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  1. 176

    Population policies and programmes: lessons learned from two decades of experience.

    Sadik N

    New York, New York, New York University Press, 1991. xxiv, 464 p.

    This publication contains an UNFPA assessment of the accomplishments of population activities over the last 20 years. The world's leading multilateral population agency, UNFPA decided to conduct the study in order to identify obstacles to such programs, acquire forward-looking strategies, and facilitate interagency cooperation. The 1st section examines 3 categories of population activities: 1) population data, policy, and research; 2) maternal and child health, and family planning; 3) and information, education, and communication. This section also recognized 9 key issues that affect the success of population programs: political commitment, national and international coordination, the role of non-governmental organizations (NGOs) and the private sector, institutionalization, the role of women and gender considerations, research, training, monitoring and evaluation, and the mobilization of resources at the national and international level. The 2nd section of the publication discusses population policies and programs in the following regions: sub-Saharan Africa, the Arab States, Asia and the Pacific, and Latin America and the Caribbean . Finally, the 3rd section provides and agenda for the future, discussing the significance of international efforts in the field of population, as well as pointing out the programmatic implications at the national and international levels. 2 annexes provide demographic and socioeconomic data for 142 countries, as well as the government perceptions of demographic characteristics for individual countries.
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  2. 177

    AIDS vaccine trials: bumpy road ahead.

    Cohen J

    SCIENCE. 1991 Mar 15; 251:1312-3.

    AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
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  3. 178

    Management information systems in maternal and child health / family planning programs: a multi-country analysis.

    Keller A

    STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):19-30.

    Management and information systems (MIS) in maternal and child health were surveyed in 40 developing countries by trained consultants using a diagnostic instrument developed by UNFPA and the Pan American Health Organization (PAHO). The instrument covered indicators of input (physical infrastructure, personnel, training, finances, equipment, logistics), output (recipients of services, coverage, efficiency), quality, and impact, as well as frequency, timeliness and reliability of information. The consultants visited national and 2 provincial level administrative and service points of public and private agencies. Information on input was often lacking on numbers and locations of populations with access to services. In 15 countries data were lacking on personnel posts filled and training status. Logistics systems for equipment and supplies were inadequate in most areas except Asia, resulting in shortfalls of all types of materials and vehicles coinciding with idle supplies in warehouses. Financial reporting systems were present in only 13 countries. Service outputs were reported in terms of current users in 13 countries, but the proportion of couples covered was unknown in 25 countries. 2 countries had cost-effectiveness figures. Redundant forms duplicated efforts in half of the countries, while data were not broken down at the usable level of analysis for decision-making in most. Few African countries had either manual or computer capacity to handle all needed data. Family planning data especially was not available to draw the total picture. Often information was available too late to be useful, except in Portuguese speaking countries. Even when quality data existed, managers were frequently unaware of it. It is recommended that training and consultancies be provided for managers and that these types of surveys be repeated periodically.
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  4. 179

    Why Audubon has population programmes.

    Baldi P

    EARTHWATCH. 1991; (41):15.

    The National Audubon Society began a population program in 1979, set up a 5-year plan of public education, advocacy and coalition-building in 1985, and joined a broad-based coalition of the Sierra Club, the National Wildlife Federation, the Population Crisis Committee and the Planned Parenthood Federation of America in 1990. The 1985 impetus resulted in production of teaching materials and staging of focus groups across the U.S. The 1990 coalition has directed funds to the USAID Office of Population. Another project is the International Environment/Population Network, which organizes letter-writing, media programs and town meetings for ordinary citizens to press for sustainable development. Many of the Audubon's 510 local chapters have partnerships with similar groups in other countries, as do 8 wildlife sanctuaries have links to sanctuaries abroad. An example is the Indus River in Pakistan visited by the manager of Audubon's Platte River Sanctuary in Nebraska. The 2 rivers share the problem of reduced flow and vegetation overgrowth as a result of engineering projects upstream.
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  5. 180

    Give the people what they want and spread their satisfaction for others to follow. The Indonesia FP experiences.

    Suyono H

    Jakarta, Indonesia, National Family Planning Coordinating Board, 1989. 12 p. (HMA.78/KA/89)

    In 1970 when the family planning (FP) program was launched in Indonesia the population numbered 120 million with an annual growth rate of 2.3%. As of the early 1980's the growth rate started to decline, but the population still reached 178 million by 1989. The strategy called for institutionalizing and popularizing the concept of the small, happy, and prosperous family. The program went through several phases: institution-building, maintenance and implementation, and graduation with community participation. Rural successes in contraceptive prevalence has to be counterbalanced by an urban campaign during 1984-85 when rapid expansion of FP courses in 31 cities were initiated. The private sector supply was set up for private clinics taking care of acceptors. The Blue Circle IEC Campaign was instituted with the support of USAID and the Johns Hopkins PCS project. This entailed using private advertising to develop mass media promotion for FP providers of high quality, low cost contraceptives. In 1986 the condom called Dua Lima was introduced by cooperating with the Somarc project of The Futures Group. A 40-60% discount was effected for products under the Blue Circle label. The idea of self-reliant FP has taken hold.
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  6. 181

    Family planning, the Lebanese experience. A study on the Lebanese Family Planning Association.

    Iliyya S

    [Unpublished] 1984 Jul. [4], 193 p.

    As of 1984, Lebanon had not yet formulated a clear and specific population policy because laws existed against contraception and political differences among the various ethnic groups also existed which culminated in a civil war. Nevertheless the government condoned the creation of the Lebanese Family Planning Association (LFPA) in August 1969 and its activities. The government also helped spread family planning through its own institutions such as the Ministry of Health and the Office of Social Development. Further some of LFPA's staff members have been part of the government itself. LFPA conducted a survey in June 1975 in Zahrani in rural south Lebanon and it showed that the people wished to limit their fertility, but could not since birth control was not available. Therefore LFPA established the 1st Community Based Family Planning Services Program in Zahrani which later spread to other villages. Wasitas (field workers) served as the major means of providing birth control and information to the women. They emphasized child spacing. The wasitas also served as a major adaptive and indigenous agent of social change and development. Initially they underwent intensive training lasting at least 1 week, but in 1979, LFPA hosted annual 1 month training sessions. The wasitas use of traditional communication methods resulted in not only an increase of contraceptive use, but also in meeting the elemental needs of the women for psychological comfort and self reliance. In some instances, however, some wasitas resorted to deception in encouraging the most uneducated women to use birth control because of strong incentives, e.g., the wasita received 50% of the money earned for the sale of each contraceptive. LFPA needed to reassess those measures which lead to possible encroachment of the dignity and freedom of choice of the women villagers.
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  7. 182

    The state of world population 1991.

    Sadik N

    New York, New York, United Nations Population Fund [UNFPA], 1991. [4], 48 p.

    Developing countries increased their commitment to implement population policies in the late 1980s and early 1990s with the support and guidance of UNFPA. These policies focused on improving, expanding, and integrating voluntary family planning services into social development. 1985-1990 data revealed that fertility began to fall in all major regions of the world. For example, fertility fell most in East Asia from 6.1-2.7 (1960-1965 to 1985-1990). This could not have occurred without strong, well managed family planning programs. Yet population continued to grow. This rapid growth hampered health and education, worsened environmental pollution and urban growth, and promoted political and economic instability. Therefore it is critical for developing countries to reduce fertility from 3.8-3.3 and increase in family planning use from 51-59% by 2000. These targets cannot be achieved, however, without government commitments to improving the status of women and maternal and child health and providing basic needs. They must also include promoting child survival and education. Further people must be able to make personal choices in their lives, especially in contraceptive use. Women are encouraged to participate in development and primary health care in Kerala State, India and Sri Lanka. The governments also provide effective family planning services. These approaches contributed significantly to improvements in fertility, literacy, and infant mortality. To achieve the targets, UNFPA estimated a doubling of funding to $9 billion/year by 2000. Lower costs can be achieved by involving the commercial sector and nongovernmental organizations, building in cost recovery in the distribution system of contraceptives, operating family planning services efficiently, and mixing contraceptive methods.
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  8. 183

    Complementarity of formal and non-formal population education in the Pacific. A report of a Regional Seminar, Nuku'alofa, Tonga, 23-27 November 1987.

    UNESCO. Principal Regional Office for Asia and the Pacific; UNESCO. Office for the Pacific States

    Bangkok, Thailand, Unesco Principal Regional Office for Asia and the Pacific, 1988. [3], 58 p. (UNFPA Project RAS/88/P60)

    At present, there are 10 UNFPA-funded, UNESCO-guided projects in the Pacific conducting population education activities in the formal and nonformal sectors. This seminar, attended by representatives of these programs, sought to develop strategies for greater complementarity between these 2 sectors. Country reports from Cook Islands, Micronesia, Fiji, Kiribati, Marshall Islands, Palau, Papua New Guinea, Solomon Islands, Tonga, Vanuatu, and Western Samoa revealed that there is little planned coordination between the formal and informal sectors in the implementation of population education programs. A basic problem is the absence in some countries of clear statement of population policies and goals. Although population education has been introduced in some schools in the region, it has not been integrated into teacher training. The absence of a central agency to assume overall responsibility for population education has created serious problems in terms of coordination and a flow of information from national to local levels. The 1st step to remedy this situation involves ensuring that government decision makers formulate population policies (including education) at the national level and appoint a full-time person to coordinate all population education activities. To improve intersectorial linkages, establishment of a task force comprised of senior-level government officials and representatives of nongovernmental organizations is recommended. Such a task force could ensure that the content of the various formal and nonformal programs is complementary and assume responsibility for staff training.
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  9. 184

    Project success through NGO and government collaboration in Bangladesh.

    Moncaster L; Musa M

    IN TOUCH 1989 Mar; 13(90):17-9.

    An expanded immunization program (EPI) in Bangladesh was begun in 1979 in which a technician would be assigned to each subdistrict health unit. These subdistricts had approximately 150,000 to 200,000 people. The technician was responsible for collecting vaccines, immunizing, record keeping, and reporting to the district. In 1985 a review of the immunization program revealed that coverage of infants under 1 year for vaccines on tetanus, diphtheria, whooping cough, polio, tuberculosis, and measles was less than 2% for every year of vaccination. The United Nations agencies helped design new strategies for the national vaccination program. To improve the service delivery, the government in partnership with WHO, UNICEF and the Bangladesh Rural Advancement Committee (BRAC) launched an intensive program. UNICEF supplied the materials and equipment. CARE provided planning, training, management, and social mobilization components at all levels. WHO assisted in training support and BRAC's activities where similar to CARE's. With the CARE staff at all levels there was a continuous flow of information up from the field and down from the national level. Because of the feedback from the field, decisions and changes were made on a regular and continuous basis through an institutionalized system. Outreach service delivery and community participation were the focus of the new program. The lessons learned after 2 years of operation suggest that the project staff should be assigned at every level from the grass roots to the national level. Information should flow up from the field and down from the national level continuously. A forum should be set up at the national level and be attended by all parties constantly. Also, a relationship should be developed by immediate counterparts at each level.
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  10. 185

    Distribution and logistics.

    Fabricant S

    In: ICORT II proceedings. Second International Conference on Oral Rehydration Therapy, December 10-13, 1985, Washington, D.C., [edited by] Linda Ladislaus-Sanei and Patricia E. Scully. Washington, D.C., Creative Associates, 1986 Dec. 83-5.

    At a recent international conference on Oral Rehydration Therapy (ORT) there were discussions on policy issues. Advances in oral rehydration solution (ORS) local production, and the use of private sector and public sector distribution. It was agreed that the roles of ORS packets and home solutions must be carefully thought through and the be the basis of the program. If ORS is going to be available at the household level then the use of the private sector should be considered. The policy to use informal distribution channels and traditional healers has shown to increase public access to ORS. Also, donor support of ORS commodities may not lead to self sufficiency. Governments should plan for self sufficiency in advance and should manage donor support. Advances in local ORS production include factors that promote low cost production such as efficient personnel, economical procurement of materials, appropriate choice of equipment, minimizing duties, and using existing production facilities. The adoption of a citrate ORS formula allows the use of cheaper packaging material. The private sector can and should be used to make ORS available on a wide scale. Product pricing is a highly complex problem and the mothers ability to pay must be balanced against the profit incentives in the distribution system. Subsidies have been necessary to encourage the private sector and mass media campaigns have proven to be a useful subsidy. The key factor in gaining wide coverage is the person who contacts the mother. Competition can be useful in gaining greater effective usage but there are tradeoffs. The high costs of import licenses and hard currency have been stumbling blocks for the private sector production in some countries. It was found that it is inadvisable to set up a separate distribution system for ORS and it should not be given priority over other child survival interventions. Also a policy of cost recovery can make a program more viable in the absence of donor assistance and has increased confidence in the product and therapy.
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  11. 186

    Present status of contraceptive vaginal rings.

    Jackson R; Hickling D; Assendorp R; Elstein M

    ADVANCES IN CONTRACEPTION. 1990 Sep; 6(3):169-76.

    Clinical trials of vaginal rings containing progestins or ethinyl estradiol and progestins by WHO, the Population Council and private firms are reviewed. Contraceptive steroids can be formulated into Silastic vaginal rings because they are released continuously from this material (zero-order kinetics). Vaginal rings have the advantage of avoiding the 1st pass effect on the liver, as well as self- administration, unrelated to the timing of coitus and regulation of withdrawal bleeding with removal for 7 days per cycle. The shell vaginal ring, with an inert core, a layer of Silastic containing the progestogen, and an outer Silastic layer is designed to regulate release by the thickness of the outer layer. The WHO tested rings releasing 200 mcg norethisterone/day resulting in too many menstrual side effects; and 50 mcg/day with too high a failure rate. A ring releasing 20 mcg levonorgestrel is expected to perform well. The Population Council designed rings releasing 152 mcg ethinyl estradiol and 252 mcg levonorgestrel, and 183 mcg ethinyl estradiol and 293 mcg levonorgestrel. These resulted in pregnancy rates of 2/100 woman years, and continuation rates of 50%, but unacceptably adverse lipid effects. Women discontinued for vaginal symptoms. Compared to a similar combined oral pill, the rings offered no advantage. WHO subsequently introduced a ring releasing 20 mcg levonorgestrel: efficacy was 3.8 and continuation over 50%. A new segmented ring with desogestrel is causing fewer androgenic effects and bleeding complaints. Another ring in current trials gives off 120 mcg desogestrel and 30 mcg ethinyl estradiol with no pregnancies and good acceptability in 100 women to date. Availability of Silastic material and quality control in manufacture are seen as obstacles to overcome for mass production of these vaginal rings.
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  12. 187
    Peer Reviewed

    Global health, national development, and the role of government.

    Roemer MI; Roemer R

    AMERICAN JOURNAL OF PUBLIC HEALTH. 1990 Oct; 80(10):1188-92.

    Health trends since 1950 in both developed and developing countries are classified and discussed in terms of causative factors: socioeconomic development, cross-national influences and growth of national health systems. Despite the vast differences in scale of health statistics between developed and developing countries, economic hardships and high military expenditures, all nations have demonstrated significant declines in life expectancy and infant mortality rates. Social and economic factors that influenced changes included independence from colonial rule in Africa and Asia and emergence from feudalism in China, industrialization, rising gross domestic product per capita and urbanization. An example of economic development is doubling to tripling of commercial energy consumption per capita. Social advancement is evidenced by higher literacy rates, school enrollments and education of women. Cross-national influences that improved overall health include international trade, spread of technology, and the universal acceptance of the idea that health is a human right. National health systems in developing countries are receiving increasing shares of the GNP. Total health expenditure by government is highly correlated with life expectancy. The view of the World Bank and the International Monetary Fund that health care should be privatized is a step backward with anti-egalitarian consequences. The UN Economic Commission for Africa attacked the IMF and the World Bank for promoting private sector funding of health care stating that this leads to lower standards of living and poorer health among the disadvantaged. Suggested health strategies for the future should involve effective action in the public sector: adequate financial support of national health systems; political commitment to health as the basis of national security; citizen involvement in policy and planning; curtailing of smoking, alcohol, drugs and violence; elimination of environmental and toxic hazards; and maximum international collaboration.
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  13. 188

    1989 World Survey on the Role of Women in Development.

    United Nations. Department of International Economic and Social Affairs. Centre for Social Development and Humanitarian Affairs

    New York, New York, United Nations, 1989. [2], vii, 397 p. (ST/CSDHA/6)

    This is the 1st update of the World Survey on the Role of Women in Development published by WHO. 11 chapters consider such topics as the overall theme, debt and policy adjustment, food and agriculture, industrial development, service industries, informal sector, policy response, technology, women's participation in the economy and statistics. The thesis of the document is that while isolated improvements in women's condition can be found, the economic deterioration in most developing countries has struck women hardest, causing a "feminization of poverty." Yet because of their potential and their central role in food production, processing, textile manufacture, and services among others, short and long term policy adjustments and structural transformation will tap women's potential for full participation. Women;s issues in agriculture include their own nutritional status, credit, land use, appropriate technology, extension services, intrahousehold economics and forestry. For their part in industrial development, women need training and/or re-training, affirmative action, social support, and better working conditions to enable them to participate fully. In the service industries the 2-tier system of low and high-paid jobs must be dismantled to allow women upward mobility. Regardless of the type of work being discussed, agricultural, industrial, primary or service, formal or informal, family roles need to be equalized so that women do not continue to bear the triple burden of work, housework and reproduction.
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  14. 189

    Trip report: boosting ORS commercialization in the Philippines (part II), September 12-22, 1989.

    Saade C

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1989. [2], 19, [4] p. (USAID Contract No. AID/DPE-5969-Z-00-7064-00)

    A social marketing consultant sponsored by the US Agency for International Development visited the Philippines to assist in boosting oral rehydration solution ORS commercialization. The task includes following up on current ORS commercialization efforts in analyzing proposals from companies for strategies on rural distribution, promotion, pricing, and introduction scheduling as requested by the Department of Health (DOH) and to develop a plan of action that will lead to a final selection of companies and to develop the terms of reference for working relationship between the DOH and the selected companies. The 6 companies contacted were divided into 2 groups, 1 that insisted on using ORESOL exclusively, and those willing to use ORESOL as a generic name. All the advantages for the selected companies as well as the disadvantages for each, was weighted. Other factors considered were the political environment within the pharmaceutical market and the timing of the ORESOL launch. To provide DOH with the best objective decision, the Keptner-Tregoe decision making technique was used. This process showed an advantage to use the open market companies. An action plan outlining specific tasks to be done, responsibilities of various parties, and the dates of completion is described.
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  15. 190

    [Motion pictures and commercial television: a co-production of public and private sectors to promote family planning in Mexico] Cine y television comercial: una coproduccion de los sectores publico y privado para promover la planificacion familiar en Mexico.

    Ruiz de Chavez S; Urbina Fuentes M; Schlosser R

    [Unpublished] 1989. Presented at the II Congreso Latino-Americano de Planificacion Familiar, Rio de Janeiro, Brazil, August 20-24, 1989. [2], 6, [5] p.

    A film about a young couple experiencing infertility and a television series which introduces new customs in each independent chapter were 2 productions of a cooperative program of the private and public sectors to promote family planning in Mexico. Each production questions sexual stereotypes and opens the possibility of reflection on themes related to sexuality and family planning. The target group is young people aged 15-30 years. The topics covered were selected on the basis of KAP studies to identify areas of conflict and of common interest. The Office of Health provided technical advice and coordination and provided 70% of the financing for the film and 50% for the television series using UN Fund for Population Activities funds. The films combine entertainment with educational content. The producers, script writers, and specialists in sexuality and family planning worked together to develop the scripts by defining the objectives of the project and identifying the most relevant themes. The film, "Let's Try It Again" (Va de Nuez) employed scenes from everyday life in a comedy format with characters displaying a mixture of positive and negative characteristics. The topic of infertility, a perinatal death, and an unplanned pregnancy in a young adolescent were the vehicle for consideration of several themes related to reproductive life: the decision to have a child, intracouple communications, ideas about paternity and maternity, unprotected sexual relations, the importance of the time between marriage and the 1st birth, and male infertility, among others. The weekly television series "The Good Customs" (Las Buenas Costumbres) consisted of 26 episodes lasting 24 minutes each. Each episode is independent in plot development but all are thematically related. The protagonist is a physician. Various common and recurring situations in Mexican life are approached through the physician-patient relationship.
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  16. 191

    Health care financing in Latin America and the Caribbean, 1985-89: findings and recommendations.

    Gwynne G; Zschock DK

    Stony Brook, New York, State University of New York at Stony Brook, 1989 Sep. xiv, 65 p. (Health Care Financing in Latin America and the Caribbean [HOFLAC] Research Report No. 10)

    Recently a 4 year research project was conducted in Latin America and the Caribbean on health care financing, sponsored by the US Agency for International Development. The work focused on 3 areas: health care costs, household demand for health care, and alternatives to the financing of health care from general tax funds. The work focuses on 10 countries of lower to middle income with small populations (except Peru), making them comparable. In most of these countries unfavorable economic conditions have prevented the governments from expanding primary health care, and have caused the deterioration of many health services. These conditions have stimulated private health care spending which has expanded in proportion of total health financing. Cost studies have indicated a wide variation of annual costs of primary care in the public, social security, and private sectors. In hospitals the larger facilities take a bigger share than standard accounts show. Research suggests that if user fees were charged for outpatient care in public hospitals, the overall use would stay the same, but some users would switch to private providers. Since private hospitals charge considerable more, inpatient care is more suited to public facilities. Findings here show the importance of social security in the financing of medical care, especially in these countries where 20-30% is paid from it. Recommendations from these studies include limiting personnel expenditures and cost containment in hospitals.
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  17. 192

    For our mutual benefit.

    Grose B

    AIDS ACTION. 1989 Jun; (7):1-2.

    The most valuable resource that NGOs can bring to the AIDS programs is experience in community level work. The 3 basic goals of WHO are to prevent HIV infections and AIDS, to limit the personal and social impact of AIDS, and to unify national and international efforts. NGOs share the first 2 goals and can respond to local needs more quickly than governments. At the national level, 3-5 year plans are created and coordinated with NGOs to avoid duplication of work and to send unified messages. WHO can distribute updated scientific information to NGOs and can receive information on evaluation, planning and project operations from them. The WHO Global Program on AIDS (WHO/GPA) works with AIDS service organizations, NGOs with experience in primary health care, as well as hemophilia societies, ethnic organizations, and labor unions, that are involved in AIDS problems. WHO/GPA is involved in encouraging NGO participation in international meetings, the creation and exchange of information between WHO and NGO groups, and developing a directory of national and international NGOs involved in AIDS prevention. At the national level, they promote coordination of NGOs and national AIDS programs in areas such as the promotion of educational materials.
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  18. 193

    Health personnel training.

    Northrup RS

    In: ICORT II proceedings. Second International Conference on Oral Rehydration Therapy, December 10-13, 1985, Washington, D.C., [edited by] Linda Ladislaus-Sanei and Patricia E. Scully. Washington, D.C., Creative Associates, 1986 Dec. 85-9.

    Training for oral rehydration therapy (ORT), requires a broad area of education not only for health workers, but for community leaders and children. In some countries, doctors refuse to use ORT and mothers may not understand how to make the solutions properly, even though the information is available. In some clinics, diarrhea cases are mixed with others and can be left for a long time unattended. For successful programs in ORT, training must be done by qualified personnel; doctor- nurse teams have been recommended. There should be plenty of ORT packets available and medical personnel should handle at least 10-15 cases personally and work with the mother directly. Also, follow-up is needed to help people manage when they return to their homes. Training activities and financing should include the private sector, as well as government and other organizations, and evaluation and monitoring are and integral part of theses programs. Operations research is needed to enhance training. Donor support can include the following: creation of ORT units in medical schools. Curricula reform in schools, distribution of WHO materials to communities, assistance in training private sector people, and other approaches such as residency programs and operations research for better training programs.
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  19. 194

    Inventory of nongovernmental organizations working on AIDS in developing countries. Preliminary version.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1989. xii, 288 p. (GPA/DIR/89.10)

    The World Health Organization has produced an inventory of nongovernment organizations (NGOs) working on AIDS problems in developing countries. This guide lists over 40 countries where NGOs are located, and lists the NGOs separately in alphabetical order. It provides the address of the NGO, its branch offices, the phone number, and the contact person. It defines the type of organization and shows what groups the NGO is a member of. It also lists the main activities of the NGO, the main target groups that it focuses on, and the countries where AIDS activities are conducted. The budget of the NGO is given in US dollars and the source of the funding is shown. The percentage of the funds used in AIDS related activities and who they are provided to is also given. A list of publications and audiovisuals of the NGO is provided. Organizations are listed by category, by areas of AIDS related activities, and by main groups targeted.
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  20. 195

    Expanding the role of non-governmental organizations (NGO's) in national forestry programs. The report of three regional workshops in Africa, Asia, and Latin America.

    Hazlewood PT

    Washington, D.C., World Resources Institute, [1987]. 44 p.

    Efforts of the World Resources Institute (WRI), the World Bank, the United Nations Development Programme, and the Food and Agriculture Organization have resulted in a common framework to save tropical forests--the Tropical Forestry Action Plan. A 1st step includes national forestry sector reviews to coordinate aid agency and government involvement in identifying investment priorities and significant policy reforms to reverse deforestation and promote sustainable development and then incorporating them into their national development plans. This represents a shift from the focus of national government and aid agency forestry programs of the late 1970s, which was on commercial or industrial forestry, to forestry which provides for people's basic needs. To be successful, this plan requires the involvement of farmers and local communities. Involving NGOs and their capabilities can complement government and development assistance programs. NGOs' greatest contribution is the promotion of community based, participatory forestry programs that benefit economically or socially disadvantaged groups. WRI and the Environment Liaison Centre hosted 3 regional workshops to discuss NGOs roles in reforestation. Participants agreed that, to establish a basis for constructive collaboration, NGOs, governments, and aid agencies must mutually understand their complementary roles. Further governments and aid agencies must change policies and procedures to assist and enhance NGO involvement in policymaking and the project cycle. This includes finding new mechanisms to direct funds to NGOs, and for governments and aid agencies to respect the autonomy of the NGO and therefore enable it to achieve its goals.
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  21. 196

    Biotechnology and the Third World: caveat emptor.

    Dembo D; Dias C; Morehouse W

    Development: Seeds of Change. 1987; (4):11-8.

    3 basic categories of institutions in research and development (R&D) of biotechnology include universities, small biotechnology R&D venture capital financed firms, and transnational corporations in the US and other more developed countries (MDCs). Almost 24 transnationals, which predominantly manufacture pharmaceuticals and petrochemicals, lead the biotechnology industry by contracting research arrangements with universities or venture capital financed firms or by establishing their own R&D, manufacturing, and marketing activities in biotechnology. On the other hand, in less developed countries (LDCs), the private sector plays no role or a relatively small role in biotechnology. National level government programs are developing biotechnology capabilities in some LDCs, however. In MDCs, the move towards privatization of biotechnology, especially with the ability to patent technologies, restricts the free flow of research information, thereby inhibiting the diversity and pace of technological innovation, widening the technological gap between MDCs and LDCs, and thus maintaining LDCs' dependence on MDCs. The leading role of transnational corporations in biotechnology R&D causes skewed research priorities that the corporations determine based on their own global strategies. These research priorities are determined by potential profit, and not by the needs of the LDCs. Even though products of biotechnology have the capability to improve the lives of many in the world, they displace more traditional products of LDCs. For example, sugar will soon be displaced by immobilized enzyme technology produced high fructose, therefore affecting the economies and poor of sugar exporting nations. LDCs must act now so as not to fall behind in the biotechnology revolution, such as establishing their relevance at the grass roots level.
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  22. 197

    PRITECH process evaluation of the ORT component of the Primary Health Care Financing Project.

    Schlendorf J; Basilio J; Brown R; Chang J; Steinwand R; Tomaro JB

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care, 1988. 51, [43] p. (USAID Contract No. AID/DPE-5927-C-00-3083-00)

    Personal interview, site visits to Regions VII and VIII (Philippines), and record reviews were the principal methods used to evaluate the Oral Rehydration Therapy (ORT) component of the Primary Health Care Financing (PHCF) Project designed to increase the use of oral rehydration therapy as a primary preventive measure against diarrheal death among infants and young children. The project is designed to increase ORT utilization through a 2-pronged approach which creates demand for ORS products through training physicians, nurses, midwives, and health educators in the public and private sectors; and information, education, and communication campaigns to promote ORT among the public. The most serious concern regarding clinical training was the poor quality of case management observed in regional, provincial, and district hospitals. There seems to be no national plan or budget for the production of print materials to support IEC program activities. A wide disparity was found between projected demand and actual use of ORS, called ORESOL. The present distribution practices of the Department of Health translate to oversupply or nonavailability of ORS. Private sector pharmaceutical firms take a limited/traditional approach to product distribution, and commercial distributors capable of reaching the rural population should be identified and encouraged to market ORS.
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  23. 198

    Financing as an instrument of public policy.

    Frenk J


    The Word Bank Study "Financing Health Services in Developing Countries: An Agenda for Reform" is centered on a thesis of decreased government responsibility for financing health services. The study points out that more basic medical services are needed for the poor, but the aged and increased urbanization are forcing the application of more finances into hospitalization services. The World Bank study incorrectly assumes that the above problem is due to an epidemiologic polarization of rich vs. poor and that the only benefits from curative medicine are private, not societal, benefits. The proposal stemming from these assumptions financially separates curative from preventative services, regardless of its proven costliness and inefficiency. The 4 suggested specific World Bank reforms are: 1) charging fees for the use of health services; 2) provision of insurance or other risk coverage; 3) effective use of nongovernment resources, i.e. private practices, midwives; and 4) decentralization of government health services. These are interesting, although imperfect, solutions to the pressing problem of health care finance. The largest issues may be problems from the fragmentation of health services, cost inflation, and lack of effective controls--issues that are not dealt with in the World Bank study.
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  24. 199

    Economics and health: beyond financing.

    Horwitz A


    World Bank publications have a large influence on the decisions of governments. This article analyzes the publication "Financing Health Services in Developing Countries: An Agenda for Reform" part of the World Bank Policy Studies series. This study assesses only peripheral reasons for the lack of public and private financial investments in health services. It does not include the result of economic recession, budget cutbacks, and poverty on financing systems. There has been excessive expenditure on luxury in health institutions which takes considerable finances from disease prevention and health promotion services. There is low demand for private services because of the high cost, but public health services sometimes lack tools and money necessary for adequate care. The study does not address the relationship between needs and demand and the supply of health services. It outlines "4 Policy Reforms" in which the aims are to increase to cost of curative services and to use the additional money for prevention. The World Bank favors using private sector services but does not seem to view decentralization of health care as important. Social security systems have been in place in Latin America for 63 years. These systems are funded by wage earners and do not cover lower income rural citizens. Chile was the 1st country to adopt compulsory insurance in 1924 for catastrophes and diseases. The Chilean National Health Service combines institutional and community resources to provide quality health care. Social insurance and other prepayment systems are the rational approaches for financing health care in the Americas. These systems should be based on contributions by the State, employers, and urban and rural workers. There is a need for fund redistribution from institutional curative care to community preventative care. Health care costs should reflect income proportionally. The World Bank contributes vital analysis to the problem of health service financing. Hopefully American governments will recognize the need for health care reform.
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  25. 200

    Nongovernmental organizations in international population and family planning.

    Population Crisis Committee [PCC]

    Washington, D.C., Population Crisis Committee, 1988 Dec. 20 p. (Population Briefing Paper No. 21)

    This paper provides information on the aims, funding sources, size, and budget, as well as the names of chief executives, of 50 selected non-governmental organizations (NGOs) working in international population and family planning. Most are based in the US, some in Europe or Asia. A supplemental list gives less detailed information about other selected NGOs, training and research centers, regional organizations with population activities, United Nations organizations providing population assistance, and major national government agencies providing international population assistance. The organizations listed include those focussing on funding or technical assistance for family planning programs, and/or publishing influential materials, or having extensive public outreach and political influence.
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