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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.
In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American Univeristy of Beirut, 1980. 13-21.During 1979, the International Year of the Child, the World Health Organization (WHO) encouraged efforts to improve the collection of information on health and health related problems faced by underprivileged populations. To focus attention on health care for children, the theme of this year's World Health Day on April 7 was the well being of the child. The slogan, "a healthy child, a sure future," was chosen to promote breastfeeding, oral rehydration, nutrition, education, and immunization against the 6 major childhood diseases included in WHO's expanded immunization program. Currently, less than 10% of children in developing countries receive immunization. WHO and its member countries have committed themselves to providing immunization services for every child in the world by 1990, as part of the goal of "health for all by 2000." WHO recommends that each country appoint a program manager and supporting staff to provide detailed plans of operation for immunization. Emphasis in the planning stage should be on the integration of immunization services within the primary health care network for each country. Diarrheal diseases rank among the 1st 3 leading causes of death in children, taking an estimated 5-18 million lives a year, particularly among children under age 5. Dr. Halfdan Mahler, Director General of WHO, has said that the task of safeguarding the health of children cannot be realized through conventional means. What is required is a "radical new approach" which emphasizes the mobilization of national and international resources, the imaginative use of traditional medicine, and the development of health technologies relevant to local needs. A WHO study in 8 developing countries found that 90% of all child deaths could be avoided by safe water and sanitation. This can be regarded as the core of the problem, which indirectly relates to population dynamics and community attitudes. There also appears to be a link between child deaths and births. Maternal and child health care services are not well established in developing nations. Guidelines, quoted from David Werner's book "The Village Health Worker" are quoted to help bridge the gap in reaching the masses. Community health programs will have to be organized on the basis of local needs and priorities. Local health workers from within the community will have to be selected and trained in the delivery of simple basic health care and be responsible to the community.
In: Camp Dresser and McKee. Report of the Water and Sanitation for Health [WASH] Project. Arlington, Virginia, CDM FIVE, 1980. 4 p. (Contract no. AID/DSPE-C-0080; Control no. PN-AAJ-536)Recently the World Health Organization (WHO) has intensified its efforts to promote and expand diarrheal disease control programs in developing countries by means of oral rehydration therapy within the framework of primary health care. The objective of the WHO strategy is the delivery of oral rehydration solutions (ORSs) containing glucose (or sucrose) and salts of sodium and potassium for all cases of diarrhea, especially in infancy. The focus in this discussion is on the microbiological safety of solutions prepared with contaminated water. The observation is presented that simple exposure to sunlight of ORS contained in transparent vessels renders these solutions bacteriologically safe, without deterioration of the ingredients. In the course of a study on the small-scale disinfection of water for home use by exposure to sunlight, it has been observed that sunlight destroys bacteria, including pathogens. These findings prompted experiments to determine the applicability of this simple, inexpensive technology to disinfection of ORS prepared with contaminated water. For this purpose 15 liters of bulk ORS were prepared by dissolving the requisite amount of salt-sugar mixture recommended by WHO in chlorine-free tap water contaminated with fresh sewage. 1 liter of this solution was transferred into each of 15 sterile polyethylene bags. These bags are graduated up to 2.5 liters and have a wall thickness of 0.13 mm and screw cap closures. 2 experiments were conducted on different occasions according to the following protocol: 3 sets of 3 bags each were exposed to direct sunlight; 2 bags were kept in the dark; and 2 others were kept under room conditions (artificial and natural light). Results indicate that a zero coliform count/ml of ORS which is considered to be a rather stringent requirement, were attained in about 1 hour. Similar results were obtained in some 50 experiments using highly contaminated water contained in an assortment of vessels made of transparent glass or plastic and having different colors and shapes. The rise in temperature of the test ORS not exceeding 5 degrees Celsius on exposure to sunlight for 2 hours leads to the conclusion that in this case heat is not a factor involved in the destruction of microorganisms. It appears that the germicidal action is due to solar radiation. The inability of the microorganisms to regrow 24 hours after solar irradiation allows for storage or transport of treated ORS.
The baby killer scandal: a War on Want investigation into the promotion and sale of powdered baby milks in the Third World.
London, War on Want, 1980. 208 p.This sequel to "The Baby Killer", focusses on the advertising, marketing, promotion, and use of infant formulas in developing countries since 1974. Malnutrition and infection from bottle feeding in developing countries has continued to increase because of the lack of education, extensive advertising and promotion of formula manufacturers, and poor sanitary conditions. For example, in Papua New Guinea, 97.6% of infants were breast fed at 3 months in 1972, but by 1976, 35% of mothers surveyed were artificially feeding their babies. Breast milk is shown to be better for babies and mothers because of its protection against infection and malnutrition, high costs, and the loss of emotional bonds between mother and child. In addition, breast feeding is important for natural birth spacing. Factors which continue to influence the decline in breast feeding are urbanization, modernization, available alternatives for artificial feeding, and advertising of manufacturers. One of the major reasons for mothers to turn to bottle feeding is insufficient milk. Problems with the use of formula are the directions for use, incorrect mixing by illiterate people, lack of sanitation, and lack of responsiblity in distribution of products to developing countries by manufacturers. International and national companies have responded to the bottle feeding problem. The Nestle Company was particularly selected for boycott action. Recommended programs which aid in the development of breast feeding are outlined and priorities for changing policy in developing countries are discussed.
World Health. 1980 Feb-Mar; 36.The point was made recently in an article in "World Health" in December 1980 that hospitals continue to risk becoming breeding grounds for disease unless people take the right precautions. Florence Nightingale, writing 120 years ago, noted her horror upon seeing the cholera and dysentery infested hospitals of the British army during the Crimean war of 1853-1856. She suggested that hospitals may have actually increased, rather than diminished, the rate of mortality. She identified 5 essential points for securing "the health of houses": pure air; pure water; efficient drainage; cleanliness; and light. If by pure air and light she meant good environment, her message was the same as the message of the World Health Organization (WHO) today. Nightingale also stressed the need for a sensible diet. By primary health care is meant the need for health care to reach all the millions of people who are still without access to doctors or hospitals or drugs.