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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.
[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.
Food emergency in wonderland: a case study prepared by the League of Red Cross and Red Crescent Societies for the training of relief workers.
In: Advances in international maternal and child health, vol. 4, 1984, edited by D.B. Jelliffe and E.F. Jelliffe. Oxford, England, Oxford University Press, 1984. 110-23.This monograph chapter is an exercise whose aim is to help relief workers to be better equipped to solve the practical problems of an emergency relief operation. Its events and contents are imaginary, but are drawn from direct experience. It has been used extensively in Red Cross training projects in several countries, and is designed, 1st, to be complemented with other types of educational media, and 2nd, to be adapted to the training requirements of diverse types of project, through "biasing" in favor of health, nutrition, sanitation, or logistics. A description is given of the management of the case study educational setting, based on real experience with the use of the material; the best results appeared achieveable through a class session on part 1, consisting of initial assessment of an hypothetical nutritional emergency, followed by work in small groups on part 2. Part 1 consists of presentation of situation characteristics, e.g. "overworked health assistant reports a big increase in chest infections, diarrhea, and typhus," and "there is a hand-dug well 1/2 mile from the shelter." Part 2 describes the situation 2 months later, after intervention has begun. Situation characteristics appear such as, "Records from clinic attendance indicates that the commonest disease symptoms are diarrhea, cough with or without temperature, general aches and pains, worms, and eye infections." The case study also includes additional information on food stocks, demographic data, and nutritional survey data (the latter not included in this article). Concluding the article are examples of topics for group discussions and presentations.
[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.
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.
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.
Who Chronicle. 1984; 38(2):47-59.The 73rd session of the World Health Organization's (WHO) Executive Board met in January 1984 to review progress in implementing strategies for health for all by the year 2000, based on information emanating from the countries themselves. This monitoring function was assigned to the Board by the World Health Assembly in 1981 and calls for the Board to evaluate progress towards health for all at regular intervals and to report back to the Health Assembly. The 1st country reports together with comments of the regional committees and relevant information provided by theSecretariat were examined in November 1983 by the Board's Program Committee. Emphasis at this stage was placed on reviewing the relevance of national health policies to the attainment of health for all and the progress being made in implementing national strategies. Actual evaluation of the strategies will begin in 1985. As many of the country reports submitted were not as complete or as accurate as they could have been, the overall progress report submitted were not as complete or as accurate as they could have been, the overall progress report suffered from a lack of detailed and precise informattion on many important aspects that were crucial to national health for all strategies. Dr. Brandt, presenting the Program Committee's views, told the board that the report did indicate that a high level of political sensitization had occurred and that the political will to attain the goal of health for all existed in a large majorithy of the countries that had reported. The report indicated that to a large extent the Secretariat had met its responsibilities. It was the Member States that had to shoulder the responsibility and reaffirm their commitment by action. The Program Committee's progress report points to the existence of specific technical needs, particularly in national capability to carry out health policies. Among the areas requiring strengthening are information analysis and management, financial analysis, assessment of status of public information, competence in planning and management, effective involvement of relevant sectors in health, and measurement of intersectoral action for health. The Board urged Member States to give highest priority to the continuing monitoring and evaluation of their health for all strategies and to assume full responsibility for this process. In regard to the action program on essential drugs and vaccines, priority in the last 2 years has gone to training and manpower development, the dissemination of experience and information, cooperation in the procurement and production of essential drugs, technical cooperation among developing countries, and contracts with nongovernmental organizations and the pharmaceutical industry. During the far ranging discussion that ensued in the Executive Board, members addressed themselves in considerable detail to numerous aspects of the action program. The Board approved a new and carefully phased procedure for the review of substances to be recommended for international drug control.
Planned Parenthood Review. 1984 Spring-Summer; 4(1):18.Since the beginning in 1971 of the Planned Parenthood Federation of America's international program, Family Planning International Assistance (FPIA), US$54 million has been contributed in direct financial support for the operation of over 300 family planning programs in 51 countries; over 3000 institutions in 115 countries have been supplied with family planning commodities, including over 600 million condoms, 120 cycles of oral contraceptives, and 4 million IUD; and about 1 million contraceptive clients were served by FPIA funded projects in 1982 aone. Since 1971, however, the world's population has increased from 3.7 billion to around 4.7 billion people. About 85 million people are added to the world each year. There is consensus that without organized family planning programs, today's world population would be even higher. FPIA measures its progress in terms of expanding the availability of contraceptive services in devloping countries. FPIA supported projects have helped make services available in areas previously lacking them, and has helped involve a wide variety of organizations, such as women's groups, youth organizations, and Red Cross Societies, in family planning services. A prime concern of FPIA, which has limited resources, is what happens to projects once FPIA support is terminated. FPIA has been paying attention to local income generation to help projects become more self-supporting and to increas staff members' management skills. The more successful income-generating schemes appear to be directly related to family planning, selling contraceptives and locally produced educational materials, and charging fees for family planning and related medical services and tuition for training courses. FPIA funded to projects use management by objectives (MBO) to help improve management skills. MBO helps grantees improve their ability to set objectives, plan, monitor, report, and do day-to-day project management.