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Strengthening government capacity for national development and international negotiation: the work of Save the Children Fund in Mozambique.
[Unpublished] 1991. Presented at the Annual Conference of the Development Studies Association, Swansea, England, September 1991. 27 p.This conference paper offers lessons learned by the Save the Children Fund (SCF) regarding work in Mozambique in the course of seven years. SCF began its involvement in Mozambique in late 1984 supporting the government's expanded program of immunization. Objectives were to support essential services by working with the authorities from national through district levels. Models of good practice were assisted at the provincial level in Zambezia. The program diversified in 1986 with the development of policy about orphaned children traumatized by the war. Nutrition, transport, and emergency support followed over the next two years with a great deal of assistance going to the Mozambican emergency structure. The current SCF program has evolved in two major directions: 1) funding, logistical, and technical support at the provincial level to develop models of good practice, and 2) technical assistance at the central government level by experienced expatriate advisors placed within the Ministries of Health and Education along with training for Mozambican counterparts. The ruling government party FRELIMO was seen to be committed to progressive development policies, particularly in primary health care, education, and social welfare. The impact of the strategy on the lives of children was difficult to assess because of the devastation of the country by war and economic decline. A functioning health information system has been developed based on the advice given by computer specialists of SCF. A special focus of SCF's contribution to alternatives to institutional care has been the assessment of the impact of war, violence, and separation on children. This includes the tracing of surviving members of families of orphaned children and reuniting them and teacher training to reconstruct the child's life in school settings. SCF's food security adviser has also contributed substantially to the World Bank Food Security Strategy Paper approved in 1989.
Geneva, Switzerland, WHO, 1991. vii, 72 p.Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):24-5.While there may be no documented evidence that mortality decline is a causative factor in demographic transition, there is a close association between reductions in mortality and fertility. The Indian experience of more than 40 years shows that consistent efforts in the promotion of family planning will be rewarded with demographic transition. In the Indian state of Kerala, population 30 million, improving child survival, female literacy, strict child labor laws, and effective high coverage primary health care reduced mortality and fertility. Its infant mortality rate is 22/100 births, which is 25% of the national average. Its birth rate is 20/1000 and is continuing to fall. In the past decade population growth was only 14% compared to 25% nationally and 28% in the northern states. If Kerala's figures were applied to all of India, there would be 2 million less infant deaths and 8 million less births. The impact of reducing infant mortality on population growth in raw numbers in insignificant. With a mortality rate of 150/1000 there are 850 survivors. If the mortality rate is cut in half there will be only a .18% increase in population, but with a 50% reduction in infant suffering and death. Historically such mortality declines are associated with a 25% or more decline in fertility. This is the reason that UNICEF has been a long-time advocate of child survival programs as an integral part of population control measures. Euthanasia is surely not the solution to the population problem. The daily loss of 40,000 childhood lives is a tragic part of the human experience. However, helping these children to become and stay healthy is the best method of reducing population.
New York, New York, UNICEF, 1991. 60 p.The 1991 UNICEF annual report contains an introduction written by the Executive Director, James P. Grant. In it he outlines the goals of the World Summit for Children which include: initiatives to save an additional 50 million children, reduce childhood malnutrition by 50%, reduce female illiteracy by 50% , and eradicate polio and guinea worm from the planet. The report discusses the programs conducted during 1991 including: the World Summit for Children, child survival and development, basic education, water supply and sanitation, sustainable development, urban basic services, childhood disability, women in development, social mobilization, emergency relief, monitoring and evaluation, inter-agency cooperation. The report also outlines UNICEF's external relations, resources, and provides several profiles including Africa's AIDS orphans. Income for 1990 totaled US$821 million for 1990, and estimated at US$858 million for 1991. Expenditures for 1989 were US$633 million, US$738 million for 1990, and estimated at US$847 million for 1991.
Oxford, England, Oxford University Press, 1991. , 128 p.The State of the World's Children for 1991 begins with a promise by world leaders to adopt an ambitious series of goals for 2000 with an objective to end child death and child malnutrition at today's levels. Keeping the promise will not be easy since raising the resources to meet this goal will mean giving children a new, higher priority. Success will only be achieved by following certain principles, for example, reaching the immunization goals for the year 2000 will require almost every organization and person in both developing and developed countries to work hard. In order to succeed in only 10 years, a new ethic must develop which gives children a number 1 priority even in bad times. Reducing child deaths by 33% during this decade will mean essential steps must be taken in the process of reducing births and slowing population growth. The current generation will be charged with caring for the largest generation of children ever. Their performance will ultimately be judged according to the outcome of the children of the 1990s.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):25-7.The article on human entrapment in India by Maurice King is just another example of the dogmatic, simplistic and reckless way in which the white scholars of the North formulate their ideas. It is these people who are responsible for the opium wars, programs against Jews, and carpet bombing, defoliation, and massacres in Vietnam. King's idea os using UNICEF and the WHO to kill the non white children of the South is just another example of this kind of racist brutality. It is based only upon the written opinions of other white scholars. In 1991 King produced no data about human entrapment in India. King ignores the writing of non whites like Ashish Bose who presided over the International Population Conference in 1989. Other mistakes that King makes include a failure to understand the applications of immunization (EPI) and oral rehydration programs (ORT). The EPI was implemented without ever taking baseline data, so that its effectiveness is impossible to determine with any accuracy. And nowhere in the world has ORT worked as well as UNICEF claimed it would. Further proof that King advocates genocide is his labeling of the insecticide-impregnated bednets as a dangerous technology in increasing entrapment. King fails to acknowledge the overwhelming influence of white consultants on the policies and planning strategies of family planning programs in India. Their list of failures includes: the clinic and extension approach, popularization of the IUD, mass communication, target orientation, sterilization camps, and giving primacy to generalists administrators. They should be held accountable for the 406 million people added to the base population between 1961-91 It should also be noted that India had the ability absorb this large number people while still maintaining a democratic structure, gather a substantial buffer stock of food grains, consistently increasing its per capita income while decreasing its infant mortality and crude death rates, increase its life expectancy at birth and improve the level of literacy, especially for females.
ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.