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POPULI. 1997 May-Jun; 24(2):6-7.Thousands of women worldwide are tricked, obliged, or abducted and sold into bondage and servitude as prostitutes, domestic workers, exploited workers or wives. They are often forced to live and work in conditions similar to slavery. The exploitation of women's bodies and labor has created an international trade system with women going from countries experiencing structural adjustment and/or deforestation to countries with better living standards. Technology, such as the internet, has allowed traders to conduct and expand their business internationally. The International Organization for Migration reports that the trade in women is caused by poverty, the lack of viable economic opportunities, the difference in wealth between countries, and the marginalization of women in their countries of origin. The promotion of tourism as a development strategy has also contributed by encouraging the trade in women for prostitution.
Mainstreaming the environment. The World Bank Group and the environment since the Rio Earth Summit, Fiscal 1995.
Washington, D.C., World Bank, 1995. xv, 301 p.Almost all countries of the world agreed with the idea of environmentally sustainable development at the Rio De Janeiro Earth Summit. This report summarizes World Bank activities that directly deal with improving the environment. Part 1 reviews World Bank activities during 1993-95 at the national, regional, and global levels and intellectual efforts toward making development environmentally and socially sustainable. Part 2 focuses on activities in the social sectors, followed by agricultural, energy, transportation, and urban development sectors, which comprise about 60% of Bank activity. Part 2 also discusses activities that did not specifically focus on the environment. Activities include education, health, and nutrition projects and other projects such as irrigation projects, which could adversely affect the environment. Some projects, such as energy projects, are trade-offs between protecting the environment and promoting economic development and poverty reduction. Part 3 illustrates the private sector's role in environmental protection and explains how the International Finance Corporation (IFC) and the Multilateral Investment Guarantee Agency (MIGA) contribute to environmental sustainability. Both the Bank and the IFC screen operations for their environmental impact. Environmental assessments are available for some projects. The Bank's Public Information Center has since 1994 disclosed environmental information on its projects. This report includes the positive progress to date and discusses areas in need of improvement. The current approach of the Bank includes an emphasis on grassroots participation and implementation, on the incorporation of environmental issues into sectoral and national strategies, and on people and social structures.
EARTH TIMES. 1997 Jan 1-15; 10(1):5-7.During 1997, the international community will move from the five-year cycle of UN summit-level conferences to a phase in which the policy goals arising from these conferences must be implemented. The success of that implementation will depend upon the choice of starting points; the balance of finance, technology, and political courage; the ability to plan specifics while viewing generalities; and the ability to preserve global responsibility in the face of global economic competition. 1997 will be marked by new UN leadership, by whether the US places environmental issues on par with economic and international affairs, and by how the issue of funding Agenda 21 is resolved. In addition, more women are needed in positions of political and economic leadership at all levels to implement the goals of the UN Conference on Environment and Development (UNCED). Another concern which must be met in 1997 is the growing divide between the public discussions of the completed UN conference cycle and the private process embraced by the World Trade Organization, which may nullify the terms of many international environmental agreements. The most easily implemented agreement reached at the UNCED was the Climate Change Convention (which would control emissions) but the voluntary target has been effectively scrapped, and 1997 will see the adoption of a realistic goal or admitted failure in implementation. Additional issues include the codification of public policy goals in privatization contracts, stemming current weapons exportation, exposing and decrying unethical expedient alliances between northern fossil fuel industries and developing countries, and promoting wildlife protection.
Washington, D.C., Population Action International, 1996 Sep. 13,  p. (Population Action International Occasional Paper No. 2)This paper presents recent trends in donor contributions for international population assistance. The 1994 International Conference on Population and Development (ICPD) spurred a number of donor governments, including the US, to make major new commitments to fund population programs. This commitment is reflected in the large increase in spending between 1993 and 1994. However, recent US cuts to international population assistance have been a major blow to overall population aid levels. This diminished US role could undermine support for population aid in other industrialized countries. For now, the rapid expansion of bilateral programs in important donor countries like Germany, Japan, and the UK has offset the US cuts to some extent. Private foundations have also re-emerged as a significant funding source, while the regional development banks and the European Union (EU) remain largely untapped as sources of population funding. The downturn in overall development assistance has stalled the momentum developed from the ICPD, hindering the chances of reaching the ICPD funding goals. The extent to which each of the following countries provides international population assistance is described: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, UK, and the US. The contributions of the EU, the World Bank, the Asian Development Bank, the Inter-American Development Bank, and private sources are also described.
Arlington, Virginia, Partnership for Child Health Care, 1995. , 11,  p. (Trip Report; BASICS Technical Directive: 008-GU-01-015; USAID Contract No. HRN-6006-Q-08-3032)As part of a series of activities designed to reduce morbidity and mortality from acute respiratory infections in children under the age of 5 in Guatemala, a consultant from the BASICS (Basic Support for Institutionalizing Child Survival) program visited Guatemala in 1995 to analyze, modify, and field test the protocol developed by the USAID Mission to document the degree to which drugs prescribed for pneumonia are available in the community through the private sector. This field report provides background information and describes the current situation in Guatemala in terms of availability of drugs in the public sector through the Ministry of Health, the Drogueria Nacional, municipalities, and the Pan American Health Organization. Relevant activities in the private sector are also described, including the for-profit businesses as well as services provided by UNICEF, the European Union, and nongovernmental organizations. A brief overview of one health area gives an example of the current situation. The result of this consultancy visit was the determination that the situation merited adjustment of the originally requested study and that the survey as designed would likely require modification and application within target communities. Included among the appendices is the original protocol developed for assessing community drug availability.
Arlington, Virginia, Population Technical Assistance Project [POPTECH], 1994 Dec. xix, 84,  p. (POPTECH Report No. 94-011-015; USAID Contract No. CCP-3024-Q-00-3012)The Tanzania Family Planning Services Support Project (FPSS) aims to improve the health and welfare of women and children by providing women and couples the opportunity to choose freely the number and spacing of children. FPSS was implemented in 1991. The three interrelated project outputs are expanded delivery of quality family planning services, enhanced Tanzanian institutional capacity, and development of an institutional base. USAID/Tanzania requested a midterm evaluation, which was conducted in December 1994. It supports FPSS by directly providing funds to the government and cooperating agencies who provide technical assistance to the National Family Planning Program and the private sector. Other significant donors to the family planning sector include UNFPA, IPPF, Overseas Development Assistance, and German Association for Technical Cooperation. During 1991-94 modern contraceptive prevalence increased from 7% to 16%. New acceptors increased 40-50%. Monthly resupply clients increased 23%. In mid-1994, 79% of women and 90% of men were familiar with at least one modern contraceptive method. The proportion of facilities providing injectables, IUDs, and vaginal foam increased more than two-fold. Almost all the facilities provided oral contraceptives and condoms. The number of first attendances for family planning services increased 46%. FPSS supported a wide variety of training (e.g., 6 types of training courses), but the needs for more training were stifled by lack of trainers and of supervisors, weak distribution of training documents, failure to institutionalize family planning into the medical and nursing schools, and lack of equipment and supplies. There were solid improvements in contraceptive logistics and availability, strengthening of the family planning unit within the Ministry of Health, and flexibility by USAID/Tanzania's management in addressing changing country needs. Based on the findings, the team developed 12 major recommendations (e.g., development of a national strategy to achieve a sustainable family planning program).
The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, 6-8 December, 1995, Ottawa, Canada.
Arlington, Virginia, Partnership for Child Health Care, 1995.  p. (Trip Report; BASICS Technical Directive: 000 HT 56 011; USAID Contract No. HRN-6006-C-00-3031-00)The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, convened in Ottawa, Canada, in 1995, promoted partnership between the private and public sectors aimed at eliminating global malnutrition through strategies such as food fortification and supplementation. Participants agreed on the goal of eliminating micronutrient malnutrition by the year 2000, with an emphasis on iodine, iron, and vitamin A deficiencies. Achievement of this goal will entail, for each country, a needs assessment and discussion of the role of micronutrient fortification, establishment of a hierarchy of foods to reach the maximum population at risk, and dialogue to provide a link for technology and information exchange. The public sector will assist in the development of standards, provide incentives, and contact industry, while the private sector will provide scientific research and development, conduct market research, develop appropriate products, and disseminate and market the products; the role of international organizations will be to provide financial support and serve as liaison between the public and private sectors.
In: Women in the age of economic transformation. Gender impact of reforms in post-socialist and developing countries, [edited by] Nahid Aslanbeigui, Steven Pressman and Gale Summerfield. London, England, Routledge, 1994. 77-94.The author presents evidence that the World Bank's privatization of health care delivery has failed to improve the quality or quantity of health services in sub-Saharan Africa. Health care service has instead deteriorated and become more scarce. Since women have greater health care needs, especially during and after pregnancy, they have suffered the most from the attempt to limit the public provision of health care. Women's ability to influence health sector reforms is, however, hampered by their lack of political power, the weakened state, and the new role of the Bretton Woods organizations in setting national policies at the international level. Women are excluded from all decision-making jobs at the four highest levels of government in 21 African countries. Although African women join organizations in large numbers, they have only minimal impact upon state policies. There is no suggestion in the literature that women have succeeded in influencing the provision of social services by the private sector. Women's best hope in influencing international policy to make them become more responsive to women's needs is to make their voices heard in large international forums such as the Fourth World Conference on Women to be held in Beijing in September 1995.
ZEITSCHRIFT FUR BEVOLKERUNGSWISSENSCHAFT. 1993; 19(3):263-8.Nongovernmental organizations (NGOs) have long been active in international population studies and programs and have participated in the shift in emphasis from data collection techniques to understanding population dynamics and establishing policies. NGOs are now playing an important role in the preparatory activities for the 1994 International Conference on Population and Development (ICPD). Indeed, NGOs are the subject of an entire chapter in the final draft document of the ICPD. NGOs have been very instrumental in implementing the plan of action which grew out of the last UN population conference, by working in partnership with local governments as catalysts for change and by channeling a third of the total expenditures for population assistance to appropriate programs. At least 135 international NGOs are currently undertaking important population activities. Foremost among these NGOs are the International Planned Parenthood Federation, the Population Council, and the International Union for the Scientific Study of Population. NGOs have been extremely involved in the planning process for the ICPD where they have participated in general debate, presented official statements, and enjoyed access to closed-door drafting sessions. The ICPD will synthesize the work of thousands of attendees from NGOs and from national governments. Many controversial items will be discussed and decided upon, as the delegates work to point the way to a better future for mankind.
Arlington, Virginia, Partnership for Child Health Care, 1994.  p. (BASICS Trip Report; BASICS Technical Directive: 000 IN 00 011; USAID Contract No. HRN-6006-C-00-3031-00)An appraisal team travelled to Indonesia in late 1994 to assess the World Bank Health Project IV (HP-IV). This project seeks to improve the quality, equity, and accessibility of basic health services in five provinces through measures such as child survival programs and improvements in health services provided through the private sector. Support from national policy makers was obtained for collaboration in East Java between HP-IV and the Basics Support for Institutionalizing Child Survival Project. Evaluators noted an excessive amount of training, causing health workers to be away from their jobs for extended periods of time. Recommended were alternatives such as on-the-job courses, a training information system, and a ceiling on time allowed off work to attend courses (e.g., nine days every six months).
IPPF / WHR FORUM. 1993 May; 9(1):20-1.The Dominican Association for Family Welfare (PROFAMILIA), an affiliate of IPPF, was the first organization to provide family planning services in the Dominican Republic. In 1966, the time of PROFAMILIA's creation, the total fertility rate (TFR) was 7.5. Shortly after PROFAMILIA's inception, the TFR began its steady decline. The 1991 Demographic and Health Survey (ENDESA-91) shows that the TFR has fallen to 3.3. PROFAMILIA persuaded the Dominican Republic's government to provide full-scale family planning services. In 1968 the government set up the National Council on Population and the Family (CONAPOFA) within the Ministry of Public Health and Social Services to provide family planning services. It now provides family planning services through more than 500 health centers. The Dominican Family Planning Association, set up in 1986, provides family planning services in the Federal District and the easternmost provinces. These family planning organizations have reduced the unmet demand for family planning in the Dominican Republic to 17%, essentially the same levels as in developed countries. Even though mean family size is 3.3, ideal family size is 2, indicating a trend toward smaller families. The adolescent pregnancy rate is 13% in urban areas and 27% in rural areas. 13.3% of adolescents in a union use modern contraceptives, while only 3% of those not in a union do. 25.4% of women of childbearing age, 38.5% of women in a union, and 65.4% of 40-44 year old women depend on sterilization. Only women less than 29 years old significantly use oral contraceptives. The family planning programs need to expand family planning messages to adolescents, particularly those not in a union. PROFAMILIA still implements new approaches to expand services, such as health promotion via community-based services. CONAPOFA has since implemented such a program. ENDESA-91 demonstrates what can be accomplished when an effective government family planning program and a private organization work together.
FAMILY PLANNING NEWS. 1994; 10(2):4.Chapter 12 of the UN's program for action focuses on more biomedical research to expand people's choice of family planning methods -- particularly male methods -- and to combat the spread of sexually transmitted diseases and AIDS. The document states that "a significant increase in support from governments and industry is needed to bring a number of potential new, safe and affordable methods to fruition." The World Health Organization [WHO] has identified a whole new range of contraceptives for the future: hormonal methods for men, including pills, injectables, implants and vaccines; blockage of the vas deferens by injection; hormone-releasing vaginal rings; biodegradable hormone-releasing implants; antifertility vaccines for women; better barrier methods for women and men; once-a-month oral contraceptives for women. Development of such methods, says the UN's program, should emerge "from a new type of partnership between the public and private sectors," which mobilizes the experience of industry while at the same time protecting the public interest. To this extent, the program describes the "important role" of the private sector -- like that of NGOs -- as "increasingly recognized." And the WHO also speaks of "a favorable climate" once more emerging for private sector research into contraceptives. The WHO reports that the unfavorable political climate of liability and regulatory constraints "are no longer regarded as the main impediments" to research. Now, the concerns are economic -- that "the cost of developing new products may be too high in relation to the paying capacity." The WHO pins its hopes for continued research on a new spirit of co-operation in which the private and public sectors work together more closely, saying: "It is now believed that the two sectors will need to collaborate in research in order to develop the contraceptives that meet peoples' needs and expectations beyond this decade." (full text)
Country report: Bangladesh. International Conference on Population and Development, Cairo, 5-13 September 1994.
[Unpublished] 1994. iv, 45 p.The country report prepared by Bangladesh for the 1994 International Conference on Population and Development begins by highlighting the achievements of the family planning (FP)/maternal-child health (MCH) program. Political commitment, international support, the involvement of women, and integrated efforts have led to a decline in the population growth rate from 3 to 2.07% (1971-91), a decline in total fertility rate from 7.5 to 4.0% (1974-91), a reduction in desired family size from 4.1 to 2.9 (1975-89), a decline in infant mortality from 150 to 88/1000 (1975-92), and a decline in the under age 5 years mortality from 24 to 19/1000 (1982-90). In addition, the contraceptive prevalence rate has increased from 7 to 40% (1974-91). The government is now addressing the following concerns: 1) the dependence of the FP and health programs on external resources; 2) improving access to and quality of FP and health services; 3) promoting a demand for FP and involving men in FP and MCH; and 4) achieving social and economic development through economic overhaul and by improving education and the status of women and children. The country report presents the demographic context by giving a profile of the population and by discussing mortality, migration, and future growth and population size. The population policy, planning, and program framework is described through information on national perceptions of population issues, the evolution and current status of the population policy (which is presented), the role of population in development planning, and a profile of the national population program (reproductive health issues; MCH and FP services; information, education, and communication; research methodology; the environment, aging, adolescents and youth, multi-sectoral activities, women's status; the health of women and girls; women's education and role in industry and agriculture, and public interventions for women). The description of the operational aspects of population and family planning (FP) program implementation includes political and national support, the national implementation strategy, evaluation, finances and resources, and the role of the World Population Plan of Action. The discussion of the national plan for the future involves emerging and priority concerns, the policy framework, programmatic activities, resource mobilization, and regional and global cooperation.
POPULATION BULLETIN OF THE UNITED NATIONS. 1993; (34-35):35-55.As preparation for the up-coming International Conference on Population and Development, an expert group meeting on population policies and programs was held in Cairo, Egypt, in April 1992. More than 20 years of experience in population policy implementation and program activity have led to continued progress, and successive evaluations have confirmed that effective policies and programs require 1) political commitment to allocate human and financial resources; 2) mobilization of individual and community support, active local participation, and the involvement of women in defining and implementing programs; and 3) development of an institutional framework for delivering services, training personnel, and developing networks of distribution points. General discussion centered on population distribution policies; globalization of the world economy; options for significantly reducing population growth rates; policies in sub-Saharan Africa, North Africa, and Western Asia; international migration; policies in Latin America and the Caribbean; policies in the developed countries; and the effect of HIV infections on health-care policies. Discussion of population programs considered the status of women, the design and implementation of programs, the challenges that remain, financial and material resources, and case studies of Rwanda and Indonesia. The mobilization of resources discussion included cost-sharing, involvement of the private sector, special problems of least developed countries, the scarcity of resources, the UNFPA, the World Bank, the AIDS crisis, the profile of bilateral donor support, socioeconomic policies, organizational research, and administrative overload in family planning programs. The expert group adopted 21 resolutions addressed to governments, social institutions, and funding agencies. The recommendations ask governments to include population considerations in all levels of decision-making, to adopt a longterm perspective in socioeconomic planning, to create an independent expert body to consider population issues, to insure awareness of the content of population policies on the part of those who must implement them, to decentralize the delivery of population policy services, to pay attention to the quality of FP programs, to improve the role of women in every aspect of life, to provide gender and age-specific FP and health care, to incorporate community participation at every stage of policy development, to develop a close partnership with the non-governmental sector, to support community-based development programs, to facilitate assistance by international organizations, to set clear population objectives, to monitor the impact of their structural adjustment programs, and to continue to strengthen the flow of information on population trends. Donors are asked to double their 1990 contributions, increase the staff devoted to population activities, and coordinate their efforts effectively. Developing countries should generate domestic resources for service-delivery. Research must be supported, and sustained political commitment is crucial.
GLOBAL AIDSNEWS. 1993; (3):7.Although treating and preventing sexually transmitted diseases (STDs) help reduce the spread of HIV, data must be obtained on the types and levels of these STDs, as well as the behavioral factors leading to their spread, before effective prevention interventions may be developed and implemented. To that end, the Department of Epidemiology of the All India Institute of Hygiene and Public Health, the World Health Organization, the Calcutta School of Tropical Medicine, the Calcutta National Medical College, and the Society for Community Development joined forces to conduct a STD/HIV survey and intervention project for prostitutes and clients in Sonagachi, a red light area in Calcutta. The cluster sample community-based survey of sexual practices and STD/HIV prevalence was the first of its kind in India. The survey revealed STD prevalences up to 50% among the prostitutes, but an HIV prevalence of only slightly more than 1%. These findings suggest an urgent need for general health care services in the area emphasizing the prevention and treatment of STDs. An integrated intervention project financially supported by the Norwegian Agency for Development was therefore developed to prevent the spread of STDs and HIV among prostitutes and their clients. The project provides basic health care services for prostitutes through a public health clinic on premises provided by a local youth club; provides educational programs and activities based on peer education and training, with materials developed for prostitutes and clients; and promotes and provides condoms.
Conservation of West and Central African rainforests. Conservation de la foret dense en Afrique centrale et de l'Ouest.
Washington, D.C., World Bank, 1992. xi, 353 p. (World Bank Environment Paper No. 1)This World Bank publication is a collection of selected papers presented at the Conference on Conservation of West and Central African Rainforests in Abidjan, Ivory Coast, in November 1990. These rainforests are very important to the stability of the regional and global environment, yet human activity is destroying them at a rate of 2 million hectares/year. Causes of forest destruction are commercial logging for export, conversion of forests into farmland, cutting of forests for fuelwood, and open-access land tenure systems. Other than an introduction and conclusion, this document is divided into 8 broad topics: country strategies, agricultural nexus, natural forestry management, biodiversity and conservation, forest peoples and products, economic values, fiscal issues, and institutional and private participation issues. Countries addressed in the country strategies section include Zaire, Cameroon, Sao Tome and Principe, and Nigeria. The forest peoples and products section has the most papers: wood products and residual from forestry operations in the Congo; Kutafuta Maisha: searching for life on Zaire's Ituri forest frontier; development in the Central African rainforest: concern for forest peoples; concern for Africa's forest peoples: a touchstone of a sustainable development policy; Tropical Forestry Action Plans and indigenous people: the case of Cameroon; forest people and people in the forest: investing in local community development; and women and the forest: use and conservation of forestry resources other than wood. Topics in the economic values section range from debt-for-nature swaps to environmental labeling. Forestry taxation and forest revenue systems are discussed under fiscal issues. The conclusion discusses saving Africa's rainforests.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992.  p.External donors provided plenty of funds to nongovernmental organizations (NGOs) in developing countries, hoping the governments would eventually support a national family planning (FP) policy. Lower levels of funding for population programs caused external donors to force NGO FP programs to become self-sustaining. Yet, it is likely to be difficult for them to improve the quality of services, expand coverage, and increase program sustainability all at the same time. External donors consider the 35-50% contraceptive prevalence rates that NGO FP programs are achieving to represent the early stages of sustainability at which time they divert funds to government programs. This loss of funds shifts the NGO program's focus from poor women to income-generation, made possible by targeting middle and upper income women. When diversion of funds resulted in a decline of contraceptive prevalence rates in Sri Lanka and stagnant rates in Pakistan and the Philippines. FP programs in Sri Lanka, Pakistan, and the Philippines first provided physician-controlled, reversible, clinical methods. Those in Sri Lanka and the Philippines next provided contraceptives through a widespread rural community-based distribution system. Pakistan held mass sterilization campaigns to address rapid population growth and high fertility. The management system of the national FP program in Sri Lanka is slow, and disruption of service delivery and supply systems is common Physician-trained nonphysician FP workers and the vertical national health and population sectors caused the stagnation in the public sector. The Philippines has trouble implementing public policy-based FP programs.
WORLD HEALTH. 1992 Sep-Oct; 28-9.Adding a tiny bit of iodine to salt is the standard and proven long-term strategy for controlling iodine-deficiency disorders such as endemic goiter and cretinism, physical and mental retardation, impaired school performance and work capacity, and increased rates of abortion, stillbirth, congenital anomalies, and perinatal, infant, and child mortality. The 1990 World Summit for Children acknowledged the magnitude and seriousness of this problem and called for efforts to eliminate the root cause of these conditions by the year 2000. Salt industry representatives and government officials from Botswana, Lesotho, Malawi, Mozambique, Namibia, Zaire, Zambia, and Zimbabwe subsequently met in April 1992 to decide how to ensure that all salt consumed in the region is iodinated at the production source. Workshop participants agreed on appropriate levels of iodine and suitable packaging to ensure the retention of iodine even after salt has been transported over great distances or stored for long periods. Moreover, the Botswana Company agreed to assume the cost of iodinating all salt for human and animal consumption which it will supply to 10 countries in southern and central Africa.
BMJ. British Medical Journal. 1993 Sep 18; 307(6906):729-30.The former Minister of Health responds to an earlier, inaccurate article about the dispute between some emergency ward physicians and the public sector in Chile. Even though the economy appears to be healthy, 38% of the population are poor. Chile has had a longterm social policy addressing socioeconomic problems in health and in education, resulting in impressive health indicators (e.g., in 1990, 97% immunization rate for children under 5 years of age. The Pinochet regime whittled away at the strong national health service, however, including a large reduction in staff in the mid-1970s and a 40% reduction in expenditures (and a response to the economy adjustment crisis). These actions became time bombs which exploded in May 1990, 2 months after the inauguration of the 1st democratically chosen president in years. The health unions and, later, physicians asked for higher wages. In late 1992, the government increased salaries by 35% in real terms and 100% in nominal terms. Between 1990 and 1993, 6000 people, which included 1200 physicians for rural areas, were added to the public sector staff. The government increased investment in equipment (around 10,000 pieces of equipment, including 10 CAT scans) and in infrastructure by 240%. 190 public hospitals are undergoing repair and renovation. 2 small hospitals have opened. 4 large regional hospitals are scheduled for completion in 1993 and 1994. During the 3 years of democracy, the public sector budget increased 50% in real terms. The World Bank has provided assistance for a health sector reform project to meet the challenges that accompany the demographic and epidemiologic transition, transitions from a planned to a market economy and from dictatorship to democracy, a cultural transition, and behavioral changes. Politicians and physicians do not necessarily support reforms, however, sometimes resulting in changes in ministers, such as the author of this article.
Lancet. 1993 Aug 14; 342(8868):440-1.The policy recommendations in the 1993 world development report (WDR) call for more investment in public health and clinical care, reducing poverty, increasing education for girls, and private health care provision. The structural adjustment policies supported by the World Bank influence growth, poverty, and health expenditure. All but 2 of the 10 studies on the effect of such policies on poverty and health were produced by or for the Bank. One study concluded that poverty levels increased in both Latin America and Africa between 1985 and 1990 and remained static in south Asia. Another study endorsed the view that structural adjustment in Africa had failed to generate economic growth, and it had resulted in a significant decline in investment. After nearly $150 billion of adjustment lending by the World Bank and the International Monetary Fund, there is a need to look for alternative policies. WDR claims that public spending on health in countries implementing structural adjustment policies recovered faster in the last few years of the 1980s than in non-adjusting countries. Yet the adjusting countries' per capita expenditure declined by the same amount as that of the non-adjusting countries between 1980 and 1990. The report's estimate of $12 per person for the cost of public health and essential clinical services in low-income countries is far beyond the health budgets of many for minimum levels of coverage of health services. In sub-Saharan Africa, donors already finance an average of 20% of health expenditure. In many areas where user charges have been introduced, there have been sharp declines in essential services and primary education and some evidence for reversals in maternal and perinatal mortality rates. In Guinea and Benin, the success of cost-recovery schemes and the improved services were in part achieved by the subsidies by UNICEF. The report does not suggest a strong commitment to integrated health systems.
[Unpublished] 1992 Apr 2. iv, 37,  p. (PN-ABL-448)The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.
Washington, D.C., Futures Group, Options for Population Policy, 1993 Feb. , 24 p. (Policy Paper Series No. 2)While in 1960, 9% of 415 million married women of reproductive age in less developed countries were using some form of fertility control, by 1990, the proportion had increased to 51% of 716 million women. Contraceptive use has expanded most in East and Southeast Asia and in Latin America. There has been also progress in South Asia, the Middle East, and North Africa. China accounts for over 40% of current users in the developing world. An approach to strategic planning at the sector level is outlined. OPTIONS for Population Policy II is a 5-year project funded by the Office of Population of the USAID. The goal of the project is to help USAID-assisted countries formulate and implement policies that address the need to mobilize and effectively allocate resources for expanding family planning (FP) services. The titles of the working papers published as part of an ongoing Policy Paper Series focusing on various aspects of operational policy in FP include: 1) Assessing Legal and Regulatory Reform in FP; 2) Strategic Planning for the Expansion of FP; 3) Policy Issues in Expanding Private Sector FP; 4) Communicating Population and FP Information: Targeting Policy Makers; and 5) Cost Recovery and User Fees in FP. Sector-level strategic planning is a 5-step process: 1) assessment of the current situation in the population/FP sector and examination of future prospects in the sector; 2) identification of the alternative program approaches that could be employed to achieve stated goals and objectives; 3) review and ranking of these programs for the selection of the one which best suits the needs and conditions of the country; 4) commitment by the decision makers to an action plan to implement the chosen program expansion strategy; and 5) agreement on arrangements for monitoring and periodic evaluations of programs.
Family planning and maternal and child health in the World Bank's Population, Health and Nutrition Program.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 548-61.Since 1969, the World Bank has been involved in lending programs for population, health research, and policy formulation. The department designation has undergone changes. The population, health and nutrition (PHN) Department is now the Population and Human Resource Division (PHR) in Country Departments. There are now country PHR divisions supported by 4 technical regional units with PHN expertise. 2% of the entire Bank's lending supports population and health activities. Lending has gradually increased and projections for 1989 are $500 million for 10 projects. In addition, the Bank has been involved with policy dialogue: the Bank has helped to raise the issue of slowing population growth in sub-Saharan Africa through conferences, workshops, and information dissemination at all levels. The importance of their work is in developing an environment for creating demand for family planning and primary health care. More projects are in Africa, but more dollars are in Asia (e.g., India and Pakistan). Improving maternal-child health is more acceptable to Middle Eastern, Latin American, and African countries than focusing on fertility reduction per se. Initial programs centered on expanding basic health services; now it also includes improving efficiency, effectiveness, and rural outreach. Recommendations are to target population groups, improve client/private interaction, flexibility in implementation based on client feedback, and utilization of nongovernmental organizations (NGOs). In 1988, civil projects constituted only 10-40% instead of 40-80% of project resources. Sponsorship serves another function of PHN, including WHO's Reproductive Research Program, Safe Motherhood Conference in 1987 and initiatives, the Task Force for Child Survival, and increasing technical abilities of NGOs.
POPULI. 1993 Jun; 20(6):6-7.The UN Population Fund (UNFPA) assists population programs and activities in 140 countries, with field offices in 95 countries and country directors in 59. Its staff of 801 worked last year on a budget of US $225 million. An evaluation of the Fund's operations was sponsored by the official development agencies of Canada, Finland, and Germany in 1992 and early 1993. Conclusions are based upon reviewed documents, interviews, meetings, and case studies of programs in Bangladesh, Bolivia, Brazil, Egypt, Indonesia, Kenya, and Senegal. Generally, the Fund has succeeded in establishing credibility and promoting population as a critical development issue, but its close ties and dependence upon the sanctions and participation of host governments have kept the Fund from maximizing the potential of nongovernmental organizations (NGO) and the private sector to implement projects. Projects are either supported because of government pressure or are not executed by the best executing agencies; only very limited project execution is conducted through the private sector of NGOs. The Fund should instead encourage competition among UN agencies, NGOs, and private companies interested in executing projects. The Deputy Executive Director agrees with these findings, but holds that their relationship with governments is the result of the UN requirement that the Fund work at the invitation of and through host governments. UNFPA-supported country programs have also relied too heavily on other UN agencies to execute projects which have suffered from poor project management and inadequate and/or poor technical support. Moreover, the evaluation revealed that the UNFPA is overextended and should emphasize helping countries which have already tried to move forward with their population programs. Countries should demonstrate need for assistance in addiction to the proper attitude and practices.
Washington, D.C., World Bank, 1993. vii, 103 p.The World Bank has conducted an assessment of the performance of family planning (FP) programs in developing countries. The first part examines their contributions and costs. It concludes that FP programs have played a key role in a reproductive revolution in these countries. Specifically, all developing regions have experienced a transition to lower fertility (e.g., in the last 20 years, fertility has fallen 33%), resulting in lower infant, child, and maternal mortality. One chapter looks at experiences in East Asia, South Asia, Latin America, and sub-Saharan Africa. World Bank staff use research to present a broad summary of what methods and characteristics achieve effective programs. The book addresses other social development interventions that contribute to a lasting reproductive revolution. Despite the positive results of FP programs, maternal mortality in developing countries is still much higher (10 times) than it is in developed countries and 25% of married women in developing countries report an unmet need for FP. Government commitment to FP programs needs to be strengthened and donor support should keep up with needs to expand successful FP programs. FP programs can satisfy these needs if they provide quality services, including a solid client focus, effective promotion, and strong encouragement of the private sector to increase their participation. Indeed, program quality must be the top priority. Strategic management of FP programs is also crucial. Programs need to integrate and coordinate effective promotion of FP, e.g., social marketing, with other activities.