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Karachi, Pakistan, APWA, .  p.The All Pakistan Women's Association (APWA), established in 1949 and granted consultative status with the UN in 1952, seeks to further the moral, social, economic, and legal status of Pakistani women and children. On the international level, APWA has played a leading role in promoting collaboration and a sharing of experiences on women's and children's issues among nongovernmental organizations. In addition, the APWA campaigns for international security conflict resolution and disarmament and was the 1987 recipient of the UN Peace Messenger Certificate. Within Pakistan, the provision of health care services to women and children in rural areas, urban slums, and squatter settlements is a priority. 56 family welfare centers have been established by APWA to provide family planning education and services, prenatal care, maternal-child health referrals, immunization, oral rehydration, breast feeding promotion, basic curative care, and group meetings. No other family planning services are available in the areas where these centers are located. The centers are staffed by a female health visitor, who provides a range of contraceptive methods and follows up acceptors, and motivators, who provide family planning education in the community. The motivator also recruits a volunteer in each community who opens her home as a place for weekly group meetings and contraceptive distribution. APWA's strategy, however, is to introduce family planning through community development projects aimed at income generation, child care, nutritional education, and primary and adult education. Since 1987, comprehensive rural development projects have been carried out in 20 villages in all 4 provinces. Another emphasis has been the improvement of women's status through legal action. The APWA was instrumental in having an equal rights for women clause inserted in the 1972 Interim Constitution and succeeded in preventing passage of an ordinance that would have made compensation for the murder of a woman half that for the murder of a man.
Geneva, Switzerland, World Health Organization [WHO], Division of Family Health, Maternal Health and Safe Motherhood Programme, 1992. , 75, viii p. (WHO/MCH/MSM/92.7)WHO's Maternal Health and Safe Motherhood Programme asked the Appropriate Health Resources and Technologies Action Group (AHRTAG) to compile this directory of organizations willing to provide funding to nongovernmental organizations to either strengthen existing maternal health and safe motherhood programs or implement such programs in developing countries thereby improving maternal health. The introduction gives general background information about the Safe Motherhood Initiative and explains how to use the directory. The directory lists the agencies willing to provide support by country. It also has a section on each agency listing the address; telephone, telex, and FAX numbers; types of projects each agency is willing to support; information on funding (grant size and length of project requirements); and conditions for support. The directory provides a section with general guidelines on how to prepare a project proposal to be submitted to the listed organizations. For example, it stresses that the proposal should be concise and short and include the following: summary of no more than 1 page in length, organizational background, statement of need, aims and objectives, strategy/workplan, monitoring, evaluation, and budget. The Appendix lists organizations that did not respond to AHRTAG's survey.
Ann Arbor, Michigan, University of Michigan, Dept. of Population Planning and International Health, . xxxiii, 134 p.In August 1989, scientists and leaders of international and national groups met at the international symposium for the Survival of Mankind in Tokyo, Japan, to discuss ideas about the interrelationship between population, environment, and development and obstacles to attaining sustainable development. The President of the Worldwatch Institute opened the symposium with a talk about energy, food, and population. Of fossil fuels, nuclear power, and solar energy, only the clean and efficient solar energy can provide sustainable development. Humanity has extended arable lands and irrigation causing soil erosion, reduced water tables, produced water shortages, and increased salivation. Thus agricultural advances since the 1950s cannot continue to raise crop yields. He also emphasized the need to halt population growth. He suggested Japan provide more international assistance for sustainable development. This talk stimulated a lively debate. The 2nd session addressed the question whether the planet can support 5. 2 billion people (1989 population). The Executive Director of UNFPA informed the audience that research shows that various factors are needed for a successful population program: political will, a national plan, a prudent assessment of the sociocultural context, support from government agencies, community participation, and improvement of women's status. Other topics discussed during this session were urbanization, deforestation, and international environmental regulation. The 3rd session covered various ways leading to North-South cooperation. A Chinese participant suggested the establishment of an international environmental protection fund which would assist developing countries with their transition to sustainable development and to develop clean energy technologies and environmental restoration. Another participant proposed formation of a North-South Center in Japan. The 4th session centered around means to balance population needs, environmental protection, and socioeconomic development.
Proceedings of the Caribbean Regional Conference "Operations Research: Key to Management and Policy", Dover Convention Centre, St. Lawrence, Barbados, May 31 - June 2, 1989.
[New York, New York], Population Council, 1989. 19,  p.Objectives, proceedings, and conclusions of a Caribbean regional conference on operations research (OR) in maternal-child health and family planning programs (FP/MCH) are summarized. Sponsored by the Population Council, USAID, and UNICEF, participants included policy makers, program managers, service providers, and representatives from international agencies in health and family planning from Antigua and Barbuda, Barbados, Dominica, Grenada, Jamaica, Mexico, St. Kitts-Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago, and the U.S. The conference was held with hopes of contributing to the legitimization of OR as a management tool, and helping to develop a network of program directors and researchers interested in using OR for program improvement. Specifically, participants were called upon to review the progress and results of recent regional OR projects, analyze the utilization of these projects by policy makers and program managers, highlight regional quality of care, and establish directions for future projects in the region. Overall, the conference contributed to the dissemination and documentation of OR, and provided a forum in which to identify important service, research, and policy issues for the future. OR can improve FP/MCH services, and make positive contributions to the social impact of these programs. The unmet need of teenagers and men and structural adjustment were identified as issues of concern. Strategies will need to be developed to maintain currently high levels of contraceptive prevalence, while responding to the needs of special groups, with OR expected to focus on the quality of care especially in education and counseling, and screening and user follow-up. The technical competence of service providers and follow-up mechanisms are both in need of improvement, while stronger institutional and management capabilities should be developed through training and human resource development.
Women's health and safe motherhood: the role of the obstetrician and gynaecologist, a report of a pre-congress workshop organized by the joint WHO/FIGO Task Force, Rio de Janeiro, Brazil, 19-20 October 1988.
Geneva, Switzerland, WHO, Division of Family Health, Programme on Maternal and Child Health, 1989. ii, 22 p. (WHO/MCH/89.3)Objectives, conclusions, and recommendations are given from the pre-congress workshop jointly convened in 1988 for the 12th World Congress of Gynecology and Obstetrics by the WHO and the International Federation of Gynecology and Obstetrics (FIGO). Objectives included: 1) Giving a definition for the role played by national OB/GYN societies as well as other professional associations in research, education, and training for women's health and safe motherhood. 2) Developing the means for collaboration between groups. 3) Appraising the collaboration between WHO and FIGO. Conclusions and recommendations included improving curricula for medical and graduate students, identifying important research issues, designing data forms to record pregnancy outcomes, designing screening and test risk-scoring systems, and evaluating educational campaigns, traditional birth attendant (TBA) training, improvements for providing prenatal care, the area of obstetric hemorrhage, and systems of communication and transportation in emergencies. It is important to have good working relations between women's organizations, midwives, and nurses and OB/GYN societies. A list of participants in the workshop is given.
Maseru, Lesotho, Lesotho Planned Parenthood Association, . , 107 p.The Lesotho Planned Parenthood Association is a private voluntary organization whose objectives are to assist government and other agencies in motivating and educating the public to understand and accept family planning and to provide family planning services to potential acceptors. It has the full support of the government of Lesotho, including the King, Moshoeshoe II. The Association also receives financial support from the International Planned Parenthood Federation. Projects were implemented during 1987 under all of the 4 major strategies of the Association: to rationalize and upgrade the Association's management capacity; to promote wider family planning awareness, acceptance, and practice; to reach specific groups with family life education; and to develop resources toward financial self-reliance. 4 management development seminars and several management workshops were organized and held. Family planning services continued to be offered in 7 government hospitals and 2 rented facilities, and community-based distribution of contraceptives continued. Family planning program awareness efforts were intensified through house and office visits, maternal-child health/family planning clinics, and other methods; and seminars were held for chiefs and church leaders. Efforts were made to recruit additional volunteers through various social functions. Field workers gave educational lectures at several industrial and business locations to try to motivate more men to participate in family planning, and a workshop was held for training teachers in family life education. Fund raising activities were only partially successful, since only 2/3 of the target sum was reached. 2 major events of 1987 were the finalization of the Personnel Management Policy Manual and the procurement of a loan for the building project from the Lesotho Building Finance Corporation. Overall, 1987 was not a successful year for program implementation, due partly to poor budgeting and management problems and a high rate of staff turnover within the Association and partly to external factors, including the severity of the winter and the return of the striking miners from South Africa, which caused widespread unemployment in Lesotho.
St. John's, Antigua, CFPA, 1987. 39 p.In the 1920s 1/3 of the children in the Caribbean area died before age 5, and life expectancy was 35 years; today life expectancy is 70 years. In the early 1960s only 50,000 women used birth control; in the mid-1980s 500,000 do, but this is still only 1/2 of all reproductive age women. During 1987 the governments of St. Lucia, Dominica and Grenada adopted formal population policies; and the Caribbean Family Planning Affiliation (CFPA) called for the introduction of sex education in all Caribbean schools for the specific purpose of reducing the high teenage pregnancy rate of 120/1000. CFPA received funds from the US Agency for International Development and the United Nations Fund for Population Activities to assist in its annual multimedia IEC campaigns directed particularly at teenagers and young adults. CFPA worked with other nongovernmental organizations to conduct seminars on population and development and family life education in schools. In 1986-87 CFPA held a short story contest to heighten teenage awareness of family planning. The CFPA and its member countries observed the 3rd Annual Family Planning Day on November 21, 1987; and Stichting Lobi, the Family Planning Association of Suriname celebrated its 20th anniversary on February 29, 1988. CFPA affiliate countries made strides in 1987 in areas of sex education, including AIDS education, teenage pregnancy prevention, and outreach programs. The CFPA Annual Report concludes with financial statements, a list of member associations, and the names of CFPA officers.
Arlington, Virginia, John Snow, Inc., Resources for Child Health Project, 1988.  p.The Resources for Child Health (REACH) has produced an IMMUNIZATION DIRECTORY which describes the immunization-related roles played by the host country governments, the major donors, and the (primarily US-based) private voluntary organizations on a country-by-country basis. The primary countries highlighted in this directory are those designated by the Agency for International Development as the 22 "Child Survival Emphasis" countries. The basic data for each country includes 1) basic demographic data, 2) national policies, 3) delivery strategies, 4) technical aspects, 5) the official immunization schedule, and 5) the activities of various international agencies. Data is included for Cameroon, Kenya, Madagascar, Malawi, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sudan, Uganda, Zaire, Zimbabwe, Bangladesh, Egypt, India, Indonesia, Morocco, Nepal, Pakistan, Philippines, Yemen, Bolivia, Ecuador, Guatemala, Haiti, Honduras, and Peru.
Status of family planning activities and involvement of international agencies in the Caribbean region [chart].
[Unpublished] 1970. 1 p.Add to my documents.
Brunswick, GA, MAP International, Learning Resource Center, 1987 May. 64 p.This guide is a complete revision and expansion of a select, annotated bibliography prepared by MAP International in 1980. The bibliography gives a reading list of key books and periodicals in health and development. Resources have been selected to introduce concepts that are current in the field. Several changes have been made in the format, such as incorporating the periodicals into the subject sections and providing author/title indexes. A new section on Social Marketing has been added, along with over 25 books and 8 periodicals. All price, availability and organization information has been updated. Resources are included which are reasonably priced so that field workers can develop their libraries of practical information. The contents are grouped under the following headings: adult learning; appropriate technology; church and social responsibility; crosscultural information; development; evaluation; health; social marketing; and organizations.
[Unpublished] 1985. 114 p.This document is a practical guide to help those Planned Parenthood Associations which want to establish contraception and counseling services for young people. It draws its examples from the considerable experience of selected European countries in what can be controversial and difficult areas. In the section devoted to adolescent sexuality and contraception, contributors cover culture and subculture, health and sexuality, sexual behavior and contraceptive services, the adolescent experience, the question of opposition to services for adolescents, and statistical indices. 1 section is devoted to examples of contraceptive counseling services for adolescents in Sweden, Italy, France, the UK, and Poland. Another section summarizes service provision examples. The 5th section presents methodology for the establishment of adolescents services and the final section discusses methodology testing of new projects. This report contends that the case for the rapid development of contraceptive/counseling services, tailored to the needs and desires of young people, is justified on moral as well as on sociological, psychological, and health grounds. It rejects totally the argument that any measure which could facilitate the sexual debut of the unmarried or legally dependent adolescent should be resisted. It does recognize public concern about family breakdown and the potential health risks of sexual activity but considers the examples given as measures designed to combat rather than ignore these. Taking into account sociological, psychological, and medical evidence, the contributors to this report challenge the following presumptions: sexual activity among the young is always and necessarily morally unacceptable and socially destructive; adolescents will resort to promiscuous sexual activity in the absence of legal deterrents such as refusal of access to contraceptive/counseling services; the potential health risks of sexual activity and use of contraceptives during adolescence provide sufficient justification for deterrent measures, including refusal of contraceptive/counseling services; and the scale of sexual ignorance and prevalence of unplanned pregnancy among adolescents can only be reduced by disincentives and deterrents to sexual activity itself. The case for the provision of contraceptive/counseling services rests on their potential to help adolescents to recognize and resist repressive forms of sexual activity, which are destructive of humanmanships. Evidence suggests that it is not difficult to attract a large cross-section of an adolescent public to use contraceptive/counseling services, where established.
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
Action now toward more responsible parenthood worldwide. (Proceedings of the Tokyo International Symposium, Tokyo, April 4-7, 1977).
Tokyo, Japan, Japan Science Society, 1977. 578 p.The Tokyo International Symposium reviewed the progress made since 1974 in integrating population policies with socioeconomic development, with additional focus on needs of rural areas. It was discovered that even countries experiencing economic growth have still failed to provide basic human needs - health, nutrition, housing, education, and employment - and that in densely populated rural areas, and marginal districts of cities, fertility decline has been slow or nonexistant. New evidence presented at the symposium suggested that now a new stage of population history is approaching, characterized by falling birth rates and slackening of world population growth; nevertheless, rapid population growth in developing countries has not ended because 1) of the high proportion of young people in many countries and 2) the fertility rates of the poorest half of the population are 50% higher than the national averages. While projections of world population are being revised downward, world population is still likely to grow from its present 4 billion to 6 billion by the turn of the century. All agencies, official or private, need to emphasize development of cost-effective methods which the government may adopt after a successful pilot study that take into account the social values, religious beliefs, and customs in each country. The symposium urges that additional resources be made available for a broad range of new initiatives in the following areas: 1) to make the fullest range of family planning services available in rural areas and marginal districts of cities; 2) to expand the social and economic roles of women and to improve their status in other fields; 3) to educate adolescents and young adults about their reproductive behavior and to underscore the impact that premature parenthood would have on themselves, their families, and communities; 4) to integrate family planning with development activities; and 5) to encourage program design by affected populations.
Financial management of population/family planning programmes. (A report of the IGCC Regional Workshop/Seminar, Manila, Phili
Kuala Lumpur, Malaysia, IGCC, 1976. 176 p.17 participants from 6 Inter-Governmental Coordinating Committee (IGCC) member countries (Indonesia, Malaysia, Nepal, Philippines, Singapore, and Thailand) took part in the IGCC Regional Workshop/Seminar on the Financial Management of Population and Family Planning Programs held in the Philippines in March 1976. In addition to the country papers, papers were presented on the following topics: 1) an operational framework for management of family planning programs; 2) planning, programming, budgeting system; 3) planning, programming, and budgeting in brief; 4) acounting and auditing concepts, tools and techniques; 5) accounting and auditing; 6) cost benefit and cost-effectiveness analysis in family planning programs; 7) cost-effectiveness and cost-benefit from the Philippine family planning program; 8) financial resources and management of the International Planned Parenthood Federation; and 9) the innovative role of United Nations Fund for Population Activities within the United Nations system. Gerardo P. Sicat in a keynote address spoke of the need for cost effective analysis and the finance managers' role in such analysis. He urged finance managers of population programs to assist in effectively mobilizing scarce financial resource to promote the success of the population program.
Geveva, Switzerland, UNAIDS, 1999 Jun. 58 p. (UNAIDS/99.8E)In response to the growing demand for HIV testing, several organizations converged to discuss the need for anonymous and voluntary counseling and testing services in Uganda. The result of these collaborative discussions was the opening of AIDS Information Center (AIC) in February 1990. The Center operates with the understanding that knowledge of one's own HIV infection status is an important intervention in controlling HIV infection. Since 1990, AIC has served more than 370,000 clients in Kampala and at branch offices in Jinja, Mbarata and Mbale. AIC services include same-day HIV testing and counseling, on-going psychological and medical support through the Post Test Club, counseling and treatment for sexually transmitted diseases and other medical problems, tuberculosis information and referral, training of Peer Educators, family planning services, condom distribution and community outreach programs. This best practice collection case study has been prepared together with the Joint UN Programme on HIV/AIDS (UNAIDS) in an effort to share the experiences with HIV testing, counseling and associated services at AIC in Uganda. This booklet includes Uganda's profile; AIC's history, geographic distribution of services, protocols in HIV counseling and testing, complementary integrated services, community outreach programs, staff training programs; the effect of voluntary counseling and testing on risk reduction; AIC's financial support; and the lessons learned.
Watertown, Massachusetts, Pathfinder International, 1994. 20,  p.Pathfinder International (PI) provides funding and technical support to local projects in over 25 developing countries in order to increase accessibility to high quality family planning (FP) services. In this PI annual report, the president of PI discusses the organization's role in the preparations for the 1994 International Conference on Population and Development and PI's hopes for the outcome of the Conference. The President also mentions two PI projects incorporating FP services into broader concerns: 1) a $11.5 million project in Uganda to integrate HIV/AIDS services with FP programs and 2) FP services expansion in Viet Nam, including a clinical FP training-of-trainers program. An overview of the year's achievements shows that 26% of PI's funds were committed to 9 African countries where PI provided managerial and technical assistance to local groups and convened a symposium on ways to coordinate HIV/AIDS and FP activities. In 1994, 50% of PI's funds went to 7 countries in the Asia/Near East region. Because PI had secured private funding to keep its program in Indonesia alive in 1989 when USAID funding ceased, PI was chosen to play a major role in USAID's $10 million Service Delivery Expansion Support project in Indonesia in 1994. This program emphasized quality of care, which can be measured by choice of methods available, client awareness, provider technical competence, continuity of care, and service site conditions. In Latin America, 24% of project funds were allocated to 7 countries for postabortal and postpartum FP services and programs to improve the quality of FP services. This annual report includes a list of foundations, corporations, and individuals who contributed funding during 1994 and ends with a financial statement.
HEALTH FOR THE MILLIONS. 1993 Jun; 1(3):8-10.India has massive problems and is in need of improving and expanding non governmental organization (NGO) programs by broadening the scope of NGO activities, identifying successful NGO activities, and by moving closer to the community to participate in their activities. The problems and experience in the last few decades indicate that with expansion bureaucratization takes place. The institution begins to depend on donors and follows donor-driven agendas. As more money is given by the government, many more so called GONGO or Government-NGO projects materialize. Another problem is that the government almost always approaches the NGOs for the implementation of a project, and there is complete lack of cooperation at the planning stage. The government is considering a loan from the World Bank and UNICEF to launch a mother and child health program, but there has not been any discussion with the dozens of people who have worked on issues concerning mother and child health issues for many years. There is a need to be more demanding of the government about the various programs that are implemented for the government. Very few NGO health and family welfare projects are run by ordinary nurses or ordinary Ayurvedic doctors under ordinary conditions. Since successful NGO work has to be extended to other parts of the country, they will have to be run by ordinary people with very ordinary resources. Over the years, the NGO community has become preoccupied with its own agenda. Today, despite very sophisticated equipment and infrastructure, they are not able to reach the 60,000-70,000 workers and employees. Some of the ideas with respect to the strengthens and weaknesses of community participation have to be shared. NGOs should include all the existing non governmental organizations throughout the country, and have a dialogue with other nongovernmental bodies such as trade unions. The challenge is to adjust the current agenda, prevailing style, and present way of operating and move closer to the people.
Lancet. 1993 Aug 7; 342(8867):360.In May 1993 in France, Doctors without Borders, Epicentre, and INSERM met to develop a practical protocol for treatment of severely malnourished children in refugee camps and to discuss use of WHO's oral rehydration solution (ORS) for treating the children who may be dehydrated. The suggested treatment formula for catch-up growth for severely malnourished children is 80 gm dried skimmed milk; 50 gm sugar; and 60 gm oil, minerals, and vitamins per liter of feed (energy density; 1 kcal/ml). Adequate potassium, magnesium, zinc, copper, selenium, iodine, and each of the vitamins must be part of this diet. (Concentrations adequate for repletion and rapid recovery of malnourished children ingesting 100-200 ml/kg/day are tabulated in the article.) The various vitamins and minerals must be packaged separately to assure stability. During the early treatment stages, refugee workers should give this formula, diluted 3:1, either orally or through a nasogastric tube. They should administer 100 ml/kg/day of the formula (133 ml with water) during the first few days. Once the children regain their appetite, refugee workers should increase the undiluted feed to about 200 ml/kg/day. Refrigeration or lactobacillus fermentation prevent pathogenic contamination of the formula. Fermentation reduces the pH and the risk of lactose intolerance and generates antibacterial products. The potassium concentration of WHO-ORS is too low and the sodium concentration too high for severely malnourished children, especially those with kwashiorkor and marasmic-kwashiorkor. Further, it does not contain the minerals needed to stop diarrhea. Refugee workers can mix 1 WHO-ORS packet, 1 sachet of each mineral used in making the formula, and 50 gm sugar in 2 l of water to make an isotonic rehydration solution. A field trial in refugee camps in Ethiopia showed that this formula and modified WHO-ORS are practical and acceptable. Participants also suggested administering broad-spectrum antibiotic treatment, parenteral vitamin A, and measles vaccine to all children, regardless of HIV status.
AUSTRALIAN NURSES JOURNAL. 1992 May; 21(10):22-4.The work of a well-baby nurse employed by Medicine Sans Frontieres, Belgium (MSF), in Section 9 of the Whitehead Detention Center (WHDC), occupied mostly by Vietnamese people and located in the New Territories of Hong Kong, started on June 1, 1990. There were 3241 residents, of whom 563 were children under 5 years olds. Save the Children Fund (SCF) and MSF ran the well-baby clinics. The Hong Kong government managed the family planning and immunization clinics. International agencies and voluntary groups were responsible for education, recreation, social work, clothing, and excursions. A random nutritional survey conducted in several camps in July 1989 showed that approximately 15% of the children between 6 months and 5 years old were in the borderline category of malnutrition (80-85% of normal weight for height;l less than 80% indicated undernourishment). Survey in 1990 and 1991 showed that children aged between 6 and 24 months were the most often malnourished. Very few babies over one year were breastfed, and some were receiving an inadequate diet. A pilot study was conducted on the effects of a supplementary feeding program giving the 16 underweight children half a teaspoon of soy oil per day. Children whose weight was less than 75% of the norm were also given yakult and banana daily. The results after 26 days showed that 12 children had weight gains of between 50 grams and 800 grams. The program was continued until each child's weight was more than 85% of the norm to two months. Subsequent to these results, the United Nations High Commission of Refugees, SCF, and MSF set up a management program for all children whose weight was less than 80% of the norm and children who weighed more than 80% but were not gaining weight. When children completed the program and/or had made satisfactory weight gains their intake of soy oil supplements was gradually halved and then stopped.
HEALTH FOR THE MILLIONS. 1993 Apr; 1(2):14-7.Approximately 80% of the rural population in developing countries do not have access to appropriate curative care. The primary health care (PHC) approach emphasizes promotive and preventive services. Yet most people in developing countries consider curative care to be more important. Thus, PHC should include curative and rehabilitative care along with preventive and promotive care. The conflict between preventive and curative care is apparent at the community level, among health workers from all levels of the health system, and among policy makers. Community members are sometimes willing to pay for curative services but not preventive services. Further, they believe that they already know enough to prevent illness. Community health workers (CHWs), the mainstays of most PHC projects are trained in preventive efforts, but this hinders their effectiveness, since the community expects curative care. Besides, 66% of villagers' health problems require curative care. Further, CHWs are isolated from health professionals, adding to their inability to effect positive change. Health professionals are often unable to set up a relationship of trust with the community, largely due to their urban-based medical education. They tend not to explain treatment to patients or to simplify explanations in a condescending manner. They also mystify diseases, preventing people from understanding their own bodies and managing their illnesses. National governments often misinterpret national health policies promoting PHC and implement them from a top-down approach rather than from the bottom-up PHC-advocated approach. Nongovernmental organizations (NGOs) and international agencies also interpret PHC in different ways. Still, strong partnerships between government, NGOs, private sector, and international agencies are needed for effective implementation of PHC. Yet, many countries continue to have complex hierarchical social structures, inequitable distribution, and inadequate resources, making it difficult to implement effective PHC.
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.
SAFE MOTHERHOOD NEWSLETTER. 1993 Feb; (10):4-5.WHO, the International Confederation of Midwives, the International Federation of Gynecology and Obstetrics, and other health professionals are jointly developing training programs to improve the skills of health professionals who attend pregnant women during delivery. 4 principles identified by WHO's Maternal Health and Safe Motherhood Programme to consider when revising training programs revolve around delegation, team work, community orientation, and participation. These training programs need to improve the skills of personnel at the most peripheral level of the health care system so they can do necessary treatments and tasks. The focal point of the team should be the midwife who handles all normal deliveries and adequately manages many complications. The training programs grant midwifery training the top priority. They need to persuade participants of the need to focus on community needs and to foster community participation. They should also stress the need for service providers to listen to mothers and invite them to be involved in making decisions affecting their health. The programs should train a team consisting of a physician, midwife, community health worker, and administrator who will be based primarily in a health center while some teams will work out of a district hospital. WHO advocates that all physicians receive training in community obstetrics. Existing health services should include traditional birth attendants as their link to mothers. All training plans should incorporate supportive supervision, i.e., the supervisor should support rather than control, motivate, and assign responsibility to subordinates. Things for health planners to consider when determining allocation of resources are the cost for a pregnant woman to receive prenatal, delivery, and postnatal care, e.g.is almost 5 times more expensive in a large hospital as it is in a small hospital, clinic, or health center and it is about 6 times more expensive to train a physician as it is a midwife or a nurse.
HEALTH POLICY AND PLANNING. 1992 Dec; 7(4):364-74.The Director of WHO's Regional Office for Africa presents a health development framework based on the primary health care (PHC) concept. the government should review national health policies, national health strategies, and national heath services to resolve basic issues. Then it should define the framework for health development by breaking down the goal into operational target-oriented subgoals for individuals, families, and communities, by creating health districts as operational units, and by organizing support for community health. Once this framework has been decided, the government should use it to restructure the national health systems. At the district level, health and development committees, helped by community health workers, and district health teams would be responsible for community health education and activities. The provincial health offices would oversee district activities, select and adapt technologies, and provide technical support to communities. A board would manage the provincial hospitals (public, private, and voluntary). These hospitals would work together to organize secondary medical care programs. A public health office wold link them with the provincial health centers. Other sectors would also be involved, e.g., departments of education and water. The national health ministry would set national policies, plans, and strategies. A suprasectoral health council would coordinate cooperation between universities and other sectors and external agencies. National capacity building would involve establishing management cycles of health development, using national specialists as health advisors, and placing health as a priority in development. To implement this framework, however, the government needs to surmount considerable structural economic, and social obstacles by at least decentralizing and integrating health and related programs at the local level, fostering a national dialogue, and promoting social mobilization.
INTEGRATION. 1992 Aug; (33):34-7.The Philippine Family Planning Program component of the UN Population Fund (UNFPA) defines the demand for family planning (FP) as the desire of couples to space or limit their children, and reduce the risks of pregnancy and childbirth. Although the teachings of the Catholic Church oppose FP, at the local level priests do not enforce this strict code. Funding is relatively sufficient, but the public support of legislators is lacking, and implementation is problematic. Nongovernmental organizations (NGOs) are instrumental in delivering 38% of FP health care service focusing on comprehensive reproductive health concerns of low- and middle-class women in urban areas exclusive of the very poor. The reporting system is ill-functioning, perinatal deaths often go unreported, and in remote areas underreporting is the rule. The collected data are not used for management or in the communities and municipalities. The prevalence of FP is 42-44%, but only 22-24% of it consists of effective methods. 23% of women aged 15-44 have unmet needs of FP. The program could be improved significantly in view of a 90% female literacy rate in 1991, an independent streak in women in urban areas, and a less male-oriented culture. The program of the UNFPA is on a 5-year cycle, and from 1993 the support of USAID, the World Bank, the German government, and the Japan International Cooperation Agency is expected.
Resolution 44/233: Prevention and control of acquired immunodeficiency syndrome (AIDS) [22 December 1989].
New York, New York, United Nations, 1990 Mar 15. 4 p. (A/RES/44/233)The UN General Assembly adopted a resolution on the prevention and control of AIDS during its 44th session in March 1990. It recognized WHO as directing and coordinating AIDS education, prevention, control, and research. It respects the human rights and dignity of people with HIV, their families, and people with whom they live. It hold that the fight against AIDS should be compatible with and not shift attention or resources from other public health priorities and development goals. It recognizes the social and economic effects of AIDS. It identifies that women and children are often at higher risk of HIV infection and may experience hardship as an indirect result of AIDS on their families and communities. It stresses the need for a supportive socioeconomic atmosphere to assure effective execution of national AIDS prevention programs and merciful care of affected persons. It calls for all sectors of society to reinforce local, national, and international efforts for HIV/AIDS prevention and control. It recognized the progress scientific research has made and emphasizes the need to offer affordable technologies and medicines as soon as possible. It appeals to the Secretary-General to work with the Director-General of WHO and other relevant organizations to deal with the likely grave consequences of the AIDS pandemic for socioeconomic development in some developing countries. It requests member nations to expand and promote national efforts to combat AIDS. It urges member nations, WHO, and other relevant organization to promote greater understanding of HIV transmission to dispel myths and to raise the public's awareness about people with HIV. It asks international, national, and research institutions to coordinate efforts to supply information to and to support policy of national AIDS committees and the global AIDS strategy. Thus the AIDS committees and WHO can appropriately develop AIDS policy and programs.