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  1. 1

    International assistance and health sector development in Nigeria.

    Parker DA

    Ann Arbor, Michigan, University Microfilms International, 1991. vii, 266 p. (Order No. 9116069)

    The effectiveness of official development assistance in responding to health problems in recipient countries may be examined in terms of 1) the results of specific aid-supported projects, 2) the degree to which the activities have contributed to recipients' institutional capacity, and 3) the impact of aid on national policy and the broader development process. A review of the literature indicates a number of conceptual and practical constraints to assessing health aid effectiveness. Numerous health projects have been evaluated and issues of sustainability have been studied, but relatively little is known about the systemic effects of health aid. The experience of Nigeria is analyzed between the mid-1970s and the late 1980s. In the 1970s, Nigeria's income rose substantially from oil revenues, and a national program was undertaken to increase the provision of basic health services. The program did not achieve its immediate objectives, and health sector problems were exacerbated by the decline of national income during the 1980s. Since 1987, a progressive national primary healthcare policy has been in place. Aid has been given to Nigeria in comparatively small amounts per capita. Among the major donors, WHO, UNICEF, and, most recently, the World Bank, have assisted the development of general health services, while USAID, UNFPA, and the Ford Foundation have aided the health sector with the principal objective of promoting family planning. 3 projects are examined as case studies. They are: a model of family health clinics for maternal and child care; a largescale research project for health and family planning services; and a national immunization program. The effectiveness of each was constrained initially by limited coordination among donors and by the lack of a supportive policy framework. The 1st 2 of these projects developed service delivery models that have been reflected in the national health strategy. The immunization program has reached nationwide coverage, although with uncertain systemic impact. Overall, aid is seen as having made a marginal but significant contribution to health development in Nigeria,a primarily through the demonstration of new service delivery approaches and the improvement of management capacity. (author's)
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  2. 2

    AIDS hits Africa: millions orphaned [news]

    NURSING RSA. 1991 Feb; 6(2):29.

    Africa is confronted with the problem of a lost generation--estimated 10 million orphans whose parents will die of AIDS. In Uganda, the problems of 40,000 children orphaned by the disease have alerted the international community to the fact that AIDS can no longer be compartmentalized as a health problem. It has unprecedented socioeconomic consequences, affecting Africa's work force, its ability to man industries, grow food, and export enough to repay its debts. According to recent surveys, in the next 5-10 years 45% of the South African work force and 90% of skilled Zimbabweans may be infected by HIV. As the 1990s progress, Uganda--with an estimated 1.3 m HIV-positive people--can expect 12,000 new AIDS cases a month. Earlier this month the World Bank and 20 other major donors sent delegates to Uganda to work out a multisectoral AIDS strategy. Everyone agreed that putting money into schools, agriculture, roads, and economic planning as well as health, was needed. But a bitter war took place between the bank and WHO, which holds the UN mandate to control AIDS programs. A myriad of small, nongovernmental organizations, which actually do the work, ganged up to stop the World Bank from imposing a monster bureaucracy on them. But Uganda welcomed the World Bank's provision of $30m (about R78m) worth of soft loans for infrastructure such as clinics, schools, and roads. It seems WHO swallowed its pride, realizing it has enough on its plate coping with AIDS statistics and policies. In the past 4 years the only people who have done anything to help 25,000 AIDS orphans in Uganda's worst-hit district of Rakai are a few irish nuns from a mission hospital. Norway's Redda Barna of Save the Children Fund (SCF) has recently set up nearby and Oxfam and SCF UK have backed work in Rakai. But just 90 minutes' drive south of the Ugandan capital of Kampala, a chronic emergency has passed unnoticed. "There are villages here of children only," an official said recently. Sally Fegan-Wyles, representative for the UN Children's Fund, says everyone was "paralyzed by the enormity of it, we had never experienced anything like it before." (full text)
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