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[Operations research in family planning programs] Investigacion operativa en programas de planificacion familiar.
In: Investigacion en planificacion familiar y servicios de salud, edited by Luis Sobrevilla, Mary Fukumoto. Lima, Peru, Consejo Nacional de Poblacion, 1984. 89-95.At the 1974 World Population Conference held in Bucharest, a World Plan of Action was adopted by 136 countries with the goal of controlling population growth. At the 1984 World Population Conference held in Mexico, many countries that previously supported pronatalist views started to promote family planning. China proposed to hold its population growth at 1200 million. Many African countries also adopted family planning programs. In the 1980s major changes occurred in strategies for the promotion of family planning. Community-based distribution, social marketing, and decentralized distribution schemes were tried. Community participation for promoting family planning was also undertaken. Operations research aided decision making and established links between health, nutrition, family planning, education, and employment. The family planning program could be divided into components such as organization (integration into health and nutrition programs, information about service users, the role of voluntary organizations); marketing (the increase of maternal age impacting demand, the choice between clinical or community distribution, social marketing or the combination of these); operations (the distribution of resources among different activities and among the three phases of the program, and personnel training for optimal resource use); and financing, budget, and control (budget controls for the stimulation of efficiency, the system of cost control in primary health centers, and the improvement of records). Operations research could also play a vital role in the design, implementation, and evaluation of different interventions.
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.
Assignment Children. 1984; (65/68):13-20.The central idea behind UNICEF's rubric of the Child Survival and Development Revolution (CSDR) is to enable parents to protect their children from preventable death an disablement. The CSDR strategy takes the demand approach, which opens the possibilities for parents to see what they should and could do to "grow" their children better. The concept of demand implies supply and therefore goes 1 step further than the concept of needs, spoken of for years in the development literature. Demand is often latent demand. The "demand" for good health and survival of a child is covered over by a widespread perception o fFate, the only explanation available to most people to help them bear their suffering. It is possible to change the climate of fatefulness through the media and the influential members of the community and to communicate the mssage that Fate is not Destiny, thus introducing the possibility of acting to change that Fate. What is therefore needed is to communicate the information and knowledge needed to bring about that change, thereby converting latent demand into articulate and effective demand to which supply is the response. 3 fronts are identified to carry out such a CSDR program: 1) training effective communicators of the CSDR message; 2) producing adequate program communication materials of sensitive and direct relevance to particular communities and 3) responding to the demand raised by hving supplies at hand. To make good on the promise of the CSDR, society needs to be mobilized, the political will stimulated and the professional will, active. Social mrketing is a new idea which is being adopted by UNICEF. It is an integral element of its program of social communication as are also public information and program communication. All 3 elements are integral to UNICEF's main programs of child development and survival.
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.
In: Research Consortium for the Infant Feeding Study. The determinants of Infant feeding practices: preliminary results of a four-country study. New York, N.Y., Population Council, 1984 Apr 45-56. (International Programs Working Paper No. 19)The World Health Assembly, governing body of the World Health Organization (WHO), adopted a Code of Marketing of Breast Milk Substitutes in May, 1981. The question of what impact legislative, reggulatory, and voluntary actions by government and industry have had on the commercial marketing of infant food in Colombia, Indonesia, Kenya, and Thailand is addressed. The research was conducted between 1981 and 1983. This study of marketing activities was intended to analyze the direct effects of marketing activities and the interaction of marketing with other factors found to influence infant feeding practices. Research objectives were organized around 3 basic questions. 1) What are the characteristics of current marketing practices and strategies of infant food companies? 2) What factors account for the current marketing environment for infant foods? 3) What is the intensity of promotional activity at this time? Data was collected through interviews and a cross-sectional survey of mothers and infants. There have been 5 important trends in the way the marketing of infant foods has changed since 1981. They are: 1) an increased amount of price competition; 2) increased product availability; 3) discontinuance of consumer-oriented mass media advertising; 4) extensive promotion of commercial infant foods to health care workers, and through them to consumers; and 5) continued distribution of infant formula samples to mothers, directly or indirectly, many of whom live in a high-risk environment.
Social Marketing Forum. 1984 Summer; 1(4):1,5.Sri Lanka's Family Planning Association has stopped selling its Preethi Regular condom, the backbone of its social marketing program for nearly a decade. Last year nearly 7 times as many Preethi condoms were sold as all other brands combined. The decision was reported to be caused by budget constraints following the International Planned Parenthood Federation's (IPPF) new policy of limiting the number of Preethi Regular condoms supplied to Sri Lanka. IPPF's Asian Regional Officer reported that the Preethi condom is a costly product, and that as many as needed of a US Agency for International Development (USAID) supplied product will be sent to Sri Lanka. The Contraceptive Retail Sales (CRS) program has devised a new sales strategy, based partly on the introduction of a high-priced condom to fill the gap left by the discontinuation of the Preethi Regular. The new Preethi Gold condom is expected to help the project become more financially self-reliant while taing advantage of Preethi's marketplace popularity. Preethi Gold is manufactured by the Malaysia Rubber Company and costs the project US $4.85/gross. It is sold for US $.14 for 3, about 3 times the price of a Preethi Regular. The project is also pushing the Panther condom, donated to IPPF by USAID. 2 Panther condoms sell for about 3.6U, about the cost of Preethi Regulars. The project also sells Moonbeam, Rough Rider, and Stimula condoms, the latter 2 at full commercial prices. A smooth transfer of demand from Preethi to Panther had been desired, but by the end of 1983 some retailers were hesitating to make the product switch because some Preethi Regulars were still available. Total condom sales in 1983 were down by nearly 590,000 from the approximately 6,860,000 sold in 1982. Total condom sales for the 1st quarter of 1984 were slightly over 1,218,000 pieces, compared to about 1,547,000 for the same quarter in 1983, a decline of 21%. The Family Planning Association is gearing up to reverse the downward trend. Panther sales increased from, 38,000 condoms in the 1st quarter of 1983 to 462,000 in the same period of 1984. The project is intensifying its market coverage by increasing the number of sales divisions from 5 to 7 to help maintain sales momentum for the new product.
The human right to family planning. Report of the Working Group on the Promotion of Family Planning as a Basic Human Right to the Members' Assembly and the Central Council of the International Planned Parenthood Federation, November 1983.
London, International Planned Parenthood Federation, 1984. 52 p.This report examines the problems involved in the exercise of the right to family planning; reviews the approaches taken towards overcoming these problems and promoting the right to family planning at local, national, and international levels, including the experience of the International Planned Parenthood Federation (IPPF); and makes recommendations to the 1983 meetings of the Central Council and the Members' Assembly on the action that should be taken by the IPPF and its members to enhance the commitment to family planning as a basic human right during 1982-84 Plan and beyond. The report's 5 sections discuss the following: the concept of the right to family planning (historical background and a conceptual elaboration); links between the right to family planning and other human rights (basic human rights and needs, advocacy for social development, and women's rights); access to fertility regulation information and services (full and voluntary choice of methods, rights of young people, financial accessibility of fertility regulation services, and the right to have children); incentives and disincentives to individuals and couples, incentives to providers of fertility regulation information and services, and research needs; and strategies for promoting family planning as a basic human right (ensuring that the individual has the knowledge of the right to fertility regulation and understands the options, generating societal support for family planning, ensuring ready access to the means ror fertility regulation, legal support for the right to family planning, and increasing political commitment to the right to family planning). The application of the term "the right to family planning" to many different elements of personal and social behavior as well as to policy making and program development has led to some confusion and potential conflict between rights and responsibilities. It is recommended that a clear distinction be made in the definition of the right to family planning to reflect 2 important components, namely, the right of everyone to have ready access to information, education, and services for fertility regulation; and the right of everyone to make decisions about reproductive behavior. Family planning organizations canachieve institutional credibility as caring organizations and assure program effectiveness by encouraging the recognition of the links between the right to family planning and the right to other social and economic improvements that are the essence of development.
World Smoking and Health. 1984 Spring; 9(1):4-6.An Expert Committee met in World Health Organization Headquarters in Geneva in November 1982 to discuss Smoking Control Strategies in Developing Countries. They reviewed the harmful health effects of different types of tobacco which characterized developing countries and the adverse effects of tobacco use on their economics due to smoking related diseases and higher smokers' work absenteeism. It advised on the objectives of smoking control programs, including data collection; education and information; legislation; smoking cessation; the role of medical, political, social, and religious leaders; the role of WHO, UN agencies, and nongovernmental organizations; research on smoking behavior; and evaluation of program efficacy. In addition, the Committee provided guidance on how to counteract tobacco industry arguments. More than a million people worldwide die prematurely each year because of cigarette smoking. In developed countries smoking is generally understood to cause lung cancer, coronary heart disease, chronic bronchitis, and other respiratory disorders. Major campaigns have been launched to reduce the rate of smoking. The public in most developing countries are unaware of the dangers, and no educational, legislative, or other measures are being taken to combat the smoking epidemic. The Committee called for firm steps to be taken to prevent this unnecessary modern epidemic. The incidence of tobacco related diseases is increasing in developing countries. Many of the developing countries have cigarettes on sale with high yields of tar and nicotine. Tobacco cultivation has spread to about 120 countries, becoming a substantial source of employment and creating new vested interests. Overall, the costs outweigh the "benefits." Tobacco taxes may be Politically comfortable," that is, easy to administer and generally acceptable to smokers, but these taxes do not contribute to national wealth but merely redistribute wealth. They cannot offset the economic losses caused by tobacco production and use: health service expenditures on smoking related diseases, disablement and work absenteeism, domestic and forest fires, use of scarce fule to cure tobacco, and reduced food production. Action against smoking can be inexpensive yet effective. Health warnings can be placed on cigarette packets, and legislation can be enacted to put an end to the double standards in marketing practices, whereby cigarettes of the same brand carrying health warnings in developed countries are marketed without these warnings in developing countries. Recommendations issued to governments and public health authorities in developing countries are listed.
Lancet. 1984 Jan 7; 1(8367):23-4.The epidemic of tobacco smoking is quickly spreading to developing countries with the encouragement of UK- and US-based companies. A 1983 World Health Organization (WHO) report catalogues the evidence that the smoking diseases have already arrived in the developing countries. High death rates for lung cancer are reported from India, China, Hong Kong, and Cuba, and in the Bantu of Natal. Coronary heart disease associated with cigarette smoking is a major feature in India, Pakistan, and the Philippines. Perinatal mortality rates are doubled in Bangladesh women who smoke. WHO makes a strong appeal for effective change. The question is whether governments and health ministries will face up to this challenge any more than they did to 2 earlier WHO reports on smoking. Developing countries are now urged to give high priority to smoking control activities. Although malnutrition and infectious diseases may seem to be more pressing, only action now can prevent their exacerbation by smoking-related diseases. Each country should establish a central agency with responsibility for smoking control action. Special steps should be taken to safeguard the health of children through educational programs. The sale of cigarettes to minors should be prohibited. Particular attention should be paid to traditional smoking materials as a cause of ill health, and advertising and promotion of tobacco products should be banned. Where tobacco is a commercial crop, every attempt should be made to reduce its role in the national economy and to investigate alternative use of land and labor. The UK bears considerable responsibility for the present situation. Yet, far from discouraging exports to developing countries, the reverse is true. Britain offers no overseas assistance for anti-smoking programs. Instead, it has provided funds for the development of tobacco industries. Individual doctors in Britain can provide an example by pressing for smoking control policies in all hospitals and health service premises. They can voice their concern at the activities of the tobacco companies both at home and abroad, and they can consider the propriety of holding tobacco shares either themselves or via the universities or institutions with which they are associated.