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[Unpublished] 1980.  p.This meeting of the ASEAN Heads of Population Program (AHPP) convened to to review and consider the earlier Report of the Experts consisting of the following: Phase I ASEAN Population Program; the Pre-Implementation Meeting Report of the Phase II ASEAN Population Program; interrelationships between and among Phase I and II projects; and the rules and procedures for the implementation of the ASEAN/Australia Population Project. It was generally agreed that the implementation of Phase I has stimulated greater cooperation and collaboration among the member countries in the field of family planning and population through important contacts and exchange of expertise. More ASEAN experts and expertise in the population field have resulted. Though it is too early to assess the impact of these projects, experiences gained in their implementation have already been applied to national programs in most countries. Efforts must be made to maximize the utilization of the findings of these projects, including making available financial and other resources to analyze, disseminate and utilize information. A structured mechanism to sustain and maintain a link between researchers and program managers needs to be designed.
Unpublished . Paper prepared for Beijing International Round Table Conference on Demography, 1980, Beijing, 20-27 October 1980. 11 p. (UNFPA Project No. CPR/80/P01; entry no. 0258 (CPR80P010528))A review of international population policies, strategies, programmes, and assistance. The development of national policies addressing population size, growth, distribution, and demographic factors is traced. The World Population Plan of Action, adopted by 135 states at the World Population Conference in Bucharest in 1974, is identified as the most important international population strategy. The general principles on which the plan is based, and its objectives and targets are presented and discussed. Other relevant strategies identified and discussed include the International Development Strategy for the 3rd Development Decade (expected to be adopted by the UN General Assembly) and the WHO-UNICEF declaration of health for all mankind by the year 2000. The increase in population assistance from 125 million in 1970 to 500 million dollars in 1980 is discussed. Over 80 governments have contributed to international population assistance, but most aid comes from less than a dozen countries and is channelled through multilateral organizations such as the UN Fund for Population Activities and the International Planned Parenthood Federation. 121 developing countries receive population assistance. Definite effects of this aid cannot be demonstrated, but a significant accomplishment in promoting awareness of population issues is recognized. Traditionally, donors have stressed fertility control as the major objective of their assistance, but recently some donors have revised their policies to emphasize such problems as migration, urbanization, refugees and aging. Priorities for resource allocation for population assistance are discussed.
In: Schima ME and Lubell I, ed. Voluntary sterilization: a decade of achievement. Proceedings of the 4th International Conference on Voluntary Sterilization, May 7-10, 1979, Seoul, Korea. New York, Association for Voluntary Sterilization, 1980. 1.Introduction to the proceedings of a conference on voluntary sterilization. Reflects on the accomplishments of the decade of the 1970s, remaining problems and issues, and new ones generated by success. Development of innovative solutions to manpower, funding and transportation problems that hinder delivery of sterilization and family planning education to those in need; grand multiparity as an indication for sterilization; legalization of voluntary sterilization; and the need for improved, inexpensive techniques that are deliverable to remote areas were topics of discussion at the conference. Because of continued growth in acceptance of voluntary sterilization it now offers genuine demographic potential.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 183-9.Reviews the interrelationships among epidemiology, medical education, and the planning, organization, and provision of health services. Epidemiology can be defined as the application of the scientific method and of biostatistical reasoning to the problems of health and disease in communities. Clinical epidemiology is of value in resolving problems arising from misallocation of manpower, facilities, technology, and service; adoption of unevaluated or inappropriate forms of medical intervention; overemphasis on laboratory and clinical medicine; and inadequate education and training in population-based medicine. Several reasons for the usual lack of success in teaching an epidemiological perspective have been identified. Some epidemiologists have recently made efforts to integrate the teaching of epidemiology with clinical medicine, and it is widely agreed that epidemiology and biostatistics should be included at all stages of the medical curriculum. Epidemiological scrutiny continues to be useful in elucidating the causes and risk factors of communicable and chronic disease, as well as iatrogenic disease and occupational health hazards. The importance of lifestyle and the interplay of behavioral, cultural, and economic factors with production of disease are attracting increasing attention. Increased use of epidemiological skills at all levels of medical care management and service will assist in rational allocation of health resources in developing countries, and possibly help them to resist overemphasis on advanced medical technology. Foundations can play an important role by supporting development of a consortium of clinical epidemiology units in both developing and developed countries.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 132-8.A prerequisite for developing effective health systems in developing countries is genuine concern and respect for the individual, and this perspective implies the decentralization of health systems. The greatest need in health care at paresent is for provision of already known technologies to the population; adequate knowledge already exists to achieve a dramatic reduction in deaths and morbidity from the major health problems of mankind. Most diseases are the result of a complex interaction of social, biological, and environmental factors, and financial resources and appropriate technologies to combat them should be infused at levels close to the village or family. The approach of the numerous primary health care pilot projects is based on principles of appropriate scale, flexibility, and responsibility down to the people served. Replicability inheres in the approach itself rather than in the traditional, packaged, centralized-planning topdown system. Most countries possess some type of civil and social infrastructure at the peripheral level that could handle an input of resources for flexible allocation at the village level. Donor agencies can play a critical role in encouraging developing country governments to respond to the demands of redistribution and decentralization, and providing funds for use at the village level and assisting in the necessary back-up system. Donor agencies should define the environmental and social influences on health, develop effective preventive and therapeutic methods, and assist in transfer of this knowledge to the people for implementation.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 127-31.Argues that the best way of operationalizing existing concern for the effectiveness of program implementation is through a matching strategy designed to identify those people in less developed countries able to contribute effectively to health improvements, and to help them implement the approaches they consider most suitable for their situations. This thesis is derived from the propositions that many health interventions now being implemented have merit, but that evidence fails to indicate the universal superiority of any 1 or 2 approaches. Therefore, health improvement in developing countries can best be served by seeking to match approaches to situations, by starting with the people most directly concerned with implementation of health programs. A matching strategy of this sort could be implemented by an international assistance organization in 5 steps: 1) select about 500 people from the developing world who can influence the health situation in their home countries; 2) expose them to the best available thinking on possible health improvement measures; 3) invite the surviving participants to suggest their own ideas on how to improve health in their home countries; 4) critically scrutinize the resulting ideas; and 5) provide firm support for ideas that emerge intact from the process.
In: White KL, Bullock PJ, ed. The health of populations: a report of two Rockefeller Foundation conferences, March and May 1979. New York, Rockefeller Foundation, Sept. 1980. 116-23.The quality of the health service delivery systems developed in many newly emerging nations over the past few decades has been limited. Authoritarian regimes are prominent among countries registering greater degrees of success, while health has typically received low priority in free enterprise countries. Given the variety, no 1 approach by international agencies will be suitable for all situations, but some guidelines can be suggested. Agencies should work through the ministries of health, which will be the main avenues for providing health care for the foreseeable future. Funding agencies could contribute to local costs during and after actual program initiation, to allow time for local institutions to assume the maintenance and recurring costs. The present emphasis on primary health care should be balanced by adjustments in the secondary and tertiary sector; curative and preventive services are both needed. Selected vertical programs, especially immunization programs, have a place in the overall provision of health care, but should not be stressed to the detriment of general improvement in the health of the population. Systems are needed in which appropriately trained doctors and auxiliaries can complement each other. If low level personnel are used to provide health care, they should be adequately supported and supervised. Care should be exercised in diverting scarce resources to support for traditional medicine. Key areas for future research in health care include the role and functioning of middle management, logistical support, and intersectoral schemes.
London, Her Majesty's Stationary Office, June, 1980. 38 p. (Overseas Development Paper; No. 21)Recent trends in world population growth and in governments' attitudes towards population and development are generally discussed. A historical perspective of the British Ministry of Overseas Development (ODA) involvement in population activities is given. Support began in the 1960s and ODA's Population Bureau was established in 1968 to function in an advisory capacity, promote training and research in issues related to population. The scope of the Bureau's work has broadened from clinical aspects of family planning to include demographic, social and economic factors related to population. ODA's assistance for population is outlined. Details of ODA's support of the following types of programs are given: 1) multilateral; 2) bilateral (including data collection and analysis, regional demographic training, formulation of population policies and programs, maternal and child health/family planning, and communications and education); 3) institutional support; 4) voluntary agencies; 5) research. Meetings attended by members of the Population Bureau in 1977-1979 are listed. ODA expenditure on population activities in 1977, 1978 and 1979 are listed by country or institution.
New York, UNFPA, July 1980. 142 p. (Report; No. 38)This report on areas in which Nigeria requires population assistance describes geographic, cultural, demographic, economic, and administrative features of the national setting, presents basic population data, assesses the status of population research in the country, discusses the formulation and implementation of population policies, and describes external assistance received by the country. Nigeria's very high rate of fertility and high but declining mortality yield a high population growth rate. Rural-urban and international migration contribute to differences in regional rates of growth. Exact data on population characteristics and processes are unavailable, and the Mission's recommendations accordingly focus on basic data needs and ways of improving data quality and availability. Closer liaison is needed between data suppliers and data users, and a clearinghouse for population research should be established. Recommendations were also made regarding legal provisions for age at marriage, internal migration and geographic distribution, international migration, labor force, employment, and school enrollment, population education and communication, and the role of women.
In: Schima ME, Lubell I, eds. Voluntary sterilization: a decade of achievement: proceedings of the 4th International Conference on Voluntary Sterilization, May 7-10, 1979, Seoul, Korea. New York, Association for Voluntary Sterilization, 1980. 76-7.The 22 participants in this task force, all senior government officials and ministers, recommended that efforts be made to repeal laws declaring sterilization illegal. Where no law proscribes sterilization it should be assumed that surgical contraception can be a component of family planning programs. Legal restrictions on eligibility for voluntary sterilization should also be lifted. The medical establishment and health professionals were viewed as vital to acceptance of voluntary sterilization by government decision makers. It was recommended that all governments be encouraged to establish national family planning programs with sterilization as a key component, and that recruitment and training be given top priority, preceding or occurring simultaneously with establishment and equipping of facilities. Training should take place within the country. Data collection, evaluation and management information systems were viewed as integral parts of all voluntary sterilization programs. Nongovernmental agencies were seen as initiators and catalysts that prompt governments to incorporate voluntary sterilization services in their family planning programs. Revision of the policies of international donors was recommended, to encourage rather than hamper the development and implementation of voluntary sterilization services.
SOCIAL SCIENCE AND MEDICINE. MEDICAL ECONOMICS. 1980 Jun; 14C(2):177-80.Assumptions underlying the drive to create national primary health care (PHC) programs include the following: 1) systems should be country specific; 2) a target of global access to PHC by the year 2000 will require major international efforts beginning immediately; 3) PHC in most developing countries will include personal health services, maternal and child health services, family planning, some nutritional and environmental health measures, and simple health promotion, disease surveillance, and vital registration activities; 4) services can be delivered for $2.5 per capita in low income countries and $8 per capita in middle income countries; 5) PHC programs are currently feasible on national scales; and 6) improved mechanisms for donor collaboration are needed. Development of national PHC systems will require effective political will; Ministry of health organizational support and a multi-sectoral planning capacity; a data base for planning; an operational health information system; health plan development; financing and development of local activities, manpower development, service support and logistics, and system management; phased implementation of services; and special studies and research. Donor agencies may offer support in research, evaluation, and monitoring activities, direct support of the service delivery system, and training and institutional development. Selected local currency and recurrent costs may need to be financed in the poorest countries.
SOCIAL SCIENCE AND MEDICINE. MEDICAL ECONOMICS. 1980 Jun; 14C(2):67-70.Most of the $.50 to $2 per capita devoted to health expenditures in developing countries is spent on acute curative services and technologies in urban areas, despite the predominantly rural location of their populations and the correlation of their health problems with malnutrition, infectious and parasitic diseases, and inability to limit family size. Present trends away from the "trickle down" approach and toward a strategy of involving the poor majority more directly in development and assuring that they benefit directly from growth and development, and increasing recognition of the interdependence of economic development, nutrition and health, population growth, social patterns, and political instability, are conceptual developments which promise an increased and more effective effort in international health. The major international funding agencies are revising their policies in the direction of supporting "growth from below" and meeting "basic human needs." A major challenge to such efforts is the identification of policy options within development sectors including health that will achieve the goal of providing greater benefits for the poorest strata.
In: Jelliffe DB, Jelliffe EF, Sai FT, et al., ed. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 39-44.Conventions drafted by the ILO to be submitted to governments of member states concerning maternity protection (maternity leave, health care, the right to resume employment) and provisions for working women to nurse their infants (facilities, paid breaks) are discussed. The number of states ratifying the conventions is reported, and various degrees and sources of protection and provision are described. Arrangements for maternity protection and nursing range from full coverage at community expense (social security), to special agreements made individually with employers, to very little support of any kind. The author deems matters concerning maternity protection and breastfeeding to be important for society as a whole as well as for working mothers and their children.