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Belize City, Belize, Ministry of Health, 1984. , 54 p. (EPI/84/003)An evaluation of the Expanded Program on Immunization (EPI) in Belize was conducted by the Pan American Health Organization/World Health Organization at the request of the country's Ministry of Health. The evaluation was undertaken to identify obstacles to program implementation, and subsequently provide national managers and decision makers with viable potential solutions. General background information is provided on Belize, with specific mention made of demographic, ethnic, and linguistic characteristics, the health system, and the EPI program in the country. EPI evaluation methodology and vaccination coverage are presented, followed by detailed examination of study findings and recommendations. Achievements, problems, and recommendations are listed for the areas of planning and organizations, management and administration, training, supervision, resources, logistics and the cold chain, delivery strategies, the information and surveillance system, and promotion and community participation. A 23-page chronogram of recommended activities follows, with the report concluding in acknowledgements and annexes.
Bangkok, Thailand, ESCAP, 1984. 323 p. (ESCAP Programme on Health and Development Technical Paper No. 66/PHD 19; ST/ESCAP/286)This training manual describes the organization of the courses, the course syllabus, the 1983 course on planning, development and health, the follow-up evaluation of the training courses of 1976-82 and the specialized activities in planning for health and development at ESCAP. Planning for health is viewed as an integral part of overall development planning with the conscious incorporation of clear goals, to help ensure that development programs have a positive impact on the health of the region's poor. ESCAP's training program aims to amplify, in concrete terms, the close relationship between health and development and to build the capability to take an integrated and multisectoral approach to inproving health and accelerating development. The design and implementation of a training program oriented to strengthen capacities in planning, development and health is a function of these 3 terms. The basic frame has remained farily similar to the 1976 course. Training aims at behavior change--to strengthen capacity for action, rather than to accumulate knowledge and information for information's sake. Training objectives must be appraised in terms of relevance, adequacy, effectiveness, efficacy and impact before actual implementation beings. The course is conceived as a unified, multi-sectoral approach to assess the health situation and propose intervention measures aimed at the elimination of the social causes of ill-health and disease of a country. The focus is in the relationships between health and development through systems analysis and relevant planning tools. The aim of the courses is to produce a cadre of planners for health with an innovative and intersectoral outlook, consistent with the dynamic approaches in health, development and planning and with abilities to convince the higher planning structures, rally political support and enlist coummunity involvement with focus on Health for All by the Year 2000. Tables and charts facilitate understanding of concepts involved in this training.
New York, New York, International Women's Tribune Center, 1984 Sep. iv, 116 p.The 1st 2 issues of newsletters in this volume, Women and Appropriate Technology, Parts I and II, emphasize resource materials and appropriate technology groups and projects from around the world that might be found useful. The 3rd issue, Women and Food Production, focuses specifically on the need for women to have greater access to land, technology, and capital in the production of food crops, whether for their own use or as crops for marketing. The last issues, Women MOving Appropriate Technology Ahead, concentrates on strategies for introducing appropriate technology ideas and approaches into one's own community. Together, these 4 issues combine several issues related to women's access to and uses of appropriate technologies, with practical information for concrete action and sample projects involving women from countries around the world. Originally published between 1978 and 1973, all 4 newsletters in this volume have been updated and edited in some parts to assure their continued relevance. Resource groups, UN news and conferences, available periodicals, training, credit and loan information, cash crops, international nongovernmental organizations, and government agencies are all discussed.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
[Unpublished] 1984 May 8. 31 p. (CE 92/12)This report shows how demographic information can be analyzed and used to identify and characterize the groups assigned priority in the Regional Plan of Action and that it is necessary for the improvement of the planning and allocation of health resources so that national health plans can be adapted to encompass the entire population. In discussing the connections between health and population characteristics in the countries of the region, the report covers mortality, fertility and health, and fertility and population increase; spatial distribution and migration; and the structure of the population. Focus then moves on to health, development, and population policies and family planning. The final section of the report considers the response of the health sector to population trends and characteristics and to development-related factors. The operations of the health sector must be revised in keeping with the observed demographic situation and the projections thereof so that the goal of health for all by the year 2000 may be realized. In several countries of the region mortality remains high. In 1/3 of them, infant mortality during the period 1980-85 exceeds 60/1000 live births. If measures are not taken to reduce mortality 55% of the population of Latin America in the year 2000 will still be living in countries with life expectancies at birth of under 70 years. According to the projections, in the year 2000 the birthrate will stand at around 29/1000, with wide differences between the countries of the region, within each of them, and between socioeconomic strata. High fertility will remain a factor hostile to the health of women and children and a determinant of rapid population growth. Some governments view the present or predicted growth rates as excessive; others want to increase them; and some take no explicit position on the matter. The countries would be well advised to assign values to their birthrate, natural increase, and periods for doubling their populations in relation to their development plans and to the prospects for improving the standard of living and health of their populations. An important factor in urban growth is internal migration. These migrants, like some of those who move to other countries, may have health problems requiring special care. Regardless of a country's demographic situation, the health sector has certain responsibilities, including: the need to promote the framing and adoption of population and development policies, in whose implementation the importance of health measures is not open to question; and the need to favor the intersector coordination and articulation required to ensure that population aspects are considered in national development planning.
In: Tras nuevas raices: migraciones internas y colonizacion en Bolivia [by] Carlos Garcia-Tornell, Maria Elena Querejazu, Jose Blanes, Fernando Calderon, Jorge Dandler, Julio Prudencio, Luis Lanza, Giovanni Carnibella, Gloria Ardaya, Gonzalo Flores [and] Alberto Rivera. La Paz, Bolivia, Ministerio de Planeamiento y Coordinacion, Direccion de Planeamiento Social, Proyecto de Politicas de Poblacion, 1984 Apr. 51-251.A study of colonization programs in Bolivia was conducted as part of a larger evaluation of population policy. The 1st of 8 chapters examines the history of colonization programs in Bolivia and the role of state and international development agencies. It sketches the disintegration of the peasant economy, and presents 5 variables that appear to be central to colonization processes: the directedness or spontaneity of the colonization, the distance to urban centers and markets, the diversification of production, the length of time settled, and the origin of the migrants. The 2nd chapter describes the study methodology. The major objective was to evaluate government policies and plans in terms of the realistic possibilities of settlement in colonies for peasants expelled from areas of traditional agriculture. Interviews and the existing literature were the major sources used to identify the basic features and problems of colonization programs. 140 structured interviews were held with colonists in the Chapare zone, 43 in Yapacari, and 51 in San Julian. The 3 zones were selected because of their diversity, but the sample was not statistically representative and the findings were essentially qualitative. The 3rd chapter examines the relationships between the place of origin and the stages of settlement. The chapter emphasizes the influence of place of origin and other factors on the processes of differentiation, proletarianization, and pauperization. The 4th chapter examines the productive process, profitability of farming, the market, and reproductive diversification. The next chapter analyzes the technology and the market system of the colonists, the dynamics of the unequal exchange system in which they operate, and aspects related to ecological equilibrium and environmental conservation. The 6th chapter concentrates on family relationships and the role played by the family in colonization. Some features of the population structure of the colonies are described. The 7th chapter assesses forms of organization, mechanisms of social legitimation, and the important role of peasant syndicates. The final chapter summarizes the principal trends encountered in each of the themes analyzed and makes some recommendations concerning the colonization program, especially in reference to the family economy and labor organizations.
EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
Foreign assistance legislation for fiscal years 1984-85. (Part 1) Hearings before the Committee on Foreign Affairs, House of Representatives, Ninety-eighth Congress, first session, February 8, 15, 16, 22, 23, 24; March 24, 1983.
Washington, D.C., Government Printing Office, 1984. 666 p. (Serial No. 18-1870)This report of hearings before the House Committee on Foreign Affairs contains reports to the full committee and subcommittees on international security and scientific affairs, Europe and the Middle East, Human Rights and International Organizations, Asian and Pacific Affairs, International Policy and Trade, Western Hemisphere Affairs, and Africa. The committee examined various witnesses on a list of topics that included developing country debt, the world food situation and the promotion of US agricultural export, the fiscal year 1984 security and development corporation program, and the executive branch request for foreign military assistance. The list continues with Peace Corps requests for 1984-85, information in a statement from the acting director of the Agency for International Development, International Monetary Fund resources, and world financial stability, and US interests (particularly regarding developing country debt). The committee examined a series of prepared statements and witnesses discussing foreign aid by type and strategy, and examined the question of "targeted aid" to the extremely poor. Cooperative development, the Peace Corps budget, the ethical issues of military versus development assistance, "food for work" program merits, disaster relief, maternal and child health programs, and finally, an examination of the problem of population. Written statements and responses to committee and witness questions were from the National Association of Manufacturers, US Department of Agriculture, Agency for International Development, Peace Corps, Department of the Treasury, Interreligious Task Force on US food Policy, American Council of Voluntary Agencies for Foreign Service, CARE, the Population Crisis Committee, and the Population Institute.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.Mortality has declined in all the countries of the Economic and Social Commission for Asia and the Pacific (ESCAP) region, but the declines have been far from uniform. Development may mean greater input into health services and public health, but it can also mean better transportation, more schools, higher wages, more job opportunities, and better housing. Each of these factors affects the health of the population. Mortality decline may be due to either a reduction of exposure to risk or an increased proportion of the population protected from the risk by immunization or other preventive measures. A disease may disappear, such as smallpox has, or a new treatment may substantially reduce case fatalities; both processes may be happening at once. The effective control of "preventable deaths" is the path to modern low mortality levels. Only a few ESCAP countries, those with reasonably accurate cause of death statistics, show modernized mortality levels. Deaths from infectious and parasitic diseases decline with modernization, and deaths from cancer increase. The U-shaped age pattern of mortality, in which infant and child deaths are predominant, becomes a J-shaped curve with greater mortality risk at older ages. Socioeconomic change affects mortality at national, community, and individual or household levels. Life expectancy at birth rises with per capita gross national product. On the individual level, mother's education, family income, family size, and child spacing all affect child mortality. Other sociobiological factors affect mortality risk on an individual level, such as late use of modern health services. Future mortality research needs to examine all these factors and cross discipinary lines.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.In the Economic and Social Commission for Asia and the Pacific (ESCAP) region, life expectancy at birth varies from less than 45 years in Afghanistan, Bhutan, Democratic Kampuchea, Lao People's Democratic Republic, and Nepal to 70 years and above in Japan, Australia, and New Zealand. Generally, mortality has declined in the ESCAP region in the last 25 years. Early mortality improvements can largely be attributed to new disease control technologies, such as immunization and effective disease treatment. Large-scale epidemics became rare, as did large-scale famines. In countries where population was concentrated in urban areas, such as in Singapore and Hong Kong, and in countries where health services were extended to the rural sector, such as China, mortality fell to developed country levels. Health services are not the sole agent in this process; increasing literacy, social welfare policy, adequate housing and water supplies, sanitation, and economic growth are also participants. At the root of mortality differentials between and within countries are problems associated with differential rates of socioeconomic development, income distribution, and the inadequacy of health care systems to cope with their responsibilities. Health services alone may alleviate only some of the major health problems. The sophisticated approach of Western medicine may be inappropriate for these countries. The most prevalent health problems in the least developed countries of the ESCAP region are water and airborne infectious diseases, complicated by malnutrition. Treatment, although bringing immediate relief, may not have a lasting effect on the person who must return to a disease-ridden environment.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.This paper proposes a minimum core tabulation program for national mortality analyses to 1) provide a framework for comparative country mortality analyses and 2) to encourage countries to make the best possible use of information on mortality patterns, trends, and differentials. Basically, countries should 1) go beyond this minimum program, 2) pay attention to data quality, whatever the source of data, and 3) provide complete details of definitions and data collection methods. Deaths and crude death rates should be constructed for 3 time periods--1960, 1970, and 1980, for urban and rural populations, and for administrative divisions. This approach would be useful for infant mortality rates by sex and age; it would also be useful to have infant mortality rates by socioeconomic groups and by mother's education. Mortality rates should be constructed by age and sex. The 4 leading causes of death should be given for urban and rural populations. Countries using summary measures for differential mortality should use the Gini coefficient or the Atkinson index. Countries should develop their own cross-tabulation programs for differential mortality--for example, infant mortality by mother's education and rural or urban residence or infant mortality by maternal age and parity. This program proposes a core tabulation of mortality statistics that will make international comparisons possible and promote detailed assessments of national situations.
[Unpublished] 1984. Paper presented at the Meeting on Analysis of Trends and Patterns of Mortality in the ESCAP Region, 13-19 November 1984, Bangkok.  p.Since very few developing countries have complete vital registration, most base their mortality statistics on data from occasional demographic surveys and population censuses. Brass technics are used to estimate child mortality from data on children ever born and children still living by 5-year age groups of mothers. Many of the 1980 censuses included these questions. In view of the importance of vital statistics for development planning, the UN has recently listed data to be collected by a vital registration system. Because complete registration is so difficult to achieve, some countries--India, Pakistan, and Bangladesh, for example--operate sample registration systems, which are mostly dual-method surveys, continuous registration systems coupled with periodic household surveys. Demographic survey data relies largely on indirect methods for estimating infant and child mortality. This type of survey underestimates childbearing at older ages and overestimates childbearing at younger ages. Tables 1 and 2 list information on mortality collected in the 1970 and 1980 censuses of countries in the Economic and Social Commission for Asia and the Pacific (ESCAP) region by whether information was collected on children born alive, children living, the date of birth of the last child, and whether that child is still living. Table 3 lists the UN recommendations on data to be collected in death registration.
[Unpublished] . Paper presented at the Expert Group Meeting on International Migration in Asia, Economic and Social Commission for Asia and the Pacific and Population Center Foundation, 6-12 November 1984, Manila, Philippines. 37 p.This paper briefly reviews the evidence on international migration flows relative to countries of the UN Economic and Social Commission for Asia and the Pacific (ESCAP) region. The Pacific countries covered include Australia, New Zealand, Cook Islands, Fiji, Kiribati, Nauru, Niue, Papua New Guinea, Samoa, Solomon Islands, Tonga, and Tuvalu. Asian countries covered include Afghanistan, Bangladesh, China, Democratic Kampuchea, Hong Kong, India, Indonesia, Iran, Japan, Lao People's Democratic Republic, Malaysia, Pakistan, the Philippines, the Republic of Korea, Singapore, Sri Lanka, Thailand, and Viet Nam. Although the data available for each country varies greatly, most countries attempt to estimate numbers of international migration and refugees.
[Papers presented at the First Study Director's Meeting on Comparative Study on Demographic-Economic Interrelationship for Selected ESCAP Countries, 29 October-2 November 1984, Bangkok, Thailand]
[Unpublished, 1984].  p.This study group report 1) investigates quantitatively the process of population change and socioeconomic development to identify policy recommendations for Malaysia, the Philippines, and Thailand and 2) examines the application of the "systems approach" and econometric technics for population and development planning. These country-specific studies will help to clarify the interrelationships between demographic and socioeconomic factors in the development process of each participating country and the UN Economic and Social Commission for Asia and the Pacific (ESCAP) region in general. The meeting 1) reviewed major demographic and economic issues in each participating country, 2) reviewed extant work on model building in each country, and 3) outlined a preliminary system design. Several economic-demographic models are discussed. The participants recommended that 1) the models focus of similar issues such as migration and income distribution and 2) countries should adopt, whenever possible, a similar modeling methodology. Participants agreed that models should be based, where possible, on a base-year Social Accounting Matrix (SAM). This poses no problems in Thailand or Malaysia as SAMs are already available for these countries. However, no SAM is currently available for the Philippines. Participants further recommended that the 3 models could be improved by greater collaboration among study directors during model formulation and estimation. Participants also expressed concern about the size of the computing budget and thought that models could be improved by an increased budget for computer time.
Working paper/Strategies for meeting basic socio-economic needs in the context of achieving the goals of population policies and programmes.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 253-66. (Asian Population Studies Series No. 58.)The developing countries in the Economic ans Social Commission for Asia and the Pacific (ESCAP) region present widely different development levels. 13 countries have low incomes with per capita incomes from US $80--US $370. 8 are middle income countries with incomes from US $590--US $3830. Most of the population lives in the low income countries. These populations 1) are rural, 2) have low life expectancy, 3) have high fertility, 4) have low nutrition, and 5) are illiterate. Most people do not have their basic needs met, and they live in countries with very unequal structures of income distribution. The lower 40% of the population in these countries will not be able to reach minimum levels of satisfaction for their basic needs without a development effort that is both qualitatively and quantitatively different. The middle income countries generally have declining population growth rates, higher literacy, adequate nutrition, and a life expectancy above 60. Many of the poorest countries had increasing birth rates during the 1970s. Most of the poorest countries will have a labor force that continues to be largely agricultural and rural. Countries in Southeast and East Asia, including China, have a high economic growth potential. South Asia's per capita incomes will still remain below US $200 in the year 2000. The satisfaction of basic needs remains one of the main criteria of development; this includes health, education, food, clothing, housing, and drinking water. The key elements in countries who have improved their satisfaction of basic needs are literacy rates, women's status, equal improvement for men and women, free health care, free education, and income redistribution. A basic strategy would 1) concentrate health care on maternal and child health, sanitation, and public health; 2) give educational priority to universal primary education; and 3) improve the productivity of small holdings and concentrate on staple foods.
Alternative population projections and the food and agriculture economy of the developing countries in ESCAP.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 75-82. (Asian Population Studies Series No. 58.)UN projections for the Economic and Social Commission for Asia and the Pacific (ESCAP) region indicate that its population size could grow to between 3095 and 3330 million by the year 2000. From the point of view of feeding this larger population, the region cannot be regarded as a single unit because 1) the countries have different growth rates, 2) very substantial improvements in food are necessary in some countries to eliminate undernutrition, and 3) past population growth trends may not continue. China, unlike the other countries in the region, will very likely become 100% self-sufficient in food and still provide a substantial increase in per capita consumption. The middle income countries show even higher per capita gains in consumption but have a population growth rate of 2.4%; their growth rates are expected to remain quite high in the next 2 decades. If trends in overall economic growth and food consumption continue, these countries could gain per capita food supplies so that serious undernutrition will not be present, under both high and low population growth variants, but the low growth variant will stop further declines in cereals self-sufficiency. The low income countries present a mixed picture. In some of them a continuation of trends would produce gains in per capita food supplies that will help reduce undernutrition. In others, both nutrition and food consumption will probably deteriorate.
Demography India. 1984 Jan-Dec; 13(1-2):153-67.The threshold hypothesis shares with transition theory the basic assumption that a decline in fertility is interrelated with a decline in mortality and change in the social, economic, and cultural conditions of the population. However, threshold theory fails to formulate a causal chain between fertility and the other variables and its application at the aggregate country level is limited by intracountry heterogeneity in cultural and social variables. Problematic is the fixing of the timing for a country of a decline in fertility to be inferred from the fact that some indicators of development have reached the threshold zone while others have not. This paper attempts to develope a combined index for socioeconomic development on the basis of data from 12 countries of the ESCAP region of South East Asia. Variables included were life expectancy at birth, infant mortality rate, adult female literacy, percentages of females economically active, GNP per capita, and percentage urban population. In 1970, 3 of the countries analyzed had a crude birth rate below 25, 6 countries had a rate between 25-40, and 3 had a rate above 40. The lowest value of the index recorded for countries of low fertility (crude birth rate below 25) and the highest value recorded for countries of high fertility (above 40) are taken as the threshold zones for the overall index. The number of countries in the threshold range increased from 5 in 1970 to 8 in 1975. With the increase in the index value, a reduction in the fertility level was noted. In contrast, where socioeconomic development was slow, fertility showed little change. Policy makers could use this system to assess which indicator could be pushed through to raise the overall index of development so as to effect a decline in fertility.
In: Third Asian and Pacific Population Conference (Colombo, September 1982). Selected papers. Bangkok, Thailand, Economic and Social Commission for Asia and the Pacific, 1984. 9-40. (Asian Population Studies Series No. 58)This report summarizes the recent demographic situation and considers prospective trends and their development implications among the 39 members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP). It presents data on the following: size, growth, and distribution of the population; age and sex structure; fertility and marriage; mortality; international migration; growth and poverty; food and nutrition; households and housing; primary health care; education; the working-age population; family planning; the elderly; and population distribution. Despite improvements in the frequency and quality of demographic data collected in recent years, big gaps continue to exist in knowledge of the demographic situation in the ESCAP region. Available evidence suggests that the population growth rate of the ESCAP region declined between 1970 and 1980, as compared with the preceding decade, but that its rate of decline was slow. Within this overall picture, there is wide variation, with the most developed countries having annual growth rates around 1% and some of the least developed countries having a figure near 3%. The main factors associated with the high growth rates are the past high levels of fertility resulting in young age structures and continuing high fertility in some countries, notably in middle south Asia. The population of countries in the ESCAP region is expected to grow from 2.5 billion in 1980, to 2.9 billion in 1990, and to 3.4 billion persons by the year 2000. This massive growth in numbers, which will be most pronounced in Middle South Asia, will occur despite projected continuing moderation in annual population growth rates. Fertility is expected to continue its downward trend, assuming a more widespread and equitable distribution of health, education, and family planning services. Mortality is expected to decline further from its current levels, where life expectancy is often at or around 50 years. In several countries, more than 10 in every 100 babies born die before their 1st birthday. The extension of primary health care services is seen as the key to reducing this figure. Rapid population growth and poverty tend to reinforce each other. Low income, lack of education, and high infant and child mortality contribute to high fertility, which in turn is associated with high rates of natural increase. High rates of natural increase feed back to depress socioeconomic development. High population growth rates and their correlates of young age structures and heavy concentrations of persons in the nonproductive ages tend to depress production and burden government expenditure with high costs for social overhead needs. Rapid population growth emerges as an important factor in the persistence of chronic undernutrition and malnutrition. It increases the magnitude of the task of improving the educational system and exacerbates the problem of substandard housing that is widely prevalent throughout Asia.
In: Aspects of population change and development in some African and Asian countries. Cairo, Egypt, Cairo Demographic Centre, 1984. 43-56. (CDC Research Monograph Series no. 9)This paper examines the relationship between economic development and demographic change in the 13 states of the Economic Commission for West Asia (ECWA) region. Demographic variables considered include per capita income, proportion urban, proportion in urban areas with over 100,000 inhabitants, literacy among those over 15 years, and literacy among women. Unweighted rankings on these variables were added to produce a development ranking or general development index. Then this index was used to investigate the relationship between development and individual scores and rankings for various demographic indices. The development index exhibited a rough fit with the mortality indices, especially life expectancy at birth. Mortality decline appears to be most closely related to rise in income. At the same income level, countries that have experienced substantial social change tend to exhibit the lowest mortality, presumably because of a loosening in family role patterns. In contrast, the relationship between development and fertility measures seemed to be almost random. A far closer correlation was noted between the former and the general development index. It is concluded that economic development alone will not reduce fertility. Needed are 2 changes: 1) profound social change in the family and in women's status, achievable through increases in female education, and 2) government family planning programs to ensure access to contraception.
ESCAP/POPIN Working Group on Development of Population Information Centres and Network: report on the meeting held from 20 to 23 June 1984.
Popin Bulletin. 1984 Dec; (6-7):99-102.The Expert Working Group on the Development of Population Information Centers and Networks met in June 1984 to consider the organizational and technical aspects of the development of national population information centers in the countries in the Bangkok region, as well as national, regional and global networking. Representatives from China, India, Indonesia, Malaysia, the philippines, the Republic of Korea, Sri Lanka, Thailand and Viet Nam participated in the meeting. POPIN was represented by its coordinator. Among the major issues considered by the Working Group were the role and functions of population information centers with special reference to the positioning of centers in national population programs user-oriented products to facilitate the utilization of research findings for policy formulation and program implementation, and the possible approaches to be developed by population centers in facilitating in-country networking to extend population information services beyond capital cities to the local level. The mandate and responsibilities of national population information centers should be explicitly stated by the highest authority. Centers should contribute to the national population programs by collecting, processing and disseminating population information effectively. Greater flexibility in performing activities should be given to centers. Training of staff should be expanded; external funding should be continued; and research and evaluation techniques should be developed. Surveys of users and their needs should be periodically undertaken to determine needs. Systematic user education programs should be provided and policy makers should be informed of current research findings and policy implications. Automation of bibliographic information should be undertaken. The Asia-Pacific POPIN Newsletter produced by ESCAP should be institutionalized as a channel of information centers in the region. ESCAP should take the initiative in establishing a South Asian network along the lines of ASEAN-POPIN to facilitate exchange of ideas and information. Efforts should be directed at linking the WHO Health Literature Library and Information Serivces (HELLIS) and POPIN in the Asian and Pacific region.
[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.
POPIN Working Group on Dissemination of Population Information: Report on the meeting held from 2 to 4 April 1984.
Popin Bulletin. 1984 Dec; (6-7):69-79.The objectives of this meeting were: to analyze the general dissemination strategy and functions of POPIN member organizations and assess the methods currently employed to identify users; to select publications or other information output and evaluate how they are being distributed and how procedures for the selective dissemination of information are developed; to develop guidelines for determining the potential audience and reader's interests; to discuss the methodology for maintaining a register of readers' interest; to develop guidelines for establishing linds with key press and broadcasting agencies to ensure rapid dissemination of information; to dientify media and organizations currently involved in the dissemination of population information; to document experience and provide recommendations for the utilization of innovative approaches to serve audiences; and to explore ways and means to meet the special needs of policy makers. Problem areas in population information dissemination were identified at the meeting as well as priority areas in meeting speical information needs of policy makers. Collection of information for dissemination is difficult, costly and time-consuming; there is a shortage of staff trained in the repackaging and dissemination of population information; the direct use of the mass media for information dissemination is still very limited; and financial resources are limited. Priority areas include: compilation of a calendar of events or meetings; conducting media surveys and inventories of population infromation centers and their services and compilation of results; resource development through product marketing and preparation of resource catalogues; and preparation of executive summaries highlighting policy implications to facilitate policy making. Recommendations include: promotion of training and technical assistance in population information activities by the POPIN Coordinating Unit; encouraging member organizations with relevant data bases to develop subsets for distribution to other institutions and, where feasible, to provide technical assistance and support for their wider use; the POPIN Coordinating Unit should alert its members regularly of new technological facilities and innovations in the field of information; organizations conducting population information activities at the national and/or regional levels should be encouraged to provide the POPIN Coordinating Unit with yearly calendars of meetings for publication in the POPIN Bulletin; and the members of POPIN are urged to emphasize the need to incorporate specific plans and budgets for population information activities.
POPIN Working Group on the Management of the Population Multilingual Thesaurus: report on the third meeting (26-29 March 1984).
Popin Bulletin. 1984 Dec; (6-7):61-8.The main objective of this meeting was to review the revised edition of the Thesaurus before its publication. Participating in the meeting were the members of the Working Group and observers representing the Information Systems Unit of the Department of International Economic and Social Affairs of the UN Secretariat and SEADE, Sao Paulo, Brazil. The agenda consisted of a progress report on Thesaurus-related activities of Working Group members; the revised edition of the Thesaurus (English, French and Spanish versions); other language versions of the revised Thesaurus (Portuguese, Arabic and Chinese); and recommendations. Discussion of the revised edition focused on: the alphabetical list of descriptors and nondescriptors, institutional terms and geographical names; distribution of descriptors and nondescriptors according to a thematic scheme; presentation of hierarchical display; permuted index; cover page; and the introduction. Each participant was called upon to give a brief progess report on related activities of their organization. The DOCPAL staff were working closely with the staff of CLADES concerning the development of a commen methodology, worksheets and the use of ISIS software. During the year, CICRED concentrated efforts on producing the revised edition of the Thesaurus, taking into account the recommendations of the Working Group at its 1982 and 1983 meetings which were endorsed by the POPIN Advisory Committee. DOCPOP focused on published and unpublished documents produced since 1980, on population and related fields on or about Brazil. The main activities of the ESCAP Regional Population Information Center related ot the Thesaurus included the creation of key file of EBIS/POPFILE descriptors and the integration of terms from the Population Multilingual Thesaurus and the OECD Macrothesaurus, as well as terms proposed by the Center to develop EBIS common indexing vocabulary. Work was focused on the preparation of the revised edition of the POPLINE THESAURUS, which was expected to be completed by June 1984. It was agreed that the terms to be included in the Population Multilingual Thesaurus should be listed vertically, instead of horizontally as in the draft presented to the Working Group. 3 language equivalents would appear (English, French and Spanish). Contributors to the revised edition were urged to continue their collaboration in updating the Thesaurus by constantly forwading suggestions for addition, deletion and substitution of terms.
New York, New York, FPIA, 1984 Mar. , 113 p.Family Planning International Assistance (FPIA) initiated strategic planning in 1983, including mission statement, objectives, means, and tactics commonly used to reach the objectives and considerations for strategy development. This document contains background information, FPIA's rationale for developing a 3-year strategic plan, the plan's method, a strategic plan summary, and country plans for countries in the Caribbean, Central America, South America, Asia, and Africa. FPIA's rationale for developing a 3-year strategic plan is as follows: to address AID/W's ongoing need for a clear rationale for continued funding in a time of limited resources; to increase FPIA's capability to make decisions systematically; to organize efforts to carry out decisions and to measure decisions through systematic feedback; to increase FPIA's capability to monitor progress in reaching objectives; to increase FPIA's control over its environment; to continue to address 1981 evaluation findings; and to decrease time involved in plan preparation by planning over a longer time period. FPIA's tactic statements describe the basic approaches to be used in carrying out a predetermined strategy by: extending existing family planning services of government and nongovernment institutions to new geographic areas or to new populations; initiating family planning service in institutions not currently involved in service provision; providing parallel or complementary services; transferring management technology; training staff; working with resistant populations, adolescents, utilizing local resources; and supplying family planning commodities to projects and nonproject institutions. Once objectives were set, the regions were ready to write a strategy for each country. To facilitate writing the strategies, each region received the following series of strategic considerations: state of development of the family planning program in each country; government plans, AID, and USAID mission strategies; type of program FPIA, AID/W, and USAID currently is funding; and rationale for continued private voluntary organization/FPIA support to the country. The strategic plan summary (1984-86) includes FPIA's goals, policy, and philosophy and FPIA's mission, goals, and objectives.