Your search found 53 Results
Adolescence Education Newsletter. 2004 Dec; 7(2):19-20.For three years (2001-2003), the approach was pilot-tested in two sites (Kamasakit, Dallah Township and Sarmalauk, Nyaungdone Township), giving rise to a number of communityoperated youth centres. The lessons from these pilot tests were described in a new publication by the UNFPA Country Technical Services Team in Bangkok: The crucial support of community leaders was key to the community-based approach. Advocacy was carried out in the initial stage of implementation with activities targeting both national and local leaders and influencers. Activities were implemented regularly in the form of meetings, orientation and training sessions, participatory training workshops and site visits from high-level officials. (excerpt)
Geneva, Switzerland, UNAIDS, 2001 Jun. 94 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/01.32E)Many approaches to HIV prevention and care require people to know their HIV status. The importance of voluntary counselling and testing (VCT) has brought about the wider promotion and development of VCT services. However, since the majority of countries where HIV has a major impact are also the poorest, the lack of resources has meant that VCT is often still not widely available in the highest-prevalence countries. For VCT services to be prioritized and for resources to be provided for their development, demonstrating the effectiveness of VCT is essential. One of the difficulties in evaluating VCT's effectiveness is the complexity of the VCT process and the wide range of possible outcomes. The term VCT has also been used in many contexts to cover a broad spectrum of interventions. In this article it includes interventions that comprise a minimum of pre- and post-test counselling associated with testing. However, it acknowledges that many VCT services offer ongoing/supportive counselling. This paper examines the diverse roles of VCT, considers the various outcomes of VCT that can be evaluated and discusses the limitations and difficulties associated with VCT evaluation. (excerpt)
WHO healthy cities and the US family support movements: a marriage made in heaven or estranged bed fellows?
Health Promotion International. 1996; 11(2):137-142.The family support movement in the US emerged at about the same time that the WHO Healthy Cities project was gaining momentum in Europe, and the underlying principles and ecologic frameworks of the two have much in common. However, while many 'Healthy Cities' in Europe have included activities that benefit families, this has not been made a major focus. There seems to be little awareness of experience gained in the US in terms of establishing programs with limited or no government funding, using volunteers, and developing social marketing and advocacy strategies sustain long term viability. Similarly, cities and states in the US are struggling to develop networks of family support programs and they appear to be doing this without the benefit of experience gained in Healthy Cities projects on how to engage political leadership, develop public policies, establish intersectoral councils, fund a coordinator position, mobilize neighborhoods, and evaluate community wide health promotion programs. The purpose of this paper is to examine how these two movements might join forces and learn from each other. (author's)
In: Women, international development, and politics: the bureaucratic mire. Updated and expanded edition, edited by Kathleen Staudt. Philadelphia, Pennsylvania, Temple University Press, 1997. 167-182.Using a feminist lens to inspect current PVO (private voluntary organization) family planning programs, we first define the feminist perspective as it applies to such programs and then compare that feminist vision with the reality found in the field. This paper examines the political dynamics of working for a feminist agenda within the community of population PVOs. The following case study illustrates these dynamics and leads to a discussion of both the obstacles to the realization of a feminist vision and the political strategies and attitudes that help implement this vision. Together, we draw on seventeen years of work with a variety of PVOs involved in family planning and reproductive health. (excerpt)
Sport for development and peace: towards achieving the Millennium Development Goals. Report from the United Nations Inter-Agency Task Force on Sport for Development and Peace.
New York, New York, United Nations, 2003. vi, 36 p.This report analyses in detail the potential contribution that sport can make towards achieving the United Nations Millennium Development Goals (MDGs). It provides an overview of the growing role that sports activities are playing in many United Nations programmes and crystallizes the lessons learned. It also includes recommendations aimed at maximizing and mainstreaming the use of sport. (excerpt)
Where there's a will there's a way. Nursing and midwifery champions in HIV / AIDS care in Southern Africa.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2003. 65 p. (Best Practice Collection; UNAIDS/03.19E)The report describes some of the many ‘champions’ of the profession—individuals who, with singular commitment and resourcefulness, are delivering good-quality care to people with HIV/AIDS, or who are otherwise helping families and communities to understand the epidemic, to come to terms with their own fears and prejudices, and to protect themselves from infection. However, this is not some kind of league of heroines and heroes of the epidemic. The champions featured here are just a few of the ordinary nurses and midwives who are simply doing their job well, under difficult circumstances. There are, without doubt, very many more of them. In describing the work of a few, the intention is to pay tribute to all who are doing a caring, committed job in the face of great odds, and to share as widely as possible the valuable lessons they have learned from experience. The report was commissioned by the SADC AIDS Network of Nurses and Midwives (SANNAM) in collaboration with UNAIDS. It involved original investigation in the field by a consultant who, over the course of one month, visited five countries in Southern Africa—namely, Botswana, Lesotho, Namibia, South Africa and Zambia—to link up with the national nursing associations and speak to a wide range of people. In addition to nurses and midwives, these included some of the people they work with in communities, such as volunteer caregivers, members of youth groups, and PLWHA and their families, as well as people working within ministries of health, and relevant United Nations agencies and nongovernmental organiza-tions. Besides being aimed at nurses and midwives themselves, the report is addressed at all those with an interest in improving the quality of care and support of people living with HIV/AIDS (PLWHA), especially those responsible for training, managing and supervising nursing and midwifery staff, and policy-makers within the health services. (excerpt)
[The role and responsibility of volunteers in context of APFs] Papel e responsabilidade dos voluntarios no contexto das APFs.
Sexualidade e Planeamento Familiar. 2001 Jan-Jun; (29-30):37-9.The International Planned Parenthood Federation (IPPF) is considered the primary organization in the world in the area of sexual and reproductive health, however, potential donors have viewed it as too rigid. The IPPF organized a task force to confront this charge and come up with recommendations for improvement. Their proposal was that IPPF should be comprised of a diverse collection of volunteers in terms of age, sex, socioeconomic origin, occupation, performance, race, creed as well as linguistic and geographical representation in such a way that this can represent the communities in which they function.
New Delhi, India, WHO, SEARO, 1991 Dec. , 35 p. (Regional Health Paper, SEARO, No. 20)The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
Colombo, Sri Lanka, Family Planning Association of Sri Lanka, 1989. 43 p.The Family Planning Association of Sri Lanka (FPASL) is a member of the International Planned Parenthood Federation (IPPF). According to the FPASL the family planning (FP) acceptor rate in 1988 declined by 22% compared to 1987 and is primarily the result of civil war and an election year. Because of complex political and sociological factors, people have been more concerned with staying alive, than with FP. District level programs designed to improve the quality of life for mothers and children were often halted during the end of the year because of terrorist activities and counter security measures. The following contraceptive methods experienced declines in acceptors: sterilization 48%, IUD 12%, pill 12%, injectables 8%, foam tablets 22%. In 1988 there were 629 vasectomies, and 393 tubectomies. Of the new acceptors of temporary methods 57.8% chose depo provera, 21.3% IUD, 15.9% orals, and 5% Norplant. Sales of contraceptives have changed with condom sales down 3.6%, orals up 7.5%, and foam down 78.25%. The Community Managed Integrated Rural Family Health Programme (CMIRFH) has been recognized globally as a story of success. Since 1980 over 45,000 people have volunteered to help this program. In 1988 1676 programs were carried out by these enthusiastic young volunteers. Of the 25,000 estimated villages in Sri Lanka, the FPASL and CMIRFH program had reached 1689 villages through the end of 1988. The Youth and Population Committee is trying to reach the young people with the message that the population is growing out of hand. In July a seminar was conducted when the population of Asia reached 3 billion.
London, England, International Planned Parenthood Federation [IPPF], 2001. xiv, 706 p.This book is collection of personal memoirs of Avabai Wadia, a long-time family planning (FP) advocate. Wadia describes the beginnings of the FP movement in India and the international networks that led to the formation of the International Planned Parenthood Federation (IPPF), now the world's largest voluntary organization in the field of sexual and reproductive health. Launched in 2001, the International Year of the Volunteer, this book also illustrates the vision behind volunteering, and the instincts of the millions of volunteers who support IPPF.
Real Lives. 2002 Jan; (7):40-1.This paper relates the experiences of a volunteer who has been with the Family Planning Association of Pakistan (FPAP) for five years. Invited by the FPAP to participate in a college drama competition at age 19, the young woman wrote a play on the theme “girl child” that was well received and won a best actress award. Eventually, the young woman became more involved in the organization, eventually representing them at national and international meetings.
REAL LIVES. 2001 Feb; (6):45-6.Volunteers offer commitment, a sense of welfare for the development of the individual and society, and free help when finances are constrained. Although they have brought about huge changes in societies, their role is evolving. The need for volunteers who will design, deliver and coordinate effective training programs has emerged. In turn, it must be recognized that these volunteers need to be motivated, monitored, and valued. There is also a need to re-examine volunteer policy and evaluate controversial issues such as job substitution, the role that volunteers should perform, and what support and benefits are offered to them. The UN has designated the year 2001 as the International Year of Volunteers, aiming to enhance recognition, facilitation, networking and promotion of voluntary service. In 2001, people should establish the importance of the volunteer as essential to peace, development, social integration, and a higher quality of life for all people everywhere.
AL-AHRAM. 1994 Jul 7-13;  p.An estimated 20,000 people will attend the UN International Conference on Population and Development to be held in Cairo, Egypt, in September 1994. The group of attenders will include approximately 5000 representatives of 191 countries and 57 international organizations, representatives of 1200 accredited nongovernmental organizations (NGOs), and 3000 journalists. As the conference approaches, the people charged with managing the logistics of this large group of visitors are gearing up. The official UN conference will be held in the Cairo International Conference Center (CICC), while a parallel NGO forum takes place in the neighboring indoor stadium in Nasr City. Participants will welcome the proximity of the two conference sites to each other. Transporting conference attenders from downtown Cairo to Heliopolis, the tendency for conferees to book late, staffing, and the youth volunteer group Friends of the Forum are discussed.
FORUM. 1997 Jul; 13(1):20-1.This article describes the activities of the Asociacion Demografica Salvadorena (ADS) in provision of family planning services and education in El Salvador. ADS works directly with UNFPA to provide sexual and reproductive health services to the working class population. The programs operate with El Salvador government funding and technical and financial support from UNFPA and are operated by a nongovernmental organization. Program efforts include operating public education programs, training of volunteers in sexual and reproductive health from a gender perspective, training for couples and individuals in decision-making, and raising women's levels of self-esteem and decision-making capabilities. The program operates 25 Reproductive Health Units (UDESARs) within various companies. Trained staff offer family planning, counseling services, testing for cervical and uterine cancer, breast self-exams, and HIV and sexually transmitted disease prevention and reduction of reproductive risk. UDESARs use volunteer disseminators who educate and motivate coworkers on a variety of sexual and reproductive health issues. ADS initiated program operations by first sensitizing and motivating company owners. Only 1 in 3 companies was willing to cooperate, provide office space for services, and allow worker motivators. UDESAR total staff includes 25 counselors and 82 disseminators for 12,500 workers. 80% of workers are women, and about 80% are aged <30 years. Industry will benefit from better planned pregnancies, fewer absences, and shorter maternity leave. Workers gain from family stability, increased proximity of services and improved health, greater gender equity, and reduced risk.
PEOPLE AND DEVELOPMENT CHALLENGES. 1997 May; 4(7):13-4.Member family planning associations in the East, South East Asia, and Oceania Region (ESEAOR) of the International Planned Parenthood Federation (IPPF) have long recognized the importance of having a strong volunteer base for resource development and program sustainability. About 60 volunteers currently participate in the Planned Parenthood Federation of Korea's (PPFK) hotline counseling service for adolescents launched in 1985 with financial assistance from the IPPF. Upon recruitment, the volunteer trainees receive 40 hours of basic training, followed by refresher training courses held 6 times per year. The volunteers, mostly women, are encouraged to fill in for each other when unexpected family problems arise. The difficult and delicate nature of sexuality counseling, however, has led some volunteers to abandon work in the counseling program. The Japan Family Planning Association's (JFPA) Reproductive Health Center Clinic is staffed by 1 full-time doctor, 4 part-time doctors, 1 full-time clerical staff, 30 part-time co-medicals who are mainly nurses and midwives, and 6 peer counselors who operate the hotline on infertility. The co-medicals are qualified family planning workers (FPWs) and adolescent health workers (AHWs) who receive a small honorarium for their services. FPWs must attend and pass the examination of the Licensing Course for FPW implemented by the JFPA and the Family Planning Federation of Japan. AHWs are trained by the JFPA under the auspices of the Health Ministry and the Japan Society of Adolescentology.
FPAN NEWSLETTER. 1996 May-Jun; 16(3):2.Two-day orientation programs conducted in Kathmandu, Dhankuta, Baglung, Dang, and Doti sought to familiarize Family Planning Association of Nepal (FPAN) volunteers with the association's new Strategic Plan. Papers were presented on the following topics: introduction to the International Planned Parenthood Federation (IPPF), introduction to FPAN, IPPF's member responsibilities and policies, responsibilities of the various volunteer committees, and roles of volunteers and staff in realization of the Strategic Plan. Recommendations and suggestions emanating from these orientations will be used as the basis for formulating a set of guidelines for FPAN volunteers.
FPAN NEWSLETTER. 1994 May-Jun; 14(3):1-2.The International Planned Parenthood Federation (IPPF) in conjunction with the Nepal Family Planning Association sponsored an orientation program for about 50 branch executives from Valley, Kavre, Chitwan, and Nawalparasi in May 1994. Other orientations were held in Pokhara, Dhangadhi, Surkhet, Dhanusha, and Morang on other occasions and in other locations for branch managers. The aim was to unveil the new 10 year strategic plan and to provide for the informing of volunteers and branch chiefs about the new plan's objectives. One objective was to facilitate the coordination between volunteers and family planning branch staff. The orientation program highlighted the importance of voluntarism in plan implementation and how to improve existing leadership and cooperation between levels and between staff and volunteers. The Central President of the Association provided well wishes for successful program implementation and reiterated that the role of volunteers had always been important and that the staff and volunteers complemented each other. The Senior Program Advisor of IPPF also gave his best wishes for the implementation of the strategic plan and commended the Nepal Association as the first to conduct an orientation program to familiarize its constituency about the IPPF objectives. Cooperation between volunteers and staffs was considered instrumental to program success. A description was provided of IPPF's organizational structure, funding, and operational system. The Central Treasurer of the Association spoke about the history of the Nepal program since its inception in 1959.
In: Implementing primary health care: experiences since Alma-Ata, edited by Pieter Streefland and Jarl Chabot. Amsterdam, Netherlands, Royal Tropical Institute, 1990. 33-40.Community health care in developing countries consists of 1) self-medication, traditional medicine, and modern drugs; 2) the activities of village health workers (VHW) and village health committees (VHC); and 3) the outreach activities of basic health services (BHS). The village population, with it social stratification, sustains community-based health care (CBHC). In Africa, the VHWs are young literate males trained in curative and preventive work, or older, illiterate female traditional birth attendants (TBAs). TBAs are part of traditional medicine. Training of both paramedical in a district health center provides the TBA with a delivery kit and the VHW with 10-15 essential drugs for treating common illnesses. BHS is often entangled in the skirmishes of governments eager to promote primary health care and non-governmental organizations testing CBHC initiatives. VHWs are pain in different ways: 1) regularly by the government as is the case in Liberia, Zimbabwe, and India; 2) through remuneration by the community; or 3) not at all (they volunteer their services). The preconditions of the viability of CBHC that it be tailored to a specific sociocultural situation (thus avoiding an ineffectual blueprint approach) and that outside donor support be used prudently beyond an initial training. The question of financial reward for the VHWs by the village, the household, or the individual is also linked to CBHC viability. The selection of VHWs and the composition of VHCs require careful deliberation. Successful CBHC mandates clear rules, accountability, and a clearly-defined operation.
New York, New York, AVSC, 1991. 28 p.The annual report for 1990-1991 of the Association for Voluntary Surgical Contraception (AVSC) enumerates changes that came about in 1990, accomplishments of the last decade, and then summarizes activities by region with a brief feature on 1 country in each. Some of the developments in 1990 included introduction of Norplant, a training workshop in Georgia for physicians from newly independent CIS states, and the Male Involvement Initiative. The Gulf War delayed major activities requiring travel. Overall, in 1990 the AVSC provided 133,328 sterilizations, 72% female and 28% male in 50 countries, trained 325 doctors, led 58 courses in counseling and voluntarism training 568 counselors, and published or collaborated on numerous professional articles and teaching materials. In-country work emphasized no-scalpel vasectomy and minilaparatomy female sterilization under local anesthesia. As an example of country projects in 20 African nations, a client-oriented, provider-efficient system for improving clinic management and quality of care called COPE, was the focus in Kenya. Male responsibility was an emphasis in Latin America. In India, where sterilization is the most popular contraceptive method, training centers were upgraded in 12 states. In the US, AVSC conducted training sessions for physicians in laparoscopy under local anesthesia.
New York, New York, UNFPA, . v, 69,  p. (Evaluation Report)In 1991, a mission in India, Bhutan and Nepal evaluated UNFPA/WHO South East Asian Regional Office (SEARO) maternal and child health/family planning (MCH/FP) projects. The Regional Advisory Team in MCH/FP Project (RT) placed more emphasis on the MCH component than the FP component. It included all priority areas identified in 1984, but did not include management until 1988. In fact, it delayed recruiting a technical officer and recruited someone who was unqualified and who performed poorly. SEARO improved cooperation between RT and community health units and named the team leader as regional adviser for family health. The RT team did not promote itself very well, however, Member countries and UNFPA did request technical assistance from RT for MCH/FP projects, especially operations research. RT also set up fruitful intercountry workshops. The team did not put much effort in training, adolescent health, and transfer of technology, though. Further RT project management was still weak. Overall SEARO had been able to follow the policies of governments, but often its advisors did not follow UNFPA guidelines when helping countries plan the design and strategy of country projects. Delays in approval were common in all the projects reviewed by the mission. Furthermore previous evaluations also identified this weakness. In addition, a project in Bhutan addressed mothers' concerns but ignored other women's roles such as managers of households and wage earners. Besides, little was done to include women's participation in health sector decision making at the basic health unit and at the central health ministry. In Nepal, institution building did not include advancement for women or encourage proactive role roles of qualified women medical professionals. In Bhutan, but not Nepal, fellowships and study tours helped increase the number of trained personnel attending intercountry activities.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
Summary of proceedings, Consultative Meeting on the Philippine Family Planning Program, 12-13 July 1990.
Manila, Philippines, Dept. of Health, 1990. , 35 p.This publication presents an overview of the Consultative Meeting on the Philippine Family Planning Program held on July 12-13, 1990, a conference designed to clarify the government's population policy and bring attention to the revitalization of family planning. Organized by the Department of Health (DOH) and non-governmental organizations (NGOs) involved in family planning, the meeting was also an effort to generate interest among external funding agencies in the Philippine Family Planning Program (PFPP). In the conference's keynote address, Secretary Cayetano W. Paderanga, Jr. described how population control is inseparably tied to economic growth and other development plans. His speech also explained the PFPP's guiding principle -- informed free choice. Another speaker discussed the rationale, objectives, implementation strategies and financial requirements of the PFPP. Some of the major issues discussed included: 1) the need to improve the political climate for family planning; 2) the need for community participation; 3) the mechanisms for horizontal and vertical coordination; and 4) financial concerns and the need for external assistance. The meeting also focused on the new dual role of the DOH, which now serves as both an implementing agency for service delivery and a coordinating agency for all other participating agencies. The contributions of NGOs, additional government agencies, and local governments were also discussed. Present for the proceedings, representatives of international agencies praised the initiatives of the Philippine government and expressed readiness for increased support. The publication contains the following annexes: a copy of the conference's schedule; a list of participants; transcripts of the welcoming remarks, keynote address, and closing remarks, and an integrated summary of papers.
MEDICINE AND WAR. 1989 Jul-Sep; 5(3):132-6.Health care in post war Nicaragua, specifically interventions directed at infant and child mortality, rehabilitation of war disabled and counseling of the aggrieved, was surveyed in a 2-week study tour by the Health Network of the (British) Nicaragua Solidarity Campaign in 1987. There has been a grassroots health program initiated by the Government to use a system of health "briagadistas" and "multipliers" whereby volunteers train others in immunization and oral rehydration. The workers who have only some primary education receive 2 weeks intensive training followed by 1 day per month. In the last 4 years 70 of these workers have been killed by Contras. The infant mortality rate was cut from 120/1000 live births in 1977 to 75 by 1983. Mass immunizations were held on special health weekends. Poliomyelitis has been eradicated; no cases of diphtheria have been reported since 1985; and the incidence of measles has fallen. Rehabilitation of persons disabled by loss of limbs is limited by facilities: only 1 42-bed rehabilitation hospital with 1 orthopedic surgeon donating a few hours per week is available for a population of 3.3 million. Outside donors have set up prosthetics and wheelchair workshops, using local materials as much as possible. There is also a center in Managua teaching manual trades to 75 disabled. About 65,000 people have died in the civil and Contra wars, about 3 times the death rate in Britain in World War II. Caregivers are being trained in grief counseling by teams from Mexico at Nicaragua's 2 medical schools.
HEALTH POLICY AND PLANNING. 1989 Sep; 4(3):239-43.The civil war in El Salvador has played havoc with health care, especially in rural places. The Catholic Archdiocese of San Salvador undertook a program to train village health promoters in an effort to alleviate the critical shortage of primary health care. Objectives of the program are the promotion of community development and health education along with taking medical care to where it is most needed. Volunteer promoters received a 4-week training course. From 1984 on, Aesculapius International Medicine, a private nonprofit international organization, took over the supervision and training of a group of promoters in the northern province of Chalatenango. The effectiveness of the program was reviewed by a continual review of health personnel at regular monthly meetings, and, if possible, by direct observation of their work. Those who had finished the initial training course and were working in their communities for at least 1 year were surveyed. The promoters were between 16 and 55 years of age. All had other responsibilities. The average education was the equivalent of a 2nd or 3rd grade US education. The training course was made up of 4 6-day sessions throughout the year. Basic needs of the individual, first aid, identification of community health problems, administration and medications, home care of the sick, diagnosis and treatment of common illnesses, environmental sanitation and nutrition are covered in the course. 47 students from 19 villages in the Chalatenango area started the basic course in 1984-5. In the 2nd year, an additional 2-week maternal/infant course was offered to those who had finished the basic course. Ongoing support of the promoters has been the most difficult part of the program. A questionnaire was given in interviews with 30 or 34 promoters who were working from November, 1986 to January, 1987. The survey showed that much more time was spent on treating illnesses than on community education. In 1987, a community education course was offered. There is a need for continued support and follow-up volunteer village health workers. (author's modified)