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  1. 126

    Reproductive health programs supported by USAID: a progress report on implementing the Cairo Program of Action.

    United States. Agency for International Development [USAID]. Center for Population, Health and Nutrition

    [Washington, D.C.], USAID, 1996 May. [3], 20 p.

    This report details progress made by the US Agency for International Development (USAID) in implementing the Program of Action of the 1994 International Conference on Population and Development. The report contains an introduction and an overview of the USAID program. USAID reproductive health programs have: 1) provided leadership for a supportive policy environment through multilateral, regional, and country-level initiatives; 2) developed innovative techniques for operations, biomedical, social science research and for evaluation; and 3) implemented reproductive health programs that promote access and quality in family planning and other reproductive health services, maternal health, women's nutrition, postabortion care, breast feeding, sexually transmitted disease and HIV prevention and control, integrated reproductive health programs, programs and services for youth, prevention of such harmful practices as female genital mutilation, male involvement, reproductive health for refugees and displaced people, and involvement of women in the design and management of programs. USAID programs to advance girls' and women's education and empowerment have forwarded women's legal and political rights, increased access to credit, and developed integrated programs for women. Priority challenges and directions for the future include: 1) determining the feasibility, costs, and effectiveness of reproductive health interventions; 2) improving understanding of reproductive health behavior; 3) continuing development of service delivery strategies; and 4) mobilizing resources for reproductive health.
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  2. 127

    World is less crowded than expected, the U.N. reports.

    Crossette B

    NEW YORK TIMES. 1996 Nov 17; 3.

    According to a UN survey covering 1990-1995, world population growth is 1.48%, significantly less than the 1.57% projected in the 1994 report. Fertility declined to an average of 2.96 children per woman; the projected figure was 3.1. The world's population could number 9.4 billion in 2050, nearly half a billion lower than the 1994 projection. World population now numbers 5.77 billion and will stabilize, sooner than expected, at 10.73 billion in 2200 (chart). Joseph Chamie, director of the UN Population Division, cites family planning programs of the 1960s and 1970s and recent programs improving women's status for creating a steady continuous fertility decline in every region. J. Brian Atwood, administrator of the United States Agency for International Development (USAID), called the gains heartening at a time when population and development assistance programs are being cut. International family planning program critic, Representative Christopher H. Smith (Republican, NJ), is concerned abortions will be funded. He believes that money would be better spent on improving children's lives and strengthening market economies to create better living standards and smaller families, and that Western family planning programs are culturally intrusive. Mr. Chamie responds that population declines are much slower if couples lack access to safe, culturally and religiously acceptable contraception. As seen in Bangladesh, Syria, and Turkey, where birth rates declined before living standards rose, socioeconomic growth is unnecessary to bring down fertility. Childbearing and marriage are being delayed, and people are being given the chance to choose better lives.
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  3. 128
    Peer Reviewed

    Cairo dreams shattered.

    Potts M

    Lancet. 1996 Oct 12; 348(9033):976.

    In early October 1996, members of the US Congress voted for an omnibus spending bill, to take effect October 1, 1996, that provides $75 million less to population activities than the budget approved by the US Senate earlier in 1996. The budget for population matters is now set at $385 million. The US Congress has blocked any spending for population matters until March 1, 1997, effecting even more damage. It now has unprecedented controls on how USAID spends its money. The US gives less than 0.2% of its gross domestic product to foreign aid. The 1997 population budget equals the cost of one cheeseburger per US citizen. Yet, the US was the largest donor of population funds for many years. The 1993 Cairo International Conference on Population and Development (ICPD) stressed the need to improve reproductive health worldwide. The neediest countries can not afford to improve reproductive health on their own. ICPD identified a need for $5.7 billion annually from the donor community for family planning and reproductive health between 1993 and 2000. The US Congress' action has reduced actual funding to perhaps 20% of that target. People worldwide want smaller families. Women suffer from untreated sexually transmitted diseases and the ever-expanding HIV/AIDS epidemic. The newest cuts in population funds will make the Cairo dream a nightmare of increased expectations and declining resources.
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  4. 129

    Summary report of: Updating Service Delivery Guidelines and Practices: a Workshop on Recent Recommendations and Experiences, Guatemala City, Guatemala, March 6, 1995.

    Keller S

    Research Triangle Park, North Carolina, Family Health International [FHI], 1995 Aug. [2], 26 p. (MAQ: Maximizing Access and Quality)

    In March 1995, Family Health International (FHI), JHPIEGO Corporation, and seven collaborating agencies hosted an international workshop in Guatemala City so 60 family planning specialists from 23 countries could discuss how national guidelines for the use of contraceptives can be developed and implemented that are universally agreed upon and accepted. This workshop was held because a key obstacle of achieving high-quality family planning services is the lack of such guidelines. The participants reviewed the international recommendations developed by USAID and the World Health Organization (WHO). They also discussed the merits of the guidelines principle and learned from the pioneering countries in this initiative. The pioneering countries were presented in Session II as country case studies and included Mexico, Tanzania, and Turkey. The first session addressed the international initiative to update service delivery guidelines and practices, specifically how medical barriers stand in the way, and the WHO and USAID guidance documents. Session III involved working groups on contraception for young adults, contraception in postpartum care, contraception in postabortion care, progestin-only methods, and client perspectives. Participants suggested that the workshop be adapted into an easily replicated format to introduce the guidelines worldwide. The next step would be to translate the documents into national guidelines and convert them into changes in practice. One way would be to publish training materials for all levels of family planning providers. JHPIEGO has already published a user-friendly pocket guide in five languages to simplify the USAID and WHO documents. FHI has developed Contraceptive Technology Modules to educate policymakers and providers on the latest scientific information. JHPIEGO and FHI have created expert slides to accompany the modules.
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  5. 130

    Midterm review of the Tanzania Family Planning Services Support (FPSS) Project (621-0173).

    Shutt MM; Fleuret A; Kapiga S; Kirkland R; Magnani R; Mandara N; Mpangile G; Olson C; Omari CK; Pressman W

    Arlington, Virginia, Population Technical Assistance Project [POPTECH], 1994 Dec. xix, 84, [40] 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).
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  6. 131

    $17 billion needed by year 2000.

    Finger WR

    NETWORK. 1995 Sep; 16(1):13.

    The United Nations Population Fund (UNFPA) estimates that US$17 billion will be needed to fund reproductive health care in developing countries by the year 2000. About US$10 billion of would go for family planning: currently, the amount spent on family planning is about US$5 billion. Donors are focusing on fewer countries because of limited resources. The United States Agency for International Development (USAID) is planning to phase out support for family planning in Jamaica and Brazil because the programs there have advanced sufficiently. Resources will be shifted to countries with more pressing needs. Dr. Richard Osborn, senior technical officer for UNFPA, states that UNFPA works with national program managers in allocating resources at the macro level (commodities, training). Currently, two-thirds of family planning funds spent worldwide come from developing country governments (mainly China, India, Indonesia, Mexico, South Africa, Turkey, and Bangladesh). Sustaining programs, much less adding new services, will be difficult. User fees and public-private partnerships are being considered; worldwide, consumers provide, currently, about 14% of family planning funds (The portion is higher in most Latin American countries.). In a few countries, insurance, social security, and other public-private arrangements contribute. Social marketing programs are being considered that would remove constraints on prescriptions and prices and improve the quality of services so that clients would be more willing to pay for contraceptives. Although governments are attempting to fit family planning into their health care budgets, estimates at the national level are difficult to make. Standards are needed to make expenditure estimates quickly and at low cost, according to Dr. Barbara Janowitz of FHI, which is developing guidelines. Studies in Bangladesh, Ecuador, Ghana, Mexico, and the Philippines are being conducted, with the assistance of The Evaluation Project at the Population Center at the University of North Carolina and in-country organizations, to determine the amounts from government resources spent on family planning services in general and by function (training, administration, service delivery, and information).
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  7. 132

    Withholding of population funds, 13 August 1987.

    United States. Agency for International Development [USAID]


    The United States Agency for International Development (USAID) withheld from the United Nations Population Fund (UNFPA) $25 million appropriated for the Fund by the United States Congress. This was the third year that funds had been withheld. As in earlier years, the Reagan administration objected to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of limiting family size to one child, as sanctioning coercive abortions. (full text)
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  8. 133

    ICPD perspectives: institutional views. USAID begins initiatives, continues long-standing commitment.

    Gillespie D

    NETWORK. 1995 Mar; 15(3):25-7.

    The program of action developed at the 1994 International Conference on Population and Development will serve as the benchmark for policy discussions on population issues for years to come. It was made clear during the conference in Cairo that countries and the international community cannot afford to address key sustainable development issues one at a time. Instead, a commitment must be made to comprehensively and concurrently improve women's status, strengthen measures to protect the environment, advance reproductive health and rights, and stabilize population growth. UN experts estimate that a total of US$17 billion will be needed by the year 2000 to meet the basic population and reproductive health needs called for in the program of action. The US Agency for International Development (USAID) is participating in a cooperative global effort to implement the Cairo document. The entire agency is involved to some degree. In the population, health, and nutrition programs, which are the major focus of the Cairo recommendations, USAID will continue to invest considerable resources. USAID has emphasized maximizing access and quality of care in family planning, through improved training and other technical assistance to program managers and service providers in host countries. USAID has also begun new initiatives, including a focus upon the educational and service needs of youth, breastfeeding, emergency obstetrical care, family planning counseling and services, better access to prenatal and postnatal care, integrating STD prevention efforts with family planning, and improving STD diagnostic and treatment technologies. USAID is stressing a coordinated approach among related programs.
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  9. 134
    Peer Reviewed

    Interaction of condom design and user techniques and condom acceptability.

    Gerofi J; Deniaud F; Friel P

    CONTRACEPTION. 1995 Oct; 52(4):223-8.

    In November 1991 in Cotonou, Benin, 30 sex workers complained that the World Health Organization (WHO) blue condoms were not as good as the USAID condoms. The National AIDS Programme had replaced the USAID condoms with WHO condoms. Leading complaints about WHO condoms were in order of importance: causes pain in vagina, too short, too small, insufficient lubrication, breaks easily, and several condoms needed per client due to breakage. Samples of both condoms underwent laboratory tests to learn more about the complaints. Informal interviews were conducted with professionals in contact with users (e.g., family planning workers and condom vendors) and condom users (prostitutes, bar girls, and men). There were some differences between the two condom types. For example, the USAID condom exerted 20-30% less pressure on the penis than the WHO condom. However, researchers considered the differences to be too small to completely explain the complaints. Two social workers had done a suboptimal job of explaining to sex workers how to unroll condoms. Other than these sex workers, others accepted the WHO condom well. Both condoms had at least the same strength, suggesting that other factors likely explain the complaints (e.g., breakage). The WHO condom had less lubricant than the USAID condom (223 vs. 451 mg), yet the amount was within the range of that on the commercial market. One batch of WHO condoms had much less lubricant than other WHO batches. Even though the sex workers complained that the WHO condom was too short, it was actually longer than the USAID condom, suggesting that the WHO condoms were not unrolled completely. These findings indicate the need to teach correct application procedures to condom users and to make condoms as immune as possible to incorrect or suboptimal techniques (e.g., changes in lubricant).
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  10. 135

    Prepared remarks.

    Wilson A

    [Unpublished] 1994. Presented at the Conference on Unsafe Abortion and Post Abortion Family Planning in Africa, Mauritius, March 24-29, 1994. 2 p.

    A representative of USAID addressed the International Planned Parenthood Federation Conference on Unsafe Abortion and Postabortion Family Planning (FP) in Africa, which was held in Mauritius in March 1994. She noted that USAID's population and health sector strategy has the following priority objectives: 1) to promote the rights of individuals and couples to determine freely and responsibly the number and spacing of their children; 2) to improve individual health, with special attention to the reproductive health needs of women and adolescents and the general health needs of infants and children; 3) to establish programs which are responsive and accountable to the people who use them; and 4) to achieve population growth rates which are consistent with sustainable development. The goal of halving the current maternal mortality rate within a decade is consistent with these objectives, and, thus, unsafe abortion is an area of critical interest. First of all, unsafe abortion is among the five primary causes of maternal death and leads to serious morbidity. Secondly, treatment of the complications of unsafe abortion consumes large amounts of the health resources in many developing countries. USAID will continue to make access to voluntary FP services a priority and will give increasing emphasis to the provision of postabortion FP counseling and services.
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  11. 136

    Collaborative planning exercise with WHO / AFRO in support of immunization and disease control programs in Africa, Brazzaville, Congo, February 13-17, 1995.

    Steinglass R

    Arlington, Virginia, Partnership for Child Health Care, 1995. [3], 11, [44] p. (BASICS Trip Report; BASICS Technical Directive: 000-AF-51022; USAID Contract No. HRN-6006-C-00-3031-00)

    The BASICS (Basic Support for Institutionalizing Child Survival Project) coordinator of the Expanded Program on Immunization (EPI) went to Brazzaville, the Congo, to take part in a collaborative planning activity with the World Health Organization (WHO)/AFRO, the US Agency for International Development (USAID)/Global Bureau, and USAID/Africa Bureau staff to draft immunization activities that BASICS and WHO/AFRO will conduct over the next three years. USAID/Africa Bureau is supporting WHO/AFRO child survival activities, particularly immunization and malaria control. It is funding BASICS to strengthen systems and capacity-building for immunization and disease control programs in Africa. The BASICS Coordinator helped WHO/AFRO with preparations of a proposal for an EPI grant from USAID/Africa Bureau (Development Fund for Africa). The proposal addresses funding gaps to support implementation of the regional plan of action. The proposed project aims to increase the effectiveness and sustainability of EPI in Africa by improving regional and national capacity to plan, manage, monitor, and evaluate immunization programs. Its components include the planning of a national immunization program, vaccine supply and quality assurance, training, and strengthening of logistics and cold chain systems. The grant is for $780,050 in year 1 and $535,950 in year 2. WHO/AFRO will give preference to those countries with USAID missions. BASICS will obtain funds from different areas (e.g., USAID Africa Bureau and USAID missions) to provide WHO/AFRO technical support.
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  12. 137

    Planning meeting to discuss development of a health facility quality review, WHO / CDR and USAID / BASICS, Geneva, May 15-19, 1995.

    Murray J

    Arlington, Virginia, Partnership for Child Health Care, 1995. [4], 9, [2] p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 55 012; USAID Contract No. HRN-6006-C-00-3031-00)

    In May 1995, representatives of the World Health Organization Division of Diarrheal and Acute Respiratory Disease Control and of the US Agency for International Development's Basic Support for Institutionalizing Child Survival Project (BASICS) met in Geneva to discuss the first phase of the process of developing a methodology for collecting information on the quality of facility services in areas where integrated case management is being used. This monitoring and evaluation instrument is called Health Facility Quality Review: Case Management of Childhood Illness. The discussions revolved around the focus of activities, series of quality review activities, personnel, facilities, health workers observed and interviewed, indicators, pre-assessment for program planning, the process, materials, sampling, guidelines for developing forms, country adaptation, and format. A BASICS staff member has developed a pre-assessment tool for program planning scheduled to be used in Eritrea in June 1995. Content categories of the Health Facility Quality Review forms should include case observation, case examination, caretaker interview, health worker interview, review of records, review of facility space and furnishings, review of availability of facility equipment and supplies, review of drug supplies, review of vaccines available, review of other supplies, drug management, staffing, supervision, clinic organization, and interventions. BASICS will budget and make plans for the field test of the quality review during June-July 1995. It will oversee the pretest of forms probably in October 1995.
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  13. 138

    Visit to WHO / GPV to discuss introduction of vaccine vial monitors, March 20-24, 1995.

    Fields R

    Arlington, Virginia, Partnership for Child Health Care, 1995. [3], 10, [14] p. (BASICS Trip Report; BASICS Technical Directive: 000 HT 51 012; USAID Contract No. HRN-6006-C-00-3031-00)

    In March 1995, a BASICS (Basic Support for Institutionalizing Child Survival) Project technical officer participated in a World Health Organization (WHO) Global Programme on Vaccines and Immunization (GPV) meeting in Geneva, Switzerland, about introduction of vaccine vial monitors (VVMs). VVMs constitute color-coded labels that can be affixed to vials of vaccines which, when exposed to heat over time, change irreversibly. In 1994, WHO and UNICEF requested that, starting in January 1996, VVMs be affixed on all UNICEF-purchased vials of oral polio vaccine. Yet, UNICEF does not require vaccine manufacturers to include VVMs in their vaccine labels. USAID has supported much of the development and field testing of VVMs since 1987. Participants discussed status of interactions between UNICEF and vaccine manufacturers, issues and means related to introducing VVMs worldwide, and the prospect for conducting a study or studies on the initial effect of VVMs on vaccine-handling practices. They also heard an update on the pilot introduction of VVMs in some countries. BASICS could contribute to the development of a plan for global VVM introduction, since time constraints and heavy workloads face WHO/GPV leaders. UNICEF and GPV staff suggested that other VVM products from different manufacturers also be sold to avoid a monopoly. Participants considered issues of global introduction and resolution of issues with manufacturers of VVMs and vaccines to be high priority issues. WHO and UNICEF asked BASICS to draft general training materials for staff at the central, provincial, district, and periphery levels, focusing on actions that each level should take as a result of VVM use. They also asked BASICS to develop a quick-reference sheet for policy makers.
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  14. 139

    Withholding of funding for UNFPA, 1988.

    United States


    In 1988, USAID decided for the fourth year in a row to withhold its contribution to the UN Population Fund (UNFPA). The contribution amounts $25 million. The stated reason for the withholding of funds was the same as in past years: the Agency's objection to UNFPA support for China. It viewed China's family planning program, which emphasized the importance of one child per family, as sanctioning coercive abortions. (full text)
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  15. 140

    Cameroon: official lethargy blamed for donor pull-out.

    AIDS ANALYSIS AFRICA. 1995 Jun; 5(3):9-10.

    Cameroon participated in World Health Organization (WHO)-coordinated global AIDS control efforts for about 10 years, when the HIV/AIDS epidemic was just beginning in Cameroon. The government established a National AIDS Committee and AIDS Control Service to provide information on prevention of HIV/AIDS. The National AIDS Program was donor-oriented, donor-driven, donor-sustained, and donor-sustaining. It failed, as illustrated by a strong increase in HIV seroprevalence between 1989 and 1992 from 60 to 1304 cases. The donors then abandoned Cameroon. Government officials did not decentralize the program, largely because they believed that districts and communities are incapable of understanding HIV/AIDS-related issues and of managing money from donors. Since the primary health care (PHC) system broke down, it was impossible to integrate HIV/AIDS control activities into PHC, needed for program sustainability. The government did not commit financial resources to the national AIDS program. When donors first provided monies to Cameroon, the economy was strong. 10 years later, a politically and economically unstable situation prevails in Cameroon. WHO has recalled all its staff in Cameroon. The donors often attached conditions that hurt HIV-infected persons. The European Union did not implement a project to train laboratory technicians in the screening and diagnosis of AIDS because of problems encountered with its blood banking and its youth projects, also in Cameroon. Both of these projects have ended. The USAID Office closed in 1994 with about three months' notice, allegedly due to clashes with the Cameroon government. Not all persons working with the funding agencies have totally abandoned Cameroon, however. The government needs to be more concerned about its people and allocation of resources. As Cameroon struggles with its problems, HIV/AIDS is increasing in Cameroon.
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  16. 141

    Partners: existing health institutions.

    Rosenbaum J

    In: Partners against AIDS: lessons learned. AIDSCOM, [compiled by] Academy for Educational Development [AED]. AIDS Public Health Communication Project [AIDSCOM]. Washington, D.C., AED, 1993 Nov. 67-76. (USAID Contract No. DPE-5972-Z-00-7070-00)

    AIDSCOM's Resident Advisor to the WHO Caribbean Epidemiology Centre (CAREC) discussed partnerships with existing health institutions. These institutions included Ministries of Health, multilateral agencies (e.g., WHO and UNICEF), family planning associations, universities, international private voluntary organizations, bilateral agencies (e.g., Canadian International Development Agency), and indigenous nongovernmental organizations (NGOs). AIDSCOM helped them develop an appropriate and effective conceptual approach to HIV prevention, which generally meant integrating new HIV prevention skills and concepts into existing programs and activities. AIDSCOM technical assistance addressed issues of accessibility of health services, testing, counseling, policy and confidentiality. Technical assistance included improved planning and management, program design skills, materials development, training in prevention counseling and condom skills, and a model for personal and professional behavior regarding AIDS, sex and risk. A key factor contributing to a successful partnership with CAREC was continuity of AIDSCOM staff contact. AIDSCOM helped CAREC with social marketing and behavioral research. It helped CAREC and its national counterparts to develop a regional KABP protocol for all 19 countries. AIDSCOM helped implement the protocol and strategize how to develop programmatic activities based on the results. The identified activities were training health workers and HIV prevention counselors promoting condom skills, establishing 5 national AIDS hotlines, developing 3 national media campaigns, and developing music, theater, and radio dramas. AIDSCOM and CAREC became partners with local NGOs who had access to hard-to-reach groups. Lessons learned included: technical assistance helps heath projects shift program emphasis from information to behavior change; successful partnership result in innovative programs; and proven effectiveness can be replicated in parallel programs.
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  17. 142

    Re-tooling in applied social investigation for development planning: some methodological issues.

    Cernea MM

    In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 11-23.

    Rapid assessment procedures (RAP) grew explosively in the 1980s in the social investigation of development work, with four main trends to be distinguished: 1) fast repertoire enrichment with new and imaginative procedures; 2) application of RAP in new sectors through content-adaptation and cross-fertilization (rapid rural appraisal by Chambers); 3) geographic broadening in both elaboration and application of RAP (from Sussex, England, to Thailand, Kenya, and India); and 4) the growing shift from technique to substance. There has been compelling demonstration of RAP's potential for changing and improving the planning of development. RAP can increase the planners' ability to put people first in the development projects. Furthermore, a decade of RAP work has launched some social sciences on a path of methodological retooling. Some major development agencies (the World Bank, USAID, ODA) have started to use RAP. The World Bank has been striving to promote the use of sociological/anthropological investigation methods for generating social information needed in projects. The RAP field work of a medical anthropologist who had received a 2-year contract from USAID to conduct research in Swaziland within a water-borne disease project illustrates the value of RAP. He questioned the lengthy sample survey and carried out an informal study of the health beliefs and behavior among traditional healers and rural health motivators. Within 6 months he collected sociocultural information and specific health-related data which led to significant improvement in the public health network via cooperation between traditional and modern health practitioners. The epistemological risks of RAPs result from the limitations intrinsic to the procedures themselves: accuracy, representativeness, cultural appropriateness, and subjectivity. The extrinsic risks are an improper contextual place or weight within the research strategy. These limitations can be overcome by professional training of RAP practitioners. Nevertheless, RAPs are not a universal cure for gaps in social information, and long-term social research is still essential.
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  18. 143

    Indonesia trip report, September 1994.

    Frere JJ

    Arlington, Virginia, Partnership for Child Health Care, 1994. [3], 10, [4] p. (BASICS Trip Report; BASICS Technical Directive: 000 IN 00 011; USAID Contract No. HRN-6006-C-00-3031-00)

    A World Bank-supported BASICS project will respond to the government of Indonesia's request to improve the public provision of health care. An informal agreement existed between BASICS, the World Bank, and the Indonesian Ministry of Health to conduct a joint visit to Indonesia during the preparation of the Bank's Health Project IV. That visit was conducted between September 21 and October 8, 1994, and included several field trips to East Java, East Nusa Tengara, West Kalimantan, and Central Java. The technical note included in this report considers some possibilities of the expansion of the private sector in modern Indonesia. The provision of specialized health services to remote areas, the support of training activities, the stimulation of behavioral changes, and ensuring quality assurance for the private sector are discussed. The technical note also emphasizes the need to look beyond the health center especially since the current systems often fail to address basic health needs. Many opportunities exist for BASICS to play an important role in Indonesia, but it is unclear how many resources USAID/Jakarta will have to invest in child survival activities. The anticipated modest size of resources will probably restrict BASICS activities to the private sector, the district level, and potentially operations research activities. Ongoing research into urban health is a promising area. Most of the possible lines of action concerning support to the private sector are outlined in the technical note.
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  19. 144

    New world order and West's war on population.

    Wilson A

    ECONOMIC AND POLITICAL WEEKLY. 1994 Aug 20; 29(34):2,201-4.

    The aim of US-promoted population policies is maintaining and securing the economic and political dominance of capitalist states. Governments of developed countries blame overpopulation in developing countries for destroying the planet and those of developing countries blame overconsumption, waste, and industrial pollution in the capitalist countries to be responsible. Developed countries and the UN profess that population control is in the interests of development and for the sake of women's rights. Many women's groups protest planned and already existing population policies and bear witness to the suffering women from developing countries experience, raising the question of choice of these policies. Sexism served as the smokescreen behind which US strategies of population control were implemented. The concept of sustainable development is also used to advance population policies in developing countries. Developed countries use this concept to maintain the status quo, agricultural countries as such, cash crop economies, dependency on food, foreign aid, and loans and to continue their exploitation in developing countries. USAID, UNFPA, and the World Bank are the major moneylenders for population control. The US targets Africa for population control because it produces 90-100% of four minerals vital to US industry. The new phase of capitalist development has shifted the state's role from its function as a nation state to facilitator of global capital. Population control policy, national security laws, and anti-trade union laws are used to create a docile and immobile pool of labor. The World Bank, the IMF, and the WTO, through their structural adjustment policies, provide the infrastructure to implement population policies and targets. Population policies focusing on targets take control away from women. People in developing countries will not accept these population policies until they have control of their lives. They need assurance of child survival and to be in a position to plan their future. The population control lobby now uses deception to thwart resistance.
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  20. 145

    USAID negotiating Depo purchase, but shelf life proves problematic.

    FAMILY PLANNING WORLD. 1993 Jul-Aug; 3(4):7, 21.

    The discussion focused on the variations in purchasing agreements for the injectable Depo-Provera. Negotiations are in process between the manufacturer in the US (the UpJohn Company) and USAID regarding size of purchase, prices, and time schedules. A glitch is that the US production plant provides a two-year shelf life for the product, while the Belgian plants provide a three-year shelf life. The one year difference could be significant in the distribution to hard-to-reach places, but the balancing point is that USAIDs effort are a positive development for expanding distribution. The UN Population Fund (UNFPA) and the International Planner Parenthood Federation (IPPF) already distribute Depo-Provera and were charged 72 and 75 cents, respectively; UpJohn recently increased the prices to 80 and 85 cents. The UNFPA prices were slightly lower due to larger purchases, and both concerns will be awaiting the outcome of USAID's price negotiations. Other manufacturers are a company in Indonesia, which sells only within the country, and Organon in Holland, which produces the drug under the name Megstron. UpJohn has the major share of the market. The cost of supplying Depo-Provera also includes the purchase of needles and syringes. Other international agencies are not limited by anything other than finding the lowest cost. UNFPA buys its supplies in Belgium at low cost and its contraceptives in Holland. USAID, however, must purchase needles and syringes from American facilities. IPPF will be watching to assure international organizations that no duplication of effort will occur with the USAID distribution and expects the shelf life problem to be resolved. The issue may be cleared up when UpJohn has sufficient time to resubmit its application with enough research to support the 3-year shelf life; the FDA had rejected Depo-Provera repeatedly since 1961, and the approval was granted on a rushed application that only included some of the Belgian research and could empirically only support a 2-year shelf life.
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  21. 146

    The greening of giving. Aid and the environment.

    ECONOMIST. 1994 Jan 7; 53-6.

    The intricacies of aid distribution and the impact on the environment are discussed in this article. Topics include routine environmental impact assessments (EIAs), the procedures for determining aid recipients, the interaction between national and local governments and donors, the impact of structural adjustment plans, and criticisms of the Global Environment Facility (GEF) managed by the World Bank. Aid programs have been criticized for not taking environmental impact into consideration in project planning; for increasing the wealth of the recipient country's elite or professional classes; and for improving foreign technologies and changing established practices. There is also a unifying position: promotion of sustainable development regardless of economic growth. The arguments center on whether a project assured sustainable development or nor or whether the environment was good for aid. Nongovernmental organizations (NGOs) are in pivotal positions in environmental and development planning. In the US, NGOs act as watchdogs for "ungreen" activities of multilateral development banks. Their influence has positively affected activities of US AID, which routinely carries out EIAs. In 1989, the World Bank followed suit and now produces an annual environmental report. Most multilateral donors consider environmental impact at present. The objection now is that the EIAs stifle development or that development good may only be achieved with environmental harm. The way aid is given has been affected. Development programs that add an environmental component are easily accepted; for instance, a "run of the mill" power plant proposal with a strategy to improve air quality is likely to have support. There is more aid than the supply of projects. Collaborative projects are common. Capacity building is being encouraged, and investments are being made not in feasibility studies for waste disposal schemes but in designing management systems. Environmental policy must involve governments in determining priorities and developing environmental plans. Biodiversity plans are required, if the country signed the convention on biodiversity, for instance. Donor restrictions from above or secret UN project endorsements are not always well received in recipient countries; World Bank policies have indirectly impacted on the environment.
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  22. 147

    Medical education in the context of diarrheal disease control.

    Northrup RS

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1993 Jul. 20 p. (PRITECH Issues Paper No. 1; USAID Contract No. DPE-5969-A-00-7064-00)

    In the 1980s, Technologies for Primary Health Care [PRITECH] was involved in control of diarrheal diseases (CDD) projects that stressed oral rehydration therapy in many developing countries. In the mid 1980s, CDD training added diarrhea training units in teaching hospitals to train medical students in correct diarrhea case management. The World Health Organization (WHO) had developed a special case management course and supportive teaching materials for trainers and trainees that included hands-on training but not follow-up of the trainees. WHO and USAID worked with PRITECH to develop practical learning diarrhea-related activities and teaching materials for medical schools in developing countries. PRITECH introduced the activities from the medical education package in Pakistan, Indonesia, and the Philippines prior to 1988. It set up a pilot projects of the full package in the Philippines and Indonesia. WHO/CDD recommended revisions to the package in 1992. The major revision was adding a detailed workshop guide for national level workshops in introduce faculty to the new materials. The revised package was piloted in Vietnam, Nigeria, and India. In 1986, WHO and PRITECH/Sahel Office embarked on improving the diarrhea-related curriculum of nursing schools in the Sahel countries of Africa. Nursing teachers taking part in a workshop helped develop competency-based modules. These modules include an epidemiological overview and clinical concepts, treatment and prevention of diarrheal, disease, appendix (cholera), application of health education techniques to CDD programs, elements of a national program to combat diarrheal diseases, and a field training workbook and teacher's guide. 16 of 21 nursing schools in the Sahel are using them. The nursing curriculum provides for follow-up visits to CDD programs. The medical schools' teaching program needs to consider various issues, e.g., CDD medical education in an integrated context. Recommendations for donors concludes this summary report.
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  23. 148

    Discussions and briefing at the WHO Global Programme for Vaccines and Immunization, December 16, 1994.

    Steinglass R

    Arlington, Virginia, Partnership for Child Health Care, 1994. [3], 10, [29] p. (BASICS Trip Report; BASICS Technical Directive: 000 NS 01 001; USAID Contract No. HRN-6006-C-00-3031-00)

    A staff member from BASICS (Basic Support for Institutionalizing Child Survival) spent December 16, 1994, with staff of the World Health Organization (WHO) in Geneva to 1) introduce BASICS' Expanded Program on Immunization (EPI) strategy; 2) present BASICS' research and development priorities for the second year of the project; 3) review the countries currently receiving BASICS EPI technical assistance and those which may receive assistance in the future; and 4) discuss coordination with WHO of some of the upcoming opportunities in individual countries. Ways in which WHO can access BASICS resources and help open doors at country level for BASICS technical assistance were stressed. This trip report contains notes of conversations with WHO staff about these issues as well as reminders of follow-up actions needed. The appendices provide details of the WHO group briefing, the research and development priorities of the BASICS working group on sustainability of immunization programs, a list of persons contacted, the structure of the provisional staff for the Global Programme for Vaccines and Immunization (GPV), a description of the structure of the GPV, and the GPV technical briefing schedule.
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  24. 149

    International population institutions: adaptation to a changing world order.

    Crane BB

    In: Institutions for the earth: sources of effective international environmental protection, edited by Peter M. Haas, Robert O. Keohane, and Marc A. Levy. Cambridge, Massachusetts, MIT Press, 1993. 351-93. (Global Environmental Accords)

    This paper describes the political forces which have shaped the agendas and policy formulation of international population institutions (IPI) as well as their institutional characteristics and outputs. It also assesses the contributions of IPIs to national population policy formulation and implementation. During the almost three decades during which IPIs have existed, important exogenous changes have occurred in North-South and East-West relations as well as in the domestic politics of key countries involved in population issues. Although population as an issue has remained somewhat insulated from the large-scale changes in the international political and economic order, the impact of such changes on the preferences and resources of governmental and nongovernmental actors has nonetheless been evident in the decision-making forums of IPIs. There have also been changes and developments in the relevant science and technology as well as in the institutional structures and procedures of the IPIs themselves, which over time have influenced the formation of actors' preferences. IPIs are examined over the following three phases of their history: 1965-1974, the period of rapid growth in IPIs under leadership from the US and other Western donor countries; 1974-1984, a period of greater accommodation to the preferences of developing countries; and 1984-1991, a period marked by conflict over IPIs and a search for new sources of support, especially from the transnational environmental movement. A major challenge for IPIs in this recent period has been adapting to the withdrawal of the US government from participation in the UN Population Fund and the International Planned Parenthood Federation in response to domestic political pressure from individual and group lobbies against women's right to abortion.
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  25. 150

    Tuberculosis control in seventeen developing countries.

    Shepperd JD

    [Unpublished] 1994 Sep. Presented at the 122nd Annual Meeting of the American Public Health Association [APHA], Washington, D.C., 1994. iii, 28 p.

    Tuberculosis (TB) is the leading cause of morbidity and mortality from an infectious disease and is responsible for 3.9 million deaths/year. The incidence and severity of TB are exacerbated by the rapid spread of HIV infections. In 1993, a USAID task force presented a report on the TB situation in less developed countries and recommended agency actions (no policy decisions have been made). The World Health Organization (WHO) subsequently requested USAID assistance for a broad range proposal to tackle the problem of TB and implied that WHO had developed a cost effective TB strategy. USAID requested the country evaluations WHO referred to in its proposal, and this report is based on a review of those data. The country reports reviewed are from Burundi, Comoros, Ethiopia, Guinea, Rwanda, Somalia, Tanzania, Malawi, Mozambique, Afghanistan, China, India, the Philippines, Brazil, Cuba, Nicaragua, Algeria. A summary is presented for each country report (except Afghanistan), overall findings are discussed, and unmet needs are identified. In general, the reports summarized from a variety of authors indicate that TB can be controlled through an extraordinary devotion of resources. Only Cuba treats TB as a socioeconomic problem; most of the other reviewers were entirely concerned with the medical aspects of the complex multidrug therapy approach and almost ignored that fact that patient compliance averaged only 30% unless there was massive donor support. It is concluded that the following needs must be met to address TB: 1) political commitment to TB control must be strong; 2) the cost of TB to economic security must be established; 3) the public understanding of TB must be enhanced; 4) the serious barriers to treatment must be addressed; 5) the health care delivery systems in developing countries must be strengthened; and 6) the capacities to support TB control must be increased. It was recommended that existing projects could be supplemented by a program which would cost US $2-5 million/year in order to address some unmet needs in the technical areas of training, research, and advocacy in developing countries.
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