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Strengthening the co-ordination of information systems in the United Nations system. Report of the Administrative Committee on Co-ordination.
[Unpublished] 1982 Jul 5. 47 p. (E/1982/85; GE.82-64072)This report responds to the UN Economic and Social Council resolution 1981/63, which requested the Administrative Committee on Coordination (ACC) to review its decision by which it had terminated the operational functions of the Inter-Organization Board for Information Systems and abolished its secretariat. Several fundamental points concerning UN information activities are presented: 1) information systems are an integral part of UN activities; 2) a major effort at improving information flows requires a number of complementary measures, and a clear definition of objectives, costs, and benefits of the proposed measures; and 3) improvements in information systems work should be undertaken as a series of steps. The Economic and Social Council may wish to have countries' views ascertained through a joint meeting of government and secretariat representatives. Several recommendations are made. First, an effort should be made by organization and member states to acquaint users with the existence and possibilities of access to the information available in the UN family; a special panel should be set up for this purpose. Second, a specialized panel should identify the areas of information handling where the application of existing or proposed new standards is necessary. Third, a specialized panel on indexing vocabularies should be set up under the leadership of the UN's Dag Hammarskjold Library to produce a common, generic vocabulary for indexing and retrieving UN substantive information. Also recommended are the following: 1) an interagency approach to the use of common communications systems could result in more effective transfer of information while keeping costs down; 2) a panel is needed to study the most cost-effective manner of developing the UNDP's Project Institutional Memory, and of including information on bilateral technical cooperation activities; and 3) a new institutional structure is proposed which includes the maintenance of an interagency body and an interagency funded secretariat for that body. Also included is the text of the final report of the ACC.
[Unpubished] 1982 Jun.  p.The traditional practice of female circumcision has very serious health risks for the women of developing countries. The World Health Organization (WHO) sponsors activities to combat this practice as part of its broader programs of maternal and child health. The WHO believes that governments should adopt policies to abolish female circumcision and intensify educational programs to inform women and the public at large of the dangers associated with this practice. It is important to target women specifically because if they do not organize in an attempt to stop this practice, it will most likely continue. Special attention has been given to this problem by the training of health workers at all levels especially those for traditional birth attendants, midwives, healers, and other practitioners of traditional medicine. The WHO has always advised that health care professionals should never perform female circumcisions nor allow them to occur in hospitals or health care establishments.
Health and the family life cycle: selected studies on the interaction between mortality, the family and its life cycle.
Wiesbaden, Federal Republic of Germany, Federal Institute for Population Research, 1982. 503 p.The family is the basic unit of society within which reproductive behavior, socialization patterns, and relations with the community are determined. The concept of the family life cycle provides an important frame of reference for the study of the history of a family traced through its various stages of development. The World Health Organization has developed a comprehensive program relating to the statistical aspects of the interrelationships between health and the family. The main objectives are: 1) to clarify the basic conceptual issues involved and to develop a family life cycle model; 2) to explore the statistical aspects of family-oriented health demography research; 3) to test and apply the methodology to the study of populations at different socioeconomic levels; and 4) to set forth some implications of the findings for social policy, health demography research, and the generation of a database for such studies. Demography research on the family consequences of mortality changes should not be limited to the study of their effect on the size and structure of the family, but should also deal with the impact on the timing of events and the life cycle as a dynamic phenomenon that is subject to change. This publication is from the 1981 Final Meeting on Family Life Cycle Methodology. The background documents fall into 3 main topics: 1) conceptual and methodological issues, 2) review of available evidence on the interaction between mortality and the family life cycle; and 3) case studies.
Geneva, World Health Organization, . 12 p.158 countries have set for themselves the goal of "Health for All by the Year 2000." The World Health Organization (WHO), the chosen instrument for realizing this goal, was given its mandate as the UN's specialized agency for international health work in 1946, with a Constitution which took effect on April 7, 1948. The goal is that by the end of this century people everywhere will have access to health services which enable them to lead socially and economically productive lives. The Global Strategy for Health for All, adopted in May 1981, represents a solemn agreement between the governments and WHO. What is meant by "Health for All by the Year 2000" is that health resources will be evenly distributed and that essential health care will be accessible to everyone, with full community involvement. It means that health begins at home, in schools, and in factories and that people will use better approaches for preventing disease and alleviating unavoidable disease and disability. In 1978 the International Conference on Primary Health Care, held in Alma Ata, USSR, declared that primary health care is the key to achieving the goal of Health for All by the end of this century. Primary health care is based on practical, scientifically sound, and socially acceptable methods and technology. It should be made universally accessible to individuals and families in their community through their full participation at an affordable cost and on a continuing basis. The Declaration of Alma Ata defined the 8 essential elements of primary health care as: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs. WHO's primary functions are to act as directing and coordinating authority on international health work, to ensure valid and productive technical cooperation, and to promote research. Prevention is a key work in WHO. Immunization, which prevents the 6 major communicable diseases of childhood, should be available to all children who need it. WHO can organize emergency assistance using national and international resources. It identifies important research goals and organizes collaboration between researchers on all 5 continents. WHO coordinates its international action with the UN system in the field of health and socioeconomic development.
Food and Nutrition Bulletin. 1982 Jan; 4(1):7-16.This study describes 3 nutrition intervention programs in Sri Lanka; Lanka Jathika Sarvodaya Samgamaya; Redd Barna, the Norwegian Save the Children Program; and the US Save the Children fund. The Sarvodaya Shramadana Sangamaya is a private, nonprofit organization that began in 1958 devoted to mobilizing voluntary labor for village reconstruction. It is now engaged in a series of development projects in over 2,000 villages. One of its main objectives is to mobilize community resources for development. The children's service now integrates pre-school, nutrition, and community health services. There are an estimated 86 day care centers. The main service available in these day care centers, apart from physical care, is the provision of nutrition. Pre-school nutrition programs are also administered. The program costs about Rs230/beneficiary per year. The International Council of Educational Development from the United States was invited to review the program. Recommendations are given. The Norwegian Save the Children (Redd Barna) program in Sri Lanka was started in 1974. Projects are of 2 types: 1) settlement projects; and 2) integrated community development projects which aim to improve the standard of living with particular attention to child welfare. The US Save the Children Fund (SCF), a private, nonprofit voluntary organization, began its 1st project in Sri Lanka in urban community development in a slum and squatter settlement within Colombo. It focused on housing, but also includes other programs such as health and nutrition. These activities are carried out through a pediatric clinic, a home visits register, a nutritional status survey, a supplementary feeding program, nutrition, education, and a day care center. The approximate cost of the nutrition program would be Rs7700/month for an average of Rs13/month, or Rs156/year/beneficiary.
New York, UN, 1982. 210 p. (E/CN.5/1983/3; ST/ESA/125)This report, the 10th in a series dating from 1952, notes in a brief introductory statement a series of effects on the world social situation of the poor state of the world economy. The 1st major section, on living conditions and aspirations in time of renewed economic stress, contains discussions of equity and the elimination of poverty in the developing world; social justice and distribution in industrial countries; changes in family size, life cycles, and roles; the recent trends and issues in social security systems; employment issues and underemployment and unemployment in developing and developed countries, trends in international migration, and the growth of a parallel economy. A section on changes in elements of well-being analyzes trends in specific domains of social life and areas of social concern, including food and nutrition, health, education and training, working conditions, housing, and the environment. The 3rd section focuses on some major aspects of the evolution of contemporary societies that have direct effect on social programs: participation, agrarian reforms, science and technology, disarmament and development, and civil and political rights. Throughout the work, the emphasis is more on identifying regional trends and developments than on discussing situations in particular countries.
Plan of action for implementing the Global Strategy for Health for All and Index to the "Health for All" Series. No. 1-7.
Geneva, Switzerland, WHO, 1982. 55 p. (Health for All Series No. 7)The 34th World Health Assembly adopted resolution WHA34.36 in May 1981 in which it requested the Executive Board to prepare a draft plan of action to implement, monitor, and evaluate the Global Strategy for Health for All by the Year 2000. A draft plan of action was prepared by the Board at its 68th session in May 1981, reviewed by the regional committees, and finalized in January 1982 for submission to the 35th World Health Assembly in May 1982. The plan of action will be carried out by the Member States of the World Health Organization (WHO) individually and through intercountry cooperation, by WHO's governing bodies, and by the Director General of WHO to the entire Secretariat. This discussion of the plan of action covers strategies and plans of action; developing health systems; promotion and support; generating and mobilizing resources; monitoring and evaluation; and the timetable. Countries will review their health policies, if they have not done so as yet, in the light of section 2 of the Global Strategy; formulate their national strategies for health for all, if they have not already done so, or update them as necessary; decide on specific targets in accordance with section 3, paragraphs 28 and 37 of the global strategy; and develop plans of action to implement their strategies. Member States will review their health system with the objective of reshaping them as necessary. Countries will cooperate with each other in order to support the development of their health systems through information exchange, research and development, and training. Governments will consider ways of strengthening their ministries of health or analogous authorities. Member States will mobilize all human resources to the utmost extent possible for the implementation of their strategy, and they will mobilize all possible financial and material resources. Member States will introduce a process and establish the necessary mechanisms to monitor and evaluate their strategy and decide on the indicators they will use to monitor and evaluate their strategy. The timetable included for Member States, the governing bodies, and WHO Secretariat covers the period up to the date of approval of the 8th General Program of Work by the Health Assembly in May 1987. The timetable is proposed so that the results of a global evaluation will be available in time to allow any necessary updating of the Global Strategy before the Executive Board embarks on the preparation of WHO's 8th General Program of Work in May 1986.
Health and Population: Perspectives and Issues. 1982 Jan-Mar; 5(1):23-33.A new discipline, health economics, which reflects the relationship between the health objective procuring adequate health care and the financial resources available, is becoming increasingly important. The WHO definition of health, that health is a "state of complete physical, mental and social well being and not merely the absence of disease or infirmity," is criticized for not lending itself to direct measurement of the health of the individual or community. This concept should include consideration of the process of being well as well as the absence of disease. It must also recognize that services to promote health, to prevent, diagnose and treat disease and rehabilitate incapacitated people must be included in the concept. For economic analysis purposes, health services can be classified into medical care, public health services and environmental public health services. It is suggested that the cost of education and training of medical personnel and medical research should be included in computing the cost of health services. In defining economic concepts many factors including capital and current costs, and depreciation must be considered. In addition all health economists have differentiated the direct cost of sickness including cost of prevention, detection, treatment, rehabilitation, research, training, and capital investments from indirect costs which include loss of output to the economy, disability and premature death. Using these concepts, some understanding of cost trends, cost accounting, cost benefit analysis and cost efficiency analysis should be made available in the medical curriculum and for health administrators so that health management can be more standardized and effective. (summary in HIN)
Washington, D.C., U.S. Agency for International Development, 1982 Sep. 14 p. (A.I.D. Policy Paper)Population growth has been a major inhibitor of self-sustaining economic development in less developed countries. The individual and familial costs in terms of impaired maternal health, poor living conditions and child and infant malnutrition are high. Effective utilization of family planning services tends to accompany progress in other developmental sectors, such as, health, education, employment and urbanization. Family planning programs are an essential part of US development assistance, which seeks to achieve 2 objectives through the Agency for International Development (AID): to enhance opportunities for voluntarily choosing family size and spacing births, and to encourage population growth which is consistent with economic growth. AID support for family planning services is based on 2 principles: voluntarism and informed choice. AID support has been provided for supplies, health worker training, outreach program research, development of new contraceptive methods and improvement of existing methods, and dissemination of information and education to individuals and governments. Successful programs tend to develop in countries with a strong governmental commitment, an appropriate infrastructure, and a population receptive to the concept of family planning. Legislation has prohibited the use of AID monies for abortion services and involuntary sterilization. Only contraceptives approved by the Food and Drug Administration are provided to recipient countries, as well as information and education on natural family planning. In countries where acceptance or use of modern contraceptives is inhibited by lack of improvement in basic socioeconomic opportunities, AID seeks to coordinate developmental activities and assist governments in policy development. The private voluntary sector, often the initial supplier of family planning services, also receives AID support, as do local institutions that play an important role in service delivery. An important component of AID assistance is the transfer of scientific and technical knowledge to less developed countries implementing family planning programs.
Journal of Modern African Studies. 1982; 20(1):45-67.Discusses the question of government policy toward control of population growth in its relation to economic development, especially in Africa, where population growth rates are high and the rate of economic growth very low. The author reviews the debate between supports of Marx and Malthus, and the family planning versus development debate which he sees as evolving from it. Merit may be found in the arguments of all sides, but some middle ground between the radical positions must be found. It must be recognized that a population problem exists, and that family planning can play a supportive role in keeping fertility rates down, but that a certain level of socioeconomic development must be reached before much can be done about the problem while recognizing that high fertility is itself and impediment to reaching this level of development. Cultural conditions leading to high fertility must also be considered, as well as the political and administrative dimension; both are briefly examined. The author concludes that assistance for population activities is worthwhile and desirable, but not at the expense of other areas of development which contribute to lowered fertility by themselves. The United States should review its policies with this in mind. In a postscript, the author notes that U.S. policy would appear to be undergoing review by the current administration; a shift towards urban Africa and towards encouragement of participation by private industry, evidently underway, would lessen the effect of U.S. development assistance on poverty and the high fertility rates in Africa.
The ILO's population and labour policies programme in the context of strategies to achieve population goals.
[Unpublished] 1982. 5 p.This paper reviews the population and labor policies program of the International Labor Organization (ILO) with special reference to activities in Asia and the Pacific region. Since its foundation the ILO has been active in areas affected by population trends such as employment, migration, human resource development, strategies for meeting basic needs, and improving the role and status of women and social security. The tripartite structure of the ILO, in which the representatives of workers' organizations have an equal voice with governments and employers, has always meant that the ILO has been quick to respond to the problems faced by the people. Activities of the ILO's Population and Labor Policies Program may be broadly distinguished in 3 distinct parts. The research activities can be identified as 1 part, while the operational activities divide into 2 components, i.e., education and welfare on the 1 hand and the field level policy and research dimension on the other. The ILO's population and labor policies program was first introduced in Asia where most countries had embarked on national population programs. The ILO explored the demand for and feasibility of such activities in selected countries. The concept of an ILO population oriented program gradually evolved and a regional labor and population team was created. The education/welfare dimension is primarily concerned with family economics and family welfare issues presented to individuals in the work place. This aspect of the work program intends to realize increasing participation of women. The new policy and research activities, coming after the World Population Conference held in Bucharest in 1974, are designed to help countries of the region identify socioeconomic strategies which can contribute to the goals of population change along with improvements in family welfare. A major component of the global research program of the ILO that is relevant for the present Regional Seminar relates to the "Demographic Change and the Role of Women." This research program is designed to help policymakers in developing countries with information on the eocnomic contributions women are actually making and providing insights into the causes and effects of changes in women's roles. The studies using household sample surveys will collect information for a fairly large number of households on what people in the household are doing, demographic information, socioeconomic information, socioanthropological information, and information on various aspirations and expectations. The 3rd type of studies envisaged will deal with the functioning of urban labor markets.
[Reference material for health auxiliaries and their teachers. 2nd ed] Materiel de reference destine aux auxiliaires sanitaires et a leurs enseignants.
Geneva, Switzerland, WHO, 1982. 164 p. (WHO Offset Pub. No. 28)This bibliography's purpose is to provide assistance to those in developing countries who have the difficult task of producing learning materials for health auxiliaries, adapted to local conditions. The current edition is a revised and updated version of the 1976 bibliography. Of the 400 items in the original version, 80 have been deleted because the books are out of print or no longer applicable, and some 220 new entries have been added. Many annotations have been rewritten in view of new experience, and publications in both Portuguese and Spanish are now included. In each of the following subject areas the entries are in alphabetical order of authors: nursing and rural health; communicable diseases; diagnosis and treatment; midwifery; maternal and child health; family planning; health education; nutrition; first aid; environmental health; and laboratory procedures.
Bulletin of the World Health Organization. 1982; 60(5):714.The possibility exists of a higher operative complication rate when sterilization is performed immediately following childbirth. This is because the operation is performed at a time of considerable physiological change. To reduce the potential effects of the procedure, many surgeons have adopted the use of a very short incision to gain access to the fallopian tubes. In view of the lack of information on the incidence of complications associated with the use of this technique the World Health Organization (WHO) Special Program of Research, Development, and Research Training in Human Reproduction conducted a prospective, multicentered, multinational study of sterilization by means of a mini-incision carried out within 3 days of childbirth. 1043 women were included in the study, which was conducted in centers in Bangkok, Chandigarh, Havana, Manila, Santiago, Singapore, and Sydney. Data were collected 8 hours, 1 week, and 6 weeks following the operation. Complications were classified as major or minor. Major complications included abandonment of surgery for any reason, excessive bleeding requiring either replacement therapy, additional surgery, or both; damage to any part of the uterus, or any other organ, requiring additional surgery; anesthetic complications that were potentially life threatening; wound problems requiring hospitalization and additional surgery; and pelvic inflammatory disease requiring extension of hospital stay or readmission to hospital. Minor complications included minor change in surgical approach such as enlargement of the incision, loss of 50 ml or more of blood during the procedure, injury to any part of the uterus or other organ, pelvic inflammatory disease treated with antibiotics but without hospitalization, wound problems that did not require additional surgery or hospitalization, and urinary tract infections. Complaints included various symptoms such as headache, abdominal pain, nausea, and vomiting. The overall complication rate was low (4.5%) and there were no cases of thromboembolism. Thus, it appears that sterilization in the immediate postpartum period through a mini-incision adjacent to the umbilicus is a safe procedure associated with no more complications than might be expected with operation at any other time. The complications rates were similar for all modes of anesthesia. The study showed that the operation can be simply and rapidly performed under local anesthesia.
In: National Council for International Health [NCIH]. Pharmaceuticals and developing countries: a dialogue for constructive action. Washington, D.C., NCIH, 1982 Aug. 21-6.The Pharmaceutical Manufacturers Association (1972) has endorsed the underlying objective of the Action Program on Essential Drugs which is to provide and improve access to needed drugs and vaccines through public sector programs--government programs--to people in the least developed countries who are now unserved or underserved. Additionally, the industry has endorsed the concepts embodied in primary health care. Although the industry has an important role in these efforts, the principal issues and responsibilities involve public policy decisions, not the private sector. The private sector is an important factor but not the final authority in determining policy directions. Governments have a particular responsibility to set priorities and allocate resources. There has been too much emphasis on the supply of drugs and not enough on the need to improve the health infrastructure. Unless a distribution and delivery system exists, drugs are of little use. In most instances the resources required to establish this infrastructure are far greater than those needed to purchase drugs. The industry feels strongly that any efforts on the part of the World Health Organization (WHO) and national governments to implement this action program should not interfere with existing private sector operations. Industry has expressed its concern about the action program in several different ways. Possibly the most recent and significant one is through the International Federation of Pharmaceutical Manufacturers Association. Issues have been raised recently concerning the industry's marketing practices for the 3rd world, i.e., the sale of drugs overseas which are not sold in the US and labeling differences between the US and the developing countries. The fact is that the health conditions, disease incidence, and medical judgment of public health and drug authorities vary substantially from country to country. This is the result of different levels of sanitation, nutrition, medical infrastructure, the dispersion of doctors and pharmacists, racial characteristics and other factors. It is arrogant and paternalistic to insist that 1 country's decisions in this area are somehow superior to another's. It is also potentially dangerous in health terms to assert that the standards of 1 particular country should be applied to all. In 1976 the International Federation adopted a policy statement on the international labeling of drugs. The Association position is that the important information concerning side effects and indications should be communicated in the developing countries.
In: National Council for International Health [NCIH]. Pharmaceuticals and developing countries: a dialogue for constructive action. Washington, D.C., NCIH, 1982 Aug. 1-8.4 interested parties have become involved in the issue of pharmaceuticals for developing countries: the developing countries, the pharmaceutical industry, the World Health Organization (WHO), and public interest groups. Developing countries need pharmaceuticals to be available and accessible to all population groups at an affordable cost. Industry plays a vital role in fulfilling this need through research and development efforts, pricing, and assisting countries in developing quality control, logistical, and distribution systems. WHO, committed to assist poor countries, recognizes the importance of essential drugs in achieving the goal of "health for all by the year 2000." Public interest groups are working either to assist developing countries in meeting their needs or to assure international control of industry practices. The relationships between the 4 parties have been challenging. In recognition of the cost burden placed on developing countries, WHO developed an Action Program on Essential Drugs in 1978. Industry's reaction to the program was negative, accusing it of being contrary to the principles of the open market system. Concurrently, the pharmaceutical industry was being criticized by governments and public interest groups because marketing practices were not consistent with the standards of the countries of origin, e.g., false and misleading advertising, poor labelling, and exploitive pricing. The infant formula controversy also loomed at this time. Recommendations and threats to create international codes to control marketing practices resulted in industry attempts to correct abuses including the development of a voluntary code. Public interest groups gained considerable confidence during the confrontation with industry over the infant formula controversy. At the same time other participants felt additional confrontations would be destructive, possibly even to WHO. Industry has since responded more favorably to the essential drug program. The question of whether the interested parties can establish a constructive dialogue to remedy the problems associated with pharmaceuticals and developing countries remains to be answered.
In: National Council for International Health [NCIH]. Pharmaceuticals and developing countries: a dialogue for constructive action. Washington, D.C., NCIH, 1982 Aug. 27-33.The Pharmaceutical Program of the Center for Public Resources encourages cooperation among the leaders of the pharmaceutical industry in Europe and the US, the bilateral and international public agencies, and the ministries of health of the developing world in addressing issues relating to the availability of pharmaceutials in primary health care systems. Incentives for cooperation among the parties include a professional incentive to discuss common concerns, an economic incentive to find additional financial and technical resources for health care activities within development assistance, a political incentive to avoid public conflict, and a public relations incentive. The barriers to sustained cooperative resolution of pharmaceutical problems are: 1) 3rd world countries account for a very small part of the business of must US companies, 2) corporate structures lack clear foci of responsibility and are difficult to work with, 3) corporate goals and short-term time perspectives discourage cooperation, and 4) the vagaries of the international economy affect the ability of companies to put money into cooperative efforts. Trade associations hamper cooperation because they interject themselves between the company and the country, introducing problems of communication and decision making. Barriers involving the public sector also impede effective partnerships on pharmaceutical issues: 1) public agenices must be willing to take risks and to take public positions on controversial issues, difficult tasks for developing country leadership; 2) it is difficult for public agencies to modify positions already taken on issues; 3) health lacks status in the national economies of developing countries and it may be financially difficult to implement whatever is discussed; and 4) it is difficult to achieve consensus within national bilateral public agencies and international agencies. Prerequisites to overcoming these barriers include agreeing that the participants cannot seek to defeat one another; carefully choosing issue areas so that issues with some mutual understanding are intially chosen; identifying and cooperating with the individuals able to make decisions within each organization; maintaining the neutrality of the forum; and following through on decisions to show that they can be implemented.
In: National Council for International Health [NCIH]. Pharmaceuticals and developing countries: a dialogue for constructive action. Washington, D.C., NCIH, 1982 Aug. 14-20.The US Food and Drug Administration (FDA) carries out its activities relating to drugs in developing countries through dealing with drug registration authorities in each country as well as through the World Health Organization (WHO), the Office of International Health in the Public Health Service, and the Pharmaceutical Manufacturers Association. In addition about 300 foreign government officials visit the FDA annually to learn about its practices and to inquire about drug legislation practices. The FDA is often asked for copies of documents regarding drug approval and has a regular mailing list for its publications. FDA officials participate in pharmaceutical-related WHO expert committees and its International Affairs Staff provides personnel for on-site technical assistance in developing countries which are trying to improve their drug quality. There are bilateral agreements with a number of developing countries such as Egypt and Nigeria. Work is now being performed with WHO to develop new drug application standards.
Geneva, Switzerland, World Health Organization, 1982. (WHO Offset Publication No. 61)The objectives of the World Health Organization (WHO) study reported in this volume, and formulated in 1978, were as follows: to identify the main policies, objectives, and thrusts in the health manpower development (HDM) program of WHO during its 1st 32 years of existence, 1948-1980; to identify the factors influencing or determining these policies and to see how they have shaped the HMD program through changing emphases and various modes of implementation; to judge how far policy changes and achievements in health manpower development in the WHO Member States (156 in 1980) over the past 3 decades could be correlated, if at all, with HMD policies and programs in WHO; and to draw conclusions for the sound formulation of policies and programs in WHO for the near and longterm future. Information on the development of HMD policies and programs in WHO and its Member States was gathered along several lines. Reviews and critical analyses were made of the following 5 types of WHO materials: records of the governing bodies of WHO; major reports or documents submitted by the Director-General; regional office records and reports; technical books and reports; and WHO periodicals. Further information was gathered in several other ways outside the sphere of WHO. These sources and research methods included: questionnaire survey of expert opinion; country field studies; selected country literature search; general HMD literature search; health status and health manpower statistical analysis; and miscellaneous sources. Information is presented in the following categories: international health and manpower problems; the evolution of WHO manpower policy objectives; and other perspectives (experiences in the countries of Ethiopia, Indonesia, Malaysia, Gabon, Costa Rica, and Barbados and world trends in health manpower). Analytical review of HMD problems identified over the 1948-1980 period and of the policy objectives formulated in response reveals a complex evolution. HMD policy objectives in WHO have evolved since 1948 approximately as follows: increased quantity of conventional health personnel; improved quality of all types of health personnel; cross-national equality of health personnel training; geographic coverage of countries with health personnel; efficiency in production and use of health manpower; national planning of health manpower; relevance of health personnel to national needs; and integration of health services and health manpower development.
[Some facts concerning injectable contraceptives: memorandum of a World Health Organization meeting] Quelques faits concernant les contraceptifs injectables: memorandum sur une reunion de l'OMS.
Bulletin of the World Health Organization. 1982; 60(4):535-48.This memorandum seeks to clarify issues concerning the safety of injectable contraceptives and to recommend areas for further research. Depo-Provera and norethindrone enanthate, 2 long-acting progestagen preparations, offer the important advantages in contraception of high efficacy, prolonged effect, and reversibility. Depo-Provera has been used since 1950 to treat a wide variety of complaints without serious side effects. It is estimated to have been used by about 10 million women for contraception and is currently used by about 1.5 million in 84 countries. Norethindrone enanthate has been much less widely used since its appearance in 1966 and is currently available in 40 countries. The Group on Toxicologic Evaluation, reviewing the results of longterm use of the 2 steroids in mice, rats, and rhesus monkeys, found no reason to modify their earlier position that the 2 substances were sufficiently safe for use in contraceptive programs. The Group also concluded that beagle dogs are inappropriate models for observation of the effects of the 2 steroids in women because of the predisposition of beagles to mammary tumors and acromegaly and because of differences in the specificity of their progesterone receptors. Some of the dosage levels used in the beagle studies were also questioned. Results of a large number of trials on women in numerous countries were reviewed regarding consequences of the different pharmacological properties of the 2 preparations, their effectiveness at different dosage levels, the nature and consequences of bleeding problems, current knowledge concerning their effects on lipid and glucose metabolism and liver function, possible carcinogenic effects, return of fertility, and effects of exposure in utero or through the mother's milk. None of the clinical or epidemiological studies was able to demonstrate life-threatening secondary effects. The most frequent secondary effect is the disturbance of menstrual cycles which is observed in the majority of women and is the most common cause of discontinuation. Although no serious short or longterm effects have been noted, the substances have been in use for a relatively short time. Research should proceed on the effects of longterm use of both steroids on lipid and glucose metabolism, on the appearance of neoplasms, and on the later development of the fetus or nursing child exposed to them. The study group concluded that Depo-Provera and norethindrone enanthate are acceptable methods of fertility regulation.
Idrc Reports. 1982 Jul; 11(2):15-6.In developing countries breastfeeding offers the kind of nourishment that can make a life and death difference, yet an increasing number of mothers in the 3rd world are abandoning breastfeeding for "modern" feeding with bottles and formula. Human milk is a unique food. It is rich in proteins, carbohydrates, fats, acids, hormones, minerals, and vitamins. Scientists recognize that the interactions between ingredients in human milk are as important as the nutrients themselves. The milk's immunological properties against allergies, bacterial, and viral attack also protect infants during the 1st weeks of life. Both nutritionally and immunologically milk substitutes are inferior products. Bottle feeding can produce healthy infants under the right conditions, but in the 3rd world many factors combine to turn nursing bottles and breast milk substitutes into dangerous products. For artificial feeding to be safe, the bottles must be sterilized and the water used to dilute the formulas must be clean. These conditions often cannot be met by poor families in developing countries. Due to the high cost of formulas, mothers often overdilute them. The mother's decision to breastfeed provides important psychological and emotional benefits as well as a transition for the baby on the nutritional level. Breast milk can adequately meet all the nutritional requirements of a baby to the age of 4-6 months, without any liquid or solid supplementation. Women with significant nutritional deficiencies have been shown to produce milk of almost the same quality as well nourished mothers. The World Health Organization (WHO) report also states that while breastfeeding is still prevalent in many countries, the length of time babies are completely breastfed is decreasing and varies greatly. The reasons for stopping breastfeeding are many and interdependent; reliance on substitutes is preferred. In 1981, the WHO Annual Assembly voted 118 to 1 (the U.S. being the only exception) in favor of a marketing code for breast milk substitutes that, once incorporated into national laws, would limit publicity campaigns and restrict sales tactics. The formula industry companies, Nestle's, Wyatt, Mead Johnson, and Ross Abbott, continue to make inroads into 3rd world markets wherever they can. Sales offices have been created in over 50 countries, and manufacturing plants are located in several developing countries. Countries should enact legislation to protect pregnant and lactating mothers from any influences that could disrupt breastfeeding.
How many by 2000: counting births and deaths. Report of a Working Group, Rijeka, Yugoslavia, 14-18 September 1981.
Geneva, WHO, . 17 p. (WHO/HS/NAT.COM/82.375)The overall objective of the Working Group of the World Health Organization (WHO) meeting in Yugoslavia during September 1981 was to examine methods for counting births and deaths and so provide adequate health statistics as required by the community, the primary health care services and health administrators. The role of civil registration, the national census and survey procedures for providing basic demographic and health statistics was dealt with extensively. Health care workers require information that relates directly to and derives from the care they provide, in particular: maternal and child health services, including family planning; medical surveillance; and immunization. The managers and health service administrators need information that is frequently derived from these caring activities but which can then be used in defining health policy, forecasting needs, health and service planning, monitoring health programs, and technical and environmental studies. Focus in this report is on the following: sources of information on births and deaths (information from the census, information from civil registration, information from hospitals and other health centers, and the need for alternative sources of birth and death information); counting births and deaths at primary health care level (the definition of community health worker; collecting, acquiring and recording information; reporting, supervision, and information feedback; counting of births and deaths by health community workers; cause of death, presenting symptoms or complaints before death; primary health care activities as a basis for counting births and deaths; establishing boundaries and enumerating the community); survey requirements; collecting information on births and deaths--the advantages and disadvantages of principal methods; utilization of information on births and deaths; and training, teaching materials, and exchange of information. The national census and civil registration provides the essential information on the structure and composition of the population, including some information on births and deaths, but the needs of the health services for information on births and deaths are more extensive and are not fully met by the census or by a civil registration system. Additional and alternative methods for collecting this information are necessary. Recommendations are made in order to develop these alternative methods as effectively and expeditiously as possible.
Population and Development Review. 1982 Jun; 8(2):423-34.Since the mid-1960s, the US government has played a major role in influencing population policies worldwide through its assistance programs and through its activities on international forums discussing population matters. The 2 memoranda excerpted below represent probably the clearest and most authoritative articulation by the Executive Branch of the US government international population policy now on public record. (These memoranda were recently declassified officially since they were originally issued as confidential documents.) The 1st document reproduced is the Executive Summary of the U.S. National Security Council Memorandum (NSSM 200), issued on December 10, 1974 under the title "Implications of worldwide poulation growth for U.S. security and overseas interests." The 2nd document, a follow-up to the 1st item, is National Security Decision Memorandum 314, issued on November 26, 1975, by Brent Scowcroft, then President Gerald Ford's Assistant for National Security Affairs, to the Secretaries of State, Treasury, Defense, Agriculture, Health, Education, and Welfare, and to the Administrator of the Agency for International Development. (author's modified)
Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. A preliminary report.
Contraception. 1982 Jan; 25(1):1-11.A multicenter phase 3 clinical trial compared norethisterone enanthate (NET-EN) given by 2 different treatment regimens and depot-medroxyprogesterone acetate (DMPA). After 18 months of observation, preliminary findings are reported for 790 women who received NET-EN 200 mg every 60 days; for 796 women who recieved NET-EN every 60 days (200 mg) for 6 months, then 200 mg every 84 days, and for 1589 women who received DMPA 150 mg every 90 days. Overall discontinuation rates and discontinuation for bleeding and personal reasons were similar for all 3 groups after 18 months observation (61.8-63.5/100 women). Terminations due to amenorrhea were significantly higher among DMPA users (12.1 and 17.4/100 women at 12 and 18 months) than among both NET-EN groups (6.8-8.2/100 women at 12 months and 10.4-10.9/100 women at 18 months). The only significant difference in pregnancy rates observed among the 3 groups was a higher rate at 18 months among NET-EN (84 days) users (1.6/100 women), than among DMPA users (0.2/100 women). There was no overall significant difference between the 2 NET-EN groups, although between the 6 and 18 month follow-ups when the 2 NET-EN regimens diverged, the NET-EN (84 days) users' pregnancy rates rose significantly, whereas in the NET-EN (60 days) group, the pregnancy rate did not change. Weight gain was significantly higher in those subjects using NET-EN at 60 day intervals than at 84-day intervals. (author's modified)
Science. 1982 Jul 30; 217(4558):424-8.The record of the U.S. Food and Drug Administration's (USFDA) actions regarding Depo-Provera, a medroxyprogesterone acetate, as an injectable contraceptive and the international implications are reviewed. In September 1982 a special panel of scientists began deliberations to recommend whether Depo-Provera should be approved for use as an injectable contraceptive. The U.S. Agency for International Development (USAID) has been asked by developing countries to furnish the drug but will not export drugs that are not approved by USFDA. More than 80 countries have approved the drug. Advocates for USFDA approval include the Upjohn Company (manufacturer of the drug), World Health Organization, International Planned Parenthood Federation, Population Crisis Committee, and the American College of Obstetrics and Gynecology. The opposition includes the Health Research Group affiliated with Ralph Nader, the National Women's Health Network, and several right-to-life groups. Hesitation by USFDA is related to laboratory animal studies which suggest that Depo-Provera is a potential human carcinogen. Upjohn conducted a 7 year study with 16 beagles and a 10 year study with Rhesus monkeys; both of the test animals developed more tumors than the controls. Questions were raised about using the animals since the response of these two species to the drug and the human response are not necessarily comparable. Limited approval has been recommended twice by expert advisory committees in 1974 and 1975, but USFDA refused both times. It is suspected that Korea, Taiwan, Egypt, Jordan, and Yemen reversed their approval as a result of the latest USFDA rejection. This final decision will have major economic and social implications and will assume international importance.
Forum. 1982 Feb; 4(2):2-6.Traditionally, approaches to population policy have been largely conditioned by economic theories. The population dictum held that increased economic development would assure improved human development. Population control, along with increased economic productivity were seen to be the major determinants in increasing the quality of life for all. Later, a changed philosophy emerged with the realization that the issue was not a simple one--human factors had to be considered, and economic goals should not be sought at the expense of social dislocation. In particular, education, health, human rights and other interrelated factors were considered integral to the development of population policy. Education was singled out as the key to informed and effective adoption of a rational population policy. The problem of funding for population policy implementation remains a delicate one. Logically, it must take the form of a balancing out of the inequities in economic resources within the society. More and more it is apparent that help must come from within--everyone must regard this problem as his own. In an era of international "stagflation," countries cannot be dependent on international aid. Most importantly, throughout the process of planning and development it must be kept in mind that the need, 1st and foremost, is to upgrade the human condition without regard for personal standing.