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  1. 1
    071107
    Peer Reviewed

    Research priorities for diarrhoeal disease vaccines: memorandum from a WHO meeting.

    World Health Organization [WHO]. Programme for the Control of Diarrhoeal Disease; WHO/UNDP Programme for Vaccine Development [PVD]

    BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(6):667-76.

    WHO's Programme for Control of Diarrheal Diseases (CDD) promoted and supported research the purpose of which is to develop and evaluate vaccines against diarrheal diseases, but it focused on diarrhea control. In 1991, the WHO/UNDP Programme for Vaccine Development (PVD) began coordinating diarrheal disease vaccine research, yet CDD remained actively involved in vaccine trials. In March 1991, CDD and PVD cosponsored a meeting to specify new research priorities toward vaccines against rotaviruses, Shigella, cholera, and enterotoxigenic Escherichia coli (ETEC) infections. Synopses of clinical trials on vaccines that have undergone clinical trials are presented. Different methods of developing vaccines against rotavirus included heterologous rotavirus adapted to tissue cultures, incorporating the VP7 surface protein of human rotaviruses into an animal rotavirus, and naturally attenuated. Live oral vaccines, different ways to immunize with oral encapsulated antigens, and a gycoconjugate approach comprised the Shigella vaccine research. There were many candidate Shigella vaccines which the meeting participants found to be promising and challenging. Cholera vaccines included killed and live oral vaccines. The results of a large field trial of cholera vaccines (killed whole cell/B subunit and whole cell culture) in Bangladesh revealed marked improvements over injected vaccines. A study of children in Indonesia showed promise for strain CVD-103HgR as a 1 dose, live oral vaccine against cholera. Adult volunteers who received milk immunoglobulin concentrate with antibodies against several colonization factor fimbriae (LT and O antigens) and then challenged experimentally with ETEC were 100% protected. WHO emphasized the need to develop both living and nonliving oral ETEC vaccines which will grant broad spectrum immunity to young children. Specific recommendations follow each section on the various vaccines and general recommendations are included.
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  2. 2
    068364

    Vision 2000: a forward strategy.

    International Union for Health Education

    HYGIE. 1991; 10(2):3-4.

    A strategic plan for objectives and operations of the International Union for Health Education (IUHE) in the 1990s is presented. The IUHE's principal aims are to strengthen the position of education as a major means of protecting and promoting health, to support members of the IUHE, and to advise other agencies. Core functions will include advocacy/information services/networking, conferences/seminars, liaison/consultancy/technical services, training, and research. The objectives of the IUHE are to promote and strengthen the scientific and technical development of health education, to enhance the skills and knowledge of people engaged in health education, to create a greater awareness of the global leadership role of the IUHE in protecting and promoting health, and to secure a stronger organizational and resource base. These objectives will be achieved by developing an disseminating annual policy papers on key global issues, developing new procedural guidelines for the IUHE's world and regional conferences, clarifying the roles of the headquarters and regional offices, and developing recruitment incentives to boost membership. The corporate identify of the IUHE will be revised, formal U.N. accreditation will be sought, and mutually beneficial relationships will be fostered with selected U.N. and non-governmental organizations. Additionally, the scientific and technical strengths of the IUHE will be boosted, a resources referral service developed, a fund raising office created, worker achievements recognized, and a bursary fund established.
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  3. 3
    139799

    Third draft report, April 28. Sexually Transmitted Diseases Working Group, April 22-24, 1991.

    World Health Organization [WHO]. Sexually Transmitted Diseases Working Group

    [Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. [15] p.

    Comprised of an interdisciplinary group of scientists from both developed and developing countries, a sexually transmitted diseases (STDs) research working group met April 22-24, 1991, in Geneva to develop recommendations for the WHO/STD program on global STD research needs and priorities. The group took direction from a September 1989 meeting of a WHO consultative group to the WHO STD program, and a meeting of the research sub-committee of the WHO AIDS/STD Task Force held in July 1990, to consider global strategies of coordination for AIDS and STD control programs. Recommendations for the WHO/STD program on global STD research needs and priorities would stress the needs of developing countries in the areas of cost-effective prevention, case detection and management, surveillance, and program evaluation. The relevancy of potential projects to practical, operational issues was stressed throughout the meeting, and the unique global role played by the WHO STD program in encouraging and coordinating STD research and control efforts, as well as in working with donor agencies, were central themes of the meeting. The working group determined that it should prioritize research needs based upon selected factors, and consider how potential plans addressing such needs could be accomplished and funded. Program support, case management, behavior, epidemiology, and interventions were identified as broad areas of research need.
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  4. 4
    139806

    Sexually transmitted diseases research needs: report of a WHO consultative group, Copenhagen, 13-14 September 1989.

    World Health Organization [WHO]. Programme for Sexually Transmitted Diseases

    [Unpublished] 1991. Presented at the 1st International Course on Planning and Managing STD Control Activities in Developing Countries, Antwerp, Belgium, September 9-21, 1991. 31 p.

    In response to the growing needs for research into sexually transmitted diseases (STDs), the STD Program of the World Health Organization (WHO) in September 1989 convened a small interdisciplinary consultative group of scientists from both developing and more developed countries to review STD research priorities. The consultation was organized based upon the belief that a joint consideration of global STD research priorities and local research capabilities would increase overall research capacity by coordinating the efforts of scientists from around the world to get the job done. Participants considered the areas of biomedical research, clinical and epidemiological research, behavioral research, and operations research. However, research needs directly related to HIV were not considered except where they interfaced with research on other STDs. The above areas of research, as well as the expansion of interregional and interdisciplinary collaborations, the strengthening of research institutions, developing and strengthening research training, and facilitating technology transfer and the use of marketing systems are discussed.
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  5. 5
    104436

    [Population and reproduction] Poblacion y reproduccion.

    Rosenbaum RF

    In: Jornadas Multidisciplinarias sobre el Aborto, 25 de febrero al lo de marzo, 1991. Salon de Honor del Ilustre Colegio Abogados de La Paz. [La Paz], Bolivia, Sociedad Boliviana de Ciencias Penales, 1991. 45-63.

    The problems created by excessive population growth at the global level and in Bolivia, and the response of the UN Population Fund are summarized. Today's world population of 5.3 billion is projected to reach 6.25 billion in 2000. In many areas, population growth has outstripped carrying capacity. Over 90% of the growth is in developing countries, where urban growth is particularly rapid. Because balance between human population and resources and environmental protection are key elements in quality of life and for sustainable development, population concerns should be a fundamental part of development strategies. The mandate of the UN Population Fund since 1973 has been to acquire and disseminate in developed and developing countries a knowledge of population problems and possible strategies to confront them, and to assist developing countries, at their request, to find appropriate solutions to their population problems. National population goals and objectives should include reducing average family sizes, reducing the proportion of women not using contraception, reducing early marriage and motherhood, and achieving a contraceptive prevalence of at least 56% of fertile-aged women in developing countries by the year 2000. Infant and maternal mortality rates should be lowered, average life expectancy should be increased to at least 62 years, and geographic distribution of the population improved. Bolivia, with its annual population growth rate of 2.2% and total fertility rate of 5.1, per capita income of $633/year, life expectancy of 58 years, and infant mortality rate of 102, is a priority country for the UN Population Fund. No coherent program of cooperation between the UN Population Fund and Bolivia has yet been developed, but 32 projects have been assisted in Bolivia since 1972 with a total investment of approximately US$105 million, of which 44.7% was destined for maternal-child health services and 29.0% for data collection.
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  6. 6
    080918

    Improving primary education in developing countries.

    Lockheed ME; Verspoor AM; Bloch D; Englebert P; Fuller B; King E; Middleton J; Paqueo V; Rodd A; Romain R

    Oxford, England, Oxford University Press, 1991. xix, 429 p.

    The Education and Employment Division of the World Bank's Population and Human Resources Department conducted a four-year study on the effectiveness and efficiency of primary education in developing countries. The resulting book includes extensive reviews of the research and evaluation literature; consultations with policymakers in developing countries, representatives of donor agencies, and primary education specialists; and results of commissioned studies and of original research conducted in the division. Learning is the central theme of the book; it reminds people that learning occurs in schools and classrooms among teachers and children, not in government ministries of education or finance. It also tells readers that learning is foremost and that teacher training and instructional materials are important only if the children learn. Policymakers must consider the impact of the cost and financing of education on learning when making decisions. The goals of primary education include teaching children basic cognitive skills, developing attitudes and skills in children so they can function effectively in society, and promotion of nation-building. This publication examines five areas for improvement of primary education: inputs necessary for children to learn; methods for improving teachers and teaching; management requirements for promoting learning; ways to extend effective education to traditionally disadvantaged groups; and the means to afford enhanced education. The study reveals that there is limited research on children's learning and no research at all on change in learning. The chapters cover the following: primary education and development; a brief history of primary education in developing countries; improving learning achievement; improving the preparation and motivation of teachers; strengthening institutional capabilities; improving equitable access; strengthening the resource base for education; international aid to education; and educational reform: policies and priorities for educational development in the 1990s.
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  7. 7
    104184

    Safe motherhood: priorities and next steps. Forward-looking assessment on the reduction of maternal mortality and morbidity within the framework of the Safe Motherhood Initiative: (SMI).

    Law M; Maine D; Feuerstein MT

    [New York, New York], United Nations Development Programme [UNDP], 1991 Apr. [3], viii, 40, [31] p.

    Women in Development is one of six key policy areas for the UN Development Program's (UNDP) next programming cycle. UNDP acknowledges the hazards of pregnancy and childbirth that rob society of women society at the height of their productivity. It has supported the Safe Motherhood Initiative (SMI) from its inception to reduce maternal mortality and morbidity in developing countries. UNDP reviewed its contributions at the global, regional, and national levels within the framework of SMI to determine its contributions during the 1990s. A three-person, multidisciplinary team conducted a forward-looking assessment which included interviews with 200 persons in UN and bilateral donor agencies and nongovernmental organizations, a survey of UNDP staff in developing countries, and visits to Senegal and Indonesia. The team assessed progress that has been made in policies, programs, resources, coordination, research, technical cooperation, and information. UNDP support helped initiate SMI. Its support of SMI conferences has increased awareness and political commitment. UNDP contributes funds to WHO's Safe Motherhood Operations Research Programme. Some of its SMI projects will likely achieve significant improvements in maternal health. UNDP support in Senegal and Indonesia allowed the first national needs assessments and action plans in the SMI. The team found that funding of needs assessments and action plans is constructive. It agreed with UNDP's policy of pooling its support with that of other donors. It found the present organization and structure through which UNDP funds are implemented to be appropriate. It recommended that UNDP continue to contribute to SMI. It suggested that UNDP take the lead role in establishing the International Partnership to Prevent Maternal Deaths and Disability as a mechanism to take the SMI into its next phase of translating the increased concern and technical know-how into increased safe motherhood activity at the country level.
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  8. 8
    070823

    Romania.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. v, 36 p. (Report)

    The former government of Romania sought to maintain existing population and accelerate population growth by restricting migration, increasing fertility, and reducing mortality. The provision and use of family planning (FP) were subject to restrictions and penalties beginning in 1986, the legal marriage age for females was lowered to 15 years, and incentives were provided to bolster fertility. These and other government policies have contributed to existing environmental pollution, poor housing, insufficient food, and major health problems in the country. To progress against population-related problems, Romania most urgently needs to gather reliable population and socioeconomic data for planning purposes, establish the ability to formulate population policy and undertake related activities, rehabilitate the health system and introduce modern FP methods, education health personnel and the public about FP methods, promote awareness of the need for population education, and establish that women's interests are served in government policy and action. These topics, recommendations, and the role of foreign assistance are discussed in turn.
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  9. 9
    080578

    Missed opportunities for immunization: the REACH experience.

    Grabowsky M

    Rosslyn, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1991 Mar. [5], 16 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    Children may fail to come into contact with the immunization system, may drop out before becoming fully immunized, or may stay in the system long enough to gain full immunity from given target diseases. As child immunization coverage nears 80% at the end of 1990, greater emphasis will be placed upon the quality of Expanded Program on Immunization (EPI) services. It is important to lower barriers to immunization and increase the certainty that every immunized child gains full protection. While EPI managers are able to measure coverage levels and assess and monitor immunization quality with the EPI 30-cluster survey, the analysis is complex and time-consuming. The Coverage Survey Analysis System (COSAS), however, employs computer technology to quickly and accurately analyze data. COSAS was developed by the World Health Organization with the input of assisting organizations and gives program managers access to information on the age distribution of immunizations, dose intervals, dropout rates, and other factors which influence program quality. Missed opportunities for immunization (MOI) occur when a child eligible for immunization leaves a health center without obtaining antigens needed for full protection. MOIs are therefore sensitive indicators of the quality of EPI services. Exit interviews have observed MOIs in certain developing countries in the range of 17-76% with a median of 49%. This decreased likelihood of a child being immunized infers eventual higher costs, delayed or missed protection, and loss of confidence in the EPI system. COSAS may help evaluate the quality of care, but it is unable to identify the determinants of quality care. Observation checklists and exit interviews are, however, able to determine the causes of poor service quality and find that they are frequently due to false contraindications, improper screening, lack of supplies, fear of giving multiple injections, and poor clinic organization.
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  10. 10
    079669

    African debt crisis and the IMF adjustment programmes: the experiences of Ghana, Nigeria and Zambia.

    Adefulu RA

    In: Development perspectives for the 1990s, edited by Renee Prendergast and H.W. Singer. Basingstoke, England, Macmillan, 1991. 37-57.

    Sub-Saharan African countries suffer from rapidly growing external debt and the concomitant burden of its service; debt service in 1987 accounted for 40.6% of exports. Liberal and neo-Marxist rationales exist to explain the development and existence of the African debt crisis. The former view, however, drives the market-oriented development approach of the IMF and World Bank and has resulted in the development and imposition of structural adjustment programs (SAP). Main components of SAP are exchange rate reforms or currency devaluation; trade liberalization; export promotion; rationalization of public expenditure, capital, investment, and employment in the public sector; privatization and commercialization of public enterprises; producer price adjustment; wage restraints; withdrawal/reduction of subsidies; tax structure reform; and financial/administrative reforms. SAP, however, ignores that the narrow production base of post-colonial African states encourages unpredictable export earnings which in turn make it hard for countries to concurrently service debt and pay for imports to cushion the effects of SAP. Internally, programs also ignore the inflationary effect of devaluation while underestimating the social cost of domestic tightening on living standards. While national leaders are willing to take steps towards much-needed structural reform, they object to SAP policies which exacerbate Africa's dependence upon external financial flow. The African Alternative Framework to Structural Adjustment Programmes for Socio-Economic Recovery and Transformation therefore proffers that the IMF modify its policy to allow African states to strengthen and diversify production capacities. Recommendations are largely reflationary and would require substantial internal and external funding. In sum, donor and recipient states must recognize that both internal and external factors caused the present situation and that interested parties must continue to explore viable options for action; African nations need structural reform but with out paralyzing their productive bases; and that the social costs of SAP must be evenly distributed in order to be politically acceptable. The structural adjustment experience of Ghana, Nigeria, and Zambia are presented as examples of these realities and conclusions.
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  11. 11
    073420

    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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  12. 12
    072824

    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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  13. 13
    073511

    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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  14. 14
    069357

    UNICEF annual report 1991.

    UNICEF

    New York, New York, UNICEF, 1991. 60 p.

    The 1991 UNICEF annual report contains an introduction written by the Executive Director, James P. Grant. In it he outlines the goals of the World Summit for Children which include: initiatives to save an additional 50 million children, reduce childhood malnutrition by 50%, reduce female illiteracy by 50% , and eradicate polio and guinea worm from the planet. The report discusses the programs conducted during 1991 including: the World Summit for Children, child survival and development, basic education, water supply and sanitation, sustainable development, urban basic services, childhood disability, women in development, social mobilization, emergency relief, monitoring and evaluation, inter-agency cooperation. The report also outlines UNICEF's external relations, resources, and provides several profiles including Africa's AIDS orphans. Income for 1990 totaled US$821 million for 1990, and estimated at US$858 million for 1991. Expenditures for 1989 were US$633 million, US$738 million for 1990, and estimated at US$847 million for 1991.
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  15. 15
    069079

    Population: more than a numbers game.

    Walker A

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1194-7.

    World population reached 5 billion on July 11, 1987. Current UNFPA projections predict world population stabilization at 10 billion by 2050. However, the current population is already exerting a tremendous amount of pressure on the carrying capacity of the planet. Ozone depletion, global warming, and acid rain are all the result of human activity at a level of half the current projection. World food production stabilized in 1988 and fell 5% in both 1987 and 1988. In both those years, world population grew 3.6% annually. Every year 14 million tons of grain production are lost to soil erosion, irrigation damage, poor land management, air pollution, flooding, acid rain, and increased ultraviolet radiation. Controlling population growth is not an easy task because of the complexities involved. Increasing female literacy and reducing infant mortality rates are very powerful means of controlling growth. China has served as the best example by reducing its growth rate from 4.75 in the early 70s to 2.36 in just 10 years. They accomplished this in a homogeneous society by making population control a civic duty. They provided rewards for small families and penalties for large ones. Family planning need is still very high, although it ranges from 12% in the Ivory Coast to 77% in the Republic of Korea. The UNFPA goal is to make family planning available to 59% os the world is couples by 2000. To do this, an additional US$9 billion needs to be spent which is a tiny fraction of total development aid to the 3rd world. In 1990 .9% of the total amount of development aid went to population and family planning programs.
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  16. 16
    066097

    Contraceptive source and the for-profit private sector in Third World family planning. Evidence and implications from trends in private sector use in the 1980s.

    Cross HE; Poole VH; Levine RE; Cornelius RM

    [Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991. [63] p.

    Estimates by Family Health International and UNFPA predict that the annual cost of modern family planning in meeting the target overall contraceptive prevalence level of 52% will be between $5-9 billion by the year 2000. The number of couples using modern methods of contraception will increase dramatically in future years, incurring great cost to donors, governments, and users. Urbanization, rising incomes, and higher education levels are generally seen as positive factors in permitting an expanded private sector role in the provision of modern contraceptives, providing an alternative source to donor and government programs. The for-profit concerns within the private sector of developing countries, were studied using available 1978-89 data from 26 countries to examine private family planning sources of contraceptives. Also, hypothetical determinants of private family planning use are established and their interrelationship with the use of for-profit family planning services, is investigated. Contrary to result expectations, it was found that use of the major provider for-profit private sector is declining in the face of rising incomes, urbanization, and better education. Government services are crowding out the private sector. Additionally, results indicate a strong user desire for longer-term methods. Full comprehension of the private sector and the factors governing choice of contraceptive source should lead to more effective use of donor and government funding in efforts to achieve set population objectives. Policy and program development will more accurately reflect social needs. Policy implications of the results are discussed.
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  17. 17
    071987

    Child's right to special care.

    Sharma A; Gupta S

    ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.

    In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.
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  18. 18
    071112
    Peer Reviewed

    Prevention of mental handicaps in children in primary health care.

    Shah PM

    BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(6):779-89.

    5-15% of all 3-15 year old children in the world are mentally impaired. In fact, 0.4-1.5% (10-30 million) are severely mentally retarded and an additional 60-80 million children are mildly or moderately mentally retarded. Birth asphyxia and birth trauma account for most cases of mental retardation in developing countries. >1.2 million newborns survive with severe brain damage and an equal number die from moderate or severe birth asphyxia. Other causes of mental retardation can also be prevented or treated such as meningitis or encephalitis associated with measles and pertussis; grave malnutrition during the 1st months of life, especially for infants of low birth weight; hyperbilirubinemia in neonates which occurs frequently in Africa and countries in the Pacific; and iodine deficiency. In addition, iron deficiency may even slow development in infants and young children. Current socioeconomic and demographic changes and a rise in the number of employed mothers may withhold the necessary stimulation for normal development from infants and young children. Primary health care (PHC) interventions can prevent many mental handicaps. For example, PHC involves families and communities who take control of their own care. Besides traditional birth attendants, community health workers, nurse midwives, physicians, and other parents must also participate in prevention efforts. For example, they should be trained in appropriate technologies including the risk approach, home risk card, partograph, mouth to mask or bag and mask resuscitation of the newborn, kick count, and ictometer. WHO has field tested all these techniques. These techniques not only prevent mental handicaps but can also be applied at home, health centers, and day-care centers.
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  19. 19
    071608

    Resolution adopted by the General Assembly on 21 December 1990. 45/216. Population and development.

    United Nations. General Assembly

    POPULATION NEWSLETTER. 1991 Jun; (51):21-3.

    On December 21, 1990, the UN General Assembly adopted resolution 45.216, reaffirming its commitment to population and development efforts and calling for increased spending. Among other things, the resolution: 1) stresses the sovereign right of every nation to adopt and implement population policies consistent with their cultural and socioeconomic conditions, and heedful of human and individual rights; 2) acknowledges the UNFPA report on the implications of the Amsterdam Declaration on A Better Life for Future Generations; 3) urges UNFPA to maintain the momentum generated by the International Forum on Population in the 21st Century; 4) emphasizes the need to take into account all economic and social factors in integrating demographic objectives in population and development strategies; 5) calls for increased support for population activities, urging governments to make every effort to mobilize resources for population activities (which will cost an estimated $9 billion a year by the year 2000); 6) encourages UNFPA to enhance accountability, adopt a program-oriented approach, and promote decentralization; 7) calls on Un and other organizations to strengthen cooperation on maternal and child health care and family planning; 8) notes the problematic relationship between demographic pressure, unsustainable consumption, and environmental degradation; 9) reaffirms the importance of the role of population policies in relation to development; 10) stresses the need for coordination at the regional and interregional levels to focus on related issued to the attainment of specific population goals and objectives.
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  20. 20
    070682

    Contraceptive needs and logistics management.

    United Nations Population Fund [UNFPA]. Technical and Evaluation Division

    New York, New York, UNFPA, [1991]. [2], 46 p. (Report)

    This report provides an overview of the Follow-up Consultative Meeting on Contraceptive Requirements in Developing Countries in the 1990s, a meeting convened by UNFPA on May 31, 1991. Over 40 representatives from donor countries, developing countries, intergovernmental organizations, and nongovernmental organizations attended the consultative meeting. The report first summarizes the proceedings and then presents 4 technical papers that were prepared for the meeting. The meeting itself focused on the following agenda items: 1) country-specific estimates of contraceptive requirements, including current status, methodological problems, and future plans and options; 2) program needs for logistics management of contraceptives; 3) options for local production of contraceptives; 4) coordinated procurement of contraceptives; and 5) future resource needs for contraceptives. As it was pointed out during the meeting, just to maintain the developing world's combined contraceptive prevalence of 51% will require providing contraceptives to an additional 108 million married women of reproductive age. A recurring theme at the meeting was the impact of AIDS on the logistics management of contraceptives. The report provides a summary of the discussions and conclusions reached by the participants. The 2nd section of the report contains the following papers presented at the meeting: County-Specific Estimates of Contraceptive Requirements, Programme Needs for Logistics Management of Contraceptives, Options for Local Production of Contraceptives, and Coordinated Procurement of Contraceptives.
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  21. 21
    070873

    Report of the Seminar on Programme Sustainability through Cost Recovery, Kuala Lumpur, Malaysia, 21-25 October, 1991.

    International Planned Parenthood Federation [IPPF]

    London, England, IPPF, 1991. 15, [2] p.

    In the face of widespread user acceptance, rapidly growing demand, and developing country financial constraints, family planning associations must learn how to operate more efficiently and mobilize new resources with a view to ensuring greater long-term sustainability. Cost recovery was therefore identified as a means of maximizing the use of limited resources, improving program quality, strengthening management, and making service providers more accountable to clients. This document reports results from seminar participants organized to share the benefits of cost recovery with the international community, and to review policy and management issues. Reviewed in the seminar were country experiences with cost recovery, working group discussions on the definition of sustainability, the cost framework of family planning, determining user fees and clients' willingness to pay, preconditions for setting user fees, prerequisites for social marketing, models for cost sharing with the government and private sector, and country case studies from the Gambia, India, and Kenya. Those programs attaining highest self-sufficiency were aided by strong government commitment to either support family planning or to not impede program progress. Also helpful were a businesslike approach to service provision, a strong promotional campaign, organizational structure conductive to effective resource management, and resolve to try diverse approaches. In concluding, the importance of placing the customer first, cost-effectiveness, cost analysis, strategic planning, inter-FPA cooperation, and business plans are mentioned.
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  22. 22
    069594
    Peer Reviewed

    Solidarity and AIDS: introduction.

    Krieger N

    INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.

    This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.
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  23. 23
    070999

    International population assistance: past performance and future needs.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, [1991]. [4] p.

    This report examines the current level of international assistance for population activities and discusses how much assistance will be needed in order to hold population all levels to the UN's medium variant projection. Currently at 5.4 billion, the world's population is growing by some 95 million people each year. By the end of the 1990s, annual growth will have reached 98 million. At this rate, buy the year 2001, global population will have reached 6.4 billion. 95% of this growth will occur in the developing world. To hold population to the UN's medium variant population projection for the year 2000, contraceptive prevalence among married women of reproductive age in the developing world will have to increase from the current 51% (381 million couples) to 59% (567 million couples). In order to meet the cost of this increase, UNFPA estimates that total spending on population programs must reach an annual $9 billion by the year 2000 -- double the current level. About $4 billion will have to come from the international donor community. In 1989, international population assistance totaled $757 million, the bulk of which came from 18 developed countries, led by the US, which contributed 39% of the total. Japan came next with 10% followed by Norway, the Netherlands, Canada, Germany, and the United Kingdom, all of whom contributed 5% of the total. The report, however, notes that the level of assistance per donor country varied widely according to the country's Gross Domestic Product and Official Development Assistance. In addition to the contribution from the international donor community, the UNFPA will have to provide $1 billion, nongovernmental agencies $0.5 billion, users $0.5 billion, the World Bank $0.5 billion, the World Bank $0.5 billion, and the rest will have to come from developing countries themselves.
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  24. 24
    068994

    The struggle to meet great needs. Interview: Mrs. Sadako Ogata.

    Hamand J

    PEOPLE. 1991; 18(4):10-2.

    The head of the United Nations High Commission for Refugees, Sadako Ogata, anticipates continued growth in the numbers of migrants and refugees in the 21st century, in part as a result of the collapse of the political and economic systems in developing countries and Eastern Europe. Development assistance that provides jobs, alleviates poverty, and seeks to maintain family structures in developing countries is necessary for both urban and rural areas, and nongovernmental organizations are being urged to prioritize education, training, and primary health care activities. Of particular concern are the special needs of refugees and migrants who are women and children. Children are most susceptible to the diseases, especially diarrhea and subsequent dehydration, that are prevalent in refugee camps. Needing further attention is the psychological trauma to refugee children created by dislocation and exposure to war. Maternal-child health care, including family planning, is another area in need of greater emphasis. Although women head most families in refugee camps, camp management tends to be male-dominated and the special needs of women and children are not receiving sufficient attention. Activities that go beyond basic sustainment of life will have beneficial effects in the longterm as well, as refugees are repatriated and reintegrated into the community.
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  25. 25
    070625

    Contraceptive use and commodity costs, 1990-2000.

    Mauldin WP; Ross JA

    [Unpublished] [1991]. 10, [14] p.

    Based upon United Nations medium population projections, the population of developing countries will grow from 4,086 million in 1990, to 5,000 million by the year 2000. To meet this medium-level projection, 186 million contraceptive users must be added for a total 567 million in addition to increased contraceptive prevalence of 59% from 51%. This study estimates the number of contraceptive users, acceptors, and cost of contraceptive commodities needed to limit growth to this medium projection. Needs are estimated by country and method for 1990, 1995 and 2000, for medium, high, and low population projections. The number of contraceptive users required to reach replacement fertility is also calculated. Results are based upon the number of women aged 15-49, percent married, number married ages 15-49, and the proportion of couples using contraception. Estimation methodology is discussed in detail. Estimated users of respective methods in millions are 150 sterilizations, 333 IUD insertions, 663 injections, 7,589 cycles of pills, and 30,000 condoms. Estimated commodity costs will grow from $399 million in 1990 to $627 million in 2000, for a total $5.1 billion over the period. Pills will be the most expensive at $1.9 billion, followed by sterilizations at $1.4 billion, condoms $888 million, injectables $594 million, and IUDs $278 million. Estimated costs for commodities purchased in the U.S. show IUDs and condoms to be significantly more expensive, but pills as cheaper. With donors paying for approximately 25% of public sector commodity costs, developing country governments will need to pay $4.2 billion of total costs in the absence of increased commercial/private sector and donor support.
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