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  1. 76
    Peer Reviewed

    Manpower issues in Saudi health development.

    Searle CM; Gallagher EB

    New England Journal of Medicine. 1983 Fall; 61(4):659-86.

    In this examination of Saudi Arabia's health care accomplishments, it is argued that the World Health Organization's primary health care model is not the most appropriate for Saudi Arabia and countries like it. Saudi Arabia's health care policy is closely linked to its very rapid emergence as a new and distinctive society. Whereas most developing countries export physicians, Saudi Arabia imports them because the demand for physicians services cannot be met by the supply of indigenous physicians. Saudi health care development is very different from that of most of the third world. Although the country does have a great deal of western technology, Saudi Arabia seems to be following a different course of development from both the third world and the West. Unlike the West, the cost of medial technolgoy is not a problem for Saudi Arabia. Rather, it solves the problem of how to allocate its oil wealth to maintain political stability. The Saudis intend to make the best health care available to all its citizens; they are very concerned about the effect of modern technology on tradition. Therefore, the selection of technology is based on its cultural compatability, rather than on its costs. Primary care may be more technological and specialized than in the West. In Saudi Arabia primary health care may eventually be delivered entirely by specialists, rather than by general or family practitioners. The Saudis are expected to develop a health care system that will meet their particular needs. As with Saudi Arabia itself, health care is experiencing unprecedented change. Thus, the emerging Saudi system will be unique and innovative. Some of its accomplishments will be adopted by other developing countries; Western countries may look to Saudi Arabia as a natural laboratory of health care experimentation.
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  2. 77
    Peer Reviewed

    A case study in the administration of the Expanded Programme of Immunization in Nigeria.

    Jinadu MK

    Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.

    The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
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  3. 78

    Report of the evaluation of UNFPA assistance to Colombia's Maternal, Child Health and Population Dynamic's Programme, 1974-1978.

    Reynolds J; Belmar R; Rodriquez-Trias H; Segovia J; Frieiro L

    New York, United Nations Fund for Population Activities, July 1981. 181 p.

    This report for UNFPA (United Nations Fund for Population Activities) on Colombia's Maternal and Child Health and Population Dynamics (MCH/PD) program was prepared by an independent team of consultants which spent 3 weeks in Colombia in February 1980 reviewing documents, interviewing key personnel and observing program services. The report consists of 8 chapters. The 1st describes the terms of references of the evaluation mission. The 2nd chapter provides background information on Colombia and identifies some of the principal environmental factors that affect the program. Chapter 3 describes the organizational context within which the program operates. The chapter also includes a discussion of the UNFPA funding and monitoring mechanism and how that affects program planning and operations. Chapter 4 is a description of the program planning process; goals, strategies and objectives, and of the UNFPA and government inputs to the program between 1974-1978, the period under review. A large part of the report is devoted to describing and assessing each program activity. Chapter 5 consists of descriptions of management information; maternal care; infant, child and adolescent care; family planning; supervision; training; community education; and research and evalutation studies. Chapter 6 is an analysis of the program's impact on: maternal morbidity and mortality; infant morbidity and mortality; and fertility. Chapter 7 summarizes the Mission's conclusions and lists its recommendations. The final chapter deals with the Mission's position in relation to the 1980-1983 proposal. Appendices provide statistical data on medical activities, contraceptive distribution and use, content of training courses, target population, total expenditures, and norms for care, as well as organizational charts, individuals interviewed, and UNFPA assistance to other agencies in Colombia. (author's modified)
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  4. 79

    A communications research and evaluation design for the Korean Family Planning Program.

    Copp BE

    M. A. thesis, Univ. of Chicago, Division of the Social Sciences, Dec. 1973. 90 p.

    In the summer of 1971 the Planned Parenthood Federation of Korea (PPFK), with the concurrence of the Korean government, launched a new phase in the Korean family planning program--"Stop at Two" movement. With this step the 10 year old family program became the 1st in the world to openly advocate and propogate through communications the 2-child family norm. Since then the movement has been vigorously pressed through all communications channels in spite of traditional norms and the need for major outside funding. The decision to actively bring the "Stop at Two" idea to the public was based largely on the implications for the future of the success of the 1st 10 years of the national family planning program. The Korean government has set an optimistic population growth rate target for the next 5 years--1.5 to be achieved by 1976. To reach these goals it is estimated that 45% of the eligible population will have to be regularly using some form of contraception. At 1 time or another the PPFK, supporting the national program, has used every conceivable method of communication to inform, motivate, and persuade the Korean population to adopt family planning. An attempt has been made to carefully analyze problem areas in the family planning program for which communication research is needed or would be relevant. An effort is made to show how the information obtained could be used to deal effectively through communication with the conditions presented by the problem. Communication research and evaluation techniques which would be most valuable to Korea are described. A research and evaluation design which spells out the components of a program of research intended to support the already published communication strategy of the Korean family planning over the next 3 years is included.
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  5. 80

    The WHO information system and the interaction between national health information systems.

    Haro AS

    In: McLachlan G, ed. Information systems for health services. Copenhagen, World Health Organization, Regional Office for Europe, 1980. 17-25. (Public Health in Europe; 13)

    The World Health Organization's role is that of a cooperative partner in the national health programs of member states, seeking the most effective use of health resources on the intercountry, regional, or global levels. It is in this context that the interaction and interface among national health information systems, and between national systems and the WHO information system is discussed. The WHO information system makes up-to-date information readily available, thus enabling member states to study their positions in relation to those of other countries now and in the recent past, and to determine how they might be able to improve their positions. Technical information and routine statistics are provided. The programs that provide and disseminate the information are discussed. Nonstatistical publications are listed and discussed. The need for better interfacing and interaction between WHO and member states is emphasized.
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  6. 81

    [Perinatal assistance of a basic level in Latin America in 1978: description of projects under execution in 1978] Asistencia perinatal a nivel primario en areas rurales de America Latina en 1978: descripcion de proyectos en ejecucion en 1978.

    Benedetti WL; Caldeyro-Barcia R

    Montevideo, Uruguay, Centro Latinoamericano e de Perinatalogia y Desarrollo Humano, 1979 Feb. 128 p. (Publicacion Cientifica del C.L.A.P. No. 790.)

    This report investigates the status of maternal-infant services in the rural areas of 18 Latin American countries, and presents statistics on fetal, infant, and maternal mortality in the same countries. Methods and types of personnel used for the attention of pregnancy and delivery are described, together with recommendations for improvements from such international organizations as WHO and PAHO. The important role of practical midwives in all Latin American countries is stressed, as is the need for their training, especially for what concerns the identification of high risk pregnancies. The report includes a brief description of programs already implemented in 14 countries, and compares them to similar ones existing in the U.S., Holland, Nigeria, Tanzania, Thailand, China, and Ethiopia. The report concludes with recommendations from the Latin American Center for Perinatology and Human Development on simplifying perinatal care in Latin American countries.
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  7. 82

    Thailand national family planning program evaluation.

    Minkler D; Muangman D

    [Washington, D.C., American Public Health Association, 1979.] 110 p. (Contract AID/pha/C-1100)

    This reports the Third Evaluation of the Thailand National Family Program and was prepared by the entire joint Thai-American evaluation team. The summary of findings states that the NFPP has successfully achieved its target to date. The population growth rate will reach the goal of 2.1% per annum set by the Fourth Economic and Social Development Plan. It was further recommended that if the record of achievement is to be maintained through the Fifth 5-year plan (1982-6), increasing levels of support are needed both from the government and international donors. Further recommendations state that the National Family Planning Program (NFPP) should continue to focus its efforts on all regions of the country, including Bangkok. The NFPP should prioritize those georgraphic areas and segments of the population where family planning acceptance is low and/or availability of information and services are not fully developed. Targets should be set in terms of a combination of new and continuing acceptors in the next 5-year plan. Greater emphasis should be given to management and supervision at the village and health center levels. The international donor community should give full recognition to the necessity of maintaining a level of direct support for the NFPP to assist the Royal Thai Government (RTG) in achieving the goals of the Fifth National Economic and Social development Plan (1982-6). The RTG and donor agencies should continue to support public and private sector activities in voluntary sterilization.
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  8. 83

    Management and population: a systems view and review of family planning programme in India.

    Ram NV

    Delhi, D.K. Publishing House, [1974]. 130 p.

    The population program of India was examined from a descriptive analytical perspective. The organizational layout was examined and methods of operation were scrutinized from the standpoint of program policy. The 8 chapters of the monograph deal with the following: management and population; role of public administration; family planning system; an appendage of health; the law of sinecure and success; international assistance; population mangement; resume and results. The systems concept is a useful approach to the job of management, for it provides a framework for visualizing internal and external environmental factors as an integrated whole. The systems concept also permits recognition of the proper place and function of subsystems. Public administration in India suffers from several problems: 1) too many levels and positions to effect any rapid program decision and implementation; 2) too many boards and committees with vague or obscure duties and lack of responsibility on the part of any single individual or group; control orientation; and 4) generalist administration.
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  9. 84

    World Conference of the United Nations Decade for Women: equality, development and peace, Copenhagen, Denmark, July 14-30, 1980.

    United Nations Decade for Women. Secretariat

    New York, UN, 1980. 32 p. (A/CONF. 94/9)

    This report reviews and evaluates efforts at the national level to implement the world Plan of Action for the Implementation of the Implementation of the Objectives of the International Women's Year and is based on replies of 86 governments to questionnaires prepared by the Advancement of Women Branch in the Centre for Social Development and Humanitarian Affairs. It contains an analysis of the progress made and obstacles overcome in the field of health. Using as indicators increases in female life expectancy and declines in maternal and infant mortality rates, improvements have occurred in the health status of women. However, wide disparities are seen between high and low socioeconomic groups, between rural and urban women, and between minority groups and the rest of the population. Lack of financial resources is a major obstacle, compounded by inflation. The excessive physical activity of working rural women not only precludes their participation in health programs but also adversely affects their health. Additional problems are inadequate training and supervision of health administrative personnel, a lack of defined policies, and a lack of coordination between agencies. Social, religious, and cultural attitudes that no longer have validity, lack of political commitment, and an inadequate perception of the long-term health benefits of family planning, rather than its demographic aspects, restrict access to family planning for many groups of women.
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  10. 85

    Study findings on evaluation of integrated family planning programme performance.


    In 1976 the United Nations's Economic and Social Commission for Asia and the Pacific launched a comparative study on integrated family planning programs in a number of countries in the region. In November 1979 the study directors from the participating countries meet in Bangkok to discuss the current status of the studies in their countries. The Korean and Malaysian studies were completed, the Bangladesh study was in the data collecting phase, and the Pakistani research design phase was completed. The meeting participants focused their attention on the findings and policy implications of the 2 completed studies and also discussed a number of theorectical and methodological issues which grew out of their research experience. The Malaysian study indicated that group structure, financial resources, and the frequency and quality of worker-client contact were the most significant variables determining program effectiveness. In the Korean Study, leadership, financial resources, and the frequency and quality of contact between agencies were the key variables in determining program effectiveness. In the Malaysian study there was a positive correlation between maternal and child health service performance measures and family planning service performance measures. This finding supported the contention that these 2 types of service provision are not in conflict with each other but instead serve to reinforce each other. Policy implications of the Korean study were 1) family planning should be an integral part of all community activities; 2) family planning workers should be adequately supported by financial and supply allocations; and 3) adequate record keeping and information exchange procedures should be incorporated in the programs.
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  11. 86

    The ILO: legislation and working women.

    Korchounova E

    In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 39-44.

    The International Labor Organization's (ILO) conventions and recommendations that apply exclusively to women are of 2 main types: promotional and protective. The protective standards are concerned with providing them with the special protection they need because of their sociological and social function of maternity. Maternity protection is most important for both working mothers and society as a whole. This is becoming a more significant problem because of the increase in the number and proportion of women. The protection of working women in connection with their role as mothers was dealt with in 2 ILO conventions, the Maternity Protection Conventnion and the Maternity Protection Convention (Revised), and 2 recommendations. The 1919 instrument was ratified by 28 States and the 1952 instrument by 17 States (on January 1, 1977). The ILO policy on maternity protection is that maternity must be recognized as a social function and the protection of this function must be recognized as a basic human right. In relation with maternity, women and men require full and free access to information and facilities concerning family planning and the right to decide on family size and the spacing of births. The 1919 Convention provides that the working woman be allowed time to nurse her child. In a large majority of countries, rules provide for rest periods to allow a mother to feed her child during working hours. A number of legislations stipulate explicitly that the pauses for feeding must be allowed in addition to the normal rest periods. The 1952 Recommendation refers to the establishment of facilities for nursing or day care.
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  12. 87

    Charter for Health Development: a milestone for WHO's South-East Asia Region.

    WHO CHRONICLE. 1980 May; 34(5):171-4.

    This document contains the full text of the Charter for Health Development formulated by the WHO South-East Asia Region. The Chapter was endorsed at the 31st session of the Regional Committee for South-East Asia held in 1978. To date, Bangladesh, India, Sri Lanka, and Thailand have officially signed the Charter and Maldives is expected to sign in September, 1980. The Chapter affirms the importance of health, resolves to promote health development, and places a priority on 1) the delivery of primary health care to all those currently underserved inhabitants of the region; 2) the prevention and control of disease and pollution; 3) the provision of safe water supplies; 4) the prevention of nutritional deficiencies; 5) the reduction of infant, child, and maternal morbidity and mortality; 6) the development of health manpower in accordance with the needs of the people; and 7) the promotion of regional and international collaboration in health matters. In order to meet these objectives it is necessary to 1) strengthen health planning and health information systems; 2) adopt a multii-disciplinary and multi-sector approach; 3) emphasize preventive and promotive health care; 4) promote community self-help efforts; 5) develop an effective disease surveillance system; 6) formulate strategies for developing water supplies; 7) strengthen maternal and child health programs; 8) develop nutritional programs appropriate to the community; 9) reorient medical training so that the graduates of medical schools are able to fulfill the needs of rural residents; and 10) conduct practical research on health care delivery systems. The Charter also recognizes the relation between health and economic development. The Charter calls on the countries in the region to pledge to become as self-reliant as possible in providing health services and to agree to devote the maximum possible amount of their resources to health development.
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  13. 88

    Comprehensive Activities Report: 1972-June 20, 1978.

    International Confederation of Midwives; United States. Agency for International Development [USAID]

    London, England, International Confederation of Midwives, 1978. 425 p.

    This document provided a summary of the activities from 1973-June 1978 of the International Congress of Midwives and of the International Federation of Gynecology and Obstetrics and International Congress of Midwives Joint Study Group. These activities were undertaken with a USAID grant. During these years, 12 Working Parties were held in various African, Asian, and Latin American countries. The purpose of the Working Parties was 1) to exchange information of the training and utilization of midwives and traditional birth attendants and 2) to develop recommendations for expanding the role of midwives and traditional birth attendants in the delivery of maternal and child care and family planning services through legislative changes, through the development of training programs, and through broadening contacts with other health organizations. The International Congress of MIdwives determined the host country for each of the Working Parties. The governments of all participating countries were invited to send 2 delegates to the Work Party and to present a country report at the meeting. This document provided a summary of the proceedings, the country reports from the particpating countries, and the conclusions and recommendations made by the participants for each of the 12 Working Parties. Follow up visits were made to participating countries by staff members of the International Congress of Midwives in order to ascertain if the recommendations were being implemented and to offer assistance, if necessary. The results of these follow up visits were also provided.
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  14. 89


    Menes RJ

    Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)

    This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
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  15. 90

    The politics of population.

    Miller NN

    American Universities Field Staff Reports. East Africa Series. 1971; 10(2):1-15.

    Kenya was one of the 1st sub-Saharan countries to develop a national family planning program and has made considerable progress in promoting contraception; however, the program is beset with many staffing, administrative, and political problems. In 1965 the government requested the Population Council to conduct a demographic survey in Kenya and to develop recommendations for establishing a family planning program. The Ministry of Health subsequently instituted most of these recommendations and established 220 family planning clinics in various facilities across the nation. The program receives funding and other forms of assistance from a large number of outside organizations and relies on a large number of foreign advisors for planning, operating, andevaluating the program. One of the major problems confronting the program is the lack of strong and consistent program support from high level government officials. Many officials fear that they will lose political support if they issue strong family planning directives. This lack of commitment weakens the program at all levels and reduces the effectiveness of the educational component of the program. Other problems include 1) inadequate coordination and communication between the various organizations which contribute to the program; 2) internal conflicts between medical and administrative personnel; 3) high reliance on foreign advisors who tend to be insensitive tolocal issues and concerns; and 4) an insufficient number of staff personnel. Despite these problems the outlook for family planning in Kenya is good. Future funding is assured, staff increases are contemplated, and plans call for less reliance on foreign personnel.
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  16. 91

    A working paper on status, present and future utilisation of the TBA in 15 countries in the Middle East and Asia and a Regional Summary of the Far East and Africa.

    Kamal I

    [Unpublished] 1979. 27 p.

    Data on status and present and future utilization of the traditional birth attendants in countries of East and South Asia and Africa were collected through a questionnaire sent to countries of the Middle East and North Africa Region of the International Planned Parenthood Federation. There are 2 categories of traditional birth attendants (TBAs) in the Middle East and Asia: these are the "untrained midwife" who practices midwifery for a living and the birth attendant who is usually an elderly relative or neighbor and who does not earn her living from midwifery. The urban TBA fits into the 1st category; the rural TBAs are a mixture of both categories. The information provided by the questionnaire indicated that TBAs exist in all but 1 country of the region. The TBAs are employed mostly by the pregnant woman directly, and both rural and urban women use them. In most of the countries training facilities are available. The majority of the countries train only those TBAs who are already practicing midwives. Training duration ranges from 1 week to 1 year. Illiteracy appears to be the primary problem related to training. In regard to training, there needs to be careful selection, proper training, and good supervision and follow-up. Existing curricula are in need of revision.
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  17. 92


    Loomis SA

    Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)

    This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
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  18. 93

    Compendium of U.S. health professionals significantly involved in international health policy development.

    American Association for World Health

    Rockville, Maryland, U. S. Dept. of Health, Education, and Welfare, Office of International Health, 1978. 121 p.

    A compendium of United States health professionals, who are involved in the development of international health policy, was compiled by the American Association for World Health and HEW. Questionnaires were sent to government agencies, educational institutions, foundations, professional associations, voluntary health agencies, missions, and private consulting groups who dealt in international health. The questionnaires were screened for health professionals significantly involved in international health and the extent of their involvement. The compendium of professionals serves as a valuable asset to agencies and institutions concerned with international health.
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  19. 94

    Lactation, fertility and the working woman.

    Jelliffe BD; Jelliffe EF; Sai FT; Senanayake P

    London, International Planned Parenthood Federation, 1979. 163 p.

    Focus in the proceedings of the joint International Planned Parenthood Federation and the International Union of Nutritional Sciences Conference on lactation, fertility, and the working woman is on the following: 1) perspectives of the International Planned Parenthood Federation (IPPF) and the International Union of Nutritional Sciences (IUNS); 2) lactation and infertility interaction; 3) United Nations appraoches; 4) the social context (breastfeeding and the working woman, breast feeding in decline, and women's liberation and breastfeeding); and 5) case studies for the countries of France, Egypt, Ghana, Scandinavia, Chile, Indonesia, Lebanon, Yugoslavia, Singapore, and Sri Lanka. Breastfeeding supplies nutrition specifically adapted to the human infant's needs, mother/child interaction important to emotional development, and biological birth spacing resulting from maternal hormonal changes brought about by sucking. Over the last 50 years, there has been a marked decline in breastfeeding, originally in industrialized countries. Since the end of World War 2, there has been a decline in breastfeeding in developing nations. Recent scientific research has shown increasing evidence of the unique value of human milk and breastfeeding for infants in industrilized countries and developing areas. As women have become more emancipated, conflicts have arisen between their biological family reproductive role and their role as salaried workers outside the home.
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  20. 95

    Assignment report: health services development research project, West Azerbaijan, Iran, July-August 1975.

    Good B; Good MJ

    Alexandria, Egypt, World Health Organization, Regional Office for the Eastern Mediterranean, 1975 Dec. 32 p. (EM/IRA/SHS/003/DP)

    This report was undertaken to evaluate the Health Services Development Research (HSDR) project in West Azerbaijan, Iran. The report, based on observations made in July/August 1975, includes a discussion of the contractual nature of community involvement in any health care project and the use of the contract as a conceptual framework for the evaluation of the relationship between the program and villagers. Prior to land reform measures of 1963, the village headman (katkhoda) was the intermediary between the village and the landowner. After land reform each village was encouraged to elect a Village Council (Anjuman-e Deh), consisting of 5 members. From the contract model an outline of principles is derived which should guide the program in relating to the community. Specific community problems include environmental sanitation, community consensus, the relationship of the frontline health worker to traditional medical practice, (especially midwifery), and the mentally and physically handicapped. Generally it was found that community involvement in the program was good. Preventive and curative care has been brought closer to the population which had been previously isolated from services. The original scheme of maintaining 2 separate frontline health worker roles, a male and a female, to do maternal health care and sanitary work respectively, has been successful and should be continued.
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  21. 96

    Traditional birth attendants: activities, problems, and prospects for the future.

    World Health Organization [WHO]

    [Unpublished] 1979. 14 p.

    There has been a change in approach in the last few years to health development. Primary health care, with an emphasis on popular control and participation and 4-aspected care, consisting of preventive, promotive, curative, and rehabilitative services, is being stressed for developing areas. It is important that primary care be integrated into the total health system and that the personnel who provided primary care be respected by other personnel within the system. It is with this in mind that increased attention has been focussed on the utilization and training of TBAs (traditional birth attendants). TBAs can at least function better if they function with clean hands and clean instruments, a practice which cna be taught with training. Problems involved in training TBAs revolve around their own personal characteristics, the lack of acceptance by others in the organized health system, and characteristics of their communities, e.g., resistance to modern innovations. Government-sponsored training programs must offer, as incentives for taking training, subsidized fees for TBAs who accept training. Trainers must incorporate knowledge of the local communities into their courses. Systematic and direct supervision and evaluation of trained TBAs is necessary to evaluate the results of ttaining. It is actually difficult to measure the success of training. However, itshould be offered with the knowledge that it will do no harm and may do substantial good. WHO efforts in this area are summarized.
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  22. 97

    A report on UNFPA/EWPI Technical Working Group Meeting on Integration of Family Planning with Rural Development, East-West Center, Honolulu, Hawaii 15-18 February 1978.

    United Nations Fund for Population Activities [UNFPA]

    New York, UNFPA, 1979. 37 p. (Policy Development Studies No. 1)

    Unifunctional family planning programs have proven limited in dealing with the multifaceted nature of fertility regulation. Effective fertility regulation must be accompanied by improvement of socioeconomic conditions for the rural population. The organizational arrangements for the integration of family planning into other services is the main topic of this report. Many questions of integration of services cannot be answered in generalities; specific guidelines need to be applied to specific situations. Under certain circumstances family planning integration with rural development can improve the program and advance development. The partners in integration should be chosen with consideration for the conditions in each location. It is preferable to link specialized services at the point of service delivery. Plans which create large umbrella agencies should be viewed with caution. Integration in the form of community-based family planning programs can often help increase popular participation and acceptance to make family planning more successful. In the initial stages of integration, voluntary agencies or neutral government agencies can be helpful in coordinating specialized government agencies when jurisdictional concerns preclude effective intragency exchanges. Integration programs may be efficient and cost-effective in the long run, but they may require a sizeable initial investment.
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  23. 98

    The promotion and development of traditional medicine: report of a WHO meeting.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1978. 41 p. (Technical Report Series No. 622)

    A WHO meeting to study the promotion and development of traditional medicine was held in late 1977. Traditional medicine concepts and its place in health care are discussed. The fact that traditional medicine consists of a great deal more than the use of medicinal plants is illustrated with discussions of indigenous medical systems from various countries. Much of traditional medicine has been shown to have intrinsic value. It should be evaluated and its efficacy, safety, and availability improved. This should be done because the use of traditional medicine is the surest means of achieving total health care coverage of the world population, using safe, acceptable, and economical means, by the year 2000. The meeting discussed methods of integrating traditional medicine and traditional medical practitioners into the national health care systems of developing nations. Examples of such integration from various countries are cited. Manpower in this area can best be developed by utilizing and retraining, if necessary, existing personnel, including TBAs (traditional birth attendants). Research priorities in the field will vary with cultural settings. The various possible research approaches are illustrated with case studies.
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  24. 99

    Integrating oral rehydration therapy into community action programs: what role for private voluntary organizations?

    Centre for Population Activities [CEFPA]

    Washington, D. C., CEFPA, 1980. 42 p.

    A workshop, sponsored by the Centre for Population Activities, the National Council for International Health, and the Pan American Health Organization, meet in 1980 to discuss the use of ORT (oral rehydration therapy) in health and development programs and to determine how private and voluntary organizations could be encouraged to become involved in efforts to extend ORT availability. ORT is a technique for reducing dehydration in patients suffering from prolonged diarrhea. Diarrhea related dehydration is a serious problem among children in developing countries, especially among malnourished children. In 1975, 5 million children under 5 years of age died from diarrhea in Latin America, Africa, and Asia. The therapy consists of administering a solution of sodium chloride, sodium bicarbonate, potassium chloride, glucose, and water to the patient in order to balance the composition of body fluid. Initially the solution had to be administered intravenously at a treatment center; however, the solution can now be administered orally to mildly or moderately dehydrated patients by the patient's family in the home setting. The solution is given to the patient frequently and amount is determined by the patient's thirst for the solution. Packets containing enough dry ingredients to mix with 1 liter of water are now available. These packets can be centrally or locally manufactured. The solution can be mixed at health centers upon request, or the packets can be distributed directly to family members who are then taught how to mix and administer the solution. Various community action programs can incorporate an ORT component. Personnel in these community action programs, working at all organizational levels, should receive training in ORT. Community workers should receive intensive training so that they in turn can teach families in the community to use the therapy. The programs should use all available communication channels to send out accurate messages about ORT. The program should also organize the distribution of the packets and develop evaluation procedures for the ORT program component. WHO, UNICEF, USAID, and the National Council for International Health provide various forms of assistance to governments or to private and voluntary organizations interested in developing ORT programs.
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  25. 100

    Family planning in Colombia: a profile of the development of policies and programmes.

    International Planned Parenthood Federation [IPPF]

    London, IPPF, 1979 Oct. 47 p.

    The development of family planning programs in Colombia is outlined in this IPPF (International Planned Parenthood Federation)-sponsored report. Introductory demographic data are provided including information on the geography, economy, population dynamics, and available health services; this section is followed by a discussion of the government policy, which first became evident in 1968 with the inception of the national Maternal Child Health (MCH) program; the development of this program was in the face of active Catholic opposition and active leftwing proponents. Through 1979 the MCH program is still functioning with 100,000 new acceptors/year; in addition, the government only minimally inhibits the actions of nongovernment programs, such as PROFAMILIA, and allows for liberal regulations on such matters as prescription of contraceptives. The report then details the developments of individual family planning programs, some of which failed to survive the politically turbulent 1970s, e.g., ASCOFAME (Asociacion Colombiana de Facultades de Medicina), and others of which remain viable, e.g., PROFAMILIA; both of these programs are basically medical and have resulted in the following statistics of contraceptive protection from .1 in 1965 (per 1000 woman/years)-484.2 in 1975. Details of funding are provided, and expenditures and costs are presented tabularly. In addition to clinic programs, rural programs such as CBD (an adjunct of PROFAMILIA) were pioneered in Colombia, the structure of which has been emulated by all other field programs. Aspects of marketing (social marketing and mail order, e.g.,) are described and the personnel structure of PROFAMILIA is outlined. External funding of PROFAMILIA represents about 65% of its funding, and locally derived income provides the additional 35%.
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