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New Delhi, India, WHO, SEARO, 1991 Dec. , 35 p. (Regional Health Paper, SEARO, No. 20)The Joint WHO/UNICEF Nutrition Support Programme (JNSP) began operations in Myanmar in 1984 and expanded nationwide in three phases. A detailed situation analysis of nutrition conditions and nutrition programs in primary health care (PHC) were conducted prior to JNSP activities. They served as the rationale for the decision to implement JNSP activities nationally. These activities are almost entirely administered through the Ministry of Health. JNSP redesigned nutrition training for village workers, their supervisors, and district health personnel. It has strengthened nutrition units at the central and regional levels. All JNSP-technical activities revolve around nutrition monitoring and counseling. JNSP participated in the establishment and operations of a food and nutrition surveillance system. It facilitated implementation of the nutrition and nutrition-related aspects of the People's Health Plan. The JNSP was evaluated in 1989. During the JNSP period, mortality among children less than 3 years old fell. 3-year-old children grew at a faster rate than prior to JNSP. Improvements were also noted in young child feeding practices, health seeking behavior of mothers, counseling by voluntary workers, and health staff performance. The evaluators concluded that JNSP directly benefitted the health and nutrition of children less than 3 years old. External costs of JNSP added up to US$5.63 million. The government put in another US$5.43 million. The communities contributed US$2.9 million. JNSP covers 30% of the total population. Per capita annual costs were US$1.67. These low per capita costs suggest that JNSP is sustainable and replicable. JNSP's further expansion depends on expansion of the health delivery system. All levels regularly provide support and supervision. Planned evaluation and feedback is the norm.
New York, New York, AVSC, 1991. 28 p.The annual report for 1990-1991 of the Association for Voluntary Surgical Contraception (AVSC) enumerates changes that came about in 1990, accomplishments of the last decade, and then summarizes activities by region with a brief feature on 1 country in each. Some of the developments in 1990 included introduction of Norplant, a training workshop in Georgia for physicians from newly independent CIS states, and the Male Involvement Initiative. The Gulf War delayed major activities requiring travel. Overall, in 1990 the AVSC provided 133,328 sterilizations, 72% female and 28% male in 50 countries, trained 325 doctors, led 58 courses in counseling and voluntarism training 568 counselors, and published or collaborated on numerous professional articles and teaching materials. In-country work emphasized no-scalpel vasectomy and minilaparatomy female sterilization under local anesthesia. As an example of country projects in 20 African nations, a client-oriented, provider-efficient system for improving clinic management and quality of care called COPE, was the focus in Kenya. Male responsibility was an emphasis in Latin America. In India, where sterilization is the most popular contraceptive method, training centers were upgraded in 12 states. In the US, AVSC conducted training sessions for physicians in laparoscopy under local anesthesia.
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.
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.