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In: To cure all hunger. Food policy and food security in Sudan, edited by Simon Maxwell. London, England, Intermediate Technology Publications, 1991. 191-206.Targeting on grounds of equity, cost, or minimizing interference fails to consider whether targeting is politically possible. In the case of the USAID-sponsored famine-relief and emergency food aid operation in Darfur, western Sudan, in 1985, the expressed intention of target this relief was not fulfilled. The target group received inadequate amounts of relief grain owing to the lack of targeting by area councils within Darfur, and the lack of targeting within area councils. After severe rainfall failures in 1982, 1983 and 1984, large numbers of people in western Sudan faced severe food shortage, abnormal migrations, and increased risk of destitution. USAID, the principal donor for relief operations to western Sudan in 1984-85, approved 82,000 metric tons (mt) of relief grain for western Sudan in September 1984, and then a further 250,000 mt in late 1984 and early 1985. The target population for the first 41,000 mt of relief sorghum was the neediest one-fourth later, the neediest one-third. A USAID document provided estimates of people and the way the area councils conceived sheltering throngs of the target group. There was 153,141 seriously affected in Kutum area council, 102,907 in Mellit, and 507,348 in Geneina representing around 25% of Darfur's population, the size of the target group envisaged for the first 41,000 mt of relief grain. USAID made concessions to the Darfur regional government allowing South Darfur a higher proportion of early allocations than need dictated. Save the Children Fund experienced serious difficulties with the local contractor to distribute food from area-council level. Aid agencies and donors need to consider how targeting is to be accomplished and how to confront influential local players with interests contrary to such targeting. Allocations of relief grain could be made on the assumption that targeting will be only partially achieved; and through alternative forms of relief.
National Program on the Control of Diarrheal Diseases. Report of the Joint MOH / WHO / UNICEF / USAID Comprehensive Program Review, 28 January to 11 February, 1985.
Manila, Philippines, Ministry of Health, 1985. v, 36 p.In early 1985, representatives of the Philippines Ministry of Health, WHO, UNICEF, and USAID visited health facilities (barangay health stations to hospitals) and used data from 9106 households (11,131 children under 5 years old) in the provinces of La Union, Bohol, and Bukidnon in the Philippines, to evaluate implementation and effect of the National Program on the Control of Diarrheal Diseases (CDD). 10.8% of the children had had diarrhea within the last 2 weeks. Mean diarrhea episode/child/year stood at 2.8. Mean infant mortality was 62.3/1000 live births (35.8 in La Union to 94 in Bukidnon). Diarrhea-related mortality for all children studied ranged from 3 in La Union to 18.3 in Bukidnon (mean = 8.6). Between 1978 and 1982, the diarrhea-related mortality rate for all of the Philippines fell from 2.1 to 1, presumably due to the CDD Program. Diarrhea was the leading cause of death in Bukidnon (21.3%), but in La Union and Bohol, it was the 5th leading cause of death (6.6% and 10.3%, respectively). 33% of children with diarrhea received oral rehydration solution (ORS), 12% did not receive any treatment, and 72% received herbs, antibiotics, or antidiarrheals. Many of the children receiving ORS also received other treatments. 86% of mothers were familiar with ORS and 73% of them had used it. 92% would use it again. 84% would buy it from stores, if sold. Government health facilities tended to use ORS and to prescribe it for diarrhea cases. Most facilities had successfully promoted breast feeding. The supply of ORS packets in most facilities was good. Almost all health personnel had received ORT training. Some recommendations included promotion of non-ORT strategies (e.g., hand-washing and food safety), conducting research (e.g., to identify suitable fluids and foods for home-based oral rehydration therapy, and regular monitoring and evaluation of the CDD Program.
ANNALS OF MEDICINE. 1993 Feb; 25(1):57-60.A key element of international support for family planning programs in developing countries is research in the development, evaluation, and introduction of family planning methods and services. These countries have the capacity to do high quality contraceptive research (from early preclinical research to phase III clinical trials). 3 international organizations are leaders in collaborating with researchers in developing countries to develop and support a network of clinical research centers in family planning. USAID assists 2 of these organizations because of its interest in family planning research: The Population Council and Family Health International. The Population Council's chief goal is the development and introduction of new contraceptive modalities. The Council developed Norplant, the sole new contraceptive approved by the US Food and Drug Administration in recent years. The International Committee for Contraceptive Research (ICCR) implements most of the Council's development program. ICCR consists of a group of research clinics and laboratories in Chile, the Dominican Republic, Finland, France, India, and the US. It is responsible for the development of 3 Copper-T IUDs and a levonorgestrel-releasing IUD. Family Health International conducts evaluation of family planning programs, epidemiological research in reproductive health, and clinical trials. WHO's Special Programme of Research, Development and Research Training in Human Reproduction is the other major player in family planning research in developing countries, specifically, assessment of contraceptive safety and efficacy, development of new contraceptives, and infertility. WHO and the Rockefeller Foundation have established a South to South collaboration in research to promote cooperation between developing countries. National and international agencies need to further develop and maintain these various international efforts.
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.
Vulnerability and resiliency: environmental degradation in major metropolitan areas of developing countries.
In: Environmental management and urban vulnerability, edited by Alcira Kreimer, Mohan Munasinghe. Washington, D.C., World Bank, 1992. 107-52. (World Bank Discussion Papers 168)The main factors contributing to vulnerability to natural and man-made hazards and the implications of environmental degradation for large urban areas in the developing world are outlined. Many high-risk metropolitan areas in developing countries are projected to have populations of over 10 million by the year 2000; including Baghdad, Bangkok, Beijing, Bombay, Buenos Aires, Cairo, Calcutta, Dhaka, Delhi, Jakarta, Istanbul, Karachi, Manila, Mexico City, Rio de Janeiro, Sao Paulo, Shanghai, and Teheran. Water depletion and quality is a looming issue. In Thailand water demand for the area of Bangkok will increase from 2.8 million cubic meters per day in 1987 to 4.1 million by 1997, and to 5.2 million by 2007. Only 2% of the population of Bangkok is connected to the sewer system. In Calcutta there are 3 million people in settlements which have no systematic means of disposing human wastes. Fertilizers have had a severe negative impact on the environment. Among the cities which have polluted their coastlines are Alexandria, Dakar, Guayaquil, Karachi, Panama City, and Valparaiso. Montevideo and Rio de Janeiro have polluted beaches. The Torrey Canyon, the Exxon Valdez and the Gulf War each focused world attention on marine oil pollution that stems from tanker operations, refineries, and offshore oil wells; from the disposal of industrial and automotive oils; and from industrial and motor vehicle emissions. Because of inappropriate sitting, hundreds of people were killed by mudslides in Rio de Janeiro in 1988, in Medellin in Colombia in 1987, and in Caracas in 1989. In Guatemala, 65% of deaths in the capital following the 1976 earthquake occurred in the badly eroded ravines around the city. The production of greenhouse gases will lead to a rapid warming of the biosphere sometime in the next century, changed rainfall patterns, altered paths of ocean currents, and rising sea levels. A World Bank study recommends for country responses 1) to focus on particular environmental problems; 2) to concentrate on vulnerable populations using vulnerability analysis; and 3) to focus on government intervention strategy.
Arlington, Virginia, John Snow [JSI], Resources for Child Health [REACH], 1988 Sep. , 99,  p. (USAID Contract No. DPE-5927-C-00-5068-00)Building upon smallpox and measles immunization campaigns originally supported by USAID, the Centers for Disease Control, and the World Health Organization, the African region Combatting Childhood Communicable Diseases (CCCD) Project began providing immunizations, oral rehydration therapy for children with diarrhea, and malaria prophylaxis services in 1982. The project was approved in September, 1981, for spending of $47 million through fiscal 1988, and was designed to be implemented through existing publicly operated health service delivery systems with recipient CCCD project countries helping to finance recurrent costs and providing human resources for project implementation. Accordingly, almost all country project agreements were written to ensure that country governments would provide financial support for activities through direct budget allocations, user fees, or some combination of the 2. Regular analyses of service provision were also agreed upon. The development and implementation of user fees have taken place, but the overall theoretical financial strategy has yet to be met in any country project. This document discusses financing achievements and what more is needed to ensure longer term project financial sustainability. Sections review country-specific agreements to spell out original USAID/country terms on financing components; consider the capacity of CCCD project governments to finance recurrent costs in their respective macroeconomic contexts; present highlights of a review of CCCD project financing activities; summarize an evaluation of alternative health financing options; give conclusions of analyses on the financial sustainability of CCCD project activity; and make recommendations for future USAID CCCD project support with respect to financing and economics.
Cereal based oral rehydration solution and the commercial private sector. Conference proceedings, March 27, 1992.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. 23,  p. (USAID Contract No. DPE-5969-Z-00-7064-00)Public health professionals are coming to realize that the private sector provides a significant share of health care and that efforts need to be taken to improve access to and use of preventive and curative services. Further, while most USAID-supported activities have and will support the government sector, it nonetheless remains important to mobilize private sector resources to meet public health objectives. PRITECH's initial overtures to foster private sector participation and cooperation between the public and private sectors led it to sponsor an 1-day meeting on cereal-based oral rehydration solution (CBORS) and the private sector. The conference was convened to review the status of ORS products within developing country markets and to develop recommendations for what PRITECH should do to prepare for the arrival of commercial ORS products in these markets. Participants included officials from the WHO, UNICEF, and USAID as well as diarrheal disease experts and marketing specialists from public health organizations. Presentations were made on possible options in cereal-based ORT for dehydrating diarrhea; a WHO perspective on ORS and the commercial marketplace in developing countries; and a market analysis of the arrival of CBORS products. Participants agreed that PRITECH should stay involved with the private sector; that PRITECH should not actively promote the adoption of CBORS products by companies and instead help guide those which choose to manufacture them; and that impact assessments should be conducted in countries where commercial CBORS products exist. Studies will explore caretaker behavior, private health care provider behavior, ORS consumption patterns, ORS market performance, and clinical performance. A section offers precautions for companies introducing commercial CBORS products, while 1 of 8 appendices discusses mobilizing the commercial sector for ORS marketing in Pakistan.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 10,  p. (USAID Contract No. DPE-5969-00-7064-00)A visit was made to Uganda to meet with the oral rehydration solution (ORS) promotion committee to review on ORADEX sales targets, formulate regional sales goals based upon current national sales targets, and discuss product distribution concerns; to draft a document with Medipharm, ARMTRADES, and Media Consultants to review the effectiveness of promotional materials; to meet the PRITECH representative and coordinate the supervision of promotional communications between Medipharm, ARMTRADES, and Media Consultants; to meet with USAID/KAMPALA to determine the status of additional monies and provide an update on current project status; and to meet with UNICEF and review roles for continued interaction on the ORS promotional program between USAID/Kampala, UNICEF, and Medipharm. 90,837 sachets of ORADEX were sold through the end of January, 1992; above the target of 79,000. ARMTRADES, however, sold only 42,741 of its 60,000 target, while Medipharm sold 48,096 sachets; substantially more than its 19,000 target. Medipharm expressed concern over ARMTRADES' weak ability to distribute amd market ORADEX, despite ARMTRADES' claim that its sales efforts are being undermined by freely available UNICEF sachets. In response, PATH worked to improve the operational efficiencies of both Medipharm and ARMTRADES. Medipharm's present transportation facilities and institutional capabilities are insufficient to allow it to handle national distribution independently. For now, it must rely upon ARMTRADES to distribute and market ORADEX. Moreover, Medipharm needs continued supervision to properly manage distributor relations to ensure that distributors receive timely and accurate invoices, monthly statements, and payment due notices. These steps combined with accurate production and inventory planning will eventually provide Medipharm with sufficient experience to distribute and maintain stock on its own. Otherwise, the promotion committee suggested revisions for new materials future support and sales personnel and pharmacist training were discussed; and reports were cited which indicate that ARMTRADES is doing well distributing and marketing condoms through a parallel social marketing program.
[Unpublished] 1992. Presented at the 120th Annual Meeting of the American Public Health Association [APHA], Washington, D.C., November 8-12, 1992. 27,  p.In the mid 1980s, USAID started nonproject assistance, mainly in the economic sectors, to African countries. The countries received nonproject assistance after they fulfilled conditions which influence institutional and/or policy reforms. The longest running health sector reform program in Africa was in Niger and was slated to receive portions of the funds after fulfilling 6 specific predetermined reform activities. Yet, between 1986 and 1991, Niger had implemented only 2 of them. It did accomplish the population/family planning reforms: expansion of family planning services, a national population policy, analyses and implementation of improvements in the pricing and distribution of contraceptives, and legalization of use and distribution of contraceptives. Continuing economic deterioration during the 1980s and political upheavals after 1989 somewhat explained why the other reform activities were not implemented. Other equally important factors were a very complex sector grant design (more than 20 reforms in 6 policy/institutional areas) with little incentive to realize the reforms, insufficient number of staff (limited to senior personnel) to implement the reforms, and just 1 USAID staff to monitor and facilitate activities. The nonproject assistance for the primary health care (PHC) system in Nigeria had a simpler design than that in Niger. The reform goals were shifting responsibility for PHC from curative care to preventive health services. After USAID and the Nigerian government signed an agreement, they included policy reforms promoting privatization of health services. Only 1 reform was implemented. Factors which could lead to success of nonproject assistance include host government needs to perceive it owns the objectives and building financial and institutional sustainability. In conclusion, nonproject assistance can be effective when implementing policy reforms that the host government has already adopted.
Inventory of population projects in developing countries around the world, 1988/1989: multilateral organization assistance, regional organization assistance, bilateral agency assistance, non-governmental organization and other assistance.
New York, New York, UNFPA, . , 932 p.The UNFPA periodically releases a publication listing population projects supported and/or operated by various organizations. This publication also has basic demographic data and each country's population policy. The 16th edition covers the period from January 1, 1988 to June 30, 1989. The first section reviews all the countries' programs and makes up the bulk of the publication. Each division in this section begins with demographic data, followed by the government's views about population growth, specifically as it affects mortality and morbidity; fertility, nuptiality, and family; spatial distribution and urbanization; international migration. Each division next examines the population projects and external assistance. The second section examines regional, interregional, and global programs. The regional programs are divided into Africa, Asia and the Pacific, Latin America and the Caribbean, Middle East and Western Asia, and Europe. The next section lists published information sources including those used to compile the country, regional, interregional, and global reports. Other sources include periodic publications from various agencies and organizations which provide current information about population, addresses to obtain additional information, and a listing of UNFPA representatives (names, addresses, and telephone numbers) in the field. The Inventory concludes with a detailed index.
WASHINGTON MEMO. 1992 Nov 12; (17):2-3.In October 1992, the US Food and Drug Administration (FDA) approved Depo-Provera for contraceptive use thus increasing the number of available contraceptives to women. Yet USAID has distributed it through its family planning programs in developing countries for many years. It has been available in the US since 1969 for noncontraceptive purposes such as endometrial cancer treatment. More than >30 million women around the world have used it to prevent conception. Today about 9 million women in 90 countries use it. A reason FDA did not approve Depo-Provera is that some studies revealed a link between it and breast tumors and cervical cancer in animals. More recent research conducted by WHO shows no connection with cervical cancer or ovarian cancer. In fact, it demonstrates Depo-Provera may protect against endometrial cancer. Yet it does indicate an insignificant increased risk of breast cancer in younger women. Some research suggests Depo-Provera may decrease bone density leading to osteoporosis and may increase the risk of having a low birth weight infant if the child is conceived before an injection. Evidence exists that it may lead to longer delays in becoming pregnant than other forms of contraception. Still 70% do conceive within 12 months after the last injection. Each Depo-Provera injection delivers a progestin in a water-based solution over 12 weeks resulting in suppressed ovulation. Its failure rate is <.5%/year, so Depo-Provera is one of the most effective reversible contraceptive available. The most common side effects are menstrual changes and weight gain (5-15 lbs.). Some contraindications include pregnancy, heart or liver disease, and breast cancer. As of November 1992, the FDA had not announced the cost or whether there would be a reduced price for family planning and public health clinics. Women's health and rights advocates plan on monitoring introduction of Depo-Provera to make sure that women have received comprehensive information and were not coerced to use it.
Cambridge, Massachusetts, Harvard Institute for International Development, 1990 Jun. , 52 p. (Development Discussion Paper No. 344)Ideology of population control has fueled population research and fertility control programs. This ideology comprises the prochoice and prolife positions; the Roman Catholic doctrine on responsible parenthood and contraception; and fertility control professed by Marxists and environmentalists. The predominant ideology of demographic research and family planning (FP) from the 1950s to 1974 is examined. The solution of population was to be by voluntary action as demonstrated by knowledge-attitude-practice (KAP) surveys sponsored by the Population Council that was founded at the behest of John D. Rockefeller III in 1952. The Council also supported technical assistance and vigorously promoted (FP). The Ford Foundation developed a population control program in 1958, funding research with over $181 million during the period. In 1967 the Agency for International Development (USAID) joined population donors, and became the largest financier of FP programs that produced a decline of fertility from 6.1 children/woman to 4.5 in 28 countries. At the World Population Conference in 1974 held in Bucharest the claim of population growth inhibiting development was challenged, and the development of socioeconomic and health care conditions was advocated. The Project on Cultural Values and Population Policy was an 8-nation study on cultural values in FP program implementation whose utility was questioned by UNFPA staff. The World Development Report 1984 by the World Bank was influential and reiterated the danger of population growth checking economic development, although critics charged biases and distortions. The Lapham-Mauldin Scale devised for the evaluation of FP program success is replete with value judgments. FP program implementation difficulties and shortcomings are further examined in Latin America, China, India, and Indonesia.
Washington, D.C., DKT International, 1992 Jun.  p.1991 statistics form various contraceptive social marketing programs are presented in a 5-page leaflet complete with a table and 2 bar graphs. The table consists of program sales and couple years of protection (CYP) data for 32 social marketing programs in developing countries ranging from Bangladesh to Zimbabwe. 1 CYP is defined as 100 condoms or foaming tablets, 13 cycles of oral contraceptives (OCs), 0.53 IUDs, and 4 injectables. All but 2 programs distribute condoms. Peru's social marketing program markets only OCs and vaginal foam tablets. The program in Thailand just sells OCs. 12 programs distribute only condoms, including programs in Burkina Faso, Cameroon, Costa Rica, Ivory Coast, Ethiopia, Mexico, Nigeria, Pakistan, Philippines, Turkey, and the Nirodh program in India. Other contraceptives distributed by various programs are IUDs and injectables. Only the program in Sri Lanka markets Norplant. It also provides condoms, OCs, vaginal foam tablets, IUDs, and injectables. In 1991, India had by far the highest CYPs at around 3.28 million followed by Bangladesh at 1.44 million. Bolivia had the lowest CYPs (10,608), CYPs (10,608). CYPs as percentage of target market (80% of 15-44 year old women in a union) statistics do not exhibit the same pattern, however. Jamaica had the highest share (15.9%) followed relatively closely by Egypt (14.8%). 2 other outstanding countries in terms of CYPs as percentage of target market were Colombia (11.7%) and Bangladesh (9.2%). India had only 2.8% and the 3 lowest were Turkey (0.3%), Philippines (0.1%), and Nigeria (0.1%). Leading funding supporters of social marketing programs include USAID, country governments, and IPPF.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987. iii, 33,  p. (USAID Contract No.: DPE-5927-C-00-5068-00)Sudan is one of 8 USAID African child survival emphasis countries. This documents focuses upon linking the discrete areas of child survival to each other in efforts to achieve sustained reductions in national morbidity and mortality rates. The scope of the problem is briefly considered as background in the text, followed by a more in-depth presentation of government policy and programs. This section includes examination of the structure and organization of existing health services, child survival activities, and current progress and constraints. Child survival activities are listed as immunization, control of diarrheal diseases, nutrition, child spacing, malaria control, acute respiratory infections, and AIDS. The current strategy of USAID support for these activities is outlined, and includes mention of private volunteer organization and private sector participation. The role of UNICEF, WHO, and the World Bank in child survival in Sudan is also highlighted. Recommendations for child survival strategy in Sudan are presented and discussed at length in the text. Continued support to UNICEF, cost recovery and health care financing efforts through WHO, child spacing and population program support, and support to on-going USAID projects constitute USAID's priorities and emphasis in child survival strategy for Sudan. Detailed short- and long-term recommendations for immunization, control of diarrheal diseases, nutrition, child spacing, and child survival and health care financing are provided following the section on priorities. In closing, staffing and recommendations for malaria and other endemic disease, acute respiratory infections, AIDS, and management are considered. Appendices follow the main body of text.
FAMILY PLANNING WORLD. 1992 Jan-Feb; 2(1):6, 20.USAID is the world's largest distributer of condoms with over 800 million condoms distributed in 1990, the most recent year figures are available. However, this year's order is 300 million smaller because AID will no longer be supplying Bangladesh or Pakistan. This, combined with inflation has caused the price to rise 16% or from $4.51/100-$5.35/100. Bangladesh will not longer be supplied because the European Community will provide condoms as part of a new 5 year plan from the World Bank. Pakistan will no longer be supplied because US law forbids foreign aid to countries that refuse to sign the United Nations Nuclear Nonproliferation Treaty. The UNFPA distributed 98.5 million condoms last year. The WHO Global Program on AIDS supplied 140 million in 1989 and 30 million in 1990. The International Planned Parenthood Federation distributed 15 million condoms in 1990. Unlike AID, the other organizations can buy their condoms from any manufacture that meets the new international condom standard set up with the help of the WHO. AID must buy condoms manufactured in the US in accordance with US law. AID does however get a much better price for IUDs, oral contraceptive and Norplant. As a result AID is trying to work with other organizations in an attempt to maximize the amount of contraceptives available world wide for family planning. Since other groups are not restricted by the same rules, they could provide condoms, while AID could use its price advantage to supply other methods.
LINKS. HEALTH AND DEVELOPMENT REPORT. 1991 Fall; 8(3):11-2.The authors respond to Tony Dajer's critique of their study concerning the trend in Nicaraguan infant mortality and its possible explanations. It is pointed out that the sharp decline in Nicaragua's infant mortality in the mid-1970s is an intriguing phenomenon, since it began to occur at a time of economic slump, civil disturbance, and under a government that gave low priority to the social sector. It is contended that a number of factors (among them the Managua earthquake) prompted the government to shift its allocation of resources from hospital-based health care in the capital city to ambulatory health care throughout the country. After the revolution, the Sandinista government continued this process. Dajer's characterization of USAID-funded clinics as "notoriously ineffective" is rejected; arguing that although operating under overt political guidelines, these projects are well-advised by experts. Dajer's question as to the importance of health care within the Sandinista government is considered. It is maintained that the revolution was not fought in order to reduce infant mortality, and that health was not the primary concern of the Government of National Reconstruction. It was the international solidarity movement, not the Sandinista government, which focused so intently on infant mortality, hoping to find good news to report. The issue of health care had the added advantage of being politically noncontroversial. It is also maintained that since the mid-70s, the country's health policy has remained stable, despite the radical changes in government because the international arena helps determine national health policy.
Ann Arbor, Michigan, University Microfilms International, 1991. vii, 266 p. (Order No. 9116069)The effectiveness of official development assistance in responding to health problems in recipient countries may be examined in terms of 1) the results of specific aid-supported projects, 2) the degree to which the activities have contributed to recipients' institutional capacity, and 3) the impact of aid on national policy and the broader development process. A review of the literature indicates a number of conceptual and practical constraints to assessing health aid effectiveness. Numerous health projects have been evaluated and issues of sustainability have been studied, but relatively little is known about the systemic effects of health aid. The experience of Nigeria is analyzed between the mid-1970s and the late 1980s. In the 1970s, Nigeria's income rose substantially from oil revenues, and a national program was undertaken to increase the provision of basic health services. The program did not achieve its immediate objectives, and health sector problems were exacerbated by the decline of national income during the 1980s. Since 1987, a progressive national primary healthcare policy has been in place. Aid has been given to Nigeria in comparatively small amounts per capita. Among the major donors, WHO, UNICEF, and, most recently, the World Bank, have assisted the development of general health services, while USAID, UNFPA, and the Ford Foundation have aided the health sector with the principal objective of promoting family planning. 3 projects are examined as case studies. They are: a model of family health clinics for maternal and child care; a largescale research project for health and family planning services; and a national immunization program. The effectiveness of each was constrained initially by limited coordination among donors and by the lack of a supportive policy framework. The 1st 2 of these projects developed service delivery models that have been reflected in the national health strategy. The immunization program has reached nationwide coverage, although with uncertain systemic impact. Overall, aid is seen as having made a marginal but significant contribution to health development in Nigeria,a primarily through the demonstration of new service delivery approaches and the improvement of management capacity. (author's)
International Family Planning Perspectives. 1992 Mar; 18(1):4-9.Estimates of the level of contraceptive use (and its cost) in developing countries that will be needed over the next decade in order not to exceed the UN's medium population projection for the year 2000 are provided. The UN's medium projection calls for population in the developing world to increase to about 5 billion by the year 2000, a projection that has become somewhat of a goal for the population establishment, which is concerned over the impact of rapid population growth. To comply with the medium projection, population growth during the 1990s must be limited to 969 million. Relying on data from the UN, USAID, and a number of surveys, the present level of contraceptive prevalence, the prevalence of specific methods, and the present costs are calculated and future needs are estimated. Presently, the number of married women of reproductive age (15-44) in developing countries is estimated at 757 million, a figure expected to increase to about 970 million by the year 2000, according to the UN medium projection. Currently at 51%, contraceptive prevalence will have to increase to 59% to meet the medium projection. And in order to reach this level of prevalence, it is estimated that over the next 10 years service providers will have to perform more than 150 million sterilizations and distribute almost 8.8 billion cycles of oral contraceptives, 663 million contraceptive injections, 310 million IUDs, and 44 billion condoms. Providing these contraceptive commodities will likely cost about $5.1 billion. The public sector will probably have to contribute about $4.2 billion of the cost, unless a concerted effort is made to increase the share carried by the commercial and private sectors.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1987.  p. (USAID Contract No. DPE-5927-C-00-5068-00)In 1987, consultants went to Niger to prepare the plan of operations for the national Expanded Programme on Immunization (EPI). US$ 6 million from the World Bank Health Project and around US$ 5 million from the UNICEF EPI Project were available for EPI activities. Low vaccination coverage prevailed outside Niamey. Outbreaks of diseases that EPI can prevent continued to kill children. The cold chain was not maintained, especially at the periphery. Mobile teams continued to use inadequate strategies. Record keeping did not exist. The central level did not supervise the periphery. EPI staff at departmental and division levels did not have current written guidelines. Not only did poor working communications exist between the central level and the periphery, but also between the EPI Director and the other Minister of Health divisions, between WHO and UNICEF, and between both UN agencies and EPI. The EPI Director did have a good relationship with the USAID office, however. No one took inventory of EPI resources or monitored temperatures at any point in the cold chain. Even though the World Bank Health Project intended to five EPI 50 ped-o-jets, 46% of the existing 88 ped-o-jets were in disrepair and no one knew how to repair and maintain them. Thus EPI should not routinely use ped-o-jets. The consultants recommended that USAID stay involved with EPI in Niger since the EPI Director considered it an acceptable partner. EPI staff at each level should take a detailed inventory of all material resources. Effective and regular supervision should occur at the central, regional, and peripheral levels. A health worker needs to record the temperature of the refrigerator twice a day. Technical grounds should determine the standardization and selection of all equipment. Someone should maintain an adequate supply of spare parts and technicians should undergo training in maintenance.
Lancet. 1992 May 9; 339(8802):1178.Your note about river blindness (Mar 28, p803) provides an excellent summary of the outstanding achievements of the Onchocerciasis Control Program in West Africa (OCP). Unfortunately, the title you have chosen is distinctly misleading. The OCP is starting its final attack on river blindness in most parts of the 11 West African countries covered by its remit. Nevertheless, there are still more than 16 million persons infected with Onchocerca volvulus in the remaining 23 endemic countries outside the OCP area, most of which are in Africa. At least 250,000 of these dwellers in remote rural areas are blind as a result: and a similar number have severe visual impairment. For them, the attack on river blindness has scarcely begun. Their only hope lies in regular annual dosing with ivermectin. The WHO, several nongovernmental organizations (especially the recently founded River Blindness Foundation), UN agencies, USAID, and the Mectizan (ivermectin) Expert Committee are now just beginning to assist the Ministries of Health in other affected countries that are untouched by OCP. The task of delivering ivermectin in a cost-effective manner is even greater than that which faced the OCP at its outset; and the struggle will take just as long. Success may well depend on the world bank and OCP donors being prepared to help finance the scheme. The OCP's final attack may signal the end of 1 campaign, but it is far from being the end of the war against river blindness. (full text)
Arlington, Virginia, DUAL and Associates, Population Technical Assistance Project [POPTECH], 1991 Dec 5. vii, 41,  p. (Report No. 91-127-127; USAID Contract No. DPE-3024-Z-00-8078-00; PIO/T No. 623-0004-00-3-10002)In 1975, International Planned Parenthood Federation (IPPF) founded the Centre for African Family Studies (CAFS) in nairobi, Kenya to train family planning program personnel in service delivery management skills and technologies. A USAID funded 4 year CAFS Project Grant, scheduled to end in June 1993, consisted of training courses with incountry follow up to make sure courses were applicable to the changing situation of family planning programs in Africa. CAFS was to become totally self sufficient by June 1993. It planned to recover direct training costs from participants. CAFS experienced considerable difficulties in organization and management (a new director and loss of IPPF funding), during the project. The evaluation team found the training courses to be of high quality. Further former participants wished to continue receiving CAFS services and would recommended CAFS courses to colleagues. New financial procedures and addition of experienced financial staff had set CAFS on its way to financial self sufficiency, but these changes would not bring about self sufficiency by June 1993. Further CAFS restructured management and its organizational structure thereby moving it towards decentralization of authority and decision making. Even though CAFS was the only African regional institution providing training services for family planning personnel, it could lose its competitive edge since it had problems in providing francophone courses, inadequate incountry follow up visits, and insufficient research and evaluation skills in developing training programs. CAFS needed to address these obstacles. The team highlighted the need for CAFS to no longer depend on individual staff to maintain high quality courses so courses would not suffer from staff turnover. In conclusion, the team recommended that USAID continue to support CAFS.
Social Marketing of Contraceptives. A project of Government of Pakistan and USAID. Quarterly report 18, April - June, 1990.
[Unpublished] 1990. , 25 p.This quarterly report summarizes the work of PSI Marketing Associates, a social marketing agency, in Pakistan from April-June 1990. Much of PSI's work centered around assisting The Sathi Operating Group (SOG), an organization that markets the Sathi condom. Sathi sales during the quarter totalled more than 14 million condoms. Although Sathi sales have increased significantly since last year, this trend does not indicate an increase in the demand for condoms in general. Because of a continuing short supply of Sultan, another USAID-procured condoms, Sathi has filled the existing demand. One of PSI's concerns is how to increase demand for condoms in general. PSI and SOG have completed a plan for additional mass media advertising to increase condom demand. In other activities, PSI has also: 1) assisted the Domestic Research Bureau in conducting a Contraceptive Practices Survey; 2) assisted USAID in developing a long-term contraceptive marketing strategy; 3) assisted Aftab Associates in implementing its Perpetual Trade audit of condoms; 4) updated the SMC Briefing Book; 5) obtained oral contraceptive training information from IPPF; 6) participated in conferences; 7) discussed social marketing issues with USAID officers in Washington; and 8) worked with PSI officers in Washington to draft a proposal in response to USAID's Request for Proposals for a new SMC Technical Assistance Contract in Pakistan. The report notes that violence in various parts of the Sind Province in Pakistan disrupted program activities. Appendices include the PSI/Pakistan Workplan for the April-June quarter, a Sathi Sales Report, minutes of SOG meetings, and the PSI/Pakistan Workplan for the July-September quarter.
Baltimore, Maryland, JHPIEGO, 1987. iii, 23 p.The Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) is a private, non-profit corporation affiliated with the Johns Hopkins University, and funded by the U.S. Agency for International Development (USAID). It aims to increase the availability of improved reproductive health services and the number of skilled and knowledgeable health professionals in developing countries, especially in the area of family planning. JHPIEGO has supported educational programs for over 55,000 health care professionals and students from 122 countries since 1974. In 1987, it supported 46 programs for 12, 981 participants in 26 countries. 12,821 were trained in-country, 160 attended regional programs open to professionals seeking training not offered domestically, and an additional 122 studies at the JHPIEGO educational center in Baltimore for an eventual total of 13,103 trainees. 1,719 participants were from Africa, 541 from Asia, 10,426 from Latin America and the caribbean, and 417 from the Near East. Additional accomplishments include the creation of a slide/lecture set on contraception and reproductive health for distribution to selected health care leaders with teaching responsibilities in developing countries. A French translation is being developed. Proceedings from a conference co-sponsored with the World Health Organization, Reproductive Health Education and Technology: Issues and Future Directions, should also be published in Fall, 1988. The report comprehensively describes training objectives and activities for the 4 regions and the educational center, and discusses program evaluation. It further presents training and program support statistics, trends, a financial report, and supporting figures and tables.
FRONT LINES. 1989 Dec; 6, 13.Projects supported by the Directorate for Population (S&T/POP) of the U.S. Agency for International Development and aimed at increasing for-profit private sector involvement in providing family planning services and products are described. Making products commercially available through social-marketing partnerships with the commercial sector, USAID has saved $1.1 million in commodity costs from Brazil, Dominican Republic, Ecuador, Indonesia, and Peru. Active private sector involvement benefits companies, consumers, and donors through increased corporate profits, healthier employees, improved consumer access at lower cost, and the possibility of sustained family planning programs. Moreover, private, for-profit companies will be able to meet service demands over the next 20 years where traditional government and donor agency sources would fail. Using employee surveys and cost-benefit analyses to demonstrate expected financial and health benefits for businesses and work forces, S&T/POP's Technical Information on Population for the Private Sector (TIPPS) project encourages private companies in developing countries to invest in family planning and maternal/child health care for their employees. 36 companies in 9 countries have responded thus far, which examples provided from Peru and Zimbabwe. The Enterprise program's objectives are also to increase the involvement of for-profit companies in delivering family planning services, and to improve the efficiency and effectiveness of private volunteer organizations in providing services. Projects have been started with mines, factories, banks, insurance companies, and parastatals in 27 countries, with examples cited from Ghana and Indonesia. Finally, the Social Marketing for Change project (SOMARC) builds demand and distributes low-cost contraceptives through commercial channels especially to low-income audiences. Partnerships have been initiated with the private sector in 17 developing countries, with examples provided from the Dominican Republic, Liberia and Ecuador. These projects have increased private sector involvement in family planning, thereby promoting service expansion at lower public sector cost.
[Unpublished] 1990. , 3,  p.In February 1990, a writer for the international publication Population Reports attended the WHO Interagency Consultation to Discuss Strategies for Coordinating and Improving Global Condom Supply in Geneva, Switzerland to garner the most recent facts about the international supply of condoms and their distribution to be incorporated in an upcoming issue. The WHO/Global Programme on AIDS (WHO/GPA) expanded its role recently to become a major procurer of condoms. Its traditional role remained as coordinating agency of condom strategies against AIDS. The writer recommended that the issue on condoms include a short box featuring WHO/GPA condom activities. Participants agreed that national AIDS programs should focus more on condom services. This could include formation of a condom subcommittee, involvement of a condom programming specialist in drafting medium term national plans, and incorporation of condom distributor experiences in planning. Further they emphasized the need to recognize and consider family planning program experience in supplying and distributing condoms. Participants also conceded the need to no longer differentiate between condom use for AIDS prevention and for family planning. Several agencies including WHO/GPA and USAID addressed the need for quality control including increased emphasis on logistics and distribution channels. They did acknowledge, however, that implementation of quality assurance measures in many countries would be hard and time-consuming. 1 item that received considerable discussion was a generic condom which USAID intended to purchase under its next contract. USAID also planned on switching its focus from quantity to condom distribution and quality control. UNFPA adopted the new WHO Specifications and Guidelines for Condom Procurement. IPPF considered doing so also.