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New Haven, Connecticut, Yale University, Economic Growth Center, 1996 Jan. 34 p. (Center Discussion Paper No. 746)This paper accepts the premise that positive sum games exist in all dimensions of North-South economic contacts but that the management of conflicts concerning the distribution of the gains requires careful attention. It then proceeds to analyze the current state of play and the character of these conflicts in each of the main arenas, focussing heavily on trade, but also discussing public and private capital movements, technology transfer and intellectual property rights issues and labor mobility. It concludes with a discussion of possible changes in international institutions and governance. (author's)
New Haven, Connecticut, Yale University, Economic Growth Center, 1996 Sep. 28 p. (Center Discussion Paper No. 762)This paper reviews the development experience since the 1980's and finds room for guarded optimism about what we can learn from it. Firstly, a global consensus is emerging on the need for macro-economic stability through prudent fiscal, monetary and foreign exchange policies. However, at the micro or structural level, while governments need to decentralize their decision- making authority more fully than they have thus far, in reaction to the recent reappraisal of the East Asian model there is some danger that development policy will swing too far in rejecting liberalization and returning to government intervention. Secondly, the paper points out that, while there exists a well-recognized causal nexus between exports and growth, the reverse causation also holds, i.e. domestic growth patterns conditioned by education and R&D expenditures and policies determine whether or not a country can take full advantage of existing export opportunities. Finally, although fast-disbursing policy-based loans have not been as successful as they could be, largely because of the World Bank's chosen modus operandi, they represent potentially highly effective instruments that should not be abandoned. Rather, the Bank should help render such loans more fully "owned" by recipients, replace country-specific lending quotas by aid ballooning related to carefully worked out reform packages, and develop a better division of labor with other multilateral and bilateral donors. (author's)
In: Family planning, health and family well-being. Proceedings of the United Nations Expert Group Meeting on Family Planning, Health and Family Well-Being, Bangalore, India, 26-30 October 1992, [compiled by] United Nations. Department for Economic and Social Information and Policy Analysis. Population Division. New York, New York, United Nations, 1996. 338-41. (ST/ESA/SER.R/131)The World Bank started assisting population and family planning activities in 1969. Since then it has concentrated on financial lending in family planning, population, health and nutrition; policy dialogue on population with governments; and sector studies for countries and regions. During the 1970s the Bank funded 22 projects in 15 countries, lending $366 million; 19 of the projects were population related. Health, population, and nutrition activities became the focus during 1979 and 1987. 45 projects were approved with $1,209 million committed. The Bank advised governments on the integration of population issues into development planning. Family planning was supported as a part of health provision in Africa and Latin America. The World Development Report, 1984, focused on population, stressing its importance in development. Reorganization and decentralization took place in 1987 but lending continued to grow in these areas. Currently [in 1992] there are 50 ongoing projects with a total commitment of $963 million for population policy development and family planning services. Policy and research work entails family planning cost effectiveness in Colombia and Indonesia. Cooperation and collaboration with local communities and nongovernmental organizations have developed over the years. The Bank also cooperates with UNFPA, IPPF, WHO, the African Development Bank, and the United Nationals Development Program. The Safe Motherhood Operational Research fund receives Bank support. The Task Force for Child Survival is supported by a grant. An intersectoral approach is taken, thus family planning, health, education, and nutrition projects are combined in broad social sector projects. 10 of the 28 projects in 1991 were such combined social development projects with 20% of all lending. Future opportunities concern strengthening family planning services; cooperation with donors for institution building to affect demographic change; increasing the involvement of local communities and nongovernmental organizations; and further integrating population policy into development strategies for the reduction of poverty.
In: Measuring the achievements and costs of reproductive health programs. Report of a meeting of the Working Group on Reproductive Health and Family Planning, the World Bank, June 24-25, 1996. [Unpublished] 1996. 20-4.This paper discusses the impact of incorporating indicators into reproductive health projects. The Human Development Department was tasked by the World Bank to develop strategies for improving the monitoring and evaluation of Bank projects in related sectors. The first effort involved the selection of key indicators for family planning projects. It was then followed by the Cairo conference and documents developed by Anne Tinker and colleagues for women's health and nutrition. These documents aimed to provide guidance to Bank task managers on the types of indicators that might be used to monitor and evaluate projects. Initially, the process of developing the lists of indicators was to define reproductive health. This was then followed by identifying the different types of indicators that might address concerns in each area, while drawing heavily from the work of the Evaluation Project and others. Lastly, this paper presents the discussion on the specific components of the World Bank indicators model.
Washington, D.C., World Bank, Environmentally and Socially Sustainable Development Network, Social Development, 1996 Feb. , v, 59 p. (Social Development Paper No. 12)This report defines types of nongovernmental organizations (NGOs) and identifies strategies for identifying participatory NGOs. It also discusses capacity building, the tension between service delivery and capacity building, the potential to increase the scale of activity among NGOs, project or process development, and linkages between NGOs and government. The World Bank now aims to foster more participatory community-based development among development-oriented NGOs trying to reduce poverty. Development-oriented NGOs tend to have the strongest grassroots links and the greatest experience reaching disadvantaged groups with innovative methods. The World Bank has historically ignored participatory processes. The challenge is to locate NGOs willing to collaborate and those that have sufficient capacity to meet goals; to support the participatory character of NGOs; and to help reduce friction in styles with the operations of the World Bank and governments. Highly participatory NGOs tend to work on a very small scale. Another challenge is to build the institutional capacity of NGO partners. The usual management training is unsuitable and insufficient for NGO needs. History, politics, and ideology define the differences in links between governments and NGOs. Partners may be constrained by government attitudes and regulations. The cases confirm the importance of a clear, shared understanding of partner NGO roles; a flexible, staged process of collaboration; opportunities for strong, relatively homogenous common interest-based groups; a supportive, nonintrusive state context; and a shared view and willingness to cooperate among major donors.
TDR NEWS. 1996 Mar; (49):1-2.A UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) expert meeting has concluded that the means already exist with which to eliminate 4 of the 8 diseases which TDR originally identified as public health problems. Elimination in this case refers to reducing the number of cases of disease to a small and routinely manageable number. The diseases capable of being eliminated with existing tools are leprosy, onchocerciasis, lymphatic filariasis, and Chagas disease. Leprosy can be eliminated through the use of multidrug therapy, onchocerciasis through the administration of ivermectin, lymphatic filariasis through the use of DEC and ivermectin, and Chagas disease through the rational use of insecticides and the control of blood banks. Malaria, schistosomiasis, leishmaniasis, and African trypanosomiasis, however, must await better tools before their elimination can be attempted. TDR's role in identifying how to eliminate each of these diseases is described. Meeting attendees identified additional avenues of operational research upon which TDR should embark.
Measuring the achievements and costs of reproductive health programs. Report of a meeting of the Working Group on Reproductive Health and Family Planning, the World Bank, June 24-25, 1996.
[Unpublished] 1996.  p.The Working Group on Reproductive Health and Family Planning is a joint project of the Health and Development Policy Project and the Population Council. On June 24, 1996, members of the Working Group met to discuss ways of measuring the achievements and costs of family planning and reproductive health programs. It is particularly important to revise family planning program evaluation methods so that they are consistent with a client-centered, reproductive health approach, and to develop ways of evaluating the costs and effectiveness of the components of comprehensive reproductive health care. This report is comprised of papers on the following topics: performance indicators with regard to making the transition from a demographically-oriented family planning program to a client-centered reproductive health paradigm; monitoring and evaluating reproductive health and family planning programs; incorporating indicators into reproductive health projects; disability adjusted life years and reproductive health; assessing the costs of reproductive health programs; and the cost of reproductive health. A summary is presented of the technical group meeting discussion.
In: Background papers, Human Development Report 1995, [compiled by] United Nations Development Programme [UNDP]. New York, New York, UNDP, 1996. 89-104.The introduction of this background paper for the UN's 1995 Human Development Report, which examines the analytical and political visibility of the work of social reproduction, notes that social reproduction currently occupies a blank space in current economic analyses that lack a macro-framework capable of revealing the role of social reproduction of people as well as the gender and class conflicts that exist in the capitalist relationship between profit production and social reproduction. The first section of the paper discusses the difficulty of integrating domestic work into economic analysis in a way that acknowledges the differences between the production of commodities and the reproduction of the species. Section 2 places the sector and process of reproduction in the more systematic analytical location through use of the perspective of livelihood economies. The third section offers a classical surplus approach as a means of visualizing the conflicts inherent in the capitalist production-reproduction relationship, and this approach is used in the fourth section to locate domestic work in a macro economic analysis. Section 5 presents the present structuring of the global labor markets as the context in which reproduction and paid/unpaid labor must be analyzed, and section 6 assesses the gender policies of the World Bank to determine their capacity for challenging mainstream theories. The final section argues for a strategic policy of reversing the direction of the production-reproduction relationship by making production and markets responsible and accountable institutions that contribute to human welfare.
Washington, D.C., World Bank, 1996. xvi, 140 p. (Development in Practice)This World Bank publication considers why and how the downward spiral of environmental degradation in sub-Saharan Africa must be reversed to reduce poverty through the maintenance and sustainable use of the capital of natural resources and through sound environmental management. The first part of the book explores the key environmental issues and long-term perspective through an examination of 1) obstacles on the path to sustainable development in the region, 2) subregional diversity and environmental hot spots, and 3) a 30-year projection of future challenges. Part 2 presents the World Bank's experience in integrating the environment in development with a look at 1) country and World Bank experiences in achieving environmentally sustainable development, 2) integrating environmental issues in World Bank projects and programs, and 3) the World Bank's environmental capacity and lessons learned. The third part presents the World Bank's proposed agenda to promote environmentally sustainable development in sections that cover 1) objectives and strategy, 2) implementation issues, 3) mainstreaming environmental concerns into the World Bank's work, and 4) the plan of action. An appendix describes current World Bank environmental projects in the region.
In: The informal sector and microfinance institutions in West Africa, edited by Leila Webster and Peter Fidler. Washington, D.C., World Bank, 1996. 71-7.This book chapter summarizes findings about informal sectors in West Africa and from case studies of microfinancing in West Africa and discusses the implications of the dynamics of informal sector for the World Bank. Provided are an analysis of the characteristics and constraints of the informal sectors in 12 West African countries and an evaluation of nine microfinance institutions that represent the most effective ones in the region. 1) Informal sectors in West Africa are very large and are continuing to grow rapidly. 2) Much informal activity is associated with rural agriculture, but urban informal sector growth recently surpassed rural informal sector growth. 3) Poor women represent a large proportion of the informal sector. 4) Key constraints are stagnant or saturated markets, lack of access to credit and savings services, weak business skills, inadequate information, and poorly developed infrastructure. 5) Primary lending sources among poor microbusinesspersons include family and friends, money lenders, and local savings and credit groups. No one interacts with banks. 6) Microbusiness assistance programs are distributed unevenly across the region and range in scale and efficiency. The findings from nine case studies indicate that most lending institutions had effective outreach and many savings members. Credit services grew over the decade but are still small enough to serve fewer than 10,000 borrowers. Outreach tends to serve very poor clients and clients living in remote areas. Only one institution was making a profit. About 30-40% of expenses are covered. Lack of capital restricts the amount and number of loans. Most institutions are expected to improve in financial sustainability, but the fact remains that outreach to remote locations is expensive. This research suggests that the World Bank should be active within itself, with microfinance institutions, with client-country governments, and with other donors.
Household and intrahousehold impact of the Grameen Bank and similar targeted credit programs in Bangladesh.
Washington, D.C., World Bank, 1996. vii, 109 p. (World Bank Discussion Papers 320)This paper is one of several World Bank papers examining the sustainability and household and intrahousehold impact of credit programs for the poor in Bangladesh. The aim of the paper is to develop a method for estimating the costs and benefits of group-based credit programs and to determine under what conditions group-based credit programs are sustainable. Household outcome measures include school enrollment of boys and girls, the labor supply of women and men, the asset holdings of women, recent fertility and contraceptive use, consumption, and the anthropometric status of children. Findings indicate that credit to women was more likely to influence 7 out of 8 outcome behaviors than credit to men (3 out of 8). Three credit programs are evaluated: Grameen Bank, the BRAC, and the BRDB's RD-12. The methods include a comparison of ordinary least squares and complex econometric methods using a quasi-experimental design. The comparison served to highlight the importance of accounting for endogeneity in evaluating credit programs in order to avoid mistaken conclusions drawn from "naive" estimates. Findings indicate that credit was a significant determinant of household behavior. Credit in the Grameen Bank program had the greatest positive impact on outcomes associated with household wealth and women's status. Grameen Bank's credit to women had the largest impact on girls' schooling, women's labor supply, and total household expenditure. Grameen Bank's credit to men had the largest impact on fertility. Women's credit from the BRBD had the largest impact on boys' schooling and the value of women's assets. Credit did not impact on the anthropometric status of children. The effect of credit programs on contraceptive use was measured differently in the two methods. Also, the "naive" method underestimated the effect on increasing total household expenditure. Policy should consider that the credit program empowered women, decreased poverty, and had beneficial effects from credit given to men.
FINANCE AND DEVELOPMENT. 1996 Dec; 8-11.Within 30 years the world will be supplying food for an additional 2.5 billion people, most of whom will live in developing countries. Developing countries in meeting future challenges will need to implement sound and stable macroeconomic and sector policies. The World Bank is providing analysis, policy dialogue, and financial support in specific countries for opening up agricultural markets globally. Developing countries need to enhance food supplies by encouraging rapid technological change, increasing the efficiency of irrigation, and improving natural resource management. Agricultural and income growth in developing countries is dependent upon transfer of the breakthroughs in agricultural technology to the millions of small farms in the developing world. People currently use about 70% of available fresh water for irrigation, and competition for water resources with urban and industrial users has increased. Agriculture and other sectors must increase the efficiency of water use. Natural resource planning and comprehensive water and natural resource management that rely on a community-based approach have proven successful. Developing countries need to improve access to food by strengthening markets and agribusinesses, providing education and health services to both boys and girls, investing in infrastructure, and fostering broad participation. The major challenge ahead is to ensure food security for the hundreds of millions of families living in poverty. This large and complex task involves increasing agricultural output worldwide, reducing poverty, and improving health and nutrition. Progress has been made in the past 25 years in improving living conditions, but not everyone has benefitted. Almost 75% of the poor live in rural areas without access to land, and 25% are urban poor without jobs. Most of the poor live in Asia and sub-Saharan Africa. The World Bank mandate is to reduce poverty and hunger through revitalized rural development.
CURRENT ISSUES IN PUBLIC HEALTH. 1996 Oct-Dec; 2(5-6):264-9.Over the next 25 years, as populations age and tobacco consumption increases, most developing regions will likely see noncommunicable diseases become the leading causes of disability and premature mortality. The already existing problems of malnutrition and infectious diseases will remain. In this context, the World Bank is examining its role and contribution to global health. From a small start approximately 25 years ago, the Bank has greatly expanded its role in international health, population, and nutrition to become the largest single external financier of health activities in low- and middle-income countries. Many other Bank-supported activities affect health, including poverty reduction, housing, water and sanitation, and the education of girls. The Bank is also increasingly active in health policy debates, publishing numerous studies annually. Most of these studies focus upon specific countries, but some address key issues of concern to many developing countries. This article explains why the Bank continues to expand its resources devoted to health and the rationale for the changing emphasis of its activities in the field.
Income generating activities for women under the World Bank assisted ICDS project in Andhra Pradesh -- an evaluation.
In: Women's development: problems and prospects, edited by Shamim Aleem. New Delhi, India, APH Publishing Corporation, 1996. 149-56.Launched on October 2, 1975, to enhance the health, nutrition, and learning opportunities for children under age 6 years and their mothers by simultaneously providing all requisite services at the village level, the Integrated Child Development Scheme (ICDS) is the world's largest child nutrition, health, and mothercare program. The ICDS provides a package of services in supplementary nutrition, immunization, health check-ups, referral services, the treatment of minor illnesses, nutrition and health education, water supply, and sanitation. One objective of the ICDS is to enhance the capability of mothers to meet the normal health and nutritional needs of their children through proper nutrition and health education. The ICDS is currently being implemented in more than 3000 of 5153 community development blocks in India. A 6-year subprogram was launched in 1990 with World Bank support to accelerate the pace of improvement in the nutrition and health status of children under age 6 years. 6148 Mahila Mandals have been involved in the World Bank ICDS Project in 52 blocks. Subprogram evaluation findings are presented.
The condition of young children in sub-Saharan Africa: the convergence of health, nutrition, and early education.
Washington, D.C., World Bank, 1996. xiii, 43 p. (World Bank Technical Paper No. 326; Africa Technical Department Series)Persistent poverty, rapid population growth, urbanization, a changing family structure, internal civil strife, and growing numbers of orphans and displaced women have had devastating consequences for children in sub-Saharan Africa. The Africa Region's Initiative on Early Childhood Development (ECD) seeks to interrupt the intergenerational cycle of poverty and promote child survival, school efficiency, economic productivity, and social equity by targeting the critical period between birth and school enrollment. Intensive exposure to a well-planned child care intervention project (especially one that serves both child and family and provides integrated health, nutrition, and education services) can have important implications for intellectual development and subsequent school and social adaptation. The Africa ECD Initiative, described in full in this report, entails a three-pronged strategy: 1) knowledge generation and dissemination, 2) prototype program development, and 3) institutional capacity building, with an emphasis on expanding the traditional role of the female child beyond that of care giver. Given the limited financial resources in sub-Saharan Africa, ECD programs must take advantage of existing health and education programs, mobilize additional community resources, or reallocate the current budget. A second study on policy, programmatic, and financial efforts of both governmental and nongovernmental organizations to address the needs of children at risk is underway.
EARTH TIMES. 1996 Oct 16-31; 9(18):14.Heads of state at the 1995 World Summit for Social Development agreed to Commitment 8, a resolution to make sure that structural adjustment programs include social development goals such as the eradication of poverty, the promotion of full and productive employment, and the enhancement of social integration. The cooperation of international financial institutions in adhering to the commitment can be requested by interested countries. As a result of this agreement, official World Bank/International Monetary Fund policy now views structural adjustment as a tool in service to social development. This development would suggest that fiscal stability is ultimately inseparable from social sustainability. However, the author notes that despite high-level awareness of the commitment, financial planners and investors largely conduct business as usual. It remains to be determined who or what will be the watchdog of social development when pressing and difficult fiscal decisions must be made. The author also notes the absence of women in high-level international financial policy making. Commitment 8 nonetheless represents positive progress in safeguarding the survival and quality of life of populations during periods of structural adjustment.
QA Brief. 1996 Summer; 5(1):19-21.In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.
In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 369-74.This book chapter discusses the UN response to HIV/AIDS. The chapter opens with a brief sketch of the UN response, starting with the launch of the Global AIDS Strategy under the leadership of the World Health Organization (WHO) and concluding with the new Joint UN Programme on HIV/AIDS (UNAIDS) which became operational on January 1, 1996, in response to growing awareness of the necessity to coordinate efforts among agencies and of the social and political complexity posed by the pandemic. The first of two tables presented in the chapter illustrates the policies, programs, structures, and resources as of 1994 for each of the six agencies whose work in this area is now brought under the aegis of UNAIDS (WHO; UN Development Program; World Bank; UN Children's Fund; UN Population Fund; UN Educational, Scientific, and Cultural Organization). Data are arrayed for each agency's mission, primary clients, comparative advantage, HIV/AIDS strategy, current program structure, current program focus, funding levels, and staffing levels. The second table summarizes the information presented in the first table in a cross-agency analysis. These data point to the coordination challenges and opportunities which will be faced by UNAIDS.
Boulder, Colorado, Lynne Rienner Publishers, 1996. v, 151 p. (Women and Change in the Developing World)This book presents a feminist analysis of gender, tradition, and modernity as conceptualized in modernization and Marxist dependency theories and applied by the World Bank and challenged in Southern Africa. The aim is to enlighten those who attempt to offer improvements on the two paradigms or to blend the two paradigms prematurely. Modernization theory makes "artificial" distinctions between traditional and modern societies. Modernization theory formulates a system for ensuring multinational control of trade and capital without restriction from nation states. Dependency theory offers a materialistic account of the expansion and change of capitalism and class consciousness. Women's roles in capitalist development and in revolutions are defined. This study suggests that feminist standpoint theory, such as that proposed by Harding and Hennessy, can be valuable. Social systems must be understood in terms of economic, political, and ideological systems and structures of power, such as capitalism, patriarchy, or colonialism. This author seeks to move beyond a masculine conception of modernity, development, and dependence. This study is based on interpretive analysis and implicit and contextual meanings of texts. Chapter 1 provides an overview of the book's direction and purpose. Chapter 2 discusses the two approaches of modernization theory, the psychocultural and the structural-functional. The work of Inkeles and Smith is discussed in comparison to other psychocultural approaches of Lerner and McClelland. The structural approaches of Rostow, Parsons, and a committee of the US Social Science Research Council are interpreted. Chapter 3 discusses soft-state approaches of African countries that are theorized by Hyden and others. World Bank practices are interpreted in Chapter 4. Chapter 5 focuses on Frank, Amin, and other texts on dependency theory. Challenges to dependency and counterrevolution in Southern Africa are the focus in Chapter 6. Prospects for rereading and rewriting development theory that centers on the household are proposed in Chapter 7.
Washington, D.C., World Bank, 1996. viii, 102 p. (Directions in Development)Early childhood interventions aimed at improving the health of infants and children and providing psychosocial stimulation are critical to the interruption of the intergenerational cycle of poverty. Experience and research have confirmed that investments in preschool programs for disadvantaged children reduce school dropout rates and increase adult earnings potential, thereby reducing social welfare costs. The goal of improving young children's capacities to develop and learn can be reached through numerous strategies, including direct service delivery, training parents and caregivers in child care skills, strengthening community resources, and developing national child-centered policies. Most effective are programs that combine basic nutrition and health care services with activities designed to stimulate mental, language, physical, and social skills. Presented in this pamphlet are brief descriptions of 19 such programs. Among them are programs aimed at training parents to care for very young children (Israel), using community educators to work with parents (Mexico), meeting the increasing need for child care (Kenya), giving children a head start (US), restoring services for children in a war-torn society (El Salvador), and using radio to teach caregivers and children (Bolivia).
Washington, D.C., World Bank, 1996. ix, 61 p. (Directions in Development)Implementation of the reproductive and child health approach outlined at the 1994 Cairo Conference will require a reorientation of India's family welfare program. For example, the current system of numerical, method-specific family planning targets needs to be replaced with a more comprehensive system of performance goals emphasizing quality and access issues. In addition, more emphasis must be placed on reversible contraception, male methods, and the provision of a range of contraceptive choices. Recommended components of a reproductive and child health package for India include family planning, safe abortion, safe motherhood, prevention and treatment of reproductive tract and sexually transmitted infections, health and sexuality information and counseling, and referral services for all of these interventions. To ensure that programs are responsive to client needs, community involvement, especially on the part of women's organizations, must be increased. Expanded training and adequate supplies would improve the situation of front-line health providers. The private sector can contribute by adding health and nutrition products to the social marketing program, prioritizing the social marketing of oral contraceptives, increasing coverage of reproductive health services, and disseminating the results of clinical research. The most effective strategy for the public sector would be to upgrade existing primary health care services. A shift to a reproductive and child health-centered approach would cost the Government of India approximately US$1.7 billion over a five-year period--an 8.9% increase in recurrent costs per year.
WORLD WATCH. 1996 Jul-Aug; 9(4):2.Many countries will probably find it increasingly difficult to provide adequate food supplies to their populations as they continue to grow in the years ahead. The author explains that no country can develop and implement an effective food policy without first understanding what levels of crop production the world can reasonably sustain under real-life constraints. Cropland is shrinking in the face of urban sprawl; irrigation water is being diverted in ever greater quantities for industrial and municipal needs; fertilizer use in much of the world has reached a saturation point, beyond which extra doses do not increase the harvest; and the overall protein-producing efficiency of the world's agricultural system is declining, as newly prosperous Asian populations shift increasingly from direct grain consumption to meat. Demand also continues to grow by almost 90 million people annually. However, these and other constraints, such as the effects of soil erosion and air pollution on crop yields, are given little weight in the global grain production projections by the World Bank and the UN Food and Agriculture Organization. The economists who do the forecasting rely mostly upon an extrapolation of past production trends, inferring that world farmers will be able to sustain the rapid growth in the world grain harvest realized during 1960-90. Simple extrapolation from past trends never works over the long term. World Bank and FAO econometricians need to understand that food production has actually fallen over the past five years and incorporate that realization into their projections for the future. Failure to do so could lead to serious underinvestment in the areas of family planning and agricultural research.
International Family Planning Perspectives. 1996 Jun; 22(2):87-8.The World Bank began a study in 1990 to assess the demographic and economic impact of AIDS in Uganda. It determined that as of 1993, an estimated 15% of Uganda's adult population, 1.3 million people, was infected with HIV. The annual number of AIDS-related deaths has been climbing steadily and is not likely to peak until early in the next century. AIDS deaths may exceed 100,000 per year in Uganda over the next 25 years. The epidemic has also increased child mortality rates and decreased life expectancy at birth. These findings are based upon data from a variety of sources, including a 1987-88 serological survey, the 1991 census, the national AIDS control program, and numerous small-scale studies of HIV infection. The researchers based fertility and mortality estimates upon data from the 1988-89 Demographic and Health Survey. Current HIV and AIDS prevalence, projected prevalence, demographic implications, and recommendations are presented.
PHNFLASH. 1996 Feb 2; (103):1-2.An estimated 1.2-2.0 million people had been infected by 1995 in Latin America and the Caribbean, and more than 300,000 new HIV infections occur annually. The lack of seroprevalence studies, however, makes reliable estimates difficult. To date, there are 126,000 cumulative AIDS cases and 59,162 deaths recorded in Latin America, and 8065 AIDS cases and 4778 deaths recorded in the Caribbean. New infections are particularly evident among the most socially and economically marginalized populations in the region, as well as among people aged 15-25 years. Relative to other population age groups, these latter individuals are more likely to be highly mobile and involved in tourism and commercial sex, factors which may increase one's vulnerability to infection. The World Bank has sponsored a regional initiative on HIV/AIDS in Latin America and the Caribbean for the period 1996-98 designed to mobilize and unify national and international efforts against HIV and STDs by raising the awareness of regional government administrators, helping to develop a new generation of STD/AIDS control programs to follow the first generation of programs implemented in Brazil and Honduras, and helping the development of regional approaches to STD/AIDS control. The project will cost an estimated US$6.6 million, of which the World Bank will provide approximately US$1.0 million. The initiative will enable countries in the region to share the results of studies in different countries, to build upon the best practices of each others' programs, and to develop strategies for controlling AIDS and STDs across borders. The Bank has also financed projects or project components in Brazil, Haiti, and Honduras. These initiatives are briefly discussed.