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NGO's Role and Involvement in the Prevention and Control of AIDS, New Delhi. Report of a regional workshop, 30 October - 1 November 1990.
[Unpublished] 1991 Feb 19. , 19 p. (SEA/AIDS/22; WHO Project: ICP GPA 511)This regional workshop aimed to exchange information, inform nongovernmental organizations (NGOs) on the epidemiology and control of AIDS, share the experience of NGOs, identify improvements in the involvement of NGOs in AIDS control programs, and understand the impact of discriminatory measures. Topics for discussion were the global and the southeast Asian regional AIDS/HIV situation and control, the role of NGOs in control, the legal, ethical, and human rights issues in AIDS prevention and control, and the involvement of NGOs in prevention and control of AIDS. participants represented Bhutan, India, Indonesia, Maldives, Mongolia, Myanmar, Nepal, Sri Lanka, Thailand, India, and the WHO secretariat. NGOs provide information, education, policy advocacy, training, counseling, and assistance to those affected by HIV/AIDS. The methods used were culturally-sensitive mass media; a positive, holistic, and flexible approach; promotion of self esteem and confidence in target groups; target group representation; maintenance of direct contact and education for specific groups; policy advocacy; research and monitoring functions; peer group formation support; public awareness creation; and provision of medical services. Recommendations were made to NGOs to collaborate with one another and with governments, to help strengthen international and national cooperation for AIDS prevention and control, to monitor media information for reliability and uniformity and contextual relevance and lobby for necessary changes, and to set an example of human and compassionate treatment and respect the rights of AIDS/HIV and marginalized groups to medical and social services and treatment, education, employment, housing, social life, freedom of movement, freedom of choice on blood testing, and freedom from discrimination. NGOs involved need to mobilize other NGOs in AIDS prevention. Governments should include NGOs on national AIDS committees, particularly those which are community-oriented, and not politically affiliated and those which work with women and marginalized groups. Governments need to update curricula and provide family life education including education on AIDS for formal and informal groups and government officials. Governments should also set an example of responsible behavior which respects the human rights of people with AIDS, fund NGOs to train trainers, and use mass media. WHO should be more sensitive to the needs of NGOs and work to keep NGOs in the information loop of international and national governments.
Community involvement in health development: challenging health services. Report of a WHO Study Group.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1991; (809):i-iv, 1-56.In order to make community involvement in health development (CIH) a reality, countries need to go beyond endorsement of the idea and take concrete steps, reports a WHO study group examining the issue. While the idea of community involvement has gained widespread acceptance, most health services have been slow in making the necessary institutional and organizational changes, and in providing the necessary money and staff time. Furthermore, most CIH efforts have concentrated on the community side of involvement, neglecting the health development aspects and the context in which the involvement takes place. The Study Group, which met in Geneva on December 1989, was concerned with identifying specific obstacles to CIH implementation and providing recommendations. The report discusses such issues as the political, social, and economic contexts of CIH; the methodology of CIH; the training of health personnel; the strengthening of communities for CIH; and the monitoring and evaluation of such programs. Among the report's major findings: most countries have yet to truly commit to CIH; CIH programs lack the necessary support and resources; effective coordination at all levels is imperative; health personnel must be adequately educated on the principles and practices of CIH; and some health ministries promote too narrow an understanding of health. The report contains recommendations for both countries and for WHO. The recommendations for countries include several measures directed at the ministries of health, including a provision that the ministries develop guidelines for the implementation of CIH at the district level.
[Resolution No.] 1991/22. National, regional and international machinery for the advancement of women [30 May 1991].
ECONOMIC AND SOCIAL COUNCIL OFFICIAL RECORDS. 1991; Suppl 1:23-4.This document contains the text of a 1991 UN resolution on the establishment of national, regional and international machinery to promote the advancement of women. After reviewing previous UN action on this issue, the resolution recommended that: 1) all countries establish appropriate machinery for the advancement of women by 1995; 2) governments provide adequate resources to ensure the effective functioning of national machinery; 3) the UN provide technical assistance; 4) countries exchange information on this topic; 5) the UN support such an exchange of information; 6) a UN interregional advisor assist in these and related efforts; 7) technical help be provided to facilitate the preparation of reports for the 1995 World Conference on Women; 8) the UN Secretary-General report on UN activities in this regard to the 36th session of the Commission on the Status of Women; 9) the Secretary-General invite governments to publish pertinent case studies; 10) appropriate sections of the Secretariat be strengthened; 11) governments make accurate information on their national machinery available; 12) governments ensure proper training of staff and include gender-analysis training and information; and 13) the UN report on the effectiveness of these efforts to the World Conference on Women.
Review of further developments in fields with which the Sub-Commission has been concerned. Study on traditional practices affecting the health of women and children. Final report.
[Unpublished] 1991 Jul 5. , 39 p. (E/CN.4/Sub.2/1991/6)In late 1990, representatives of the Sub-Commission on Prevention of Discrimination and Protection of Minorities of the UN Economic and Social Council's Commission on Human Rights went to Djibouti and the Sudan to explore steps the governments and women's groups are taking to eliminate traditional practices adversely affecting women and children, especially female circumcision. The missions allowed the consultants to examine the problem with women and groups directly affected by the practices and within their cultural contexts. In 1991, the Centre for Human Rights and the Government of Burkina Faso organized the first regional Seminar on Traditional Practices Affecting the Health of Women and Children which considered the effects of female genital mutilation, son preferences, and traditional delivery practices, and facilitated the exchange of information on these practices to fight and eliminate them. The UN reviewed reports from governments, nongovernmental organizations, and UN agencies on these traditional practices. All these activities led the UN to make various observations and recommendations. The degree of public awareness about the harmful effects of female circumcision, nutritional taboos, and delivery practices have improved significantly. Governments and organizations have neither studied nor dealt with son preference and its effects adequately. More African governments were willing to address the problems of traditional practices, e.g., legislation against these practices. The Centre for Human Rights, WHO, UNICEF, and UNESCO should work together more closely to effectively take action on traditional practices. The Centre needs a full time professional staff to gather information, write reports, organize seminars, distribute documents, and network with appropriate organizations. The Sub-Commission should continue to have traditional practices on the agenda to keep it in the fore. No less than two more regional seminars on the issue should take place in Africa to discuss it and increase public awareness.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 46,  p.The effects of the aftermath of the August 2nd, 1990 Iraqi invasion of Kuwait, the UN Security Council imposed sanctions, and the UN military offensive against Iraq on Iraq's maternal and child health sector and its public health infrastructure are examined. A review of the UN sanctions and dates of implementation are provided. A series of international responses ensued and are described. By February 1991, Baghdad had <5% of a normal water supply and the system was in collapse. Families, particularly women and children, suffered food shortages including infant formula, burns from makeshift cooking devices, e.g., epidemiologic and disease reporting ceased, drugs and vaccines were in short supply or absent, and sanitation and sewage systems were dysfunctional. It is concluded that OAS and US action against Haiti in the form of sanctions and military action would place a tremendous burden on the poor, and it is suggested that careful consideration be given before steps are taken. Also, discussed is the modern method of conflict resolution which is fueled by weapons technology and the profit incentive. There is a called to action for developing a realistic conception framework for the study and conduct of relationships with nations. There is a need to guide change peacefully and to resolve conflict without threat to life and the public's health, human environment, and ecosystem. The modern weapons technology and the protocols allowable under the UN Charter did not accomplish this in Iraq.
POPULATION RESEARCH LEADS. 1991; (38):1-22.The relationship between migration and development in the ESCAP region including southeast and south Asian countries and the Pacific island of Fiji, Papua New Guinea, Vanuatu, Kiribati, Samoa, and the Solomon Islands is discussed in terms of mobility transition and origin and destination factors. The changing patterns of mobility in Asia are further delineated in the discussion of internal movements and international movement. Emigration in the smaller countries of the Pacific are treated separately. Future predictions are that the Asia Pacific region will experience continued fertility decline and stabilization of low rates over the next 20 years. The declines will result in slow labor force growth, and increased demand for labor in traditional core and neocore countries as defined and presented in table form by Friedman will be heightened. International movements are likely to increase in large urban areas within destination countries. Tokyo and Singapore are the principal cities in Asia. Tokyo by restrictive government policy has limited immigration, but future labor shortages of unskilled labor from southeast Asia and China are expected. Singapore is already dependent on foreign labor by >10%. Current labor shortages have led to the creation of a growth triangle between Singapore, Indonesia, and Malaysia. Other cities expected to emerge as primary cities in international regional complexes with spillover into the hinterlands include the Hong Kong, Guangzhou, and Macau triangle in the Pearl River delta, Taipei and Seoul, and possibly Kuala Lumpur. Internal migration is expected to increase in the capital cities of Bangkok, Manila,j and centers such as Shanghai, Beijing, and other large cities of southeast Asia. These cities will be linked through the flows of skilled international migrants, which began in the 1960s and is expected to become a future major flow. Recreational and resource niches will be left in much of the Pacific, the Himalayan Kingdoms, and mountainous regions of northern southeast Asia and western China. Flows will be regulated by national government policy. Difficult decisions will be made on the extent to which multinational corporations and banks are sanctioned or regulated, i.e., currently Hong Kong development is company directed within the law governing power, transport, housing, and land, while in Singapore development is government planned and directed.
Fertility trends and prospects in East and South-East Asian countries and implications for policies and programmes.
POPULATION RESEARCH LEADS. 1991; (39):1-17.Fertility trends and prospects for east and southeast Asian countries including cities in China, Taiwan, the Republic of Korea, Thailand, Indonesia, Malaysia, the Philippines, Myanmar, and Viet Nam are described. Additional discussion focuses on family planning methods, marriage patterns, fertility prospects, theories of fertility change, and policy implications for the labor supply, labor migrants, increased female participation in the labor force (LFP), human resource development, and social policy measures. Figures provide graphic descriptions of total fertility rates (TFRS) for 12 countries/areas for selected years between 1960-90, TFR for selected Chinese cities between 1955-90, the % of currently married women 15-44 years using contraception by main method for selected years and for 10 countries, actual and projected TFR and annual growth rates between 1990-2020 for Korea and Indonesia. It is noted that the 1st southeast Asian country to experience a revolution in reproductive behavior was Japan with below replacement level fertility by 1960. This was accomplished by massive postponement in age at marriage and rapid reduction in marital fertility. Fertility was controlled primarily through abortion. Thereafter every southeast Asian country experienced fertility declines. Hong Kong, Penang, Shanghai, Singapore, and Taipei and declining fertility before the major thrust of family planning (FP). Chinese fertility declines were reflected in the 1970s to the early 1980s and paralleled the longer, later, fewer campaign and policy which set ambitious targets which were strictly enforced at all levels of administration. Korea and Taiwan's declines were a result of individual decision making to restrict fertility which was encouraged by private and government programs to provide FP information and subsidized services. The context was social and economic change. Indonesia's almost replacement level fertility was achieved dramatically through the 1970s and 1980s by institutional change in ideas about families and schooling and material welfare, changes in the structure of governance, and changes in state ideology. Thailand's decline began in the 1960s and is attributed to social change, change in cultural setting, demand, and FP efforts. Modest declines characterize Malaysia and the Philippines, which have been surpassed by Myanmar and Viet Nam. The policy implications are that there are shortages in labor supply which can be remedied with labor migration, pronatalist policy, more capital intensive industries, and preparation for a changing economy.
Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
Management information systems in maternal and child health / family planning programs: a multi-country analysis.
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.