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  1. 1

    Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.

    World Health Organization [WHO]. Regional Office for the Eastern Mediterranean [EMRO]

    Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)

    All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
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  2. 2

    Family planning operations research: a twenty-year research program.

    Brambila Paz C

    [Unpublished] [1991]. 15, [2] p.

    The purpose was to summarize lessons learned from operations research (OR) for quality of care in family planning (FP) programs. OR refers to the use of scientific methods to solve managerial practices among FP programs. The OR database, compiled for the FP/OR project database and currently managed by The Population Council, includes descriptions of 243 projects conducted since the USAID/Office of Population OR program began in 1973. The database contains information of each of the FP/OR subprojects including: country and region, type of project, contractor, cost, dates of initiation and termination, purpose, design of the study, major issue, delivery system analyzed, contraceptive methods involved, and type of data and reports available. The results indicate that: 1) More than 90% of research funds allocated during the past 20 years had been for enhancing services to integrate contraceptive services with other reproductive health services (such as breast feeding, AIDS, and primary care). FP was complemented with breast feeding to improve maternal and child health in Indonesia, Honduras, and Peru. FP workers were engaged in AIDS prevention campaigns in Colombia, Mexico, Peru, Thailand and Zaire. FP services were provided to underserved populations such as indigenous groups, young adults, and high risk populations. Postpartum projects strove to increase the acceptance of contraceptive use to space births or to conclude childbearing. 2) Less than 2% of research funds had been directed to projects to enhance continuity and follow-up clients. 3) 53% of the research projects examined standard solutions such as community-based distribution systems. Only 21 projects had the aim of developing unique or alternative procedures to enhance a component of quality of care. Based on the above results, future OR could investigate new solutions to enhance quality of care, such as mechanisms to ensure continuity of use or tests to increase the contraceptive choice of heterogeneous populations.
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  3. 3

    Regional Resource Group on Safe Motherhood for Francophone African Countries. Safe Motherhood in Francophone Africa: a Review of Progress to Date, Abidjan, Cote d'Ivoire, September 10-12, 1991.

    Azefor M; Daly P; Leke R

    Washington, D.C., World Bank, 1991. 36 p. (Partnership for Safe Motherhood)

    The Regional Resource Group on Safe Motherhood for Francophone African Countries met in Abidjan, Cote d'Ivoire, in September 1991 to review the progress of safe motherhood programs in French speaking African countries. The World Bank continues to support the integration of safe motherhood efforts within existing health, population, nutrition, and other social sector programs. Participants reviewed the findings of the World Bank Survey on Safe Motherhood which included limited data on maternal morbidity, leading causes of maternal death, interconnectedness of women's health and status, and major obstacles to safe motherhood. These obstacles include lack of political commitment, limited national and local interest in reducing maternal deaths, inadequate maternal health services, and shortage of trained health personnel. The participants reached a consensus that safe motherhood interventions should meet four objectives: preventing unplanned pregnancy, managing unwanted pregnancy, reducing the likelihood of complications during pregnancy and labor, and improving the outcome of women developing such complications. Priority services should include family planning and management of abortions, essential services for safe pregnancies (prenatal, intrapartum, and postpartum care), and services for the management of obstetrical emergencies. The Resource Group agreed that each country needs to determine its own priorities and unique approach to achieving safe motherhood. The first step is a strong national political commitment for safe motherhood through the adoption of a national policy and strategy. The Group classified the countries into six different groups, the most advanced group being countries where a political commitment exists and the basic components of a maternal health care program are implemented through an integrated health service delivery system. The next meeting of the Group will be in Kigali, Rwanda, in 1992. The meeting's report has a case study of safe motherhood in Senegal.
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  4. 4

    The household survey as a tool for policy change: lessons from the Jamaican Survey of Living Conditions.

    Grosh ME

    Washington, D.C., World Bank, 1991. viii, 48 p. (Living Standards Measurement Study [LSMS] Working Paper No. 80)

    The Jamaican Survey of Living conditions (SLC), which is scheduled as a semiannual survey, was initiated during 1988/89 to monitor the Human Resources Program (HRDP). The multisectoral aim was to provide household data for analysis of the effects of government policies on living conditions of the population. As a Living Standards Measurement Study (LSMS, SLC was a small, but in-depth instrument with a narrow focus and emphasis on policy impact, i.e., capable of determining who the poor are and their responses to policy changes. LSMS surveys are flexible and can be adapted to the policy issues of importance in any country. Results can be provided quickly. The SLC was a household questionnaire, which eliminated data available from the LSMS; the SLC sample used a random 33% of the Labor Force Survey (LFS) sample and followed the LFS by a month. Between the 1st and 2nd rounds of the SLC, a training and transfer program was begun to gradually assure Jamaican staff sustainability. A key feature of skills transfer was a tutorial approach. Discussion focused on the nature of the survey, similarities to the LSMS, the adaptations made to the SLC, and the history of the development of the survey. The survey provided information on the distribution of welfare and sectoral data on health, education, and nutrition. Strategic choices were made which account for SLC's success; the lessons learned were thought to be of value to other countries involved in living standards research and policy directives. The concreteness of purpose was a strategy which appealed to both policy makers and technicians. Timeliness was traded with quality of data, which contributed to immediate policy relevance, enhanced the training functions, and allowed for refinements. The disadvantages were that good results could block further detailed work; quality issues might be compromised. Other strategies discussed were the adaptation to the existing environment, gradual training of staff, the close cooperation between several agencies, multiple analysis prospects for government staff and academics, and the extensive use of World Bank staff in the initial effort. Costs to Jamaica were low compared to other LSMS surveys, but World Bank costs were high in staff time and travel. The cost of replication for other countries will depend on existing infrastructure, sample size, and local prices.
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  5. 5

    African women. A review of UNFPA-supported women, population and development projects in Gabon, Guinea-Bissau, Zaire, and Zambia.

    de Cruz AM; Ngumbu L; Siedlecky S; Fapohunda ER

    New York, New York, United Nations Population Fund [UNFPA], 1991 Jan. 45 p.

    In the late 1980s, UNFPA-supported women, population, and development projects in 4 African countries were reviewed during their early stages of implementation. The Gabon project aimed to identify pressing needs of rural women who worked in agroindustries or participated in agricultural cooperatives so the government could know how to integrate rural women into national development and in developing programs benefiting women. It realized that providing women with information about family health and sanitation did not meet their needs unless they first had a minimum income with which to implement what they learned. The Guinea-Bissau project chose and trained 22 female rural extension workers to inform women about sanitation and maternal and child health, nutrition, and birth spacing to improve the standard of living. It also hoped to strengthen the administrative, planning, and operational capacity of the women's group of a national political party to improve maternal and child health. Yet the women's group did not have the needed knowledge and experience in project development to operate a successful extension-based program. Further, it was unrealistic to expect women to train to become extension works when the government would not hire them permanently. In Zaire, women at local multiservice women's centers in 3 rural regions imparted information and education to modify traditional beliefs and behavior norms to increase women's role in development. In Zambia, Family Health Programme workers provided integrated maternal and child health care and family planning services through local health centers countrywide. The projects used scientific field surveys and/or interviews with villagers, local leaders, and organizations to conduct needs assessments. They did not assess the institution's strengths and weaknesses to determine its ability to be a development agency. The scope of all the projects as too limited. The duties of the consultant in 2 projects were not delineated, causing some confusion.
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  6. 6
    Peer Reviewed

    IAP-IPA-WHO-UNICEF Workshop on Strategies and Approaches for Women's Health, Child Health and Family Planning for the Decade of Nineties, 22nd-23rd January 1991, Hyderabad.

    Bhargava SK; Hallman N; Shah PM

    INDIAN PEDIATRICS. 1991 Dec; 28(12):1481-2.

    In 1991, health professionals attended a workshop to develop strategies and approaches for women's health, child health, and family planning for the 1990s in Hyderabad, India. The Ministry of Health (MOH) of India should improve and strengthen existing health facilities, manpower, materials, and supplies. It should not continue vertical programs dedicated to 1 disease or a few problems. Instead it should integrate programs. The government must stop allocating more funds to family planning services than to MCH services. It should equally appropriate funds to family planning, family welfare, and MCH. The MOH should implement task force recommendations on minimum prenatal care (1982) and maternal mortality (1987) to strengthen prenatal care, delivery services, and newborn care. Health workers must consider newborns as individuals and allot them their own bed in the hospital. All district and city hospitals should have an intermediate or Level II care nursery to improve neonatal survival. In addition, the country has the means to improve child health services. The most effective means to improve health services and community utilization is training all health workers, revision of basic curricula, and strengthen existing facilities. Family planning professionals should use couple protection time rather than couple protection rate. The should also target certain contraceptives to specific age groups. Mass media can disseminate information to bring about behavioral and social change such as increasing marriage age. Secondary school teachers should teach sex education. Health professionals must look at the total female instead of child, adolescent, pregnant woman, and reproductive health. Integrated Child Development Services should support MCH programs. Operations research should be used to evaluate the many parts of MCH programs. The government needs to promote community participation in MCH services.
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  7. 7

    Report of the ESCAP/UNDP Expert Group Meeting on Population, Environment and Sustainable Development: 13-18 May 1991, Jomtien, Thailand.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific [ESCAP], 1991. iv, 41 p. (Asian Population Studies Series No. 106)

    The 1991 meeting of the Economic and Social Commission for Asia and the Pacific considered the following topics: the interrelationships between population and natural resources, between population and the environment and poverty, and between population growth and consumption patterns, technological changes and sustainable development; the social aspects of the population-environment nexus (the effect of social norms and cultural practices); public awareness and community participation in population and environmental issues; and integration of population, environment, and development policies. The organization of the meeting is indicated. Recommendations were made. The papers on land, water, and air were devoted to a potential analytical model and the nature of the interlocking relationship between population, environment, and development. Dynamic balance was critical. 1 paper was presented on population growth and distribution, agricultural production and rural poverty; the practice of a simpler life style was the future challenge of the world. Several papers focused on urbanization trends and distribution and urban management policies. Only 1 paper discussed rural-urban income and consumption inequality and the consequences; some evidence suggests that increased income and equity is associated with improved resource management. Carrying capacity was an issue. The technological change paper reported that current technology contributed to overproduction and overconsumption and was environmentally unfriendly. The social norms paper referred to economic conditions that turned people away from sound environmental, cultural norms and practices. A concept paper emphasized women's contribution to humanism which goes beyond feminism; another presented an analytical summary of problems. 2 papers on public awareness pointed out the failures and the Indonesian experience with media. 1 paper provided a perspective on policy and 2 on the methodology of integration. The recommendations provided broad goals and specific objectives, a holistic and conceptual framework for research, information support, policies, resources for integration, and implementation arrangements. All activities must be guided by 1) unity of mankind, 2) harmony between population and natural resources, and 3) improvement in the human condition.
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  8. 8

    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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  9. 9

    Workable solutions to FP in Africa.

    JOICFP NEWS. 1991 Dec; (210):1-2.

    The 3rd Pan African Conference on the Integrated Family Planning, Nutrition and Parasite Control Project (PANFRICO III) was held in October 1991 and organized by JOICFP, UNFPA and IPPF. The Ghana IP Steering Committee implemented it. In addition to the 5 IP implementing countries--Ethiopia, the Gambia, Ghana, Tanzania, and Zambia--other countries attending were: Kenya, Lesotho, Madagascar, Mali, Nigeria, Senegal, Sierra Leone, Swaziland, Togo, and Uganda. Governmental and nongovernmental organizations (NGOs) and international groups such as UNFPA, IPPF, FAO, and USAID also attended. The theme was seeking a strategic approach to family planning through primary health care. Participants resolved to increase the support and involvement of African governments in IP implementation. It was recognized that self-reliance, cost effectiveness, and efficient use of resources were important to sustainability. It was also agreed that IP should integrate family planning (FP) with Maternal and Child Health (MCH) and Primary Health Care (PHC) in order to overcome traditional and cultural obstacles to FP and to gain full participation of men in the communities. Horizontal integration was the primary thrust. there was agreement that there should be collaboration between UNFPA, IPPF, and JOICFP, and relevant governments and NGOs. Country-specific attention needs to be paid to expanding IP functions within the 5 IP countries. In Ghana, IP pilot areas have been successful in increasing the FP acceptance rate from 17.4% in 1988 to 51.9% in 1991. IP experiences in Indonesia were presented, including the concept of fee-charged PHC services in order to achieve self-reliance in FP/MCH projects. The response was the request for further technical cooperation between developing countries. The workshop activities were particularly beneficial, and requests were made for discussion of IEC, management, service delivery, nutrition, environmental sanitation, self-reliance, community participation, and evaluation. To further regional IP development within the country, it was suggested that national workshops be held. It was emphasized that FP and population are basic elements of socioeconomic development.
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  10. 10

    Renewed mobilization against malaria.

    WORLD HEALTH FORUM. 1991; 12(4):495.

    >1 million people die in the world from malaria annually, 800,000 of whom are <5 year old children in Sub-Sahara Africa. Further it affects 270 million people. In fact, >110 million develop malaria, 90 million of whom are from Sub-Saharan Africa. Thus WHO has introduced a new world initiative for malaria control to reverse the worsening trend that began in the mid 1970s. In October 1991, 150 officials from 50 African, Asian, and Latin American countries and participants from UN cooperation and development agencies and bilateral agencies attended an interregional conference at the WHO Regional office for Africa in Brazzaville, Congo. It strove to evaluate malaria situations specific to Africa, to update the malaria control plan in Africa, and to contribute to the development of an implementable world strategy. This world strategy needs to consider the local situation and encourage participation of the government and people of affected countries. Further individuals, communities, and various sectors of the national economy including those involved in health, education, development, and agriculture need to participate in malaria control. In addition, for this strategy to work, most countries must strengthen the management and financing of health services to meet their needs. For example, local populations must share local operating costs such as those for essential drugs and mosquito control operations. Community participation must also include personal protection such as impregnated bed nets and environmental measures. Besides malaria control must be integrated into the existing health system at country, provincial, and peripheral levels. In sum, improved case management, control of malaria transmission, and prevention and control of epidemics form the basis for the new strategy.
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  11. 11

    A strategy for reducing numbers? Response.

    Jolly R

    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.
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  12. 12

    Integrating development and population planning in Turkey.

    Dulger I; Kocaman T; Polat M; Uner S

    New York, New York, United Nations, 1991. viii, 67 p. (ST/ESA/SER.R/112)

    Targeted to planners and policy makers as a tool helpful for policy formulation, this report describes the integration of population and development planning in Turkey. With economic development accompanied by rapid population growth, Turkish planners have considered the important relation of such growth to income and social welfare. Reducing the rate of population growth has been a part of all 5-year development plans. The paper presents background information on Turkey, describes the structure of the study, analyzes positive results and difficulties, and discusses the information, methods, and institutions used to efficiently integrate the 2 subjects. Chapters discuss development and population trends, issues and objectives, and frameworks, knowledge, methodologies, institutions, and procedure for integrated planning. Plan implementation is then also considered. In closing, the paper notes that the concept of integrated planning has no been fully embraced by the country's planners, and that population policy formulation has yet to be truly linked with development planning. Demographic data has, however, been introduced into both overall planning and at some sectoral levels.
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  13. 13

    Strategies for Africa.

    Benzerroug EH; Elom B

    WORLD HEALTH. 1991 Sep-Oct; 6-7.

    The UN Population Division in 1990 identified malaria and AIDS as the only diseases in the world whose incidences are increasing significantly. Health specialists estimate that malaria killed 800,000 children <5 years old in 1990. Further around 110 million people have clinical malaria and 80% of them live in Africa. Perhaps 280 million people harbor the malaria parasite. Leaders concerned about the resurgence of malaria have met on several occasions to evaluate the situation and the effectiveness of present prevention and control strategies. WHO believes the best strategies are those that are specifically suited to the various types of malaria. Further local situations and resources determine the type of malaria control employed. These refer to control of mosquito vectors; the use of drugs; information, education, and communication activities; and epidemiological surveillance. The success of these strategies depends on the participation of the local community members and their ability to accept and use personal protection measures to prevent transmission. Besides local actions o prevent and control malaria must be continuous. In fact, they should be integrated into district level primary health care efforts. Regardless of strategies chosen, however, all affected populations must have access to early diagnosis and treatment. Moreover, success cannot be assured without the countries in Africa having the desire and ability to plan for the short-, medium-, and long-term. They should design plans that are appropriate to available resources and the epidemiological pattern of malaria. The WHO Regional Office for Africa in Brazzaville, Congo can provide technical support.
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  14. 14
    Peer Reviewed

    Zambia: focus on humanitarian care of AIDS patients [news]

    INTERNATIONAL NURSING REVIEW. 1991 Mar-Apr; 38(2):31.

    A brief report summarizes issues and concepts discussed by participants from Malawi, Tanzania, and Zambia at the 2nd ICN/WHO intercountry conference in Lusaka, Zambia. Broadly discussing nursing care of people with HIV/AIDS and their families, counseling and case/family support should be considered major components of local initiatives in Africa. While local constraints must be recognized in diagnosing, counseling, caring for, and supporting cases and families, programs may also build upon community strengths. Present official health services are often unable to accommodate the needs of all patients with HIV/AIDS. Participants therefore examined innovative, new home-based approaches to care and case/family support. Examples of community-based support programs tailored to meet local needs are mentioned. The role of counseling in both case/family support and for behavioral change is also voiced. A multidisciplinary approach carried out by open, flexible, and understanding personnel is required. Nurses must provide clinical care to cases while also working to facilitate behavioral change.
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  15. 15

    Priorities for maternal and child health for the 1990s.

    Belsey M

    [Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 8 p.

    The maternal and child health/family planning (MCH/FP) program at WHO specifies the priorities for MCH/FP in the 1990s. Results of the Demographic and Health Surveys (DHS) in many, but not all, developing countries have shown overall improvement in fertility and maternal and child health, especially in the family planning and child survival movements. Maternal mortality did not change, however. Moreover, maternal mortality in some countries exceeded natural maternal mortality. These elevations sparked a 3rd movement in the late 1980s, safe motherhood. These results confirm that the public health community cannot become complacent. Indeed it must strengthen the infrastructure, management, and performance of the health system to maintain gains. This involves identifying a novel strategy to priority setting and program development which are adapted to the changing needs and circumstances of each country, and even within each country. In fact, firm program strategies and policies need to concentrate on maternal health and morbidity, newborn care, breast feeding, perinatal infections, and HIV/AIDS. Based on DHS data and on evaluations of MCH/FP programs, WHO lists crucial principles for successful programs. The 1st principle includes equity in access and use of social resources which includes disaggregating data according to geographic and population subgroups to find appropriate strategies to close the widening gap within and between countries. The next principle is community and health care provider participation and ownership. Indeed successful MCH/FP programs are those where the community identifies problems and needs and evaluates the program. The 3rd principle encompasses quality data collection to assess quality of care and program effectiveness. WHO has proposed 5 priorities for organization and management of MCH/FP programs. 1 priority which WHO suspects will generate the most debate is integration of family planning, child survival, and safe motherhood programs.
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  16. 16

    In Sri Lanka, a clearer focus.

    POPULATION. 1991 Dec; 17(12):3.

    In order to improve maternal and child health and family planning services in areas of Sri Lanka that lag in health and social development, UNFPA has created a program called "More Focused." This program targets underserved places such as fishing villages, plantations, and slums. More Focused represents part of UNFPA's program package intended to help Sri Lanka reach its goal of replacement level fertility by the year 2000. The approach of More focused offers underserved regions more than simply contraceptive services. The program provides an array of services that address problems such as poor nutrition, low literacy levels, and cultural factors. For example, More Focus is attempting to improve the conditions and the self-confidence of women working in Sri Lanka's free-trade zones, which contain the heaviest concentration of malnourished women. The project gives women instruction on nutrition, money management, health, family planning, etc. The women have gained confidence and have organized themselves to discuss employment-related issues with their employees. For its 1992-96 country program, UNFPA has emphasized the "cafeteria approach" to family planning, which makes available a wide variety of contraceptives. In the past, many had complained that Sri-Lanka had concentrated too heavily on sterilization. The new approach makes contraceptive services more sensitive to specific social and cultural settings. Nonetheless, Sri Lanka still faces serious obstacles to achieving its goal for the year 2000. Years of civil war have interrupted the accomplishments of its once-legendary family planning program. Nonetheless, UNFPA remains optimistic that the country's continuing family planning effort will lead to replacement level fertility.
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  17. 17

    AIDS as a development issue.

    Campbell ID; Rader AD

    AIDS CARE. 1991; 3(4):395-8.

    While scientists demonstrated that they have pushed ahead in developing treatment and a vaccine for AIDS, comparatively little was voiced regarding AIDS as a development issue at the 7th Conference on AIDS. In the context of socioeconomic development, President Museveni of Uganda and others spoke on AIDS, recognizing the need for behavioral change in preventing HIV infection. The family was also recognized as a basic unit of caring, important in fostering global solidarity. Topics discussed included the fusion of technology and human response in the fight against AIDS, NGO-government integration, community home care, and the need for an difficulty of measuring behavior change. In research, evidence was presented attesting to the cost-effectiveness of home care, while other types of research interventions, the effectiveness of audiovisual media in message dissemination, evaluation methods, and ethnographic methods for program design and evaluation were also explored. Where participants addressed psychosocial factors in development, little was presented on training. Informal discussions were robust, and covered the need for academic research, the process of an international conference, program principle transferability, and counseling. There was, however, an overall realization at the conference that progress is slow, AIDS challenges human nature, and coordinated international efforts may be incapable of effecting more rapid positive change. Even though sweeping solutions to AIDS did not emerge from this conference, more appropriate programs and conferences may develop in the future, with this conference opening AIDS in the arenas of community, development, hope and science.
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  18. 18

    Programme review and strategy development report: India.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. vii, 96 p.

    Working to balance population growth with socioeconomic development, the Government of India has had a population policy in place since 1951. Net reproduction rate of 1 is targeted to be met by the year 2000. This paper present India's population policy, and analyzes overall strategy for achieving population goals. While strategy is basically sound, there are, however, serious problems with program implementation. Information, education, and communication activities, as well as population education are reviewed. Non-governmental organizations and organized labor are then examined in the context of their roles in overall population strategy. Programmatic review continues and concludes with discussion of integrated maternal and child health/family planning components, improving the status and roles of women, and consideration of institutional framework, coordination, and management. Specific observations and recommendations are presented for each of these issues and topics, as well as for data collection and policy analysis, and the coordination of population assistance. Future UNFPA country programs should expand already initiated projects, and develop new ones aimed at providing a wider array of locally available contraceptives. While past assistance has focused upon health and family planning, future programs may encourage other areas of population activities. Examples of such activities include demographic research and training, research and action programs in women and development, and experimental approaches to population education.
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  19. 19

    Education for all draws upon population education messages.


    In May 1991, UNESCO and the Ministry of Education of Pakistan sponsored a Regional Workshop for the Integration of Population Education in Asia-Pacific Programme of Education for All in Islamabad, Pakistan. Prior to the workshop, resource persons and experts met to develop guidelines for participants that were geared towards curriculum and material needs and core population education messages. 1 workshop group addressed integration of population education messages into primary education and the other into literacy programs. All participants observed and analyzed the problems and needs of a Muslim community and Saidpur village. The 1st group visited primary schools and spoke to teachers. The participants agreed that population education messages should be integrated into social studies, science, languages, and religion subjects at grade levels 3-5. The messages should include population related beliefs and values, problems of population growth, small family size, responsible parenthood, sex preference, population and development, the role of elders, and improving the status of women. They tested 4 of 11 developed lesson plans. Both teachers and students were generally pleased, but believed that posters and illustrations would better the plans. The other group conducted a needs assessment survey among 27 Muslim families. Participants found >100 population related issues that needed to be addressed in literacy programs. These issues fit into 6 categories and the group focused on social and cultural values and beliefs. Participants developed materials that highlighted several topics, such as early marriage and preference for males. They used puppet shows, puzzle games, posters and discussions, and story telling with pictures to communicate the messages. Puppet shows were the most popular method among housewives.
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  20. 20

    Environment action plans for the greening of Africa.

    Winterbottom R

    PEOPLE. 1991; 18(1):9-13.

    The World Resources Institute article provides a discussion of some of the problems facing African farmers, the interaction between population growth and environmental degradation and food production, and the solution in terms of an Environmental Action Plan (EAP) with the specific example of Rwanda. Data were based mainly on the World Bank's The Environment, Agriculture, and Environmental Nexus in Sub-Saharan Africa. The population increased 3.1% in 1980-87 from 2.6% in 1967-73. Deforestation is exceeding reforestation by a factor of 30; expansion of land under cultivation has increased to a rate of 3% a year. Africa is the only developing region with a decline in per capita food production. Yields are declining. 80% of land is affected by decertification, and the production of cereal grains lags behind population needs by 10 million tons with the projection to 2020 of 245 millions tons, an amount greater than the total world trade in cereals. A solution, for example, lies in the restoration of lost resources and increasing crop yields with better resource management techniques (reclaiming swamp land) - all in tandem with the promotion of family planning. It is also important to address the root cause of malnutrition, poor health status, low incomes and lack of educational opportunity. The integrated approach in the case of Rwanda's EAP involved multi-disciplinary groups.
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