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  1. 1

    Staff appraisal report: Bangladesh, Fourth Population and Health Project.

    World Bank. Population and Human Resources Division

    [Unpublished] 1991 May 20. [4], ix, 145, [2] p. (Report No. 9400-BD)

    This staff appraisal report was based on the findings of a mission visiting Bangladesh in November 1990, representatives from a number of developed countries and international organizations. An overview was provided of past development activities in health and family planning, followed by a detailed description of the Fourth National Population and Health Program (1992-96): objectives, activities, environmental considerations, costs and financing, and implementation. The benefits of the plan were identified as improved welfare of women and children through greater spacing of births and improved health status. Family planning and health services were expected to be enhanced by integration of services, reorientation of medicine to community services, and improvement in quality of services. The main risk identified was the inability to fully implement the extensive reform in the health subsector and the potential weakness of management of the health subsector. The plan incorporated features to address the risks. Agreements were reached that the Bangladesh government would hire at least 4500 qualified women as health assistants by March 31, 1992, provide transportation for family planning and health workers to attend satellite clinics, and implement the following surveys: a fertility survey in 1994, a contraceptive prevalence survey by March 31, 1993, a facilities utilization survey by September 30, 1992, a feasibility study of storage requirements for family planning and health supplies by December 31, 1992, a comprehensive baseline survey of maternal and neonatal health care in the districts of Kushtia, Tangail, Feni, and Sirajganj/Pabna. 25 other recommendations were listed. The reason for low levels of human resource development has been inadequate past and present expenditures. In order to increase the contraceptive prevalence rate government and donors must expand programs for primary health care, family planning, and primary education as quickly as possible. Long-term sustainability will depend on government and donor resources, the role of nongovernmental organizations, and cost-sharing arrangements. The failures of the past have been in the government's concern with short-term political concerns rather than long-term development. Remediation will involve sector self-reliance and not individual project initiatives.
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  2. 2

    Strengthening nutrition through primary health care: the experience of JNSP in Myanmar.

    World Health Organization [WHO]. Regional Office for South-East Asia [SEARO]

    New Delhi, India, WHO, SEARO, 1991 Dec. [3], 35 p. (Regional Health Paper, SEARO, No. 20)

    The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
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  3. 3

    Programme review and strategy development report: Botswana.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. vii, 71 p.

    The Government of Botswana followed good economic policies during the 1970s-80s and received considerable revenues from minerals which it invested in its social and economic infrastructure. this resulted in more employment and improved health, education, and skills of the population. Even though these actions were a good start in dealing with population issues, the population continues to grow rapidly (3.45%) and total fertility is high (6.39). Despite the country's small population size (1.3 million; population density=2/square km), it strains Botswana's limited resource base. In the future, the water supply will be Botswana's most serious problem. It is now facing increased teenage and unwanted pregnancies, malnutrition, overcrowding, and street children. Yet Botswana has no official population policy. Maternal and child health (MCH) programs provide family planning (FP) information, services, and supplies, but based on the growth rate, women tend to use contraceptives to space births. Contraceptive prevalence is around 32%. The government does not have a definite information, education, and communication (IEC) strategy that targets populations not served by MCH/FP programs. UNFPA recommends that the government of Botswana begin formulating a population policy and implementation strategy. It suggests that the strategy include an institutional framework; a policy document; the organization of a national population program as soon as possible; IEC; a component addressing women, population, and development; FP services; a framework for data collection and analyses; and mechanisms to improve date quality, analyses, and dissemination of findings.
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  4. 4

    UNFPA-funded projects executed by the WHO/Western Pacific Regional Office (WPRO).

    Carino L; Stray-Pedersen B; Shah U; van der Does C

    New York, New York, United Nations Population Fund [UNFPA], [1991]. [5], 44 p. (Evaluation Report)

    UN Population Fund (UNFPA)-supported projects and programs are evaluated to provide information needed in planning, programming, and decision making. Such information helps allow the improvement of current and future program activities, greater effectiveness in utilizing UNFPA financial assistance, and country government participation in improving projects and programs. This document reports results of an evaluation of UNFPA-funded regional and country projects carried out by the WHO/Western Pacific regional office (WPRO). The evaluation was conducted by a team of 4 independent consultants and 2 UNFPA officers working on-site in China, Vietnam, Papua New Guinea, the Solomon Islands, and Fiji. Discussions were held with government officials and field staff from UNDP/UNFPA and WHO/WPRO country offices. Broadly, positive UNFPA/WPRO collaboration exists in maternal-child health/family planning, and should be continued and strengthened. WPRO execution of UNFPA-funded projects is then discussed in detail in sections covering the regional project, support to country projects, issues in WPRO/UNFPA collaboration, the role of women, and important factors affecting performance. WPRO support units and procedures are then addressed, and include personnel matters, human resource development, financial matters, supply and equipment procurement, and communication issues. Recommendations are presented in a closing section.
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  5. 5

    Programme review and strategy development report: Bolivia.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. vi, 66 p.

    The UN Population Fund (UNFPA) reviewed the process of population policy formulation in Bolivia in May-June 1990 in a Programme Review and Strategy Development Report. Faced with high external debt and falling output but a population growing at 2.8%, Bolivia lacks the luxury of a vital registration system or a population policy. It is generally believed that the population density is too low for adequate production, and that a population policy means demographic birth control. An opinion survey of national leaders in 1989 showed an emerging realization of the need for a population policy, but ignorance of what such a policy entails. Bolivia has a National Social Policy Council (CONAPSO) which has produced important research and policy guidelines in other areas, but has neglected population issues. There is no research or statistical data since the Census of 1976, except for a few sample surveys; what information exists is global, and none of it is used for designing development plans. Maternal/child health (MCH) is poor in Bolivia, with significant malnutrition, infant mortality, deaths from preventable disease, tetanus, and respiratory infections, as well as excessive childbearing, nonmedical abortion, and malnutrition in women. An MCH Action Plan for 1990 has 6 clear goals and actions. No IEC program is in place. There is no appreciation of the magnitude of women's economic contribution in existing national data. Most donor funds and technical cooperation have been devoted to job creation and small projects involving health and education, such as sanitation and water projects in 11 small towns. The report ends with 9 general strategies covering such topics as population-development policy, MCH/family planning services, IEC, education of leaders, national statistics, women's issues, and increasing and coordinating international assistance.
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  6. 6

    Programme review and strategy development report: Nigeria.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 1991. iv, 73 p.

    Nigeria has more people within its boundaries than any other nation in Africa. Since it total fertility rate is so high (6.6) and the modern contraceptive prevalence rate is so low (3.5%), its population is growing considerably (3.3%). April 1989, the Government of Nigeria officially launched its National Policy on Population which set several goals, e.g., family planning (FP) coverage to 80% of women of reproductive age and reducing the population growth rate to 2% by 2000. Part of the national overall strategy for implementing the population policy in 1992-1996 includes giving priority to activities in maternal and child health (MCH)/FP; information, education, and communication (IEC); and women's role in population and development. It also stresses collection of population data, demographic analysis, and research. For example, the last population census was in 1963 so the Government plans a census in late 1991. Nigeria has integrated FP into the MCH program within the context of primary health care. Specifically, it centers on training and using traditional birth attendants to deliver infants in a safe manner, to provide FP services (e.g., as distribution of nonprescription FP methods), and to educate women about women's health and FP using IEC techniques. Further the Government intends to institutionalize the IEC strategy at all levels. For example, the Nigerian Educational Research and Development Council and its corresponding State Committees have integrated population education into secondary school curricula. In addition, IEC population education activities have been extended to nonformal and adult education, such as the organized labor sector and counseling at clinics and other health facilities. The Government has set up the National Commission for Women to integrate women's issues into all sectors of national development. Donor agencies active in population activities in Nigeria include UNFPA, UNICEF, UNICEF, USAID, the World Bank, the European Economic Community, Japan, and the Netherlands.
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  7. 7

    Evaluation report on the Philippines diarrhea clinical training program. Part A.

    Casazza LJ; Newman JS

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991. [7], 14, [50] p. (USAID Contract No. DPE-5969-Z-00-7064-00)

    In September 1991, 2 consulting groups, WHO, and the Department of Health of the Philippines collaborated in a study to determine the quality of the diarrheal training unit (DTU) courses at various hospitals in Manila, Cebu, Zamboanga, and Tacloban, the Philippines and the ability of the DTU trainees to apply what they learned. The evaluation team observed 2 courses in diarrheal case management at the National Rehydration, Treatment, and Training Center (NRTTC) in Manila and at the Southern Islands Medical Center (SIMC) in Cebu presented simultaneously between September 2-6, 1991. During the course, trainees at NRTTC were able to observe 54 diarrhea cases while those at SIMC were able to observe 8. The simulation testing showed that trainees of the NRTTC course were better able to assess and manage diarrhea cases at the end of the course than were those of the SIMC course. This was because NRTTC participants had had more extensive practical training. This finding suggested that the best training method consisted of experience and confidence acquired in actually managing cases. Case simulation was valuable in identifying deficiencies in trainee knowledge and skills that would have otherwise been missed. In fact, facilitators at SIMC observed trainee problems in all 3 major skill areas: assessment, treatment, and counseling. The evaluation of participant postcourse knowledge and skills and of content and teaching methods of the training courses should prove useful to the DTU faculty and the Control of Diarrheal Disease program in planning for future DTU training. Further it provided a base to measure ensuing participant performance in the field. The team arranged for administration of part B of the study which is to identify strengths and weaknesses of the trainees.
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  8. 8

    Bangladesh national immunization cluster survey: 1991.

    De Silva R; Herm H; Khan M; Chowdhury JH

    In: Near miracle in Bangladesh, edited by Mujibul Huq. Dhaka, Bangladesh, University Press Limited, 1991. 85-96.

    The WHO standard national immunization coverage evaluation survey of Bangladesh, which was independent of EPI reporting or the Ministry of Health service delivery system, is presented. Included are observations from the field. Multistage sampling techniques were used to identify at the divisional and national level 30 clusters from 11,000 villages and 30 from the 5 metropolitan areas. 7 children ages 12-17 months who were born between August 1989 and January 1990 were selected from each cluster. The immunization record was used where possible. Enumerators were selected from each cluster. The immunization record was used where possible. Enumerators were selected form outside the government immunization or health worker population. The results of the histograms indicate high levels of coverage of region Rajshahi and low coverage for Chittagong, a pattern typical of contraceptive prevalence, Vitamin A distribution, and literacy. Bar graphs distinguish between the fully immunized child (3 doses of DPT and OPV, 1 dose of BCG, and 1 dose of measles) at <1 year and 12-17 months, based solely on immunization record data. Dropout rates are compared between those receiving BCG and the measles vaccination. The high dropout rate means greater effort in order to maintain 80% coverage. The bar chart on reasons for not continuing immunization shows time/place unknown and unaware of the immediate need were the 2 most reported reasons at 12.2% and 11.9%. Motivation was not a reason. It is suggested that health workers did not sufficiently stress the importance of continuing vaccination. The WHO reported coverage figures did not correspond to regular reports, which overestimated; the estimated number of births may be too low, or WHO figures did not include the mop-up program begun in the last quarter of 1990, or those receiving the 3rd dose even if older than 12 months. The urban reports were lower than the WHO reports perhaps because of reporting error between hospitals and private physicians and NGOs. Reported figures for DPT/OPV3 were significantly higher than WHO figures and assumptions cannot be made that coverage is high enough to offer disease protection and mortality reduction. TT coverage was 74%, but again there was a problem obtaining records. There was a lack of antenatal care. Recommendations were, for instance, that HAs, TBAs, and FPAs emphasize the importance of follow-up coverage and antenatal care, and that the Chittagong area receive more attention. The integration of immunization with family planning and the considerable coverage in such a short time are accomplishments to be proud of.
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  9. 9

    Midterm evaluation of the Centre for African Family Studies (CAFS) Project.

    Jewell NC; Fisken B; Wright MW

    Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Dec 5. vii, 41, [28] p. (Report No. 91-127-127; USAID Contract No. DPE-3024-Z-00-8078-00; PIO/T No. 623-0004-00-3-10002)

    In 1975, International Planned Parenthood Federation (IPPF) founded the Centre for African Family Studies (CAFS) in nairobi, Kenya to train family planning program personnel in service delivery management skills and technologies. A USAID funded 4 year CAFS Project Grant, scheduled to end in June 1993, consisted of training courses with incountry follow up to make sure courses were applicable to the changing situation of family planning programs in Africa. CAFS was to become totally self sufficient by June 1993. It planned to recover direct training costs from participants. CAFS experienced considerable difficulties in organization and management (a new director and loss of IPPF funding), during the project. The evaluation team found the training courses to be of high quality. Further former participants wished to continue receiving CAFS services and would recommended CAFS courses to colleagues. New financial procedures and addition of experienced financial staff had set CAFS on its way to financial self sufficiency, but these changes would not bring about self sufficiency by June 1993. Further CAFS restructured management and its organizational structure thereby moving it towards decentralization of authority and decision making. Even though CAFS was the only African regional institution providing training services for family planning personnel, it could lose its competitive edge since it had problems in providing francophone courses, inadequate incountry follow up visits, and insufficient research and evaluation skills in developing training programs. CAFS needed to address these obstacles. The team highlighted the need for CAFS to no longer depend on individual staff to maintain high quality courses so courses would not suffer from staff turnover. In conclusion, the team recommended that USAID continue to support CAFS.
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  10. 10

    Drug supply by ration kits: report of an evaluation.

    ESSENTIAL DRUGS MONITOR. 1991; (11):12-4.

    In the late 1980s, the WHO Action Programme on Essential Drugs conducted an evaluation of the drug ration kit system in developing countries. The most successful effect on the kit system was the much improved availability of essential drugs in rural health facilities. External donors tended to pay for and supply the essential kits, however, which contributed to better availability. In those cases, where external funding did not exist, lack of funds were a major problem. Indeed the evaluation determined that the sustainability of the kit system is dependent on funding. The kit system diminished the practice of drugs being diverted to other levels of health care and wastage by expiry. Most kit programs included training for health workers in diagnosing and treating a limited list of common diseases which led to rational prescribing. An ample supply of essential drugs lent itself to quality health care and revealed ruthlessly any weaknesses in the health system, such as lack of training. It took about 2 years to iron out the problems of estimating requirements and achieving a stable kit content. Accumulation of surpluses sometimes occurred early in the kit program. The drugs that accumulated are usually stable and inexpensive drugs (oral rehydration salts and iron tablets), however. The biggest problems of matching need and supply arose from suppliers, e.g., long delivery times. The evaluation showed that a kit system can operate if health workers can adequately identify essential drugs, funding can be secured, and management if well trained and dedicated. In conclusion, the kit system addresses the logistic problem and lends itself to rational prescribing.
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  11. 11

    Evaluation of Matching Grant II to International Planned Parenthood Federation / Western Hemisphere Region (IPPF/WHR) (1987-1992).

    Wickham R; Miller R; Rizo A; Wexler DB

    Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Jul 26. xii, 48, [25] p. (Report No. 90-078-116; USAID Contract No. DPE-3043-G-SS-7062-00)

    This is a mid-term review of a matching grant given to the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) by USAID's Office of Population for 1987-1991. The grant covers projects in Brazil, Colombia, Mexico and 9 smaller countries, and 4 regional activities, commodities, technical assistance, management information systems (MIS), and evaluation support. The goal of the grant was to reach new acceptors with quality services, to exert leadership of public sector providers, and to improve internal management. The goals in the 3 large nations are to focus on pockets of need or inadequate service or method mix. The goals of attracting 2.8 million new acceptors, improving services, making detailed plans and keeping strict financial reports have been met. The most serious problem was the lack of a regional evaluation of goal evaluation, the real cost of contraception, and impediments to contraceptive use. There were also difficulties in forwarding funds at the beginning of the FPA's year, and in sending in agency workplans on time. Better communication structures could probably remedy this. It is recommended that the matching grant be renewed in 1992.
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  12. 12

    Population policies and programmes: lessons learned from two decades of experience.

    Sadik N

    New York, New York, New York University Press, 1991. xxiv, 464 p.

    This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.
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  13. 13

    Management information systems in maternal and child health / family planning programs: a multi-country analysis.

    Keller A

    STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):19-30.

    Management and information systems (MIS) in maternal and child health were surveyed in 40 developing countries by trained consultants using a diagnostic instrument developed by UNFPA and the Pan American Health Organization (PAHO). The instrument covered indicators of input (physical infrastructure, personnel, training, finances, equipment, logistics), output (recipients of services, coverage, efficiency), quality, and impact, as well as frequency, timeliness and reliability of information. The consultants visited national and 2 provincial level administrative and service points of public and private agencies. Information on input was often lacking on numbers and locations of populations with access to services. In 15 countries data were lacking on personnel posts filled and training status. Logistics systems for equipment and supplies were inadequate in most areas except Asia, resulting in shortfalls of all types of materials and vehicles coinciding with idle supplies in warehouses. Financial reporting systems were present in only 13 countries. Service outputs were reported in terms of current users in 13 countries, but the proportion of couples covered was unknown in 25 countries. 2 countries had cost-effectiveness figures. Redundant forms duplicated efforts in half of the countries, while data were not broken down at the usable level of analysis for decision-making in most. Few African countries had either manual or computer capacity to handle all needed data. Family planning data especially was not available to draw the total picture. Often information was available too late to be useful, except in Portuguese speaking countries. Even when quality data existed, managers were frequently unaware of it. It is recommended that training and consultancies be provided for managers and that these types of surveys be repeated periodically.
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