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  1. 101

    Conventional health care systems and meeting the essential needs of underserved population groups in developing countries.

    Rifka G

    In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American University of Beirut, 1980. 5-12.

    Although health is now recognized as a human right, it is questionable whether the right to health is a reality for all people. Many rural and peri-urban areas of developing countries lack any system of organized health care. Only a small proportion of rural communities have access to safe and adequate water supplies, and millions of persons are undernourished. Communicable diseases are widely prevalent, and poor housing conditions exist in many areas. Conventional health services have failed to meet the needs of the underserved populations in rural and peri-urban areas for the following reasons: total coverage of the population has not been provided; the gap in health status between the urban and rural populations has not been closed; ways and means for the participation of the community served has not been provided because the responsibility of the community for its own health care has been ignored; services provided are not relevant to the priority health problems of the majority but are oriented toward the provision of sophisticated care for the minority; the model of health care has usually been copied from developed countries where health problems, population age structure, and resources are totally different; and health workers are not trained to meet priority health needs, nor are they trained in the setting in which the majority are expected to work, i.e., the rural areas and health centers. Faced with the challenge, governments have recognized the need to develop a new approach to improve the state of the health of their people, as revealed by the series of resolutions adopted by the World Health Assembly and by Regional Committees, which are the governing bodies of the World Health Organization (WHO). The alternative approach hopefully will serve as an important mechanism for realizing the main social goal of "health for all by the year 2000," as projected by WHO. The strategy of primary health care (PHC) has been gaining wider recognition in the region and shows particular promise for the extension of health coverage to larger groups of the rural population. PHC has been defined as a "simplified, though essential, health care which is accessible, acceptable and affordable." A more detailed definition was outlined in the "Declaration of Alma-Ata," which was adopted by 140 governments participating in the International Conference on Primary Health Care held during September 1978. A number of countries have begun to train primary health workers who have completed elementary or intermediate general education, followed by a few months of health training. Further and more effective use of traditional health workers is being explored in several countries. In some countries primary care is delivered by health professionals. WHO is collaborating with countries in the planning, formulation, implementation, and evaluation of PHC programs.
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  2. 102

    The United Nations at the service of Africa.

    Djermakoye IS

    In: Organisation of African Unity, International Institute for Labour Studies. What kind of Africa by the year 2000? Addis, Adaba, Ethiopia, Organisation of African Unity, 1980. 113-23.

    The UN Department of Technical Cooperation for Development is at the disposal of African countries to elaborate and implement jointly in integrated programs of technical cooperation in several sectors. In the area of mineral resources the department has helped governments in the development of the infrastructures needed to exploit natural resources and to expand their exploitation, including undertaking geological studies, laboratory technique training, training development, drafting legislation, and preparation of contracts. The department has also taken part in several studies dealing with energy, including those about oil production and dams, to make a general assessment of all the available sites if the countries so desire. In the Sahel subregion a study was undertaken to look for ways of reinforcing the planning and programming capacity of the states for better regional economic integration of their economy. In the field of research, science, and technology, major resources have been invested such as in the organization of the exchange of scientific information in research. The department has also developed an assistance program in the field of administration and public finance to help countries increase their administrative and financial management capacity for economic and social development; 1 activity is to follow up and examine changes in public administration and finance trends as well as the study of the role of the public sector in national development. Methods have been developed for analyzing administrative problems and setting up new administrative structures. Priority will be given to: 1) the development of human resources capable of implementing programs, and 2) the reinforcement of the appropriate institutions capable of providing the techniques necessary for the development and diffusion of the sciences dealing with population and demography in African countries.
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  3. 103

    Population in the Arab world: problems and prospects.

    Omran AR

    New York, United Nations Fund for Population Activities; London, England, Croom Helm, 1980. 215 p.

    The Arab population, consisting of 20 states and the people of Palestine, was almost 153 million in 1978 and is expected to reach 300 million by the year 2000. Most Arab countries have a high population growth rate of 3%, a young population structure with about 50% under age 15, a high rate of marriage, early age of marriage, large family size norm, and an agrarian rural community life, along with a high rate of urban expansion. Health patterns are also similar with epidemic diseases leading as causes of mortality and morbidity. But there is uneven distribution of wealth in the region with per capita annual income ranging from US$100 in Somalia to US$12,050 in Kuwait; health care is also more elaborate in the wealthier countries. Fertility rates are high in most countries, with crude birthrates about 45/1000 compared with 32/1000 in the world as a whole and 17/1000 in most developed countries. In many Arab countries up to 30-50% of total investment is involved in population-related activities compared to 15% in European countries. There is also increasing pressure in the educational and health systems with the same amount of professionals dealing with an increasing amount of people. Unplanned and excessive fertility also contributes to health problems for mothers and children with higher morbidity, mortality, and nutrition problems. Physical isolation of communities contributes to difficulties in spreading health care availability. Urban population is growing rapidly, 6%/year in most Arab cities, and at a rate of 10-15% in the cities of Kuwait and Qatar; this rate is not accompanied by sufficient urban planning policies or modernization. A unique population problem in this area is that of the over 2 million Palestinians living in and outside the Middle East who put demographic pressures on the Arab countries. 2 major constraints inhibit efforts to solve the Arab population problem: 1) the difficulty of actually reallocating the people to achieve more even distribution, and 2) cultural and political sensitivities. Since in the Arab countries fertility does not correlate well with social and economic indicators, it is possible that development alone will not reduce the fertility of the Arab countries unless rigorous and effective family planning policies are put into action.
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  4. 104

    A global perspective of health, vintage 1979.

    Gangarosa EJ

    In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American University of Beirut, 1980. 1-4.

    Discussion focuses on the global state of health as an introduction and background for deliberations. There are several dramatic indications of the worsening state of global ill health, particularly in developing countries. During the past 2 decades a cholera pandemic has spread extensively in Asia and Africa. During this same time, in large areas of South Asia and Central America, bacillary dysentery has spread extensively. It too had been virtually absent from the world scene for the preceding 50 years. Like cholera, this pandemic took its greatest toll from the most deprived populations. The largest outbreaks of typhoid fever ever recorded in the literature have occurred in the current decade. Malaria has reemerged as a major public health problem in the poorest parts of Asia, Africa, and Central and South America. Diseases such as measles, diphtheria, tetanus, and polio, for which vaccines have been long available, persist as major public health problems. These diseases, especially the epidemic and pandemic diseases, may be considered public health indicators. Their resurgence in recent years after decades of quiescence is symptomatic of a state of global ill health. It is significant that developing areas have been rather exclusively affected. In recent times, seemingly, the world has been divided into epidemic prone areas and areas essentially free of the major infectious diseases. This health disparity is underscored by some startling statistics on infant mortality. The industrialized nations currently enjoy the lowest infant mortality ever, but the rate is higher than ever in most of the developing areas of Africa, Asia, and Latin America. 3 major demographic changes that have primarily affected the poor and a major economic upheaval are largely if not totally responsible for the worsening state of global ill health: the population explosion, urbanization, and migration. The fundamental problem is usually the quality of life and the common denominator is the search for a better way of life. This conference devoted to human resources for technology transfer in primary health care deals with a new direction in health care under the able leadership of the World Health Organization (WHO) and other UN agencies which have the potential to change the situation. WHO's slogan is adequate health care for all by the year 2000. The start is with a new working premise, i.e., that health is quality of life, not just freedom from physical and mental burdens.
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  5. 105

    Evaluation report of the World Fertility Survey.

    Smith TE; Berquo E; Fisek NH; Knodel J; Ordonez-Plaja A; Presser HB

    [Unpublished] 1980 Dec. 183 p. (ADSS AID/DSPE-C-0053)

    A general report follows the "Executive Summary" of this evaluation of the World Fertility Survey (WFS). The general report covers the following: previous evaluations, terms of references, and composition and itinerary for the Evaluation Mission; background and objectives of WFS (origin of the program; objectives, priorities, and strategies); organization aspects of the WFS program (headquarters, country participation, operating procedures, survey organization, and coordination); inputs (scope of support to the program, procedures for provision of funds, headquarters costs, costs of country surveys, and complementary support to the program); methodological aspects of the program (sampling procedures; questionnaires, survey procedures, and basic documentation; data processing and archives; and production of the 1st country report); execution of national surveys (nature, character, and significance of WFS assistance; implementation of survey procedures); analysis (evaluative, illustrative, 2nd stage, and comparative analyses); building the national capability (contribution to survey taking capability, contribution to data processing capability, and contribution to analatical capability); dissemination of survey results (national meetings, limits of WFS participation in national dissemination activities, actual and potential audience for WFS survey results, and libraries in the WFS despository system); and use of WFS survey results. Conclusions are reported, recommendations are made, and country reports are included for the Dominican Republic, Mexico, Jordan, Kenya, Nepal, and the Philippines. The 1st objective of the WFS is to help countries acquire scientific information that will allow them to describe and interpret their populations' fertility, to identify meaningful differentials in patterns of fertility and fertility regulation, and to provide improved data in order to facilitate efforts in economic, social, and health planning. As of July 1980, a total of 36 less developed countries had completed fertility survey fieldwork, and of these 21 had published their First Country Report. The following were among the conclusions reached concerning this 1st objective: the sampling, training, field supervision, editing, and data processing standards set by the WFS for the national executing agencies were higher than those which characterized previous surveys; data processing was the major bottleneck in the participating countries during the surveys; and at all stages of the survey there was a conflict between the time constraints on completing the survey and getting the report out and the desire to rely as much as possible on local personnel. As far as utilization of WFS data, at this stage the Mission was able to evaluate only the short range use of the results.
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  6. 106

    Research as an aid to filariasis and onchocerciasis control.

    Nelson GS

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 167-72. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    Research is the tool which can help accelerate control of filariasis including the most important, river blindness and elephantiasis. The principles for control include eliminating the vectors and changing the way of life of the people. However these methods do not take into account the different ecologies of the land, cultures of the people and technical and political differences of the endemic areas. The WHO Onchocerciasis Control Program in the Volta Basin has been highly successful, but reinvasion of vectors is possible and there is concern that unacceptable levels of pollution will occur. Several successful limited programs of control are cited, but the absence of suitable drugs to kill the parasites is evident. One of the areas of research is centering on the characterization of the parasites and their vectors. More studies of isoenzyme markers are needed to distinguish different species of filarial parasites. An important advance in the diagnosis of filariasis has been the application of membrane filtration techniques for detecting light infection. Some of the current vector research is noted. This is particularly important because the main vectors of filariasis in Africa are also the main vectors of malaria. WHO is encouraged to stimulate collaborative research in this area. Chemotherapy is currently the most encouraging aspect of research. WHO is supporting 4 major centers where old and new filaricides are being evaluated. Some experiments are indicating the possibility that resistance to the disease can be stimulated by using irradiated larvae as appear in a cat model. Testing is now underway in a bovine onchocerciasis model. The new laboratory developments must continue so they can be applied clinically.
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  7. 107

    The economic aspects of the onchocerciasis control programme in the Volta Basin.

    Bazin M

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 163-5. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    The Onchocerciasis Control Program in the Volta Basin is aimed at reducing the transmission of the disease so that it is no longer a major risk to public health and an obstacle to socioeconomic development. Aerial spraying of insecticides has been carried out over 7 countries of West Africa where 10 million people live. The economic advantages of the program come from 2 production factors: labor and land. As far as labor is concerned, the program will increase productive capacities by reducing the production losses resulting from vision disorders or blindness in the laborforce, decrease the debilitating effects of the parasite which leaves people more vulnerable to other diseases, and increase ability of farmers to cultivate land near rivers without constant exposure to hundreds of bites a day. The major economic development will come from developing new land. Several reports are cited indicating projected kilometers of new land that would become available. The major concern is the best way to organize the utilization of the new land, taking into account organized and unorganized migration. It is apparent that various areas and countries within the program have different demographic pressures on their land as well as different structures and planning institutions. Considerable resources of men and financial means are required to finance these land development programs and must come from international sources. Some of the costs and cost evaluations are given. A belief in the cooperation among rich and poor countries for a program without boundaries has already demonstrated the cooperative nature of the Onchocerciasis Control Program.
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  8. 108

    The evolution of the World Health Organization's special programmes for research and training.

    Lambo TA

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 63-70. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    While developing countries make a relatively substantial investment in health care, health research is sorely lacking. A WHO Special Programme for Research and Training in Tropical Diseases was established in 1974-5 in an attempt to harness scientific resources on a global scale. Along with the United Nations Development Program and the World Bank, its objectives are: research and development of new and improved tools for the control of tropical infections and the strengthening of the research capabilities of the affected countries. The Special Program assumes that the developing countries must have a leadership role in research, that they use multidisciplinary scientific working groups (SWG's) and that institutions and scientists from the affected countries must be included in the research. The Special Program focuses on 6 tropical diseases: malaria, schistosomiasis, filariasis, trypanosomiasis, leishmaniasis, and leprosy. The research activities center on the search for new approaches to the control of disease vectors, simple diagnostic tests, epidemiology, vector control, biomedical and social and economic research applicable to most or all of the 6 diseases. Research proposals are supported on the basis of relevance to the SWG's plans as judged by peers and must be carried out by national institutions and scientists who are from developing countries. WHO is responsible for the program's overall management. 2 charts illustrating the functional structure of the Special Program and the structure of the Joint Coordinating Board are given. The Special Programs, based on specific national needs, with policy and financial decisions made collectively by groups of cooperating governments and agencies appear to work well and could provide the pattern for other research programs.
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  9. 109

    Paying for primary health care: mechanisms for recurrent financing.

    Golladay FL; Liese B

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 35-9. (Royal Society of Medicine. International Congress adn Symposium Series; No. 24)

    Improving access to essential health care is a goal of most developing countries and donors of economic assistance. Many unsuccessful attempts have been made to help the poor through fostering a growth in production and redirecting development activities. Recently a basic needs approach dealing with poor housing, inadequate water supplies and sanitation, lack of educational opportunities, and insufficient health care, has been introduced. The goal is to encourage programs that will directly affect the poorest of the population. The current health care strategy, attempting to ensure universal access to reasonable levels of health, has profound financial implications. Initial investment costs are estimated to be about $20 per person and will probably be overshadowed by recurrent operating expenditures. Further it is believed that investment costs of new health care activities can often be financed through official or private external donors while recurrent costs will have to be met by individual countries. These operating costs are estimated to be in the US$6-15 per capita range, much higher than the US$.60 to US$2.00 range now being spent. However, voluntary organizations and individuals are spending additional funds for health care in such areas as private health care, non-prescription drugs, transportation and indigenous individuals like herbalists. The total level of spending suggests that with a reallocation of resources better care could be financed. Another consideration is that the importation of most drugs and supplies will require a country's ability to participate in a foreign exchange program. The major principles of health care finance should include establishing equity among clients in ability to pay principles, encouraging appropriate usage of health services, prohibiting policy which promotes excessively costly services, and being feasible. Part of an appropriate design of the financing system should include having operating costs born locally as much as possible. Additional specific recommendations for successful health care financing are made.
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  10. 110

    Mother and child health in the 1980s.

    Morley DC

    In: Wood C, Rue Y, ed. Health policies in developign countries. London, England, The Royal Society of Medicine, 1980. 19-23. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    During the years 1970-1980 the population of children in developing countries has increased by about 285 million, while there is an inequality in the distribution of the resources needed to care for them. At the same time, traditional medical school training caters to largely adult populations with little emphasis on the prevention of illness and the promotion of good health. In the Third World Countries children constitute almost 50%, and with the mothers 70% of the total population. In this group the mortality and morbidity rates are particularly high despite the fact that most of the conditions are easily prevented. Primary health care provided by a part-time, trained health worker who has been recruited from the community in which he will work is a very positive approach. Another area which should be expanded is the ongoing training for existing doctors through distance teaching so that their knowledge remains up to date. All levels of health workers involved in primary health care can learn through nets of information consisting of journals, correspondence, scientific meetings and visits to other centers. There are even free resources available such as Contact and Salubritas. More use should be made of the resources.
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  11. 111

    Rational organization of primary health services.

    Jancloes MF

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 11-7. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    In developing countries systems of "bare-foot doctor" health care are being used. The goal is to provide a health service that is within the reach of each individual and family in the community, is acceptable to participants, that entails their full participation at a cost suitable to the individual and the nation. As opposed to hospital oriented Western medicine, there is usually a health officer from the local community, trained and provided with a dispensary, who returns to the home community. 2 projects in progress which were having negative results, 1 in Zaire and 1 in Senegal, were evaluated. The principles which redirected the programs are discussed. Problems such as mobile centers versus fixed sites for health centers, single aim projects and self-administration of the centers are explored. The acceptance of responsibility by the local public by using funding and resources of its own was judged to run the least risk of failing in the long term. In Senegal a new law on administrative reform was passed which allowed district health committees dealing with about 100,000 people to be set up. With a system of self-financing, more than 500,000 people were treated in 3 years. The fees were modest and 65% of the income from fees was used to keep drug supplies up to date. 3 dangers were identified and overcome: risk of embezzlement by district treasurers, overconsumption of drugs, and stocking excessively expensive products. The basic conditions necessary to provide an efficient network of health services in a rural environment (Zaire) and an urban environment (Senegal) are joint financing of activities through contractual financial participation, local administration, improved medical personnel, standardized medical procedure, and continuous supervision in collaboration with non-professional health workers.
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  12. 112

    Planning for the future with people: programmes for better family living.

    Harrison C

    [Rome], Food and Agriculture Organisation, [1980]. 29 p.

    In this booklet devoted to Kenya, information is presented on the following: the country, its people and development; the demand on services and resources; government population policy and action; the long range objectives of the Programs for Better Family Living (PBFL); activities of the PBFL in Kenya; the Kenya National Family Planning Program over the 1974-79 period; and some background on the Food and Agricultural Organization (FAO) and the UN Fund for Population Activities (UNFPA). Improving the well being of the population and promoting the welfare of the individual calls for effective utilization of Kenya's natural resources. One of the most effective ways of achieving this is to help families and communities to make better use of existing resources and generate new resources. Since independence in 1963, the government and people have made considerable progress, demonstrated by rising living standards and an expanding economy. Yet, the plans for continued economic growth can be disrupted by a high rate of population growth. In 1973, Kenya's population was estimated at 12.5 million. The rate of population growth was 3.5%, 1 of the highest growth rates in the world. Such population growth creates problems in the areas of health, education, urbanization, employment, and investment and income growth. Recognizing the implications of Kenya's high population growth, in 1966 the government declared that it would pursue policies aimed at reducing the population growth rate through voluntary means. A program of education and motivation in regard to population and family planning was initiated, and family planning services were provided. Education and motivation about family size has been provided within the context of Kenya's maternal and child services. The program emphasizes the benefits in the health of mother and child that accrue from child spacing. The long range objectives of the PBFL are to help raise the level of rural welfare by educating families and communities through fostering an understanding of the relationship between family size and family and community welfare at all levels and improving the coordination of activities at all levels betwen those servicing ministries and nongovernmental organizations. The plan of the family planning program aims at recruiting about 640,000 new family planning acceptors over the 1974-79 period, with the goal of averting some 150,000 births and reducing Kenya's population growth rate to 3.25% by 1978-79.
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  13. 113

    Overview of international population assistance.

    Gille H

    [Unpublished] [1980]. 10 p.

    At this time the urgent need for a wide spectrum of population activities in developing countries is fully recognized as the legitimate concern of governments and the international community. Technical cooperation and financial assistance are provided to these countries from a large variety of intergovernmental, governmental, and nongovernmental sources of international population assistance. This discussion of international population assistance reviews the following: current levels of population assistance; sources of population assistance; types and areas of assistance; and setting priorities. Total international assistance for population activities amounted to only about US$2 million in 1960 and US$18 million in 1965. It increased rapidly to US$125 million in 1970 and to an estimated net amount, excluding double counting, of around US$450 million in 1970. In 1981 it passed the half billion dollar mark. This marked increase in population assistance is an indication of the growing commitment of many governments and international organizations concerned about collaborating in and contributing to tackling the urgent population problems of the developing world. Nearly 100 governments contributed in 1979 to international population assistance, but the major share comes from less than a dozen countries. The largest contributor, the US, provided US$182 million for population assistance in 1979 amounting to nearly 4% of its total net official development assistance. Over 120 developing countries, or nearly all such countries, received population assistance in some form in 1979. Almost all of them were supported by the UN Fund for Population Activities (UNFPA). The International Planned Parenthood Federation (IPPF) provided support for family planning associations or programs in around 80 developing countries. Almost all donors make their contributions to population assistance in grants, but a few governments also make loans available. Around 72% of total international population assistance is provided in support of family planning activities. The region of Asia and the Pacific received the largest part of the population assistance to countries, namely 50%, followed by Latin America, 19%; Africa, 11%; and the Middle East and Mediterranean, 7%. More and more attention is being devoted to setting priorities in assistance to population programs. This is due, in part, to the fact that the amount of population assistance has not increased sufficiently in recent years to keep up with the growing needs.
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  14. 114

    Report on visit to Bangkok, Manila and Bombay to study production methods of oral rehydration salt.

    [Unpublished] [1980]. 8 p.

    A study tour was undertaken by the Social Marketing Project in Bangladesh to observe production facilities of oral rehydration salt (ORS) in Bangkok, Manila, and Bombay. This report describes raw materials, plants and equipment, methods and procedures, and quality control for each country. In Thailand the Government Pharmaceutical Organization, under the Ministry of Health, supervises ORS production. ORS has been produced for the last 3 years and presently about 200,000 packets/month (equivalent of 1 litre solution) are being produced, following the World Health Organization (WHO) UNICEF formulations. The Ministry of Health in Manila has been providing ORS based on the WHO formulations for the past 6 years. Currently production is about 2 million packets with proper equipment. Distribution is through district health officials and village health workers. As an adjunct to ORS distribution there is a plan to introduce water purification tablets. The Fairdeal Corporation in India is a commercial pharmaceutical organization which produces 2 ORS solutions: 1) Electral which does not include bicarbonate and accounts for about 80% of total production, and 2) Electral Forte which has sodium bicarbonate and is recommended in severe dehydration cases in adults. Their research has shown that the WHO formulation is inadequate for many countries. Presently sales are about 500,000-600,000 packets/month mainly distributed through medical practitioners. This study also found that: 1) organic lipidity of the product is critical for acceptance; the addition of a flavoring agent is considered important especially for acceptance by small children, and 2) closely controlled humidity conditions (30-35%) and temperature (23 degrees Centigrade) are essential to the formulation and increases the life of the salts to 10-15 days even after opening the packs.
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  15. 115

    Establishment of a regional network of health literature, library and information services (HELLIS).

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, WHO, South East Asia Region, May 1980. 117 p.

    Summary of intercountry consultative meeting of administrators, librarians, and users of health libraries from the Southeast Asia region called to consider the establishment of a network of health libraries and information services in the region. Discussion centers on strengthening of libraries at the national level to provide a base for linkage and permit integration into international information retrieval systems. The major outcome of the meeting was a proposal for the establishment of flexible regional and national networks functioning on the principle of resource sharing and Country focal points. A WHO Regional Coordinating Center would act as liaison between the national level and international organizations. The intended availability of these services to all levels of health personnel, and the equal partnership of all participants in the network are stressed. Assessment of user needs would be a necessary part of the development of the system. Appended to the report is a list of participants, the program, a list of the working papers, the inaugural address of Dr. V.T.H. Gunaratne to the 27 August 1979 meeting, country situation listings, a case study of library facilities in a group of city medical colleges, a student loan scheme, description of MEDLINE services in the region, and a proposed bibliographic control system for the area, as well as a listing of low priced recommended textbooks for students.
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  16. 116

    Drug-resistant malaria--occurrence, control, and surveillance.

    Wernsdorfer WH; Kouznetsov RL

    Bulletin of the World Health Organization. 1980; 58(3):341-52.

    Chloroquine resistant strains of Plasmodium falciparum were initially reported during the early 1960s and are currently found in many areas of Asia and South America. The prevalence and degree of resistance are increasing in all affected areas, representing a serious setback to antimalaria programs. Alternative drugs are much more expensive and frequently more cumbersome to use. Consequently, it is essential that a concerted effort be made to arrest the spread of resistant strains by developing standardized national policies on drug use. The probable genetics and epidemiology of drug resistance are considered in this report, and attention is directed to the problems involved in its control. Antimalarial drugs interfere with important physiological functions of the parasites. Chloroquine and mepacrine apparently block acid proteases and peptidases in the phagosomes of intraerythrocytic parasites. Circumstantial evidence from "in vitro" tests suggests that strains of P. falciparum from various parts of the world, although primarily susceptible to chloroquine, exhibit, "a priori," different sensitivities. P. falciparum in the Sobat valley of Ethiopia and in central Sudan appears to be significantly less susceptible to chloroquine than the Uganda I strain. There are no indications yet of chloroquine resistance in P. vivax, P. malariae, or P. ovale. The relative prevalence of chloroquine resistant infections and the degree of resistance are still on the increase in all affected areas. The development of drug resistance in areas with previously susceptible parasites has thus far always been associated with the use of the particular medicaments. 4 main factors seem to be involved: the degree of drug pressure; the degree of host/parasite contact; the duration of drug pressure; and the type of drug used. The occurrence of chloroquine resistant falciparum malaria requires the urgent attention of the health authorities and that several operational measures be undertaken. Instructions must be provided concerning the principles of drug use in antimalaria programs in the event of the spread of drug resistance, and these instructions are reviewed. The methods for the monitoring of drug sensitivity are also reviewed. The World Health Organization (WHO) has developed global monitoring program, initially implemented in 1977 in the Southeast Asia Region. Program objectives are identified.
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  17. 117

    Study of Plasmodium falciparum resistance to 4-aminoquinolines (chloroquine) in Sabah, Malaysia.

    Maqsudur Rahman KM

    Journal of Tropical Medicine and Hygiene. 1980 Dec; 83(6):259-64.

    The status of Plasmodium falciparum resistance to chloroquine in Sabah, Malaysia was not known until 1971-72. In 1974 resurgence of malaria was 77% over the number of cases in 1973 despite a malaria control program. Several in-vivo studies and 1 in-vitro study were conducted from 1971-5 and showed 51% out of 57 cases were resitant to chloroquine, the substance most widely used in the control program. 1 study was started in 1978 to continue to 1980; the preliminary results show 65 cases (85%) out of 76 successful tests are chloroquine-resistant. A decision was made to change to Fansidar for treatment of P. falciparum infection and to make other changes in the anti-malaria campaign in 1978-79 such as switching to emulsion concentrate for DDT insecticide spraying and monthly mass drug administration in serious transmission areas.
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  18. 118

    Further thoughts on the definitions of economic activity and employment status

    Blacker JGC

    Population Bulletin of the Economic Commission for Western Asia. 1980; (19):69-80.

    The author cites problems in the definitions of different categories of economic activity and employment status which have been made by the UN. The term "casual workers" has never been clarified and these people were described as both employed and unemployed on different occasions; there is also no allowance for the term underemployed in the UN classification. The latter term, he concludes, is not included in most censuses. The UN in its Principles and Recommendations for Population Censuses, discusses sex-based stereotypes which he states are based on a set of conventions that are arbitrary, irrational, and complex. However on the basis of the UN rules it is possible to divide the population into 3 categories: 1) those who are economically active (black), 2) those who are not active (white), and 3) those whose classification is in doubt (gray). In developed countries most people are either in the black or the white area and the amount in the gray area is small, but in developing countries the gray area may be the majority of the population. In the Swaziland census no attempt was made to provide a clear picture of employment. In view of the complexity of the underlying concepts, the decisions as to whether a person should be classified as economically active or not should be left to the statisticians, not the census enumerators.
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  19. 119

    BCG vaccines: tuberculosis experts to discuss lack of protection.

    WHO Chronicle. 1980 Mar; 34(3):118-9.

    The World Health Organization (WHO) plan is to hold 2 meetings with tuberculosis experts for the purpose of examining the implications of a large scale trial in the south of India that has shown no protection against lung tuberculosis from BCG vaccination. Launched in 1971, the trial covered some 260,000 persons older than age 1 month. It was aimed at preventing lung tuberculosis in the population of 209 villages as well as in a town in the district of Chingleput, west of Madras. Results with the BCG vaccines have varied in the scientifically valid controlled studies that have been conducted. The success of BCG vaccines has varied by population group, ranging from good (80% effectiveness) to poor (as in the Indian trial). The following were among the questions raised by the findings of the Indian trial: were there procedural flaws; were the BCG vaccines used of adequate potency; could other factors have played a role; and should BCG vaccinations be stopped. According to the published report, there were no apparent flaws in the procedures followed in the Indian study. In the Indian trial, 2 BCG strains--Danish and French--were used in the highest tolerated doses. The strains were selected for their relatively high efficacy in experimental studies, and extensive laboratory control showed the vaccines to be of good quality. The WHO experts found the epidemiology of tuberculosis in the trial area to be peculiar in the sense that the tuberculosis occurred long after an individual was infected. Not far from the trial area, and also in south India, disease occurred soon after infection. The experts noted that this phenomenon, which requires further study, may influence the effectiveness of vaccination. According to the experts, the findings in the study population were not applicable in other parts of India. Where many factors may play a role and when the level of protection is nonexistent, as in the India trial, little can be deduced about the worth of the vaccine and its effect under different circumstances.
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  20. 120

    Recommendation by the Executive Director [of UNFPA] on assistance to the government of China's comprehensive population programme. Agenda item 7 aii, 27th session, Governing Council.

    United Nations Development Programme [UNDP]

    New York, UN, 1980 May 14. 11 p. (DP/FPA/11/Add.22)

    The United Nations Fund for Population Activities (UNFPA) proposes to fund a 4-year program with $50 million to assist the government of China in implementing its population policies. The contribution of the UNFPA will support the 1st census to be taken since 1964. In addition it will provide assistance in the following areas: demographic training and research; maternal and child health and family planning service delivery and research; training of maternal and child health and family planning personnel; family planning service statistics and program evaluation; human reproduction and contraceptive research; contraceptive production; and population information and education. The program will emphasize the introduction of new technologies and advanced equipment which is not currently available in China, the improvement of technical training and research, and institutional development. The UNFPA intends to seek additional funds for assistance to China through multibilateral resources in order to support the establishment of an Institute of Developmental Biology. The government of China has succeeded in limiting the rate of population growth from 2.34% in 1971 to 1.2% in 1978, but an imbalance remains in the rate of population growth and that of the national economy. The government has long encouraged family planning with the objective of limiting fertility. Increased action has been taken recently to speed up the implementation of the country's population policies. The government has adopted the goal of lowering the population growth rate to under 1% by 1980, to approximately 0.5% by 1985, and to zero population growth by the year 2000. China's family planning policy promotes the following 4 principles: late marriage and childbirth; child spacing; small families; and better health for the entire country. The UNFPA proposes setting aside a program reserve of $6,536,943 to meet other needs that may become apparent as program implementation progresses.
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  21. 121

    International population policies, strategies and programmes.

    Gille H

    Unpublished [1980]. Paper prepared for Beijing International Round Table Conference on Demography, 1980, Beijing, 20-27 October 1980. 11 p. (UNFPA Project No. CPR/80/P01; entry no. 0258 (CPR80P010528))

    A review of international population policies, strategies, programmes, and assistance. The development of national policies addressing population size, growth, distribution, and demographic factors is traced. The World Population Plan of Action, adopted by 135 states at the World Population Conference in Bucharest in 1974, is identified as the most important international population strategy. The general principles on which the plan is based, and its objectives and targets are presented and discussed. Other relevant strategies identified and discussed include the International Development Strategy for the 3rd Development Decade (expected to be adopted by the UN General Assembly) and the WHO-UNICEF declaration of health for all mankind by the year 2000. The increase in population assistance from 125 million in 1970 to 500 million dollars in 1980 is discussed. Over 80 governments have contributed to international population assistance, but most aid comes from less than a dozen countries and is channelled through multilateral organizations such as the UN Fund for Population Activities and the International Planned Parenthood Federation. 121 developing countries receive population assistance. Definite effects of this aid cannot be demonstrated, but a significant accomplishment in promoting awareness of population issues is recognized. Traditionally, donors have stressed fertility control as the major objective of their assistance, but recently some donors have revised their policies to emphasize such problems as migration, urbanization, refugees and aging. Priorities for resource allocation for population assistance are discussed.
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  22. 122

    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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  23. 123

    Family planning as a human right under the United Nations system.

    Saxena JN

    Health and Population: Perspectives and Issues. 1980 Jan-Jun; 3(1-2 Spec No):6-17.

    Traces the evolution of family planning as a human right under the United Nations system, with special reference to the General Assembly's resolution on population growth and economic development in 1962; the programs and priorities in population fields passed in 1965; the Secretary General's statement regarding the responsibility of the family, as the fundamental unit of society, for determining its size; the international conference in commemoration of the 20th anniversary of human rights, in 1968; the General Assembly declaration on social progress and development in 1969; and the World Population Plan of Action in 1974. The author concludes that the United Nations has taken a clear stand that it is a basic human right for couples to determine the number of their children and the consequent right to access to the relevant information and methods for implementing their decision. The author calls for a General Assembly declaration on human rights aspects of family planning. Such a declaration, while not legally binding on member states, would move the right to family planning toward legal obligation as an instance of "instant" custom, and pave the way to practical application by influencing the attitude of governments. (author's modified)
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  24. 124


    Schima ME; Lubell I

    In: Schima ME and Lubell I, ed. Voluntary sterilization: a decade of achievement. Proceedings of the 4th International Conference on Voluntary Sterilization, May 7-10, 1979, Seoul, Korea. New York, Association for Voluntary Sterilization, 1980. 1.

    Introduction to the proceedings of a conference on voluntary sterilization. Reflects on the accomplishments of the decade of the 1970s, remaining problems and issues, and new ones generated by success. Development of innovative solutions to manpower, funding and transportation problems that hinder delivery of sterilization and family planning education to those in need; grand multiparity as an indication for sterilization; legalization of voluntary sterilization; and the need for improved, inexpensive techniques that are deliverable to remote areas were topics of discussion at the conference. Because of continued growth in acceptance of voluntary sterilization it now offers genuine demographic potential.
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  25. 125

    Population and family welfare education for workers: a resource book for trainers.

    International Labour Office [ILO]. Labour and Population Team for Asia and the Pacific [LAPTAP]; International Labour Office [ILO]. Population and Labour Policies Branch

    Bangkok, ILO Regional Office for Asia and the Pacific, 1980. 64 p.

    The chapters included in this resource book for trainers, prepared for a regional audience, present those topics that are most relevant in an organized sector population/family welfare education program, i.e., a program directed to any group of workers which can be approached through an appropriate organizational channel. This book has been prepared with the trainers of instructors in mind, i.e., for those who are going to help prepare the actual factory level instructors to become efficient in family welfare education. It is most important that trainers and instructors in a family welfare education program appreciate the fact that the program is directed to explaining the relationships between the pressure of the labor supply and the well-being of the worker's family. Following an introductory chapter, the chapters of this volume present the following: objectives of International Labor Organization (ILO) Population/Family Welfare Education Program; population concepts and factors affecting population growth (population concepts and factors affecting population growth); population growth and employment; family welfare, living standards, and population change; communication in population/family welfare education; and methods of contraception. The basic objective of most ILO-designed country population education programs is to facilitate the understanding of population and family welfare factors in so far as they affect the working conditions and quality of life of the workers. The programs are generally designed to encourage active involvement and participation of the regular members of the labor force. Implicit in the objectives is the motivation to the acceptance of family planning as a means of fertility regulation. The implementation of a program at the plant level is generally a combination of work undertaken by a trainer and volunteer motivators. The trainer can present the case for family planning welfare through various mediums, and the motivators follow up by talking to colleagues either individually or in small groups.
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