezi Bora Tanzania [UMATI]; Association for Voluntary Surgical Contraception [AVSC]; United States. Agency for International Development [USAID]

    [Unpublished] 1993. [4], 23, [8] p.

    In 1993 in Tanzania, the Association for Voluntary Surgical Contraception (AVSC) helped the Tanzania organization UMATI and the Ministry of Health (MOH) evaluate the 5-year Permanent and Long-Term (P<) Contraception Program. The program planned to use the findings to develop action workplans to address the issues and to expand services. The assessment team visited sits in Dar es Salaam, Iringa and Mbeya, and Arusha and Moshi. In 4 years, the program had expanded from 2 sites to 35 sites nationwide. It trained 250 family planning providers in tubal ligation. P< providers performed more than 9000 tubal ligations (90,000 couple years of protection). The program has surpassed all its service objectives, which contributed to a lack of resources. It established a national network of interested health providers and administrators. Demand for services outpaces the supply countrywide. Since clients and providers have accepted tubal ligation, the government has incorporated sexual sterilization into its national family planning program. It is now preparing to introduce the contraceptive implant Norplant. USAID/AVSC and UMATI/IPPF, (International Planned Parenthood Federation) support 3 full-time staff positions and plan on adding staff in area offices. Other than the 3 AVSC-funded positions in UMATI, UMATI, and MOH have provided all staff time. Other donors to the P< Contraception Program include the development agencies of the UK and Germany and perhaps the World Bank. The MOH has requested future goods from UNFPA for the Interim Norplant Expansion Program. The 2 major outcomes of the assessment were realization of the need to support full-time physician-nurse teams in each UMATI area office and MOH agreement to integrate training for P< methods into the national training strategy. UMATI and USAID planned to add 2 more area offices. Service obstacles were insufficient trained staff, expendable supplies, and equipment to expand to the 35 sites (25 were planned). The key management problem was failure to completely integrate the P< program into the UMATI mainstream.
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  3. 3

    Family planning hygiene project.

    Philippines. Provincial Population Office; Philippines. Commission on Population

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [1] p. (PHI-01)

    In 1975, a USAID-Commission on Population (POPCOM) planning team reported that the key problem facing the National Family Planning (FP) Program in the Philippines was extending the program beyond its existing network of municipal-based clinics to the surrounding barrios. At that time, the number of new FP acceptors was declining, and there was a shift to less effective methods among current users. Because most clinics were urban-based, rural acceptors could not easily access FP services. The report recommended that supply depots be established in barrios and that motivators be used to distribute contraceptives and hygiene information and materials. An operations research project, which cost US $77,313, was developed to test the feasibility and cost-effectiveness of delivering FP/hygiene materials directly to households in rural areas. The Barrio Supply Point (BSP) operators were to visit and make available to every household free FP and hygiene materials. After the initial visit, BSP operators were to continue to serve as resupply agents. Although contraceptives were resupplied free, a nominal charge was required for hygiene materials. A quasi-experimental study design was employed. Pilot tests were conducted to determine what materials might be effectively distributed in addition to contraceptives. Project support was terminated in December 1978, before the project was fully implemented, because of the evolution of a national outreach program. Results of the pilot test showed that over 90% of households offered free condoms and oral contraceptives, or free contraceptives and bars of soap, accepted them. No data on use of these items were collected.
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  4. 4

    Family planning saturation project.

    American University in Cairo; American University

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (EGY-01)

    Egypt's family planning (FP) program, active since 1966, has been facilitated by the country's population density, flat terrain, and extensive health infrastructure. Nevertheless, by the early 1970s, a substantial proportion of couples were still not using contraception because of minimal clinic outreach; high dropout rates for oral contraceptive (OC) users; lack of knowledge about side effects among clinic staff and clients; disruptions in clinical supplies; and unavailability of other methods, such as the IUD, especially in rural areas. In 1971, USAID supported the American University in Cairo's (AUC) FP research activities in rural Egypt, in which household fertility survey data, a follow-up of women attending FP clinics, the cultural context of FP, communication and education, and the implementation of services were studied. In 1974, AUC initiated a demonstration project (which cost US $224,000) of a low-cost way to provide FP services to all married women in a treatment population through a household contraceptive distribution system. The interventions were implemented in the Shanawan (rural) and Sayeda Zeinab (city of Cairo) communities of Menoufia Governorate. During an initial canvas in November 1974, married women 15-49 years of age, who were living with their husbands and were not pregnant or less than 3 months postpartum and breast feeding, were offered 4 cycles of OCs or a supply of condoms. During a second canvas in February 1975, acceptors were provided with an additional 4 cycles of OCs and referred to a local depot for resupply. Each distribution area was mapped, and each housing unit numbered. Data collected through canvassing consisted primarily of eligibility screening items and provided numbers of acceptors, refusals, ineligibles, not at homes, etc. To increase coverage, 2 attempts were made to reach women not at home. Of the 2,493 women canvassed in Sayeda Zeinab, 1713 (69%) were eligible to receive contraceptives. Of these, 58% accepted 4 to 6 cycles of OCs. At the time of initial household distribution, 45% of eligible women were already using OCs. As a result of the canvass, an additional 5% of the women became acceptors. The AUC did not expand the household distribution of contraceptives to other urban areas of Cairo, because women there evidently already had adequate access to FP information and supplies. In the 6,915 households canvassed in Shanawan, 1156 of the 1820 women (64%) were eligible to receive contraceptives. Of these, 45% accepted 4 to 6 cycles of OCs. 21% of eligible women were already using OCs at the time of initial household distribution. Although condoms were offered, few were accepted, apparently because it was not culturally acceptable for women to either distribute or accept condoms. One year after the initial household distribution, contraceptive use among married women of reproductive age had increased 69% from 18.4 to 31% among all age and parity groups and at all educational and occupational levels, and the incidence of pregnancy declined from 19.3 to 14.9%.
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  5. 5

    Partners: existing health institutions.

    Rosenbaum J

    In: Partners against AIDS: lessons learned. AIDSCOM, [compiled by] Academy for Educational Development [AED]. AIDS Public Health Communication Project [AIDSCOM]. Washington, D.C., AED, 1993 Nov. 67-76. (USAID Contract No. DPE-5972-Z-00-7070-00)

    AIDSCOM's Resident Advisor to the WHO Caribbean Epidemiology Centre (CAREC) discussed partnerships with existing health institutions. These institutions included Ministries of Health, multilateral agencies (e.g., WHO and UNICEF), family planning associations, universities, international private voluntary organizations, bilateral agencies (e.g., Canadian International Development Agency), and indigenous nongovernmental organizations (NGOs). AIDSCOM helped them develop an appropriate and effective conceptual approach to HIV prevention, which generally meant integrating new HIV prevention skills and concepts into existing programs and activities. AIDSCOM technical assistance addressed issues of accessibility of health services, testing, counseling, policy and confidentiality. Technical assistance included improved planning and management, program design skills, materials development, training in prevention counseling and condom skills, and a model for personal and professional behavior regarding AIDS, sex and risk. A key factor contributing to a successful partnership with CAREC was continuity of AIDSCOM staff contact. AIDSCOM helped CAREC with social marketing and behavioral research. It helped CAREC and its national counterparts to develop a regional KABP protocol for all 19 countries. AIDSCOM helped implement the protocol and strategize how to develop programmatic activities based on the results. The identified activities were training health workers and HIV prevention counselors promoting condom skills, establishing 5 national AIDS hotlines, developing 3 national media campaigns, and developing music, theater, and radio dramas. AIDSCOM and CAREC became partners with local NGOs who had access to hard-to-reach groups. Lessons learned included: technical assistance helps heath projects shift program emphasis from information to behavior change; successful partnership result in innovative programs; and proven effectiveness can be replicated in parallel programs.
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  6. 6

    USAID negotiating Depo purchase, but shelf life proves problematic.

    FAMILY PLANNING WORLD. 1993 Jul-Aug; 3(4):7, 21.

    The discussion focused on the variations in purchasing agreements for the injectable Depo-Provera. Negotiations are in process between the manufacturer in the US (the UpJohn Company) and USAID regarding size of purchase, prices, and time schedules. A glitch is that the US production plant provides a two-year shelf life for the product, while the Belgian plants provide a three-year shelf life. The one year difference could be significant in the distribution to hard-to-reach places, but the balancing point is that USAIDs effort are a positive development for expanding distribution. The UN Population Fund (UNFPA) and the International Planner Parenthood Federation (IPPF) already distribute Depo-Provera and were charged 72 and 75 cents, respectively; UpJohn recently increased the prices to 80 and 85 cents. The UNFPA prices were slightly lower due to larger purchases, and both concerns will be awaiting the outcome of USAID's price negotiations. Other manufacturers are a company in Indonesia, which sells only within the country, and Organon in Holland, which produces the drug under the name Megstron. UpJohn has the major share of the market. The cost of supplying Depo-Provera also includes the purchase of needles and syringes. Other international agencies are not limited by anything other than finding the lowest cost. UNFPA buys its supplies in Belgium at low cost and its contraceptives in Holland. USAID, however, must purchase needles and syringes from American facilities. IPPF will be watching to assure international organizations that no duplication of effort will occur with the USAID distribution and expects the shelf life problem to be resolved. The issue may be cleared up when UpJohn has sufficient time to resubmit its application with enough research to support the 3-year shelf life; the FDA had rejected Depo-Provera repeatedly since 1961, and the approval was granted on a rushed application that only included some of the Belgian research and could empirically only support a 2-year shelf life.
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  7. 7

    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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  8. 8

    International population institutions: adaptation to a changing world order.

    Crane BB

    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.
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  9. 9

    Quality design helps to remove barriers to latrine use.

    Center for Human Services. Quality Assurance Project

    Q.A. REPORTS. 1993 Jun; 1-2.

    The Quality Assurance Project (GAP) has collaborated with CARE-Guatemala to carry out a unique application of quality assurance methods to public health promotion. CARE asked GAP to analyze the problem of inadequate latrine use among those rural communities served the CARE's water and sanitation project. GAP used a quality design techniques known as quality function deployment (QFD), which originated in Japanese industry, and considers client preferences at the product design stage. The method users matrices to compare products and to explore the relationships between a product's technical components and the user's needs and preferences. In September, 1992, GAP led a workshop for CARE and Ministry of Health staff showing the application of a simplified QFD approach by a flow chart. The group listed five priority quality characteristics for the optimal latrine: easy to clean, safe for children, allows for corn cob use, not scary to sit on, and does not smell bad. Then competing products were consideration; the latrine, the open field, and the flush latrine. Measurements were used to score each products: 1) the rate of improvement required; 2) determination of the key features for latrine promotion; and 3) the calculation of absolute and demanded quality weight. During the workshop, a water and sanitation expert presented an overview of various latrine designs from around the world and their respective worth and disadvantages. A spirited discussion made it clear that insufficient health education promoting the use of latrines was not the only factor that contributed to low utilization rates. Areas of high correlation indicated a priority area for redesign. The chart revealed a strong relationship between the toilet seat and children's safety. Guatemalan Ministry officials and USAID are considering future use of QFD in their latrine design efforts. This exercise helped them to explore user attitudes and their implications for technical design.
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  10. 10

    A return to reason; U.S. international population policy.

    Fornos W; Burdett H

    Washington, D.C., Population Institute, 1993. 15 p. (Toward the 21st Century No. 4)

    The 1980s were poor years in the fight against rapid world population growth. Although the technology, experience, and research needed to reduce fertility were available, religious fundamentalism, the Reagan and Bush administrations in the US, and a weak global economy near the end of the decade severely crippled efforts to achieve stable populations around the world. The fundamentalist opposition to abortion drove Reagan and Bush to reverse the long-standing commitment of the US to international population and family planning assistance. Reagan arranged in 1984 for the US to lose its position of lead donor to the International Planned Parenthood Federation (IPPF) and the UN Population Fund (UNFPA). US government funds were then prohibited from being used by nongovernmental organizations which provide abortion services to overseas clients under the "Mexico City policy." The Kemp amendment and China and the UNFPA are discussed as elements of this low point of America's role in providing international family planning services. Reagan's international policy ran counter to the US policy implemented over the previous two decades. Bush continued the Mexico city policy and the funding boycott against the UNFPA. It was not until the Democratic administration of President Bill Clinton that a rational and enlightened approach to population growth was restored to US international policy. Clinton overturned the Mexico policy by executive memorandum two days after taking office. In 1993, the US Agency for International Development restored the flows of money to the UNFPA, the IPPF, and the World Health Organization human reproduction program. A record $392 million for population development assistance in 1994 was appropriated by Congress, almost all of the $400 million requested by the Clinton administration.
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  11. 11

    Treatment kit nips STDs in the bud.

    AFRICA WOMEN AND HEALTH. 1993 Apr-Jun; 1:24-6.

    Within the framework of a pilot project, nearly 100 pharmacies in Cameroon will start selling antibiotics in a treatment kit for sexually transmitted diseases (STDs). The objective is to control STDs as well as to reduce the transmission of AIDS, because the presence of genital ulcers increases the risk of getting infected with HIV fifty-fold. The Ministry of Health is sponsoring the project in collaboration with Family Health International and Population Services International with fund from the U.S. Agency for International Development. This social marketing project hopes to attract clients with low product prices and availability, thereby improving the quality of STD treatment. About 90% of people with STDs go to a local healer or pharmacist, where they receive inadequate treatment. Antibiotics are often sold by untrained staff, who cannot provide instructions for use. Incomplete dosages fail to cure the infection and contribute to the increase of resistant bacterial strains. The strict controls over antibiotics were relaxed recently. In 1991, the U.S. food and Drug Administration allowed the over-the-counter sale of an antibiotic drug to treat vaginal candidiasis. The Cameroon treatment kit will include appropriate antibiotics to treat the most common strains of gonorrhea and chlamydia, promote correct condom use, and include 2 packages of condoms and a partner referral card to seek treatment. A number of baseline studies are underway, including surveillance among pregnant women and commercial sex workers to learn about the prevalence of STDs, and research concerning the pathogenesis of male urethritis. The strong private pharmacy distribution system will help realize the project. The campaign messages will focus on proper STD treatment and lowering the chances of getting AIDS. Advertising will link treatment with prevention and the Prudence condom, while radio commercials and leaflets will promote the kits as an effective means of treatment for STDs.
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  12. 12

    Foreign aid and family planning [editorial]

    WASHINGTON POST. 1993 Nov 24; A16.

    The resumption of United States aid to the International Planned Parenthood Federation (IPPF) was announced on November 23, 1993, at the State Department. The IPPF had not received any American funds since 1984 because of President Reagan's Mexico City policy, which barred foreign nongovernmental organizations from subsidies if they were engaged in abortion-related activities. President Clinton invalidated this policy immediately after his inauguration, and IPPF received $13.2 million as part of a $75 million 5-year package. While US participation in international family planning programs was suspended, population budgets in bilateral programs had continued to increase. The US contributes 40% of total global population assistance programs. Achievements in this area include decreasing fertility rates and average family size in the developing world. Yet, total world population continues to grow, since the number of people of reproductive age is still rising. The world's population was 5.5 billion in 1993, a figure that would double in 40 years at the current rate of growth. Uncontrolled population growth adversely affects economic development, political stability, health, education, and the environment. Reagan and Bush administrations denied these effects. The commitment of the Clinton administration to providing family planning information and services through the foreign aid program, underscored at the signing ceremony, are just as important as the IPPF grant.
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  13. 13

    AID renews ties with IPPF as major foreign aid policy changes are seen. But UNFPA funds being temporarily withheld.

    WASHINGTON MEMO. 1993 Dec 7; (19):1-2.

    The United States government and the International Planned Parenthood Federation (IPPF) reestablished their relationship in November 1993, and the United States Agency for International Development (AID) committed $75 million to IPPF, after nine years of official US hostility because IPPF would not renounce abortion-related research and services. The administration also delivered to Congress a final draft of its rewrite of the Foreign Assistance Act (FAA), with significant policy changes for international population aid. Preparations are underway for the 1994 International Conference on Population and Development in Cairo, where the US intends to participate in the world debate, AID has awarded IPPF $13.2 million for fiscal 1994. The Reagan and Bush administrations had concluded that the presence of the United Nations Population Fund (UNFPA) in China, where coercive abortion does exist, made UNFPA guilty by association. But the Clinton administration determined that UNFPA did not support abortion services at all. Nevertheless, the Justice Department withheld UNFPA's initial fiscal 1994 funds pending a hearing. The administrator of AID expressed his strong support for UNFPA as well as IPPF following the signing of the cooperative agreement between IPPF and AID. He emphasized that support for family planning would remain the core of the US program, and that information about family planning is a fundamental right. The Clinton administration seeks to connect family planning and the prevention of sexually transmitted diseases, especially HIV/AIDS, safe motherhood, post-abortion contraceptive service, and the special needs of adolescents. A new FAA bill would encourage sustainable development by promoting economic growth, preserving the global environment, supporting democracy, and stabilizing world population growth. This will be the subject of congressional hearings in early 1994. The administration intends to eliminate the ban on the use of foreign aid funds for abortion, but the bill would continue to prohibit coercive abortion or sterilization. Because of severe budget constraints, AID has decided to close 21 mission offices overseas, reducing AID's presence to about 50 countries.
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  14. 14

    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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  15. 15

    AID awards Planned Parenthood grant.

    Goshko JM

    WASHINGTON POST. 1993 Nov 23; A12-3.

    On November 22, 1993, the administration of US President Clinton awarded $13.2 million to the International Planned Parenthood Federation (IPPF) as the first part of a 5-year USAID commitment of $75 million. The US also intends to resume funding in January to the UN Fund for Population Activities and other organizations that had been omitted from eligibility for the $430 million the US provides annually to foreign family planning (FP) programs. Eligibility had been withheld since 1984 during the Reagan and Bush administrations from organizations which performed or promoted abortion as a form of FP. US law continues to prohibit the use of US funds for abortion-related activities. USAID will enforce this restriction on use of the funds and on use of the money for coercive birth control practices in China. USAID Administrator, J. Brian Atwood, has determined that his agency's severely reduced budget will be targeted toward sustainable development with work in 4 basic areas: population and health, economic growth, the environment, and democracy. He stated that population problems are at the core of seemingly intractable problems in some developing countries and that the US must address the issue of population growth in order to meet any of its foreign policy objectives. He also stated that, in the view of the Clinton administration, access to FP information and services is a fundamental human right. The US grant will increase the IPPF's available funds for developing countries by about 20%.
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  16. 16

    The transition to sustainable family planning programs.

    International Planned Parenthood Federation [IPPF]

    IPPF / WHR FORUM. 1993 May; 9(1):15-6.

    USAID, through the matching grant project, provided International Planned Parenthood Federation's Western Hemisphere Region (IPPF/WHR) funds to increase and strengthen family planning (FP) services in Latin America. Family planning associations (FPAs) were to match any USAID-awarded funds with other funds, supporting efforts to promote sustainability of service delivery. The matching grant was an extremely effective and efficient means to expand access to good quality, voluntary FP services to low income, underserved people. Local income funded about 33% of Matching Grant FPA budgets. USAID and IPPF or other donors shared the other 66%. The Matching Grant FPAs reached the original target of 2.8 million new acceptors. The project was so successful that USAID awarded IPPF/WHR a new 5-year (1992-97) Transition Project. In Latin America and the Caribbean, its goals are to increase people's freedom to choose the number and spacing of their children and to promote a population growth rate appropriate to each country's socioeconomic development goals by helping some FPAs to become sustainable without USAID funding. Strengthening the institutional capacity of FP programs and evaluation of their performance and impact are 2 ways to achieve these goals. BEMFAM/Brazil, PROFAMILIA/Colombia, MEXFAM/Mexico, INPPARES/Peru, APROFA/Chile, CEPEP/Paraguay, AUPFIRH/Uruguay, FPATT/Trinidad and Tobago, PLAFAM/Venezuela, and BFLA/Belize have received matching subcontracts for FP service delivery and sustainability. IPPF/WHR considers Brazil, Colombia, Peru, and Mexico to be high-priority countries, largely because they have more than 60% of the population of Latin America. About 81% of Transition Project funds will go to in-country sub-grants and on regional activities, matched on a 1-to-1 basis. 86% of subcontracts will go to Colombia, Mexico, and Peru. Technical assistance and funding are also targeted to HIV/AIDS and sexually transmitted disease prevention.
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  17. 17

    Strategic planning for the expansion of family planning.

    Merrick TW

    Washington, D.C., Futures Group, Options for Population Policy, 1993 Feb. [2], 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.
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  18. 18

    USA President Clinton acts to ensure reproductive health.

    IPPF OPEN FILE. 1993 Feb; 1.

    In 1984, in Mexico City, the Reagan administration announced its policy prohibiting USAID from supporting any nongovernmental organization which used its own or US funds for any abortion-related activities. Even though this policy was intended to reduce the incidence of abortion, it had the opposite effect because the cut in funding left some areas of the developing world with no family planning services or information at all. Further, this policy resulted in a loss of $17 million (US) or 25% of the budget of the International Planned Parenthood Federation (IPPF). On January 22, 1993, US President Clinton reversed this policy. IPPF considered President Clinton's action to be a significant event for women's health, human rights, and global development. This reversal will provide family planning services to about 300 million couples who want to practice family planning but could not do so because they did not have access to it. Shortly after President Clinton's announcement, IPPF began writing a proposal to USAID for funds to restore programs that the Mexico City policy eliminated. IPPF hoped the reversal would spark international recognition of the need for safe access to abortion. Other actions President Clinton has taken to promote reproductive health are reversing the Reagan and Bush administrations' rule prohibiting abortion counseling at federally-funded clinics, requesting that the US Food and Drug Administration study the possible marketing of RU-486, removing the ban on abortion in military hospitals, approving regulations allowing fetal tissue research, and appointing an abortion rights advocate as Surgeon General. The Catholic Church opposed all of Clinton's abortion policies. However, many congregations, priests, and Vatican officials are dissatisfied with the Pope's anticontraception position.
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  19. 19

    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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  20. 20

    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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  21. 21

    Condoms becoming more popular.

    Manuel J

    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.
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  22. 22

    Can AIDS prevention move to sufficient scale?

    Slutkin G

    NETWORK. 1993 May; 13(4):16-7.

    Much has been learned about which AIDS prevention interventions are effective and what an AIDS prevention program should look like. It is also clear that important program issues must be worked out at the country level if effective interventions are to be had. Programs with successful interventions and approaches in most countries, however, have yet to be implemented on a sufficiently large scale. While some national programs are beginning to use proven interventions and are moving toward implementing full-scale national AIDS programs, most AIDS prevention programs do not incorporate condom marketing, are not using mass media and advertising in a well-programmed way, do not have peer projects to reach most at-risk populations, and do not have systems in place to diagnose and treat persons with sexually transmitted diseases (STD). Far more planning and resources for AIDS prevention are needed from national and international public and private sectors. International efforts by the World Health Organization (WHO), UNICEF, UNDP, UNESCO, UNFPA, and the World Bank have increased markedly over the past few years. Bilaterally, the US, Sweden, United Kingdom, Canada, Netherlands, Norway, Denmark, Japan, Germany, France, and other countries are contributing to WHO/GPA and to direct bilateral AIDS prevention activities. USAID happens to be the largest single contributor to WHO/GPA and is also the largest bilateral program with its $168 millions AIDSCAP funded over 5 years. AIDSCAP integrates condom distribution and marketing, STD prevention and control, behavioral change and communication strategies through person-to-person and mass media approaches, and strong evaluation components. AIDSCAP can help fulfill the need to demonstrate that programs can be developed on a country-wide level by showing how behavior can be changed in a broad geographical area.
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  23. 23
    Peer Reviewed

    Study and introduction of family planning methods in developing countries.

    Rivera R

    ANNALS OF MEDICINE. 1993 Feb; 25(1):57-60.

    A key element of international support for family planning programs in developing countries is research in the development, evaluation, and introduction of family planning methods and services. These countries have the capacity to do high quality contraceptive research (from early preclinical research to phase III clinical trials). 3 international organizations are leaders in collaborating with researchers in developing countries to develop and support a network of clinical research centers in family planning. USAID assists 2 of these organizations because of its interest in family planning research: The Population Council and Family Health International. The Population Council's chief goal is the development and introduction of new contraceptive modalities. The Council developed Norplant, the sole new contraceptive approved by the US Food and Drug Administration in recent years. The International Committee for Contraceptive Research (ICCR) implements most of the Council's development program. ICCR consists of a group of research clinics and laboratories in Chile, the Dominican Republic, Finland, France, India, and the US. It is responsible for the development of 3 Copper-T IUDs and a levonorgestrel-releasing IUD. Family Health International conducts evaluation of family planning programs, epidemiological research in reproductive health, and clinical trials. WHO's Special Programme of Research, Development and Research Training in Human Reproduction is the other major player in family planning research in developing countries, specifically, assessment of contraceptive safety and efficacy, development of new contraceptives, and infertility. WHO and the Rockefeller Foundation have established a South to South collaboration in research to promote cooperation between developing countries. National and international agencies need to further develop and maintain these various international efforts.
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