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Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
[Unpublished] 1984. v, 37,  p.This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
Geneva, Switzerland, WHO, . 16 p.This report discusses the important place of women in health and development as perceived by WHO and as formulated in various World Health Assembly resolutions, particularly those concerned with the UN Decade for Women. Underlying all objectives is that of increasing knowledge and understanding about how the various socioeconomic factors that make up women's status affect and are affected by their health. The aim of WHO's Women, Health and Development (WHD) activities, is the integration or incorporation of a women's dimension within on-oing programs, specifically as part of "Health for All" strategies. Chief among WHD objectives and groups of activities are the improvement of women's health status, increasing resources for women's health, facilitating their health care roles and promoting equality in health development. Overall WHD activities stress the importance of data on women's health status, the dissemination of this and related information, and the promotion of social support for women. The WHD component of ongoing WHO programs focuses mainly on managerial and technical support to national programs of maternal-child health/family planning care. The present report also includes an update on the incorporation of women's issues within WHO's on-going programs in human reproductive research, nutrition, community water supply and sanitation, workers' health, mental health, immunization, diarrheal diseases, research and training in tropical diseases and cancer. Women's participation in health services is discussed mainly within the context of primary health care and is based on their role as health care providers. The results of a multi-national study initiated in 1980 on the topic of women as health care providers should be ready in early 1984 and are expected to contribute a basis for further action.
Asian and Pacific Population Programme News. 1981; 10(1-2):25-8.Association of Southeast Asian Nations (ASEAN) experts and heads of national population programs held their 4th meeting in Singapore from November 24-28, 1980. Program heads resolved to take steps to link their national activities in the population field with those of the ASEAN Population Program and carry out studies and a joint programming exercise in 1981. Progress reports on the following Phase 1 projects were given: 1) integration of population and rural development policies and programs in ASEAN countries including Indonesia, Malaysia, Philippines, Singapore, and Thailand; 2) development of an inter-country modular training program for personnel in population and rural development; 3) multi-media support for population programs in the context of rural development in ASEAN countries; 4) utilization of research findings in population and family planning for policy formulation and program management in ASEAN countries; and 5) migration in relation to rural development. Phase 2 projects approved by ASEAN country participants were also discussed: 1) institutional development and exchange of personnel, 2) women in development, 3) developing and strengthening national population information systems and networks in ASEAN countries, 4) population and development dynamics and the man/resource balance, 5) studies on health and family planning in ASEAN countries, 6) population migration movement and development, and 7) development of ASEAN social indicators.
Journal of Population and Health Studies. 1981 Dec; 1(1):135-78.This paper concentrates on the management development aspects of the Korean family planning program which began in 1962. Population growth rate in Korea went from 2.9% in 1962 to 2% in 1971, and total fertility rate declined 57% from 1960 to 1979. Program cost during 1962-80 totaled $147.7 million, of which 81.2% came from the national government. It has been calculated that between 1962-80 about 3.5 million births were averted. In December 1980 the program employed a total of 3811 full time employees in 4 different organizations; currently the coverage is about 1 family planning worker for every 4200 urban couples, and for every 1200 rural couples. Major methods of birth control used the IUD, the condom, the pill, female sterilization, male sterilization, and menstrual regulation. A total of 1.107 million acceptors received services between 1962-80. Responsibility for the national program rests with the Ministry of Health and with the Economic Planning Board. If it is reasonable to say that the program has been successful, there are still problems to be solved which include: 1) an inadequate approach to contraceptive services in rural areas, 2) a high discontinuation rate of contraceptive usage, 3) high turnover of fieldworkers, 4) poor coordination with other health programs, 5) poor quality of research, and 6) weak management training. Improvements in program management functions include program planning, better distribution of economic resources, better training and use of personnel, and better use of private clinics and mobile vans. Also necessary are interministerial and interagency coordination, improvements in the record reporting system, and better program evaluation. The current management system is making efforts to integrate family planning services with maternal and child health and expand the role of international agencies in training courses and research investment.
[Women and development: ideas and strategies of international organizations] Femmes et developpement: idees et strategies des organisations internationales.
Revue Tiers Monde. 1980 Oct-Dec; 21(84):845-62.The International Year of the Woman, which marked the beginning in 1975 of the Decade of the Woman organized by UNESCO, had as its goal the sensibilization of the public to the problems of women, the diffusion of results of studies conducted on women in several countries, and the elaboration of new strategies to improve women's status worldwide. Factors which played a role in advertising worldwide discrimination against women were external to UNESCO, such as the birth of radical feminist movements in the 1960s and the diffusion of new feminist ideas by the mass media, and internal to UNESCO, such as the great number of studies sponsored and financed by UNESCO on the condition of women, and especially of third world women. The revision of strategies within UNESCO is visible in the changing themes of the studies sponsored from 1965 to 1980. Studies done between 1960-70 dealt essentially with the importance of primary, secondary, and university education for women. Studies done between 1970-75 investigated the relation between formal education and actual probability of women's employment. Studies sponsored between 1975-80 investigated the right of women to equal participation in the national economy and development. Unfortunately, the global budget dedicated to women's studies is only of 13.5 million French francs. Ongoing studies examine whether feminist ideas are applicable to third world countries, or if they are to be reviewed according to different societies and cultural environments.
In: [Ford Foundation]. Conference on Social Science Research on Population and Development, Ford Foundation, 1974. [New York, Ford Foundation], 1975. 283-310.This paper presents a statement of research issues and questions to which USAID intends to give major program support over the next 2 or 3 years. 2 central questions needing further research are socioeconomic correlates and determinants of fertility, and the demographic impact of family planning programs. Historically USAID has been more interested in applied than in basic research and in research where fertility is the central demographic variable. Short-term rather than long-term benefits were the results. Social science research is not oriented toward the less developed countries, especially those experiencing the most rapid rates of population growth. "A Strategy for A.I.D. Support of Social Research on Determinants of Fertility," is an attachment to the paper and outlines abstract issues and the partiuclar circumstances of each country where they may be applied in terms of a research strategy. A hierarchy of questions is presented. The first question asks how, holding all other variables constant, much of the observed variation in fertility can be dirctly attributed to family planning programs and how much can be attributed to variables other than family planning. Many writings suggest that 1 of the most powerful determinants of societal fertility is income. Other writings claim that changes in individual perceptions of the future accompanying modernization are more important factors in family planning decisions.
In: [Ford Foundation]. Conference on Social Science Research on Population and Development, Ford Foundation, 1974. [New York, Ford Foundation], 1975. 267-72.The UNFPA provides priority support to the types of research required for or related to action programs and its interests include the relatively long-term concern with training, institution-building, and basic data. Nearly 30% of UNFPA total resources are utilized for the promotion of basic population data, assistance is given to carrying out population censuses and sample surveys, and establishing vital statistics and registration. The largest of such programs is in Africa. In the area of demographic research, the UNFPA provides support for projects on the interregional level carried out by UN organizations. Assistance to sociological research for the improvement of development goals is rather new; awareness of the need for such research has emerged in response to the need for understanding motivation, attitudes, and the climate for social change. The need for channelling the findings of demographic and sociological research to those who can make use of them; UNFPA is attempting to disseminate data in order that policymakers and others may use them. Several examples of the diversity of research activities supported by the UNFPA are presented. Also included are the programs and institutions which may be candidates for joint or multiple agency funding. They are: CELADE-ELAS program, PISPAL, the Value of Children study, CODESRIA, the World Fertility Survey, CICRED, ICARP, and the 1980 Round of Censuses.
Demography India. Dec 1974; 3(2):185-194.Add to my documents.
Journal of Applied Behavioral Science. 1983; 19(3):307-17.Applied behavioral science is both relevant and responsible to Third World development, but so far, these qualities have neither been recognized nor acted upon. This relevancy and responsibility lie in 3 basic areas that could significantly contribute to development programs and that have numerous implications for the ABS field: the training of trainers, organization design and development, and development strategies. In programs that generally last 4 weeks, officers were trained in a wide variety of practice theories and skills. Basic communication skills--active listening, paraphrasing, giving and receiving feedback have formed the foundation of these programs. An effective linkage between development programs and the community requires that the development worker not only transfer cognitive material but also work with farmers in developing skills and in exploring attitudes and values. The area of organizational design relates specifically to the professional and experience of ABS practitioners. Third World countries need to design development organizations that do not depend upon such external influences as donor agencies; to design organizations connected to the constituent culture, history, and traditions; and to design organizations that focus on problems. As a field, ABS exercises little influence on development in the Third World. In order to further its influence, development strategies should include exchanges between ABS professionals. Third World practitioners, for example, need support in building in-country capabilities. With an ABS exchange network, they may look to their colleagues in the industrialized countries for such support, and in turn, they may offer ABS practitioners in industrialized countries opportunities for involvement in development in Third World countries.
[Unpublished] 1983. Presented at the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C. 3 p.Training of health services personnel at all levels and education of both mothers and community members should be an essential and integral part of the Diarrheal Diseases Control Program. Experience demonstrates that mere distribution of oral rehydration solution (ORS) in the community fails to bring about its proper utilization. The National Institute of Cholera and Enteric Diseases (NICED) in Calcutta monitors training of health personnel at all levels in connection with the National CDD Program of India. Since 1980, 37 2-day national seminars on OR therapy (ORT) were organized by NICED with assistance of the World Health Organization (WHO). Thus far 1754 medical personnel were trained, including 1196 clinicians, 174 public health doctors, 259 health administrators, and 125 of various other categories. The training program was evaluated by WHO in 1982. Wherever training was conducted, there was a significant increase in the proportion of diarrhea cases treated with ORS. Also observed was a downward mortality trend. It is proposed to organize about 400 district level training courses to train the primary health center (PHC) doctors during 1983-84. As a WHO-collaborating Center for Research and Training in Diarrheal Diseases, NICED has conducted 6 intercountry/interregional courses on the different aspects relating to the CDD Program. 92 scientists from 11 countries have been trained. A key question is who to train first if the resources are scarce. Since the community health worker will have to play the pivotal role in home delivery of ORT, they have to be trained by the doctors in charge of PHCs. Thus, the doctors at the different levels of the health care delivery system will have to be trained first. If the decision is made to implement salt/sugar mixture at the house level rather than packets of ORS, the training of the community health workers will have to be geared and designed in such a way that they will be in a position to educate the mothers to prepare the homemade mixture properly. Training should be an integral part of a broad PHC training program. Doctors will be the best trainers because of the clinical nature of the training involved. To improve the training components of the ORT program, the following steps need to be taken: motivation of the national CDD program managers to undertake the training program, preparation of curriculum and teaching aids for the trainers at different levels, establishment of clinical demonstration centers, and provision of adequate funds for training.
Evaluation of the regional advisory services in population education and communication in Sub-Saharan Africa of FAO, the ILO and UNESCO, 1978-1982.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1983 Jun. iv, 64 p.This evaluation was conducted to assess alternative modes of providing regional population education and communication (PEC) advisory services in the African Region in the future, in addition to assessing past performance of existing projects. In the absence of specific and measurable project objectives, as well as uniform, reliable and comparative data for the different projects included in this evaluation, it was not possible to determine exactly the quantity and quality of the achievements of the regional advisory projects over the period under review. Nevertheless, it is concluded that the achivements had been relatively limited, partially because of inherent difficulties associated with the provision of advisory services in the region (e.g., distances, inter-and intra-country communication problems) but more so because of weaknesses in the formulation and implementation of the regional advisory projects. These weaknesses include: 1) differing views on the part of the Executing Agencies and the United Nations Fund for Population Activities (UNFPA) about the functions of the regional advisors which underlie the rather vaguely defined functions presented in the project documents; 2) insufficient planning of the regional advisory teams' activities; and 3) recruitment difficulties which led to vacancies and high turnover as well as to the hiring of partially qualified advisors. Furthermore, the present arrangement for the delivery of regional PEC advisory services, e.g., separate agency teams and advisors located in different countries, impedes the effective delivery of services because the advisors under this arrangement cannot function as 1 team. It is recommended that the functions of the regional PEC advisors in Africa be concentrated on assistance to country project formulation, advice on country project management and systemenatic particiaption in country project monitoring and evaluation. Recommended regional PEC advisory services are 1 team for PEC in the non-formal sector and another team for population education in the formal sector. Other recommendations deal with the role of Headquarters vis a vis regional follow-up and monitoring/supervision of regional advisors, other in-country activites and need for resident country advisors.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1982 Dec. xi, 44,  p. (Project SWA/75/P01)The long range objective of this project (1976-1981) was to improve and enhance the health and welfare of mothers and children, especially in rural areas. In assessing Project achievements and the degree to which progress toward the long term objective has been accomplished, the Evaluation Mission found that the immediate objectives had, to a large degree, been met within the general framework of the Ministry of Health's (MOH) development program. Service delivery points in governmental, mission private and industrial/plantation health facilities are now widely distributed throughout Swaziland. The integration of preventive and curative is clearly in place in the rural health clinics and health centers. Analysis of service statistics data indicates that a large % of pregnant women attend antenatal clinics. Family planning services are now offered in 86 clinics with 27,094 clinic attendances recorded for 1981. The pill is the most popular method, followed by condoms, injectables and IUDs. An adequate though incipient health education program is functioning. The MOH strengthened the health infrastructure for, and has in place a program of, maternal child health (MCH) and family planning (FP). The strong points of the program are the government's commitment to MCH/FP, the general strategy, the training component, the number and quality of staff involved in service delivery, the number of service delivery points and the system of recruitment and the employment of Rural Health Motivators (RHM). Weak points, which appear to have hindered a more effective program performance, are planning and management, the lack of solid socio-anthropological knowledge to base, the lack of a focal point for FP, supervision at all levels and the lack of monitoring and evaluation which, if properly undertaken, could have led to changes and adjustments in the program. Future activities supported by the United Nations Fund for Population in the organization and management of family planning activities within the MCH program and within other government and voluntary organizations. UNFPA should help the government prepare a new proposal for UNFPA assistance to family planning activities in the country and should consider supporting supervision and training activities.