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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.
Program report [of the Central America regional seminar-workshop entitled] New Focuses of Family Planning Program Administration: Analysis of Contraceptive Prevalence Surveys and Other Program Data, [held in] Antigua, Guatemala, May 25-30, 1980.
[Washington, D.C., CEFPA, 1980.] 30 p. (Contract AID/pha-c-1187)This report 1) presents a summary of the planning process of the seminar-workshop in family planning held in Antigua, Guatemala from May 25-30, 1980; 2) reviews program content and training methodology; and 3) provides feedback on the evaluation of the program and in-country follow-up responses to the workshop. Negotiations were made between the Centre for Population Activities (CEFPA) officials, USAID (U.S. Agency for International Development) population/health officials, and family planning officials from each participating country to elicit program suggestions and support. The ensuing communication process facilitated the development of the program in many ways, including: 1) program design, which incorporated in-country family planning program needs, suggested workshop topics, and country-specific requests for workshop objective; 2) participant selection; and 3) USAID mission commitment. The workshop aimed to provide an opportunity for leaders of family planning and related programs to make an intelligent and effective use of data available to them. The training methodology consisted of structured small-group exercises. Program content included: 1) contraceptive prevalence survey case exercise, which aims to identify problem areas and need in the delivery of family planning and maternal child health services as a tool in assessing progress towards family planning goals; 2) other data sources available to family planning program managers, including World Fertility Survey data and program service statistics; 3) program alternatives in the form of mini-workshops on such topics as logistics management, improving clinic efficiency, primary health and family planning, adolescent fertility, and voluntary sterilization; and 4) program planning, which enables participants to interpret data and apply them in the planning process. In evaluating the workshop, a majority of the participants reported that the workshop and their own personal objectives were either completely or almost completely achieved, and they also indicated that more workshops at the regional and national levels should be conducted.
In: Research Triangle Institute and South East Consortium for International Development. Rural development programs and their impacts on fertility: state-of-the-art. Summary report [Research Triangle Park, North Carolina, RTI, 1980]. 91-100. (AID Project 931-1170: Rural Development and Fertility)6 categories of rural development activities (RDAs) have been assigned high priority by USAID as policy instruments and/or program interventions: 1) participation of the rural poor in the design, financing and implementation of rural development projects; 2) extension of the health care, education, and welfare services in rural areas; 3) rural marketing systems that extend the infrastructure, including agricultural coops, roads, and storage facilities; 4) rural financial markets extending credit to farmers, coops, small scale industry; and, 6) off-farm employment opportunities generated by small scale industry, craft cooperatives, or other activities, especially for women. This paper provides examples of how to apply assessments of the potential impact of RDAs which represent the 6 priorities. The ultimate impact on fertility behavior depends upon the objective of self-help activity. 2 examples offered are construction of an elementary school and construction of an all-weather road to that same community. The ultimate objective is to be able to suggest not only the direction of fertility influence but also something about the strength of that influence. More precision will be achieved through various case studies.
[Washington, D.C.], U.S. Agency for International Development, 1980 May. 19 p. (A.I.D. Project Impact Evaluation Report No. 5)Since 1970, the Government of Kenya has been involved in a program to bring water to all its population. Although the investment has been high, the results have been disappointing. The government is still committed to the long term goal of universal supply, but recognizes that competing demands may now require a review of the long term objectives for water development. The lessons learned from past efforts are important for AID as it assists water supply projects in other countries. Kenya's national rural water program differs from that in most other countries in the size of the project and method of supplying water. The typical Kenyan water system is large. The aim of most systems is to supply water to individual families through metered private connections; because Kenyan communities are dispersed, long distribution lines are used. These complex systems are impeded by problems of design, construction and maintenance, making them unreliable. Maintenance problems are mainly due to low government funding levels. The government discourages the use of communal facilities by locating them inconveniently. AID has provided funding to self-help systems through CARE-Kenya. Recommendations include: insuring adequate funding for operation of systems, selecting technology from the full range of options available, and involving the community in the process of providing supplies. System reliability should be a primary concern. Rural water projects require varying amounts of institutional support based on the technology used.
[Unpublished] 1981. 267 p. (Authorization: Ltr. AID/DS/POP: 2/12/81; Assgn. No. 582059)The major purposes of this evaluation were to assess Pathfinder's program of in-country assistance to family planning projects. A 2-part framework was followed. The general evaluation considered the organization's policy, including the composition and functions of the board, the project development strategy, and future planning; the management structure in Boston and in the field and program support; and project management. The country evaluation framework considered the country background in terms of demographics, overall family planning services, population policy, and laws and legislation; organizational structure and program support of Pathfinder management; several aspects of project management including project descriptions, design and selection, implementation and monitoring, and evaluation; and project effectiveness. Regional evaluations were separately prepared for Africa, Latin America, and Asia and the Middle East. Within the African region country reports and evaluations of specific projects in Nigeria, Kenya, and Zaire are presented; in Latin America reports are included for Brazil, Peru, Guatemala and Colombia; and in Asia and the Middle East reports were prepared for Indonesia, Bangladesh and Egypt. General recommendations are applicable to the overall program and recommendations and suggestions specific to a region, country or project are included in the individual regional reports. In general terms the team concluded that the Pathfinder Fund is using the USAID grant effectively. Specific projects are innovative, and no major insurmountable problems in the field were noted.
In: O'Connor RW, ed. Managing health systems in developing areas: experiences from Afghanistan. Lexington, Massachusetts, D.C. Heath, 1980. 117-20.Most donor/contractor relations within the health care field in Afghanistan have been excellent. Primary interaction and responsibility was with USAID (U. S. Agency for International Development). The nature of the project, however, required cooperation with other donors, e.g., UNICEF, UNFPA, and the World Bank. The USAID team gave the project staff a great deal of freedom of management. When more than 1 donor happened to be involved with a particular rural health project, none tried to take over control of the project. Locally knowledgeable personnel should be used for program development instead of USAID relying on outside contractors with minimal knowledge of the country.
Washington, D.C., Agency for International Development, Office of Women in Development, 1980 Dec. 45 p. (Contract AID/otr/147-80-76)Of all of USAID's various projects, income generating programs attract the most interest. Women's income generation includes any self-supporting project where benefits accrue to women participants from sale of items for money, from employment for wages, or increased produce. Projects which include planting trees to increase fuel or fodder supply, conserving soil, using appropriate technology, or eliminating waste, may benefit participants either in income or in acquisition. Poor women in India are paid in precooked food. Selecting the right project for the right group of people is the key to success. Specific considerations include the following: 1) products being supplied to the market; 2) available economic, natural, and skill resources; 3) any social organization which includes the identified group of women; 4) what social welfare needs have the highest priority; and, 5) how can the political structure help or hinder the identified group's economic participation and/or success? An insufficient resource base, market and management skills have been identified by many developers as the weakest aspect in women's projects. For small businesses the most important questions are as follows: what is the market; why is the project needed by the market; what are the steps from obtaining raw materials until the profits are distributed or reinvested; what are the potentials for growth; what is the outside expertise needed; and, how will the outside expertise be obtained and paid?
In: Santamaria J, Richards P, Gibbon W, eds. The dignity of man and creative love: selected papers from the Congress for the family of the Americas, Guatemala, July 1980. New Haven, Connecticut, Knights of Columbus, 1980. 188-95.The USAID (U.S. Agency for International Development) has since 1960 promoted abortion worldwide, without concern for the laws, customs, or mores of foreign lands. USAID still promotes the sale and the use of Depo-Provera in Latin America. Depo-Provera, a drug that acts as a contraceptive and abortifacient, is considered by the U.S. Food and Drug Administration to be unsafe for birth control in the U.S. USAID also promotes the sale and the use of the Dalkon Shield type of IUD, which was recalled in the U.S. in 1975 for its hazardous side effects. Moreover, USAID supports abortion research worldwide; for example, there are 3 main USAID funded university research projects in the U.S., beside the London-Based IPPF, and the Boston-based Pathfinder Fund. It is about time that the American people, and the Prolife movement in particular, realize USAID's abortion activities, and act to have Congress pass the Helms Amendment of 1973, which intented to rid USAID of any involvement in abortion related activities.
New York, Foreign Policy Association, 1980 Oct. 80 p. (Headline Series 251)World population will be facing serious problems in the 1980s and 1990s as a result of 2 population trends which are presently dominating the demographic scene. The number of young people aged 15-30 in developing countries is increasing rapidly and they will be soon asserting themselves politically, economically, and socially. The 2nd trend which exists is the disparity between high population growth in the impoverished developing countries and the lower rates in the affluent industrial countries. This century's population growth has occurred primarily in the developing world and is the result of lower death rates rather than higher birthrates. The situation is attributable to demographic transition; however, the major demographic questions of how quickly birthrates will fall and how wide the gap will be before birthrates follow the classic transition remain unanswered. 3 approaches to help answer these and other demographic questions are: 1) demographic approach; 2) historical approach; and 3) observation of recent events. These various approaches are given attention in this monograph. The consequences of too rapid population growth can be seen in the low food supplies which exist leaving many in developing countries undernourished, in a decline in the quality of life, in the reduction of the potential capacity to produce what is necessary (diminished land resources, pollution of water and air), in the increases in the price of energy and natural resources, in the difficulties in acquiring employment opportunities, and in burgeoning urban growth (which puts a serious strain on housing, transportation, etc.). Family planning was adopted in various countries in the world despite government policies to counter this. While there is recognition of the need for measures to be taken to reduce fertility, the question of how to accomplish this still remains. A brief overview of developing country adoption of family policies is included. What become clear is that family planning programs do make a difference in birthrate reduction and in population growth control. An effective, extensive family planning/population program exists in the People's Republic of China; Indonesia, Colombia, Tunisia, and Mauritius are other countries with successful programs. Various socioeconomic factors influence fertility and they include: literacy and education, urbanization, improvement in the status of women, health, family or community structure, development (modernization), and even the lack of development. Population and development will be greatly affected in the future by the quality and depth of leadership. Government leadership and the private sector, donor agencies, as well as international leadership, especially that of the UNFPA, will be critical. Also included here are discussion questions and reading references for those who are interested.
In: Zatuchni GI, Labbok MH, Sciarra JJ, eds. Research frontiers in fertility regulation. Hagerstown, Maryland, Harper and Row, 1980. 58-63. (PARFR Series on Fertility Regulation)The important characteristics of a contraceptive are as follows: 1) sex of the user; 2) duration of effectiveness; 3) probability and ease of reversibility; 4) timing of use; 5) ability to be used after the suspicion or recognition of conception; 6) mode of applciation; 7) frequency of use; 8) safety and side-effects; 9) contraceptive effectiveness; 10) need for continuing volition or motivation to use the method; and, 11) peer approval. Scientists often underestimate the potential for misuse of even the simplest means of fertility control. One-time methods such as the IUD or sterilization have been found effective in developing countries unable to provide a continuous supply of contraceptives to their population. For the IUD, adequate follow-up care msut be available. Many methods require a sophisticated health care system. To expect physician-dependent delivery of anything but a 1-time only method as a practical approach to family planning is unrealistic. Community workers, auxiliary, and paramedical personnel have been able to reach many couples with Western style methods, e.g. pill distribution. Contraceptives like the condom can be distributed through commercial systems. By procuring contraceptive commodities competitively and in bulk, USAID has negotiated extremely low costs. From 1968-79, over $233 million was spent for these commodities.
New Scientist. 1980 Sep 25; 87(1220):945-6.Women in Bangladesh are under pressure to participate in a mass program that uses injectable contraceptives. The reason is that the big aid donors, particularly the World Bank, are pressuring Bangladesh to show quick results in its family planning program. In many areas of Bangladesh, the women who are sterilized or on injectables receive 6 kg of wheat a month, plus oil, powdered milk, and fish meal. These incentives are taken from the United Nations World Food Program. United States law bars the United States Agency for International Development (USAID) from supplying Depo-Provera because it has been banned in the United States as it causes cancer in animals. As there are no restrictions preventing United Nations agencies from supplying potentially dangerous drugs, the United Nations Fund for Population Activities provides Depo-Provera to Bangladesh. 1/3 of the women suffer unacceptable side effects from the Depo-Provera, particularly irregular menstruation. 5% have serious bleeding. With Depo-Provera, women cannot stop and permit the side effects to go away; they have the unexpected problems for the 3-month duration of the shots.
In: Files LA, ed. Research on the management of population programs: an international workshop. Chapel Hill, NC, Univ. of NC, School of Public Health, Dept. of Health Administration and the Carolina Population Center, 1980. 9-13.In discussing program management and effectiveness from the perspective of funding agencies, focus is on the following: 1) the importance of management in the effectiveness of population programs; 2) the quality of management of population programs in terms of both strengths and weaknesses; 3) means to improve the quality of management; and 4) willingness, intentions, and commitments on the part of the United States Agency for International Development (USAID), the Population Council, the Ford Foundation, the Pan American Health Organization (PAHO), the World Health Organization (WHO), and the World Bank to help improve the quality of management of population programs. The discussion confirmed an inherent contradiction of some donor agencies. On 1 hand there is the rhetoric of decentralization, encouragement of local initiatives, and responsiveness to local needs, yet there is a pressure to adapt 3rd world programs to donor agency criteria. The point was noted that since program and political leadership are critical, this may become a significant criterion of selection of a country for funding. Centralization of decision-making was also noted as an important variable.
HASTINGS CENTER REPORT. 1980 Apr; 10(2):30-7.One of the most sensitive subjects in the field of non military foreign assistance is aid for abortion. Consequently, it is very difficult to gather data. Information from interviews was combined with scattered fragments of existing data in the effort to construct a composite picture of the international abortion scene. Apart from any outside intervention, induced abortion is a common practice in developing countries. Abortion is frequent and is a prominent cause of death and illness among women of childbearing age. Foreign aid is a small proportion of the total aid for population activities, and, with the exception of the United Nations agencies, most organizations supplying funds for abortion operate on a clandestine and usually illegal basis. The most common type of foreign aid involves the technique known as uterine aspiration, which goes under various code phases. Abortion can be a profit-making proposition in developing countries. In the United States the politics of abortion have had an overwhelming impact on foreign aid for abortion. As of 1979 only a handful of international donors were involved in direct support of abortion activities in the developing countries; others provided indirect assistance for research, meetings, and information activities. The Agency for International Development (AID) was an ardent supporter of abortion until it was brought to a standstill by the Helms Amendment of 1973. AID was forced to withdraw from most abortion activities. The only agencies operating openly in this field are the World Bank and the United Nations Fund for Population Activities. The International Planned Parenthood Federation has been the most outspoken advocate of legal abortion services in developing countries.
Washington, D.C., U.S. Dept. of State, 1980 Apr. 42 p.Focus in this 4th Annual Report of the National Security Council Ad Hoc Group on Population Policy is on United States population policy in the context of international demographic and program developments, the range of activities and organizations relevant to implementation of this policy, and the proposed future directions and emphases. The report's 4 sections deal with global trends and implications and regional and key country trends and programs; international conferences and statements, population assistance of other donors, and U.S. government population activities. The world's population growth rate gradually slowed during the 1970 decade, reflecting fertility declines in developing and developed countries. Yet, there is a built-in demographic momentum because of the youthful age structure in the 3rd world. This means that by the year 2000 the current 4.4 billion population will increase to over 6 billion. During the 1970 decade much of the economic gains and increased food output by the 3rd world were cancelled out by the steady increase in population. In recent years it has been the policy of the United States government to respond promptly and totally to requests from developing countries for assistance in dealing with their population growth problems. Emphasis is on encouraging leaders of developing countries to establish and actively promote national programs to reduce fertility levels. U.S. international population policy is reflected in a range of activities.
[Unpublished] 1980. 28 p.This document contains the testimony presented by R. E. Benedick, the Coordinator of Population Affairs of the U.S. Department of State, before the House Subcommittee on International Economic Policy and Trade on February 29, 1980. The Population Affairs Coordinator 1) described how rapid population growth erodes the impact of development programs in developing countries; 2) urged the adoption of U.S. policies to ameliorate the problem; and 3) described the duties and specific activities of the office of the Population Affairs Coordinator. Population growth erodes the impact of development programs by 1) increasing the amount of money spent on consumption goods and reducing the amount of money available for investment; 2) diverting scarce foreign exchange to food imports; 3) increasing the amount that must be allocated to service provision; and 4) enhancing the already existing problems of unemployment, overcrowding, inadequate housing, urbanization, and international migration. Although some progress has been made in reducing fertility rates in Indonesia, Thailand, Colombia, and Mexico, most countries have made little headway in reducing population growth. In order to significantly reduce population growth in the future, high priority must be placed on 1) extending family planning services in rural areas; 2) developing more effective contraceptive methods; 3) improving social and economic conditions so as to facilitate family planning motivation; and 4) encourage the political leaders in developing countries to commit themselves to population growth reduction. In accordance with these priorities, the U.S. should 1) provide more funding support for bilateral family planning program assistance, contraceptive retailing programs, and paramedical training programs; 2) allocate more funds for biomedical and motivational research and less for demographic and social science research; 3) encourage the leaders in developing countries to strengthen population programs; and 4) strengthen USAID commitment to population growth reduction and increase our contribution to UNFPA. The duties of the office of Population Affairs Coordinator are 1) to encourage U. S. diplomatic support of U.S. and international population policies; 2) to serve as a spokesman for U.S. and international population policies; and 3) to utilize all opportunities to implement these policies and to enhance program effectiveness by cooperation with other government and non-government agencies and organizations. The specific activities of the office are also described.
Intercom. 1980 May; 8(5):1, 12-15.Africa's growing population problems and the role of family planning in Africa were described. Population growth in Africa is accelerating more rapidly than in any other region of the world and population pressures on the continent are just beginning to emerge. The current population of Africa is 472 million and constitutes 10% of the world's population. Most countries in Africa are just entering the early phase of the demographic transition. Mortality rates are declining but the birth rates remain high. Africa's growth rate increased from 2% to 3% from 1955-1980. In sub-Saharan Africa vital statistics are not available for many of the countries and population estimates are based on inadequate data. Fertility is high in the region and the average woman has 6-7 children. Population problems in the region are masked to some extent because population density is still relatively low; however, land pressures are beginning to mount as overgrazed, deforested, eroded, and exhausted land areas increase. Per capita food production is declining by 1.4% annaually due in part to the outdated transportation and marketing systems which characterize many of the sub-Saharan countries. In many of these sub-Saharan countries there is a lack of interest in family planning and some governments have pronatalist population policies. Family planning is viewed by some Africans as an attempt on the part of Westerners to suppress the native population. National governments often hesitate to establish family planning programs for fear that these will be interpreted as veiled attempts to reduce the political influence of opposing tribal groups. Most family planning activities in sub-Saharan countries are financially supported by private and international organizations. Major contributors in 1979 were UNFPA, which provided $18 million primarily for the collection of demographic data, and IPPF, which spent $7.5 million on family planning programs. Other organizations providing assistance are 1) the Pathfinders, 2) the Population Council, and 3) the Family Planning International Assistance. USAID provides direct funding and also funds bilateral and regional programs through individual governments.
Integrating oral rehydration therapy into community action programs: what role for private voluntary organizations?
Washington, D. C., CEFPA, 1980. 42 p.A workshop, sponsored by the Centre for Population Activities, the National Council for International Health, and the Pan American Health Organization, meet in 1980 to discuss the use of ORT (oral rehydration therapy) in health and development programs and to determine how private and voluntary organizations could be encouraged to become involved in efforts to extend ORT availability. ORT is a technique for reducing dehydration in patients suffering from prolonged diarrhea. Diarrhea related dehydration is a serious problem among children in developing countries, especially among malnourished children. In 1975, 5 million children under 5 years of age died from diarrhea in Latin America, Africa, and Asia. The therapy consists of administering a solution of sodium chloride, sodium bicarbonate, potassium chloride, glucose, and water to the patient in order to balance the composition of body fluid. Initially the solution had to be administered intravenously at a treatment center; however, the solution can now be administered orally to mildly or moderately dehydrated patients by the patient's family in the home setting. The solution is given to the patient frequently and amount is determined by the patient's thirst for the solution. Packets containing enough dry ingredients to mix with 1 liter of water are now available. These packets can be centrally or locally manufactured. The solution can be mixed at health centers upon request, or the packets can be distributed directly to family members who are then taught how to mix and administer the solution. Various community action programs can incorporate an ORT component. Personnel in these community action programs, working at all organizational levels, should receive training in ORT. Community workers should receive intensive training so that they in turn can teach families in the community to use the therapy. The programs should use all available communication channels to send out accurate messages about ORT. The program should also organize the distribution of the packets and develop evaluation procedures for the ORT program component. WHO, UNICEF, USAID, and the National Council for International Health provide various forms of assistance to governments or to private and voluntary organizations interested in developing ORT programs.
PEOPLE. 1980; 7(2):20-6.Following a study by the International Institute for Environment and Development (IIED) of the environmental management capacity and performance of leading lending institutions, the World Bank, the Inter-American Development Bank, and 5 other leading banks issued a Declaration committing them to examination of development activities to ensure environmental soundness. Recommendations were made by the IIED to improve donor agencies's environmental performance. There is a need to define each donor agency's environmental and natural resource concerns in the context of its aid program as a whole. High priority should be given to helping developing countries build their capacity to study and manage their own environmental problems. Totally inadequate resources have been committed to conservation and rehabilitation projects. Sectoral policy documents, produced in each agency to guide government project design and exection, often lack adequate attention to environmental implications. Only USAID has evolved a set of procedures for determining environmental impact of a program. The U.S. Congress and the public have become increasingly conscious of environmental impact and have demanded environmental information on development programs. Other donor countries, e.g., Canada, Germany, and Britain, have yet to become as environmentally conscious.
Agenda. 1980 Mar; 3(2):8-11.Although the baby formula controversy continues, an important step toward resolving the issue was undertaken recently at an international conference of industry representatives, physicians, and nutritionalists, sponsored by WHO and UNICEF. At the conference, industry spokesmen agreed to ban all infant formula advertising which discourages breast-feeding and to ban all promotional activities in hospitals. Opponents pointed out that 1) the success of the ban is dependent on voluntary compliance and 2) the conference failed to address the issue of whether baby formulas were completely inappropriate for use in many developing countries. Conference participants also agreed 1) to stress the contraceptive value of breast-feeding; 2) to promote the use of contraceptives which do not interfere with lactation; 3) to promote nutritional education and the granting of longer maternity leaves to working women. In line with these recommendations AID has initiated a project aimed at helping countries expand and develop maternal health and nutritional program. As part of the project, AID will help the American Public Health Association develop a clearinghouse for infant and child nutritional information and will lend assistance to a number of organizations which plan to develop nutritional training programs. AID will also assist a number of organizations in their investigation of infant formula marketing practices and will help the Department of Agriculture develop and market local weaning foods.