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WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
Health and health services in Judaea, Samaria and Gaza 1983-1984: a report by the Ministry of Health of Israel to the Thirty-Seventh world Health Assembly, Geneva, May 1984.
Jerusalem, Israel, Ministry of Health, 1984 Mar. 195 p.Health conditions and health services in Judea, Samaria, and Gaza during the 1967-83 period are discussed. Health-related activities and changes in the social and economic environment are assessed and their impact on health is evaluated. Specific activities performed during the current year are outlined. The following are specific facets of the health care system that are the focus of many current projects in these districts; the development of a comprehensive network of primary care programs and centers for preventive and curative services has been given high priority and is continuing; renovation and expansion of hospital facilities, along with improved staffing, equipment, and supplies for basic and specialty health services increase local capabilities for increasingly sophisticated health care, and consequently there is a decreasing need to send patients requiring specialized care to supraregional referral hospitals, except for highly specialized services; inadequacies in the preexisting reporting system have necessitated a continuting process of development for the gathering and publication of general and specific statistical and demographic data; stress has been placed on provision of safe drinking water, development of sewage and solid waste collection and disposal systems, as well as food control and other environmental sanitation activities; major progress has been made in the establishment of a funding system that elicits the participation and financial support of the health care consumer through volunary health insurance, covering large proportions of the population in the few years since its inception; the continuing building room in residential housing along with the continuous development of essential community sanitation infrastructure services are important factors in improved living and health conditions for the people; and the health system's growth must continue to be accompanied by planning, evaluation, and research atall levels. Specific topics covered include: demography and vital statistics; socioeconomic conditions; morbidity and mortality; hospital services; maternal and child health; nutrition; health education; expanded program immunization; environmental health; mental health; problems of special groups; health insurance; community and voluntary agency participation; international agencies; manpower and training; and planning and evaluation. Over the past 17 years, Judea, Samaria, and Gaza have been areas of rapid population growth and atthe same time of rapid socioeconomic development. In addition there have been basic changes in the social and health environment. As measured by socioeconomic indicators, much progress has been achieved for and by the people. As measured by health status evaluation indicators, the people benefit from an incresing quantity and quality of primary care and specialty services. The expansion of the public health infrastructure, combined with growing access to and utilization of personal preventive services, has been a key contributor to this process.
New York, New York, FPIA, . 227 p.This report summarizes the work of Family Planning International Assistance (FPIA) since its inception in 1971, with particular emphasis on activities carried out in 1983. The report's 6 chapters are focused on the following areas: Africa Regional Report, Asia and Pacific Regional Report, Latin America Regional Report, Inter-Regional Report, Program Management Information, and Fiscal Information. Included in the regional reports are detailed descriptions of activities carried out by country, as well as tables on commodity assistance in 1983. Since 1971, FPIA has provided US$54 million in direct financial support for the operation of more than 300 family planning projects in 51 countries. In addition, family planning commodities (including over 600 million condoms, 120 million cycles of oral contraceptives, and 4 million IUDs) have been shipped to over 3000 institutions in 115 countries. In 1982 alone, 1 million contraceptive clients were served by FPIA-assisted projects. Project assistance accounts for 52% of the total value of FPIA assistance, while commodity assistance comprises another 47%. In 1983, 53% of project assistance funds were allocated to projects in the Asia and Pacific Region, followed by Africa (32%) and Latin America (15%). Of the 1 million new contraceptive acceptors served in 198, 42% selected oral contraceptives, 27% used condoms, and 8% the IUD.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
[Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
[Health costs and financing and the work of WHO] Cout et financement de la sante et activities de l'OMS.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):339-50.This discussion examines the international responses to issues and problems in the cost and financing of the health sector, focusing on the work of the World Health Organization (WHO). It describes the growth of attention to these concerns beginning in the 1970s, reviews methods and applications of financial analysis in greater detail, and summarizes progress to date and the agenda for work. Emphasis is on the developing countries, for they face the most urgent problems regarding costs and financing, and more attention is directed to their needs for support in this area. By the early 1970s it was clear that progress in health development particularly in the most underprivileged countries was unsatisfactory and that changes were needed if services were to have an appreciable impact on the health problems of developing populations. A major study conducted jointly by the UN Children's Fund (UNICEF) and WHO identified several of the critical problems associated with resources. The essential financial concerns requiring attention in connection with primary health service coverage, the need for more equitable distribution of existing resources for health and the priority of resources allocation to peripheral health services were examined in detail by a WHO Study Group on Financing Health Services which met in 1977. Among the problems of health finance, those of the overall lack of funds, the maldistribution of health resources, rising health care costs, and the lack of coordination were found to be particularly important. The Study Group concluded that, despite difficulties, it was possible to collect information of sufficient reliability for planners' needs and at a modest cost, even for the private sector. To help bring this about, it recommended that research centers and universities, in collaboration with national health authorities of their country, devote considerable attention to data collection methods. The reports, studies, and papers prepared at various meetings deal in general with specific aspects of health cost and financing. A major element, and evolving product, of the meetings and studies related to developing countries was a manual on financing health services, originally based on the recommendations of the 1st Study Group meeting. This draft document served as background material for a series of further meetings and was used to guide many of the country financing studies. A number of other health financing manuals were also developed between 1979-81. In its final published form the WHO manual attempts to be relevant to all developing countries. The manual describes health policies and their financial aspects and outlines techniques for data collection. If the recommendations of the 1st Study Group are compared with the achievements recorded thus far, the following facts come to light: many countries have undertaken surveys of health sector financing and resource allocation; increased interest in this subject has been shown by other international organizations; much progress has been made in the development and refinement of methodologies for collecting and using financial data; international activities and country studies have made it possible to provide reports for country leadership; and issues of financial planning and management often appear in medium and longterm plans.
Mortality and health policy: highlights of the issues in the context of the World Population Plan of Action.
In: Mortality and health policy. Proceedings of the Expert Group on Mortality and Health Policy, Rome, 30 May to 3 June 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 37-79. (International Conference on Population, 1984.; ST/ESA/SER.A/91)This paper reviews the major issues that have emerged in the analysis of mortality and health policy since the 1974 World Population Conference. The 1st part summarizes current mortality conditions in the major world regions and evaluates progress toward achieving the goals of the World Population Plan of Action. It is noted that the current mortality situation is characterized by continued wide disparities between the more developed and less developed regions, especially during the 1st year of life. The 2nd part focuses on the synergistic relationship between health and development, including social, economic, and health inequalities. It is asserted that mortality rates in developing countries are a function of the balance governments select between development strategies favoring capital accumulation and concentrated investments on the 1 hand and strategies oriented toward meeting basic needs and reducing inequalities in income and wealth. Data from developed countries suggest that economic development does not necessarily lead to steady gains in life expectancy. Some variations in mortality may reflect changes in family relationships, especially women's status, that are induced by social and economic development, however. The 3rd part of this paper analyzes the effect of health policies on mortality, including curative and preventive programs and primary health care. The lack of community participation is cited as a key factor in the weak performance of primary health care in many developing countries. In addition, there is strong evidence that the concepts and technologies of modern medicine must be adapted to existing systems of disease prevention and care to gain acceptability. The 4th section, on the implementation of health policies, discusses health care management, planning, and financing. It is noted that successful implementation of health policies is often hindered by scarcity, inadequate allocation, and inefficient utilization of health resources. Finally, more effective means to cope with rising costs of health care are needed.
Washington, D.C., World Bank, 1984. 153 p. (World Bank Staff Working Papers No. 688; Population and Development Series No. 13)The 5 chapters of this document, which traces the sources of assiastance for family planning and other population programs from developed countries and the flow of assistance through principal channel organizations to developing countries, focus on the following: population assistance flows; rationales for population assistance; the shape of population programs; the major channels; and the future of population assistance. Official development assistance for population comes primarily from the US, the Nordic countries, and more recently from the Federal Republic of Germany and Japan. Population assistance is channeled primarily through the UN Fund for Population Assistance (UNFPA), nongovernmental organizations, bilateral programs, and the World Bank. In discussing why developing countries seek and why developed countries provide population assistance, this paper concentrates on official views of how population growth and high fertility affect economic development, environment, maternal and child health, and women's welfare. It explains why some countries are reluctant to seek or provide more population assistance. The paper also analyzes what population assistance does to extend reliable and affordable family planning services and information and to improve understanding of population growth, its causes, and consequences. It summarizes current population policies and family planning programs in major regions of the 3rd world and considers the role of assistance. This paper identifies the comparative advantages of principal organizations providing population assistance, focusing on UNFPA, the major nongovernment organizarions, and the major bilateral programs. Finally, it discusses the evolution of "policy issues" affecting population assistance, particularly donors' concern for "demand" for family planning, cost effectiveness of family planning services, safety, and voluntarism.
The use of indicators of financial resources in the health sector. L'emploi des indicateurs de ressources financieres dans le secteur de la sante.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):450-62.This article provides an overview of the application of financial resource indicators in health. The focus is on indicators at the country level, although in certain instances related sub-national indicators are considered as well. 1st the different categories of financial resource indicators are described. The international experience in data collection, and problems of data availability and comparability are reviewed. Although the points addressed are relevant to all countries, the discussion is most applicable to the developing world where health information is limited. Particular attention is given to the design adn use of financial resource indicators in monitoring progress towards the goal of health for all. Finally, the steps that may be taken to increase the contribution of financial resource indicators to the health development process are discussed. Viewed economically, the health sector consists of production and consumption of services which have relatively direct influence on population health status. The different types of resources may be linked to their respective prices to show the financial flows that operate within the health system. The sources and uses of funds are identified. 3 types of financial resource indicators can be identified: health within the national economy, the provision of funds from primary sources and the functional and programmatic uses of funds. The 1st type is concerned with the aggregate availability of funds within the national economy and the fraction of those funds which are allocated to health. The 2nd component relates to the origins of the funds which make up the total health expenditure, under the broad headings of public, private and external sources of health finance. The 3rd type refers to the variety of used to which funds from these sources are put (expressed in terms of function e.g. salaries), program type (e.g. primary health care), or activity (e.g. health education).
Assignment Children. 1984; (65/68):43-8.The General Assembly Resolution 35/36 called for accelerated progress towards social, child-oriented goals as part of the International Development Strategy for the 3rd UN Development Decade. The reduction of mortality rates is seen as a major objective; life expectancy in all countries should reach 60 years as a minimum and infant mortality rates should reach 50/1000 live births, as a maximum, by the year 2000. The Resulution also called for full and effective participation by the entire population at all stages of the development process. Women, in particular, should play an active role in that process. All countries should respect and snsure the right of parents to determine the number and spacing of their children and make universally available advice on and means of achieving the desired family size. A comprehensive and adequate system of primary health care, as an integral part of a more general health system and as part of a general improvement in nutrition and living standards, is the strategy through which an acceptable level of health for all by the year 2000 can be achieved. The response of UNICEF should be an intensification of its concern with seeking more resources for children's services by promoting and protecting breastfeeding and improving maternal nutrition. In 1981 the Executive Board of UNICEF decided upon these objectives and stated that basic services strategy was the principal approach to be followed. The 1982 Executive Board meeting called for a new attack on child and maternal nutrition and for the inclusion of low-cost interventions in infant and child feeding, diarrheal disease control, and child immunization. The elements of UNICEF's Childrens Revolutioon are Oral Rehydration Therapy, universal child immunization, the promotion of breastfeeding, growth charts, birth spacing and food supplements. The 1683 Executive Board meeting supported the initiatives aimed at effecting a child health revolution. In 1984, the Executive Board meeting agreed that achieving the full potential f the child survival and development revolution would require strengthened program delivery and more effective program implementation at the national scale, aiming at universal coverage of target population groups.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):296-302.The international Conference on Population, held in Mexico City in August 1984, met to review past developments and to make recommendations for future implementation of the World Population Plan of Action. Despite the several ifferences of opinion, the degree of controversy was minor for an intergovernmental meeting of this size. The 147 government delegations at the Conference reached overall agreement on recommendations for future international commitment to expanding population efforts in the future. This review examines the recommendations of the Mexico Conference with regard to health, family planning, women in development, research, and realted issues. The total 88 recommendations wre intended to reaffirm and refine the World Population Plan of Action adopted in Bucharest in 1974, and to strengthen the Plan for the next decade. Substantial improvement in development was noted including fertility and mortality declines, improvements in school enrollement and literacy rates, as well as access to health services. Economic trends, however, were much less encouraging. While the global rate of population growth has declined slightly since 1974, world population has increased by 770 million during the decade, with 90% of that increase in the developing countries. Part of the controversy at the Conference focused on the remarkable change of position by the US delegation, which largely reversed the policies expressed at Bucharest. The US delegation stated that population was a neutral issue in development, that development is the primary requirement in achieving fertility decline. Several recommendations emphasized the need to integrate population and development planning, and called for increased national and international efforts toward the eradication of mass hunger, illiteracy, and unemployment; achievement of adaquate health and nutrition levels; and improvement in women's status. The need for futher development of management, training, information, education and communication was recognized. A clear call to strenghten global efforts in population policies and programs emerged.
Who Chronicle. 1984; 38(4):155-60.The voice of the World Health Organization's (WHO) internal world is reassuring and tells of widespread political will to attain the goal of health for all, yet another voice says that if the policies adopted in WHO are slowly trickling into national health systems, the process of infiltration is much too slow and may still be far from completion by 2000. A number of developed countries are taking the challenge of health for all very seriously both within their own boundaries and in their dealings with less developed countries, but too many of them did not even take the trouble to report on the results of their monitoring of the health for all strategy. Some claimed off the record that it would have been too complicated in view of the size and complexity of their health system; others that they were not really in need of a strategy since their health service was so comprehensive. If the developed countries shy away from the responsibilities they accepted, why should more be expected of the developing countries. At Alam Alta there was enthusiastic support for action from all countries, no matter what their level of development. Most difficult to assess is the extent to which people themselves are taking the goal of health for all seriously. If the social aspects of the strategy are difficult to monitor, one would expect that the financial aspects should be clearer. This is not the case. Few countries, including the most economically developed, were able to assess the amount and flow of resources for health for all. In particular, they were unable to distinguish between the allocation of funds for the continuation of old policies and for the promotion of new ones. WHO has embarked on a new General Program of Work -- the 7th in the history of the organization. The program aims at making member nations more self-reliant than ever in the fields of health. The major task is to build up solid health infrastructures that are capable of delivering the most needed programs to the most people on the basis of equality of access for all. Unfortunately, only the sounds of the 7th program have made themselves heard, not the substance. Among the organization's successes can be included many of WHO's publications, particularly the "Health for All" series, but these publications are being used much too sparingly. New managerial arrangements have been introduced to help countries make the best use of everything WHO has to offer, yet all moves too slowly.
People. 1984; 11(4):4-7.A significant happening at the International Conference on Population, which took place in Mexico City during August 1984, was the world consensus on the need to act more urgently to deal with the interrelated problems of population and development and to provide the conditions of life and means by which everyone can plan their family. The note of concern about the impact of population growth and about its distribution and structure was consistent. Support for expanded family planning services came from all sides, including Africia and Latin America. The UN agencies and the World Bank came nearest to injecting a visionary and emotional charge into the occasion. Their near universal message was the need to release and mobilize the energies of the people and slow excessive population growth by investing in their health, education, environment, employment opportunities and in family planning. Bradford Morse, Administrator of the UN Development Program, added a powerful plea, that the international factors of protectionism, debt, and high increase rates, arms spending, and ddeclining aid flows must be addressed if the goals of the original Plan of Action, i.e., to promote "economic development, wuality of life, human rights, and fundamental freedoms," were to be dealt with. James Grant, Executive Director of UNICEF, stated tha the experience of the past decade confirms "that development and population programs are interacting, mutually reinforcing efforts that work with the 'seamless' web of income, nutrition, health, education, and fertility." The final document put the same idea into various paragraphs. This consensus position was simple and consistent, but in its way, revoluntionary. The elements which brought about this agreement were made clear from the start. The 1st was the change in government attitudes towards population. In 4/5 of the world governments regard population as a key factor inn development strategy. A 2nd factor was that governments now feel more independent and less under external pressure. A 3rd element was that women in nearly all countries desire fewer children than they wanted previously and many are coming out openly and stating that they did not want their last child. A 4th factor was the awareness that population problems affect developed countries as well as developing countries. Along with these changes has come greater awareness of the health and social benefits of family planning. These ideas find expression the the 38 pages of recommendations which were eventually agreed on. The most significant of these was the added emphasis given to the role and status of women.
Grassroots initiatives in developing countries and UNDP project planning and implementation. Summary and recommendations of the SID GRIS Policy Dialogue with UNDP in New York, 3-4 June 1983.
Development: Seeds of Change. 1984; 2:70-2.Some of the concepts of people-based development discussed at the SID GRIS Policy Dialogue are very important. Much benefit can be derived from exchanging information with staff and with resource people from the university sector, grassroots groups, or nongovernment organizations. In terms of field programs, it is important to know the country well to be able to identify and support those entities which benefit from support. Supporting a number of groups with a high potential for participatory development creates a critical mass. Once these grassroots grow, consumer organizations and certain government entities start interacting with one another in a country, and if enough participatory prone groups at different levels are supported a certain synergy is created, which over time builds up to become a dominant thrust in government. It is also important to establish criteria for those programs: what do they do for or with the poorest in the community; and what do they do for the most disadvantaged of disadvantaged groups, women and youths. Advocacy with governments is an obvious role for the UN, possibly by reinforcing those groups in government that are making progress so that they get a sense of reward, enough support through budgetary allocations, and are sustained because the outside world begins to look at them with a certain amount of admiration. There is a whole series of things that can be done in the program planning process to be more effective. It is very clear that local procurement is becoming much more significant. The decentralization of personnel and decision making has become more and more a fact of life in the UN International Children's Emergency Fund, where 75-80% of the staff are now based in the field. Decentralization must continue with more outposting of staff into smaller towns, because they interact with local government and encourage them to plan at that level with the people. There is a move to recruit more social scientists with the grasp of the social elements of development and participation, and more women professionals are also recruited. Staff development and training becomes very different. Grassroots development begins in one's own organization and making that come about can create tension. Budgeting becomes a significant area, and relations with national committees and donor governments require discussion and reeducation.
Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
Who Chronicle. 1984; 38(3):109-15.The theme of the 1984 World Health Day--children's health, tomorrow's wealth--provides an occasion to convey to a worldwide audience the message that children are a priceless resource, and that any nation which neglects them does so at its peril. World Health Day 1984 spotlights the basic truth that the healthy minds and bodies of the world's children must be safeguard, not only as a key factor in attaining health for all by 2000, but also as a major part of each nation's health in the 21st century. An investment in child health is a direct entry point to improved social development, productivity, and quality of life. Care of child health starts before conception, through postponement of the 1st pregnancy until the mother herself has reached full physical maturity, and through spacing of births. It continues from conception on, through suitable care during pregnancy, childbirth, and childhood. In the developing countries the child must be protected by all available means, particularly from the killer diseases. What happens in the immediate family and community around the mother and child, and even far away in the world, can have a direct impact on the health and security of both of them. The mother and child need to be placed in an environment that will ensure their health by protecting the overall setting in which they live. This means providing clean water, disposing of waste, and helping to improve shelter. Nothing can diminish the importance of good food, enough food, and proper nutrition for children and their mothers. Beyond the immediate physical needs are the equally important needs for love and understanding which stimulate the healthy development of the child. The emergence of new health problems of mothers and children in developing and developed countries should be kept in mind. Better health services must be made available to all who need them. The World Health Organization (WHO) provided resource material on World Health Day issues for dissemination throughout the world. Extracts from 4 articles on this year's theme are reproduced. The articles report on the success of the Rural Health Center in Ballabhgarh (India) in reducing maternal and infant mortality, the value of breastfeeding as 1 of the simplest and safest ways of ensuring adequate spacing of births, Tunisia's integration of a program of immunization into the routine activities of the health care system, and the needs of the healthy child.
Doctors--barefoot and otherwise. The World Health Organization, the United States, and global primary medical care.
Jama. 1984 Dec 14; 252(22):3146-8.The international effort to provide primary health care (PHC) services for all by the year 2000 requires the development of appropriate manpower resources in the developing countries. Given the limited health budgets of developing countries, research on manpower development is necessary to ensure that funds for manpower development are used in the most efficient manner. In recognition of this need, the World Health Organization (WHO) and the International Organization for Medical Sciences convened a workshop, entitled "Health for All - A Challenge to Health Manpower Development Research" in Ibadan, Nigeria in 1982. The participants at the workshop agreed that manpower development strategies must be developed in the context of PHC, and that the current manpower development strategies in most developing countries do not provide the type of manpower required in PHC systems. Specifically, the workshop recommended that health manpower development strategies must 1) take into account the fact that health improvement is dependent not just on health services but on improvements in sanitation, water, housing, and nutrition; 2) recognize that PHC systems require an extensive cadre of health workers, paramedics, and auxiliary personnel, and that PHC systems are not highly physician dependent; and 3) recognize that medical schools must train physicians capable of serving the needs of the entire population rather than just the needs of the elite few. Participants also recognized that the development of effective strategies may be hindered by various professional, technical, financial, and bureaucratic factors. Given the pressing needs and scarce resources of developing countries, manpower development research must be highly policy oriented. The recommendations of the workshop were endorsed by WHO's Advisory Committee on Medical Research in 1983 and then distributed to WHO's 6 regional offices. The regional offices are currently discussing the recommendations with individual countries in an effort to determine how each country can implement the recommendations. The success of the effort to train appropriate manpower will require the assistance of developed countries and especially the US. The US can assist by providing training in US institutions for individuals from developing countries. Training programs, however, must be reoriented in such a way as to equip students to work in PHC settings. Medical personnel from the US can provide technical assistance in the developing countries, but efforts must made to ensure that this assistance is directed toward the development of PHC prsonnel and services.
In: Ghosh PK, ed. Health, food and nutrition in Third World development. Westport, Connecticut, Greenwood Press, 1984. 125-52. (International Development Resource Books No. 6)Malnutrition is a serious problem which can be solved only through the development of an effective international network of organizations and agencies committed to nutritional intervention. The magnitude of the malnutrition problem is described, the inadequacies of the current international structure to deal effectively with the problem are delineated, and suggestions for overcoming these inadequacies are provided. 1.3 billion individuals, or 2/3 of the population of the developing countries, suffer from some form of nutritional deficiency, and 900 million or these individuals, or 50% of the population of the developing countries, have a severe daily deficit of 250 calories. The major cause of malnutrition is poverty rather than food shortages. Other factors which contribute to malnutrition include cultural practices, health beliefs, cooking practices, intrafamily food distribution patterns, and deficient food production and distribution systems. Inaction in addressing these problems stems from a lack of coordination between the many agencies which deal with the problem, the failure to develop national and international nutrition policies, and a lack of knowledge about nutrition problems and the relative costs and benefits of different types of nutrition interventions. Currently there are a vast number of organizations and agencies which deal with nutrition either as a primary or secondary task. The majority of these organizations, committees, groups, and agencies are part of the UN structure. Many other national and voluntary agencies which have nutrition programs also have links with agencies within the UN. Although these diverse groups all interact with each other, there is a glaring lack of coordination between them. The functions performed by this loosely structured network include 1) collecting and dissemination information; 2) providing food, supplies, and technical assistance; 3) financing; and 4) coordination. Each of these functions is described, and the major organizations which perform these tasks are noted. Factors which reduce the effectiveness of the network include 1) inadequate coordination, 2) a failure to allocate responsibility and to delineate lines of authority, 3) inadequate review and evaluation mechanism, 4) a failure to depoliticize staff recruitment policies, and 5) the hesitancy of international agencies to take a stand on nutrition issues for fear of being accused of lacking respect for national sovereignty. Efforts to improve the current situation should include revamping the structure of the UN's nutrition network and expanding the role of the recently created World Food Council (WFC) of the UN. The WFC should assume the role coordinating the international network and of delineating the tasks of each agency or group within the network. The capacity of the WFC to function effectively in a leadership role will be realized only if the member states, especially the US and USSR, are willing to delegate sufficent authority to the WFC. In addition, nations and international agencies must place a higher priority on eradicating malnutrition and develop policies in accordance with this priority. Research directed toward identifying the costs and benefits of specific types of nutrition interventions can facilitate the development of effective policies.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.
London, England, IPPF, 1984 May. ii, 59 p.The Bellagio consultation was held in July, 1983 on the initiative of the Programme Committee of International Medical Advisory Panel to consider more closely what the needs of adolescents are and what more should be done to meet them. Participants from several countries--within and outside of IPPF--were invited. Before the Consultation, participants exchanged information, experience and ideas in writing as a basis for their discussion. 3 topics were focused on: 1) needs and problems; 2) information, education, and counselling; and 3) reproductive health management. An action plan for the next 3 to 5 years was drawn up. It offers broad suggestions about the kind of activities that would be appropriate for family planning associations and IPPF to take. Adolescents all over the world are in need of much better education and health care related to fertility, these are not the same in each society. A comprehensive approach to adolescent needs is favored. The recommendations form part of a broad discussion about how adolescents can best be helped to behave responsibly. Adolescent fertility has implications for health, psychological, social and economic well being. General program and operational guidelines are given, as are 8 areas for action: 1) creation of awareness and advocacy; 2) youth leadership and participation in adolescent programs; 3) information and education; 4) counseling; 5) fertility-related services; 6) sharing of experience, information and resources; 7) training and skill development; and 8) research. A list of participants and background papers is given.
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
Social Science and Medicine. 1984; 19(4):373-84.This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)
Lancet. 1984 Aug 11; 2(8398):340-1.The implementation of primary health care seems seriously hampered because it is not properly handled by many of the international agencies. Initial concern is the haste with which primary health care projects are being established and executed. These projects are expected to improve the health status of the target group within 2-3 years. Almost everywhere health officials are trying to expand primary health care schemes as rapidly as possible and to provide a maximum of the population with village health workers, yet little attention is directed to the structure needed to support the village workers nor to the problems related to their training motivation and financial reward. There is also the tendency to ignore the complex interrelations between the socioeconomic, cultural, and political factors and health improvement in general. A better way of attaining permanent improvement in health is to build slowly, using the local results and positive experiences in primary health care to reinforce the awareness and political organizations of the poor so that they will have more power to demand a shift in money allocation in their favor from their governments. In most countries this is not likely to happen even after the year 2000, and the World Health Organization (WHO) should stop advertising "Health for All by the Year 2000" and call for slow and careful expansion of the primary health care policy. There are some negative aspects to the amount of money available for primary health care. Donors keen to help with primary health care may not see that it needs the assistance of all medical departments to operate effectively. Despite considerable financial investment in primary health care over the past few years, few countries have been able to change their health budgets from hospital-based services to primary health care. The priorities in the ministries of health still seem heavily biased toward the existing curative and urban-based health services. Through primary health care, predominantly Western values are introduced into the countries to be served by the projects. 1 such case is the emphasis on efficiency in establishing and running primary health care projects. The preoccupation with data collection in primary health care is another example of Western influence as is the tendency to plan, in as much detail as possible, the objectives to be met at each stage of a project. A less ambitious approach to a community health care proposal by the government of Giunea-Bissau with less defined objectives would have been preferable, but it is questionable whether the Western donor would have accepted such a "vague proposal.
Draper Fund Report. 1984 Jun; (13):1-3.The UN International Conference on Population to be held in Mexico City in August 1984, responding to an unprecedented upsurge of interest in population over the last decade, offers developed and developing countries the opportunity to assess current and likely future population trends, to comment on programs and progress during the past 10 years, and to determine desirable future directions. More developing countries are reporting diminished declining fertility and family size in countries of widely varying ethnic, social, and economic makeup. Although it is likely that the future will bring a steadily declining rate of world population growth, culminating in stability, present trends indicate that it will take more than a century for world population to stabilize. Meanwhile growth continues. The developing world's annual average birthrate from1975-80 was twice as high as the developed world's. Also there are large areas, much of Latin America and most of Africa, where growth rates continue very high. Other areas, such as parts of Asia, do not follow the general declining trend despite trend despite, in some instances, a long history of population programs. Interest in population programs and demand for resources to support them are growing, but the population dimension is sometimes unrecognized in development planning. The experience of the last decade illustrates that population assistance can make a uniquely valuable contribution to national development when it is given in accord with national policies, is appropriate to local conditions and needs, and is delivered where it can make the most impact. Substantial evidence exists that women in the developing world undertand the risks of repeated pregrancy and would like to take steps to reduce them. It is evident that providers of family planning services are not yet sufficiently responsive to women's own perceptions of their needs and that the social and economic conditions which make family planning a reasonable option do not yet exist. Influxes of immigrants, short and long term, legal and illegal, create particular problems for receiving countries. It is important for sending countries to know what effect the absence of their nationals is having on the domestic economy and essential for receiving countries to consider the protection of the human rights of international migrants, including settlers, workers, undocumented migrants, and refugees. It is a particular responsibility of the industrialized nations to make careful use of limited resources and to ensure that their comsumption contributes to the overall balance of the environment. In most developing countries infectious and parasitic disease remains the primary cause of death, particularly among the young. Much of this toll is preventable. The International Conference on Population provides an opportunity to establish in broad terms the conditions and directions of future cooperation.
Asian-Pacific Population Programme News. 1984; 13(2):25-30.Differences between the Report of the UN World Population Conference and the Report of the Third Asian and Pacific Population Conference were discussed in reference to 1) the relative importance placed on family planning and development in lowering fertility levels, 2) the degree to which family planning and development programs should be integrated, and 3) setting family planning targets. The UN conference was held in Bucharest, Hungary, in 1974 and the Asian and Pacific Conference was held in Colomb, Sri Lanka in 1982. The relative importance of family planning and development on fertility was a major issue at the Bucharest conference. The World Population Plan for Action (WPPA) formulated at the Bucharest conference did not recommend family planning as a strategy for reducing fertility; instead, the WPPA recommended that countries interested in reducing fertility should give priority to development programs and urged developed countries to promote international equity in the use of world resources. In contrast, the Asia-Pacific Call for Action on Population and Development as formulated at the Colomb conference, strongly recommended both development and family planning programs as a means to reduce fertility. It urged governments to adopt strong family planning policies, to make family planning services available on a regular basis, and to educate and motivate their populations toward family planning. In regard to integration strategies, the WPPA called for integrating family planning programs and development programs wherever possible, and particularly recommended integrated delivery of family planning and health services. The Asia-Pacific Call for Action supported an integrated approach, but only in those situations where it was proven to be a workable approach, i.e., where it improved the efficiency of family planning services. Combining family planning and maternal and child health programs is known to be an advantageous approach, but the consequences of integrating family planning with other health programs and with development programs needs further study. The WPPA recommended that governments set targets for life expectancy and infant mortality, but it did not mention setting fertility targets or establishing an ideal family size. It did urge governments to create the type of socioeconomic conditions which would permit couples to have the number of children they desired and to space them in the manner they wished. The WPPA noted that substantial national effort would be required to reduce the birthrate to the UN projected rate of 30/1000 population in developing regions by 1985. The Asia-Pacific Call for Action urged countries to set specific targets which would make it possible for them to attain replacement level fertility in the year 2000. It will be interesting to observe the degree to which the Asian and Pacific countries will be able to influence the participants at the upcoming International Conference on Population to their way of thinking on these critical issues. A copy of the Asia-Pacific Call for Action on Population and Development is included in an annex to the article.