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IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
New York, New York, UNFPA, . , 16 p. (Programme Advisory Note)This report explains that a comprehensive strategy is needed to meet the reproductive health needs of young people and to facilitate their participation in development. Out of a world population of 5.3 billion people, 1.5 billion are between the ages of 10 and 24 years. 82% of these young people live in developing countries. And with the total fertility of developing countries at 4.0, the number of young people will continue to increase. Developing countries already face enormous problems in providing education and employment to these young people. The report identifies the issues that are involved in youth, population, and development, such as reproductive health information, family planning services, population distribution and urban migration, and sustainable development. The report also provides examples of UNFPA-funded youth projects. A program in Thailand, for example, aims to raise contraceptive awareness among adolescents in school. The outcome of these projects indicates the need fora comprehensive strategy that takes into account the following: 1) developing and implementing youth policies, plans, and programs; 2) carefully targeting IEC activities to specific audiences; 3) strengthening maternal and child health/family planning services for young people, including unmarried youth; 4) improving the status of young women; 5) increasing the involvement of men in family matters, especially family planning; 6) complementing other development activities that have wide-range impact; and 7) using nongovernmental organizations to help empower young people.
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.
[Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991.  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.
CONSCIENCE. 1991 Sep-Oct; 12(5):22-3.Congressional legislation seeking to overturn US government restrictions on international family planning assistance face a possible presidential veto. Dating back to the Reagan years, the 1984 Mexico City Policy prohibits foreign nongovernmental organizations (NGO) receiving US money from performing or actively promoting abortion as a family planning method. Even if abortion is legal in that particular country, the agency involved may not even discuss abortion as one of the medical options of a pregnant woman. In line with the Mexico City Policy, the US has withdrawn funding from both the International Planned Parenthood Federation, the largest NGO in the population field, and the Family Planning International Assistance, the international division of the Planned Parenthood federation of America. One of the effects of the Mexico City Policy has been to make family planning more controversial, and to increase opposition to birth control. In addition to the Mexico City Policy, the Reagan years also saw the implementation of a policy that denies funding to the UNFPA, charged by the US of "co-managing" China's population program that engages in coercive abortion and involuntary sterilization. The UNFPA has denied such charges. So far, President George Bush -- previously a supporter of family planning programs -- has sided with opponents of abortion, and has threatened a veto threat may soon be tested, since Congress has drafted a foreign aid appropriations bill that has includes a measure saying that NGOs should be treated in the same manner as their governments, which are exempt from the Mexico City Policy so long as US funds are not used to support abortions.
INTEGRATION. 1991 Sep; (29):6-7.Providing resources for family planning programs in the USSR, where an extremely high rate of abortions threatens the lives of women, will require a multi-sectoral approach involving the government, international agencies, and the private sector. Every year, some 10-13 million of the USSR's 70 million women of fertile age undergo an abortion (only 7 million of the abortions every year are considered legal). A recent report indicates that only 15-18% of Soviet women have not had at least one abortion in their lifetimes. A result of the high rate of illegal abortions, morbidity and mortality affects many Soviet mothers. Additionally, infant mortality rates is as high as 58.5% in some areas of the USSR, a figure similar to that found in developing countries. Knowledge of modern contraception is high, but use remains low. This is due primarily to the lack of contraceptive availability. IUD's injectables, implants, and oral contraceptives are scarce. And even when oral contraceptives are available, few women opt for this method, due to the rampant misinformation and exaggeration concerning its side-effects. While the USSR does produce condoms, their quality is poor. Part of the solution to the lack of available contraception rests in the transition to a market economy. As the demand for these services increases, the market will begin meeting this demand. The government also has a important role to play, which includes the provision of information, medical and paramedical education, sex education, and service delivery. And international agencies will need to provide the necessary technical assistance.
Population Reports. Series J: Family Planning Programs. 1991 Nov; (39):1-31.This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.
Report of the Seminar on Programme Sustainability through Cost Recovery, Kuala Lumpur, Malaysia, 21-25 October, 1991.
London, England, IPPF, 1991. 15,  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.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
Lot quality assurance sampling techniques in health surveys in developing countries: advantages and current constraints.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1991; 44(3):133-9.Costly, time-consuming, traditional survey methods usually provide information only at national or regional levels. Information from the health center and community levels is, however, also of interest particularly in managing and directing supervisory activities. An industrial method is described with practical applications for conducting health surveys to monitor health programs in developing countries. This lot quality assurance sampling (LQAS) methodology was developed in industry for quality control, and allows the use of small sample sizes when surveying small geographical or population-based areas. The paper describes the method, explains how to build a sample frame, and how to conduct the sampling necessary for field application of LQAS. Sampling unit selection for health program monitoring is described in detail. Simple- and double-sampling schemes are discussed, as well as interpretation of survey results and the planning of subsequent rounds. Constraints limiting use by health planners are explored with suggestions provided on modes of overcoming obstacles through future research.
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA. 1991 Jun; 5(2):221-34.Public and private domestic expenditures for health in a total 148 developing countries for 1983, were estimated to be $100 billion. 1986 external donor health expenditures totalled $4 billion, a small percentage of overall health expenditure for developing countries. U.S. direct donor assistance for development was 0.5% of the federal budget for 1988, with approximately 10% of all U.S. development assistance allocated for health, nutrition, and population planning. As such, the U.S. accounts for 13% of total health contributions from external donors to developing countries. Approximate at best, private and volunteer organizations are estimated to contribute 20% of all such health assistance. Developing countries are therefore required to efficiently use their own resources in the provision of national health services. Technical assistance and donor experience also counting as external assistance, the overall supply of health financing is far greater than developing country demand in the form of well-articulated, officially approved proposals. Reasons for this imbalance include health ministry unfamiliarity with potential donor sources, passive approaches to external financing, unfamiliarity with proposal preparation, increasing competition from other sectors of developing nations, limited numbers of trained personnel, and lack of an international system of support to mobilize financing. The paper discusses 6 years of Pan American Health Organization interventions for resource mobilization in Latin America and the Caribbean, and suggests World Health Organization regional extension backed by U.S. encouragement and support.
New York, New York, New York University Press, 1991. xxiv, 464 p.This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
Management information systems in maternal and child health / family planning programs: a multi-country analysis.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):19-30.Management and information systems (MIS) in maternal and child health were surveyed in 40 developing countries by trained consultants using a diagnostic instrument developed by UNFPA and the Pan American Health Organization (PAHO). The instrument covered indicators of input (physical infrastructure, personnel, training, finances, equipment, logistics), output (recipients of services, coverage, efficiency), quality, and impact, as well as frequency, timeliness and reliability of information. The consultants visited national and 2 provincial level administrative and service points of public and private agencies. Information on input was often lacking on numbers and locations of populations with access to services. In 15 countries data were lacking on personnel posts filled and training status. Logistics systems for equipment and supplies were inadequate in most areas except Asia, resulting in shortfalls of all types of materials and vehicles coinciding with idle supplies in warehouses. Financial reporting systems were present in only 13 countries. Service outputs were reported in terms of current users in 13 countries, but the proportion of couples covered was unknown in 25 countries. 2 countries had cost-effectiveness figures. Redundant forms duplicated efforts in half of the countries, while data were not broken down at the usable level of analysis for decision-making in most. Few African countries had either manual or computer capacity to handle all needed data. Family planning data especially was not available to draw the total picture. Often information was available too late to be useful, except in Portuguese speaking countries. Even when quality data existed, managers were frequently unaware of it. It is recommended that training and consultancies be provided for managers and that these types of surveys be repeated periodically.
EARTHWATCH. 1991; (41):15.The National Audubon Society began a population program in 1979, set up a 5-year plan of public education, advocacy and coalition-building in 1985, and joined a broad-based coalition of the Sierra Club, the National Wildlife Federation, the Population Crisis Committee and the Planned Parenthood Federation of America in 1990. The 1985 impetus resulted in production of teaching materials and staging of focus groups across the U.S. The 1990 coalition has directed funds to the USAID Office of Population. Another project is the International Environment/Population Network, which organizes letter-writing, media programs and town meetings for ordinary citizens to press for sustainable development. Many of the Audubon's 510 local chapters have partnerships with similar groups in other countries, as do 8 wildlife sanctuaries have links to sanctuaries abroad. An example is the Indus River in Pakistan visited by the manager of Audubon's Platte River Sanctuary in Nebraska. The 2 rivers share the problem of reduced flow and vegetation overgrowth as a result of engineering projects upstream.
New York, New York, United Nations Population Fund [UNFPA], 1991. , 48 p.Developing countries increased their commitment to implement population policies in the late 1980s and early 1990s with the support and guidance of UNFPA. These policies focused on improving, expanding, and integrating voluntary family planning services into social development. 1985-1990 data revealed that fertility began to fall in all major regions of the world. For example, fertility fell most in East Asia from 6.1-2.7 (1960-1965 to 1985-1990). This could not have occurred without strong, well managed family planning programs. Yet population continued to grow. This rapid growth hampered health and education, worsened environmental pollution and urban growth, and promoted political and economic instability. Therefore it is critical for developing countries to reduce fertility from 3.8-3.3 and increase in family planning use from 51-59% by 2000. These targets cannot be achieved, however, without government commitments to improving the status of women and maternal and child health and providing basic needs. They must also include promoting child survival and education. Further people must be able to make personal choices in their lives, especially in contraceptive use. Women are encouraged to participate in development and primary health care in Kerala State, India and Sri Lanka. The governments also provide effective family planning services. These approaches contributed significantly to improvements in fertility, literacy, and infant mortality. To achieve the targets, UNFPA estimated a doubling of funding to $9 billion/year by 2000. Lower costs can be achieved by involving the commercial sector and nongovernmental organizations, building in cost recovery in the distribution system of contraceptives, operating family planning services efficiently, and mixing contraceptive methods.