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In: To cure all hunger. Food policy and food security in Sudan, edited by Simon Maxwell. London, England, Intermediate Technology Publications, 1991. 191-206.Targeting on grounds of equity, cost, or minimizing interference fails to consider whether targeting is politically possible. In the case of the USAID-sponsored famine-relief and emergency food aid operation in Darfur, western Sudan, in 1985, the expressed intention of target this relief was not fulfilled. The target group received inadequate amounts of relief grain owing to the lack of targeting by area councils within Darfur, and the lack of targeting within area councils. After severe rainfall failures in 1982, 1983 and 1984, large numbers of people in western Sudan faced severe food shortage, abnormal migrations, and increased risk of destitution. USAID, the principal donor for relief operations to western Sudan in 1984-85, approved 82,000 metric tons (mt) of relief grain for western Sudan in September 1984, and then a further 250,000 mt in late 1984 and early 1985. The target population for the first 41,000 mt of relief sorghum was the neediest one-fourth later, the neediest one-third. A USAID document provided estimates of people and the way the area councils conceived sheltering throngs of the target group. There was 153,141 seriously affected in Kutum area council, 102,907 in Mellit, and 507,348 in Geneina representing around 25% of Darfur's population, the size of the target group envisaged for the first 41,000 mt of relief grain. USAID made concessions to the Darfur regional government allowing South Darfur a higher proportion of early allocations than need dictated. Save the Children Fund experienced serious difficulties with the local contractor to distribute food from area-council level. Aid agencies and donors need to consider how targeting is to be accomplished and how to confront influential local players with interests contrary to such targeting. Allocations of relief grain could be made on the assumption that targeting will be only partially achieved; and through alternative forms of relief.
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.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
New York, New York, United Nations, 1991. x, 58 p. (ST/ESA/SER.R/113)With approximately 12% of its 1980 population over age 60, Argentina's elderly constitute a higher-than-average proportion of the total population when compared to other developing countries. Governments are increasingly assuming greater responsibility for the care and support of the elderly. Accordingly, this paper describes the social and economic aspects of population ageing in Argentina, with the aim of providing planners with a better understanding of the social and economic implications of these demographic changes. Better understanding should result in the development of appropriate plans and policies targeted to the elderly. While the ageing process in Argentina is comparatively advanced when compared to other developing countries, ageing presently proceeds at a slower pace when compared to past trends. Slow ageing is also projected into the future. The elderly, themselves, have been ageing, and tend to live to a greater extent in urban areas. Elderly women when compared to men are more likely to live alone and in urban settings. Despite a stagnating economy, social gains and improvements in living conditions for the elderly have been largely sustained. The working-age population grew more slowly, however, over recent decades than the total population. The number of retirement system beneficiaries also grew over the period, with retirement benefits reported as the leading sources of income among the elderly. The health care system remains strained by the country's present economic situation, with care failing to reach all of the elderly. Wide societal agreement exists that the family should be a major care provider. With more than 1/2 of all persons aged 65 and over living in extended or mixed households, the family plans an important care and support function.
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991 Jun.  p. (Occasional Operations Papers; USAID Contract No. DPE-5969-Z-00-7064-00)The paper presents results from diarrheal disease control (CDD) activities in Kenya. A World Health Organization Diarrheal Diseases Household Case Management Survey of 23,884 children under 5 years of age indicates a high use of recommended fluids before and during episodes of diarrheal illness. ORT use was high, while ORS use and volume were low, with better diarrheal management practiced in Western Kenya. Children with diarrhea in districts with CDD communication program are more likely to receive proper care. For home treatment of diarrhea, the Kenyan Food and Fluids Panel recommends mothers to use uji, a locally available porridge, liberal quantities of plain water, fresh fruit juices, fermented milk, and coconut water; exclusive breastfeeding for the 1st 4 months of life; continued feeding of at least 5 times/day during diarrhea; and improved, targeted communication for behavior change especially among mothers of at-risk children. Additional research on food, feeding, communications, and marketing ORS was also recommended. Principal research findings of the survey are discussed in detail. Messages most effective in improving the management of diarrhea include emphasizing feeding during diarrhea, stressing the use of nutritional fluids, continued hesitation of ORS promotion until 1.2- liter packets become generally available through the health system, and emphasizing the rare need for drug therapy of diarrhea. Recognizing signs suggesting the need for health facility treatment should be reinforced.
Evaluation of Matching Grant II to International Planned Parenthood Federation / Western Hemisphere Region (IPPF/WHR) (1987-1992).
Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Jul 26. xii, 48,  p. (Report No. 90-078-116; USAID Contract No. DPE-3043-G-SS-7062-00)This is a mid-term review of a matching grant given to the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) by USAID's Office of Population for 1987-1991. The grant covers projects in Brazil, Colombia, Mexico and 9 smaller countries, and 4 regional activities, commodities, technical assistance, management information systems (MIS), and evaluation support. The goal of the grant was to reach new acceptors with quality services, to exert leadership of public sector providers, and to improve internal management. The goals in the 3 large nations are to focus on pockets of need or inadequate service or method mix. The goals of attracting 2.8 million new acceptors, improving services, making detailed plans and keeping strict financial reports have been met. The most serious problem was the lack of a regional evaluation of goal evaluation, the real cost of contraception, and impediments to contraceptive use. There were also difficulties in forwarding funds at the beginning of the FPA's year, and in sending in agency workplans on time. Better communication structures could probably remedy this. It is recommended that the matching grant be renewed in 1992.
[Unpublished] 1991.  p.Jose G. Rimon, II, Project Director for the Johns Hopkins University Population Communication Services (JHU/PCS) Center for Communication Programs, visited Finland to attend a NORPLANT planning meeting. Meeting discussion focused upon issues involved in expanding NORPLANT programs from pre-introductory trials to broader national programs. Financing and maintaining quality of care were issues of central importance for the meeting. Participants included representative from NORPLANT development organizations, the U.S. Agency for International Development, the World Bank, and other donor agencies. Mr. Rimon was specifically invited to make a presentation on the role of information, education, and communication (IEC) on NORPLANT with a focus upon future IEC activities. The presentation included discussion of the need to develop a strategic position for NORPLANT among potential customers and within the service provide community, the feasibility of global strategies positioning in the context of country-specific variations, the need to identify market niches, the need for managing the image of NORPLANT, and the need to study IEC implications in terms of supply-side IEC, content/style harmonization, materials volume, and language and quality control. Participants collectively agreed to develop an informal group to address these issues, concentrating upon universal issues potentially addressed on a global scale. A meeting on strategic positioning is scheduled for August 19-20, 1991.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):1-18.A study investigative the pros and cons of financial payments for sterilizations to clients, medical personnel, and agents who motivate and refer clients was conducted by the government of Bangladesh in conjunction with the World Bank. Results indicate that Bangladeshi men and women opt to be sterilized both voluntarily and after consideration of the nature and implications of the procedure. Clients were also said to be knowledgeable of alternate methods of controlling fertility. A high degree of client satisfaction was noted overall with, however, 25% regret among those clients with less than 3 children. Money is a contributing factor in a large majority of cases, though dominating as motivation for a small minority. Financial payments to referrers have sparked a proliferation of many unofficial, self-employed agents, especially men recruiting male sterilization. Targeting especially poor potential clients, these agents focus upon sterilization at the expense of other fertility regulating methods, and tend to minimize the cons of the process. Examples of client cases and agents are included in the text along with discussion of implications from study findings.