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NEW INTERNATIONALIST. 1988 Oct; (188):32.One of Africa's most rural and densely populated countries, Burundi is a landlocked nation in Central Africa. The 4.9 million people are 85% Hutus, agricultural people of Bantu origin. However, the Hutus are excluded from power by the minority Tutsis, and the 2 groups have engaged in violent conflict. After a military coup in 1987, a new president, Major Pierre Buyoya, was installed, but restrictions on the Hutus continue. The major difference in Burundi has been a relaxation of restrictions on the Catholic church, which were severe under the former President Bagaza. Most Hutus are Catholic, with a minority of Muslims. For the peasant farmer, faced with diminishing arable land and reliance on 1 export crop (coffee), life is becoming more difficult. An expansion of sugar production was planned to reduce reliance on coffee, although the government has a rather ambivalent approach to development. While promoting private sector development with the help of the World Bank and the U.S. government, the Burundi government maintains a rigid 1-party system with strict control over the lives of the people. Infant mortality stands at 196/1,000 live births and life expectancy is low--43 years for women and 40 years for men. The literacy rate is low (39% for men, 15% for women), and the GNP per capita is low ($230). Most land is used for subsistence crops such as cassava, bananas, sweet potatoes, maize, pulses, and sorghum.
The role of international agencies, governments, and the private sector in the diffusion of modern contraception.
TECHNOLOGY IN SOCIETY. 1987; 9(3-4):497-520.This paper views diffusion as encompassing three processes: the acceptance of the idea and practice of contraception by consumers; the establishment of the institutions or programs to provide services; and the development of technical capability in research and development and in the production of contraceptives. The historical development of the family planning movement is described, and the contribution of international agencies, governments, and private sectors is discussed in the context of changing development approaches. Substantial achievements have been made, but, in view of future needs and the uncertainty of political and financial commitment to family planning on the part of donors, the future presents a continuing challenge. (EXCERPT)
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
The ECOP-ILO Population Education Program: a report on program implementation (January 1985 - December 1986).
[Unpublished] . 11 p.A 2-year (Jan. 1985 - Dec. 1986) Population Education Project was carried out by the Employers Confederation of the Philippines (ECOP) and the International Labor Organization (ILO) with the objectives of informing employers of the importance of population and family life education and assisting them in the provision of family life education programs and family planning services for their workers. ECOP undertook a preliminary survey of 269 companies, which showed that: 1) Only 49 had family planning programs; 2) Only 37 of the others had any interest in having one; 3) Only 8.7% of the workers were acceptors; 4) Only 45 companies had clinics; 5) Only 7 had incentive schemes to motivate the workers; and 6) 98% of the 210 respondents felt that ECOP should not be involved in family planning. To accomplish its objectives ECOP held 22 population education seminars, attended by 98 company representatives over the 2-year period. With the assistance of the Population Center Foundation (PCF) ECOP established an In-Plant Family Planning Program, which determined the existing knowledge, attitude and practice of workers; recruited and trained clinic staffs and volunteers; disseminated information; and delivered family planning commodities and services. The ECOP also approved an incentive scheme to encourage employers to support the program. The ECOP Population Unit participated in the 1986 Philippine International Trade Fair by setting up exhibits, showing audiovisual presentations, and distributing ILO handbooks on population education. The ECOP project officer attended an inter-country population workshop in Tokyo. The ECOP recommended that the participating companies meet to discuss the project's accomplishments, implement incentive plans, assist in setting up family planning programs, join with family planning agencies to provide services, devise ways of making men aware of their responsibilities in family planning, and study the productivity of workers who practice family planning.
[Unpublished] 1987. 55,  p.Marketing is a branch of economics which includes the analysis, planning, implementation, and control of promotional programs designed to encourage a target population to accept an organization's product or service. Social marketing (SM) is the application of marketing technics to alter the behavior of a target population toward the acceptance of a social project. Early efforts in social marketing involved public service or "social" advertising via mass media; and early projects were directed toward family planning, health and nutrition in developing countries. Several lessons were learned from these early projects: 1) Persuasive technics must be geared to the specific project; 2) Pilot projects should be limited in scope; 3) Target populations are variable and must be precisely defined; 4) Constant feedback is essential; 5) In developing countries mass media campaigns must be directed, not only at the end-user population, but also at the intermediary government officials, health workers, teachers, and food distributors; 6) Maximum use must be made of the small amount of media time available; 7) In poor, underdeveloped countries persuasion technics must take account of cultural and psychological barriers to behavior modification; 8) Social marketing is not competitive in the commercial sense; 9) Careful market research must be done in order to avoid mistakes due to failure to understand cultural barriers; 10) Health education efforts must address the whole health environment, not merely one aspect of it because the different aspects are interrelated, e.g., the relation of food hygiene to the cleanliness of the water supply; 11) Social marketing cannot overcome basic economic and political barriers to the reception of a new project. Some recent examples of social marketing include the experience of SOMARC (Social Marketing for Change), a private voluntary organization which worked with the Indonesian government to distribute condoms; HEALTHCOM, which worked with oral rehydration therapy in 8 countries; the Johns Hopkins Population Communication Services, which used popular music to "sell" chastity to young people in Latin America; and China's "one child" program. The present project involves a cooperative effort among the General Foods Corporation, the International Chamber of Commerce, the International Advertising Association, the Industry Council for Development, and the World Health Organization Consultation of Health Education in Food Safety. This project will test the adaptability of commercial food marketing technics for use with a target population which buys different foods, largely unpackaged and unlabelled. The effort must be coordinated with local health workers and will involve training of local food handlers and technicians and the use of some give-away item such as a calendar to serve as a reminder and hold the attention of the target population. Similar cooperative ventures, involving pharmaceutical firms, local organizations, local governments, and the World Health organization have shown the effectiveness of social marketing in reaching target populations in developing countries.
DEVELOPMENT: SEEDS OF CHANGE; VILLAGE THROUGH GLOBAL ORDER. 1987; (4):117-21.In this article the relations between government and non-government organizations (NGOs) are analyzed. In many countries, government and NGOs are 2 different worlds with little interaction between them. The differences between the 2 types of organizations could be summarized as the difference in the scale of operations, in the approach to development, different underlying philosophies, a different way of operating, different counterparts in developing countries, different projects and programs and a different way of dealing with the political context of development projects and programs. Collaboration between developed countries' governments and NGOs to stimulate development could be improved through: 1) a more systematic exchange of information between the 2 types of organizations; 2) the formulation of conditions for success in a particular country; 3) more sub-contracting of certain kinds of projects and project components to NGOs; 4) carrying out activities together; 5) improving the modalities and procedures of financial support to NGOs and in some cases its volume as well; and 6) moving from emergency to prevention. It is important to search for new fields of collaboration between government and non-government organizations. Examples are working with NGOs to formulate and implement food policies, relying on NGOs for feedback on certain policies, or in trying to achieve structural adjustment with a human face.
PEOPLE. 1987; 14(2):33.3 agencies in Turkey are placing family planning centers in factory settings: the Family Planning Association of Turkey (FPAT), the Confederation of Trade Unions (TURK-IS), and the Family Health and Planning Foundation, a consortium of industrialists. The FPAT started with 27 factories 7 years ago, educating and serving 35,000 workers. The 1st work with management, then train health professionals in family planning, immunization, infant and child care, maternal health, education, motivation techniques, record-keeping and follow-up. Worker education is then begun in groups of 50. New sites are covered on a 1st-come-1st-served basis. This program is expected to be successful because newcomers to city jobs are beginning to see the need for smaller families, and accept family planning. TURK-IS has conducted seminars for trade union leaders and workers' representatives and provided contraceptives in 4 family planning clinics and in 20 hospitals run by Social Security, a workers' health organization. They have distributed condoms in factories and trained nurses to insert IUDs in factory units. The businessmen have opened family planning services in 15 factories, with support from the Pathfinder Fund, and hope to make the project self-supporting.
In: Family planning within primary health care, edited by F. Curtis Swezy and Cynthia P. Green. Washington, D.C., National Council for International Health, 1987. 112-4.The World Bank's appreciation of the unique role of NGOs in working beyond the effective reach of government systems in reaching underserved populations and communities has come with its increasing involvement in social sector development. NGO understanding of the needs of communities, underserved populations, and special subgroups constitutes a strong basis for designing and implementing actions to promote social and behavioral change. NGOs can complement the skills available within governments to put their people-oriented policies into meaningful effect. This NGO support may be sine qua non for the success of such policies, and of the programs and projects the Bank supports in the social sectors. The Bank is still developing ways to encourage NGO participation in such programs and projects. Staff in the Population, Health and Nutrition Department of the Bank are directing much more effort now to working with NGOs in family health and population work, particularly in subSaharan Africa where the greatest current challenge exists. At the international level, in order to promote policy dialogue with an operational perspective between the Bank and the NGO community, a Bank/NGO committee has been established. Composed of NGO representatives from both donor and recipient countries and Bank staff, it meets regularly and has proven helpful in identifying mutual interests and common objectives in a number of important areas, including food security. The committee does not replace collaborative mechanisms at the country level, but it has been successful in inspiring both the Bank and NGPs to pursue collaboration more assiduously at the country and sectoral levels.
Population Reports. Series J: Family Planning Programs. 1987 Sept-Oct; (34):921-51.Family planning services through the workplace is an idea that is attracting more attention, benefit's workers, employers, and nations. Large manufacturers and plantations in India first offered family planning to workers in the 1950s. Now also in Indonesia, the Philippines, Thailand, South Korea, Turkey, Egypt, Kenya, and elsewhere, many large companies have added family planning to other health services. In some Latin American countries social security systems have added family planning for many workers. Many different groups, including compaines, labor unions, government-sponsored social marketing programs, and the military, run employment-based programs. Services are offered in workplace clinics, through referrals, in free-standing facilities, in social security hospitals, and in community clinics. Funding comes from employers, governments, unions, family planning associations, and USAID. The most effective programs offer supplies and services as well as information, offer them directly at the workplace, and use worker-volunteers to distribute pills and condoms. Successful programs require the full support of company management. Favorable cost-benefit projections can show managers that offering family planning makes financial sense and contributes to employee health.
JOURNAL OF POPULATION STUDIES. 1986 Jun; (9):193-212.Population studies have been well developed in many countries of the world, but not so in Taiwan. Many academic people and general citizens in the Taiwan area are still not very familiar with the significance of population research within and outside of the nation. The purpose of this paper is to help readers understand the importance and development situation and trend of the field of population studies, so that they can be motivated to carry out population research and can become more knowledgeable of institutions and organizations both in Taiwan and abroad. Important concepts of the development and trend of population studies presented in this paper are developed by the author after many years of population study. Most sources used in this paper are secondary, and appear in various population references and documents of population organizations. The paper includes 3 main parts: the importance of population studies, the development of population studies in Taiwan, and international population research and sponsoring organizations and agencies. In the 1st part, the important need for population studies has been comprehensively discussed. In the 2nd part, discussions are extended to 3 subjects government's role on data collection and data analysis, teaching and research developments in acdemic institutions, and the role of private organizations in the promotion and application of population studies. In the 3rd part, more than 70 international institutions and agencies of population studies have been introduced and examined. Partticular attention has been paid to characteristics and functions of 3 organizations: UN Population Divisions, IUSSP, and CICRED. In addition, many other international public and private agencies in different countries have been listed and their locations mentioned. In this paper, discussion has not focused on the development of population in the US. It is because the development status in the US is unusually important and requires a separate, special report. The author has made such a report on population studies in the US a decade ago, and it will not be repeated here. (author's modified) (summary in ENG)
Bangkok, Thailand, The Population Council, Regional Office for South and East Asia, 1985. 30 p.This brochure describes the work of the Population Council in Asia in mid-1985. It focuses on work that is being done within the region under the auspices of the Council's Regional Office for South and East Asia located in Bangkok. The brochure does not describe the work of Council staff based in New York who are conducting research on or in collaboration with colleagues in several Asian countries, with special focus on Bangladesh, China, India, and Indonesia. Information about these and other Council activities can be found in the Council's Annual Reports. The Population Council's program of activities in South and East Asia spans the full range of Population Council interests in the social, health, and biomedical sciences. As of mid-1985, activities managed by the Regional Office for South and East Asia consist of 12 projects falling under 4 broad program categories: Family Planning and Health; Infant and Child Mortality; Social Science Research on Population and Development Interactions; and Contraceptive INtroduction. The objectives, staff, and activites of each project are described. Appendices include 1) a list of publications generated by the projects, 2) a list of specific awards under projects, 3) a Population Council staff list for Asia, and 4) advisory panels for projects. (author's modified)
New York, New York, United Nations, 1985. 38 p. (ST/ESCAP/397.)This document reports on the Policy Workshop on International Migration in Asia and the Pacific (Bangkok, October 15-21, 1985), which was organized and funded by the UN Economic and Social Commission for Asia and the Pacific (ESCAP) and the UN Fund for Population Activities, and whose objectives were to 1) review the results of 7 studies initiated at a similar conference the preceding year, 2) relate the research findings to government policies for return migrant reintegration, and 3) make and disseminate policy recommendations to ESCAP regional governments. The subjects of the 7 studies concerned 1) decision making processes and the value orientation of return migrants, 2) Korean migrants returning from the Middle East, 3) return migration in Mediterranean basin countries, 4) return migration in Sri Lanka, 5) Thai return migration, 6) Filipino return workers, and 7) return migration's effects on a Tongan village. Conference attendees came from Australia, Bangladesh, India, Pakistan, the Philippines, Korea, Sri Lanka, Thailand, Tonga, and Italy. The workshop concentrated on migrants returning from jobs in the Middle East, since in 1983, 3.5 million ESCAP overseas workers were employed in that region. The workshop's agenda included 1) return migration measurement, 2) government and private company policies, 3) reintegration of return workers, 4) return migration in Mediterranean basin countries; 5) the village level impact of international migration, and 6) policy formulation for return migrants. The most important recommmendations made by the workshop were that 1) a major study should be undertaken to ascertain the numbers and skills of migrant workers in the Middle Eastern receiving countries, 2) this study should estimate future Middle Eastern labor demand, in terms of volume and skills, and 3) the study should be conducted under appropriate experts appointed by the ESCAP secretariat, and should report their findings as soon as possible.
Populi. 1985; 12(4):22-31.Although the UN's charter (1945) provided for arrangements with non-governmental organizations (NGOs), relations between the 2 have been uneasy, since NGOs are often ignored or not listened to fully. The 1974 World Population Plan of Action delegated NGOs to a peripheral role, but the 1984 Plan both commended their work and recognized the partnership that has developed between governmental and private sector and voluntary organizations in many nations. NGOs include professional organizations, advocacy organizations, and many broadly based organizations for women, youth, churches, education, science, and the environment. This article describes the following NGOs in terms of their growing influence on the UN and how the UN and UNFPA have helped these NGOs make full contributions: 1) the International Union for the Scientific Study of Population (IUSSP), founded in 1928 in Paris, was the first NGO accorded consultative status by the Economic and Social Council; 2) the International Planned Parenthood Federation (IPPF), founded in 1952, attained consultative status in the mid-1960s, and has been on a partnership basis with the UNFPA since its inception, although, in 1984, it became a target of major US policy change; 3) the Population Council, begun in 1952 by John D. Rockefeller under National Academy of Sciences auspices, has trained thousands of demographers, economists, and social scientists and has made major contributions to the UN's 1954-1984 population conferences; 4) other NGOs such as the Population Reference Bureau, the Population Crisis Committee, the Population Institute; and 5) less specialized NGOs such as the International Association for Maternal and Neonatal Health, and the International Association of Obstetrics and Gynecology. NGOs help give the necessary public support to population efforts, but their diversity can cause coordination problems that must be settled as national levels or by the UN.
Assignment Children. 1985; 69/72:397-414.The recent immunization campaign in El Salvador has been a success despite the civil war. Both the government and the guerrillas agreed that the goal of immunizing children was an ideal transcending all differences, and that immunization should be taken to all parts of the country and all Salvadorian children. The campaign had the personal support of the head of state, the church, UNICEF, PAHO/WHO, ICRC and other organizations who worked with the parties to implement the campaign. The 3 national immunization days, held on February 3, March 3, and April 21, 1985 were transformed into days of tranquillity. This article describes how the campaign was organized and presents an assessment of its achievements. An executive committee was created and both UNICEF and PAHO/WHO took part in its meetings. Specific commissions handled channeling, training, supplies, the cold chain, information and evaluation, and promotion and education. The plan of action proposed that all branches of government and the private sector support the immunization campaign and a national support council was establish for this purpose. The original goal was to immunize 400,000 children under 3 years of age against diphtheria, pertussis, tetanus, polio, and measles. The goal was extended to cover children under 5 years of age. Funding was provided from both public and private organizations. Reasons the campaign was a success despite war conditions include: the campaign was backed by political commitment; the mechanisms created to implement the campaign functioned smoothly; mobilizing the media generated a change in opinion and attitude. The campaign rested on solid technical and political foundations. It reached 87% of children under 5 in the area.
[Washington, D.C.], U.S. Agency for International Development, 1979 Dec. 13 p. (A.I.D. Project Impact Evaluation Report No. 2)In 1964, hybrid maize was released for commercial production in Kenya. An aggressive private firm, the Kenya Seed Company, reproduced the seed, distributed it, and promoted it throughout the country via a network of private storekeepers. Hybrid maize allowed Kenya to feed itself and to industrialize rapidly at the same time in the face of a very rapid increase in population. Hybrid maize made it possible for Kenya to earn foreign exchange from the export of cash crops by reducing the demand for land for food crops. There were, however, limits to this success: 1) an indigenous maize research capacity has not been created in Kenya; 2) a substantial number of the country's poor have not been able to participate directly in achieving the increased yields; and 3) the policies of the government have not changed sufficiently to allow the full economic benefits of the technology to filter through the existing marketing systems to smallholders. The Agency for International Development (AID) played a role in the success of the hybrid maize. AID shares responsibility for the successful diffusion of the seed to neighboring countries in Eastern Africa. Several lessons were learned from the observations of Kenyan maize growers: 1) simplicity and viability were the decisive technical factors in the success of hybrid maize; 2) the private sector was crucial in its diffusion; 3) equity cannot be expected; 4) long term continuity of foreign experts was basic to the success of the breeding program; 5) foreign advisors do not automatically create an institutional capacity to perform agricultural research; 6) pragmatism should surround AID support for regionalism; and 7) too many lessons should not be drawn from the Kenyan experience.
Populi. 1985; 12(3):34-9.The US Agency for International Development (USAID) in consultation with the government of Kenya agreed in 1983 to prepare a demonstration family planning project, which would assist the private sector as well as other major nongovernment providers of health services to upgrade their health services, train and augment their nursing and other medical staff, provide family planning equipment and free contraceptives, and establish these health facilities as full-time family planning service delivery points. The Family Planning Private Sector Program (FPPS) will assist 30 private sector firms, "parastatal" organizations, and other private and nongovernment organizations that already provide health services to their workers, their dependents, and in many cases the surrounding communities to upgrade their services and add a full-time family planning facility. As some of the firms or organizations have multiple outlets, the program will create 50 or more new family planning delivery points throughout Kenya, thereby also relieving some of the pressure on government facilities. The FPPS sub-projects are to recruit at least 30,000 new acceptors. FPPS has added a guideline that at least 60% of these new acceptors be retained in the program for at least a period of 2 years. The FPPS program has received an enthusiastic reception from employers, the unions, and nongovernment organizations such as the Protestant Church Medical Association and the Seventh Day Adventists. The FPPS team can provide projects with a variety of services and funds for family planning related equipment, supplies, and activities. These include assistance with project design, training existing medical staff in family planning service delivery, the collection of baseline information, and the provision of funds for equipping family planning clinics. The government has encouraged FPPS to be innovative and to introduce family planning services into as wide a variety of health services as possible. As presently designed, the FPPS program is primarily a service delivery program but is beginning to play an increasingly dynamic role in information and education activities about family planning. From the start, the participating projects demanded assistance in spreading the family planning message to the workers, their families, and the community. It is evident that the program has stimulated management, clinic staff, and workers and has generated competition between projects to reach and exceed their targets of both new acceptors and high continuation rates.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
Washington, D.C., Population Crisis Committee, 1985 Dec. 8 p. (Status Report on Population Problems and Programs)In 1985 Brazil's new civilian government took a potentially significant step towards political commitment to a national population program by appointing a national Commission for the Study of Human Reproductive Rights and by accepting large-scale external assistance to implement a nationwide maternal and child health program intended to include family planning services. Brazil's traditional pronatalist policy has been undergoing a change since 1974 and family planning is now viewed as an indispensable element of Brazil's development policy. Several laws which had long impeded the growth of family planning services have been revised or repealed. It is no longer illegal to advertise contraceptives, but abortion is only allowed in restricted circumstances. Approval for voluntary sterilization is easier to obtain. Brazilians who practice family planning obtain services primarily through commercial channels or the private sector. The government and private family planners are faced with a major problem of organizing family planning services for rural areas and the vast city slums. The estimated cost of a national family planning program for Brazil is between US$221 million for 1990 and US$182 to US$324 million for the year 2000. The various aspects of the government program are discussed. The private sector was instrumental in introducing family planning to Brazil. A private non-profit organization was established by a group of physicians to encourage the government to develop a national family planning program and to inform the public about responsible parenthood. This organization (BEMFAM) was given official recognition by the federal government and a number of states and declared a public convenience. Another organization (CPAIMC) was established to provide maternal and child health care in poor urban areas. The sources of external aid, accomplishments to date and remaining obstacles are discussed. Sources of external aid include: UNFPA, USAID, IPPF, the Pathfinder Fund and Columbia University's Center for Population and Family Health (CPFH). A change in popular and official pronatalist attitudes has been effected.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
General lessons learned from evaluations of MCH/FP projects in Botswana, Malawi, Swaziland and Zambia.
New York, New York, UNFPA, 1984 Dec. iv, 41 p.4 maternal-child health/family planning (MCH/FP) projects were evaluated by the United Nations Fund for Population Activities (UNFPA) in the Southern Africa Region between 1981-1984. The projects were in Botswana, Malawi, Swaziland and Zambia. An overriding finding at the time of the Evaluation Missions was the acceptance of family planning (child spacing) by all 4 governments, when at the onset of the projects, family planning was either not included in the project documents or was included only as a minor contributant to the MCH programs. The intervention by UNFPA was very important for the acceptance and promotion of family planning activities by the governments. The Evaluation Missions concluded that there were 3 primary reasons for the successful intervention: UNFPA has a broad mandate to provide assistance in MCH and FP, a commitment to development projects in line with the governments' priorities, and the ability to fund projects very quickly, facilitating project implementation. Each of the 4 projects is assessed in terms of population policy changes, MCH/FP program strategy and serive delivery, organization of the MCH/Fp unit, health education, training, evaluation and research systems, and administration and management. Essential factors affecting the project are outlined and recommendations made. The last section discusses general lessons derived from the MCH/FP projects evaluated. 5 areas are identified where similar problems exist to varying degrees in all the projects evaluated. These are: training of medical personnel in FP (the main MCH/FP service provider in these projects was the nurse/midwife); supervision of personnel and the supply and distribution of contraceptives; research and evaluation, especially regarding the sociocultural setting of target populations and the inadequacy of existing service statistics and other sources of data; project monitoring (technical and financial) and finally project execution by the World Health Organization (WHO). Specifically in regard to the recruitment of experts, the provision of supplies and equipment, and the provision of funds for local costs, WHO execution has been deficient.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
The use of indicators of financial resources in the health sector. L'emploi des indicateurs de ressources financieres dans le secteur de la sante.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1984; 37(4):450-62.This article provides an overview of the application of financial resource indicators in health. The focus is on indicators at the country level, although in certain instances related sub-national indicators are considered as well. 1st the different categories of financial resource indicators are described. The international experience in data collection, and problems of data availability and comparability are reviewed. Although the points addressed are relevant to all countries, the discussion is most applicable to the developing world where health information is limited. Particular attention is given to the design adn use of financial resource indicators in monitoring progress towards the goal of health for all. Finally, the steps that may be taken to increase the contribution of financial resource indicators to the health development process are discussed. Viewed economically, the health sector consists of production and consumption of services which have relatively direct influence on population health status. The different types of resources may be linked to their respective prices to show the financial flows that operate within the health system. The sources and uses of funds are identified. 3 types of financial resource indicators can be identified: health within the national economy, the provision of funds from primary sources and the functional and programmatic uses of funds. The 1st type is concerned with the aggregate availability of funds within the national economy and the fraction of those funds which are allocated to health. The 2nd component relates to the origins of the funds which make up the total health expenditure, under the broad headings of public, private and external sources of health finance. The 3rd type refers to the variety of used to which funds from these sources are put (expressed in terms of function e.g. salaries), program type (e.g. primary health care), or activity (e.g. health education).
Development: Seeds of Change. 1984; 2:63-4.The need to completely rethink the practice of rural development strategy is clear, but the danger lies in restricting the reexamination to merely a fragment of the process--planning--when rural development should be considered in its entirety as a process in which rigid and conventional planning has serious limitations. The issue is not whether some "adaptation" of the classical approach will work, but whether the basic assumptions were meant for rural populations. Actually, practical experience shows that "success" has often been the result of respecting a more natural rural development process in which the following 6 principles have been interwoven: rural development cannot be based on classical planning methods that assume a planning implementation dichotomy; implementation must not be the application of a readymade plan, since planning, execution, and evaluation are a constantly ongoing interacting process; environmental complexity requires an analysis and a detailed dynamic comprehension of the ecological, human, political, economic, and institutional variables affected; the complexity and slow pace of the environment's evolution requires that, from the onset, the intervention occurs in a restricted geographical area over an extended time period of from 10-20 years; the participation of target groups in the implementation and evaluation of activities must depend on their increased participation in the ongoing design of the project; and the comprehensive mobilization of the population requires support from all the local structures (nongovernmental organizations, private sectors, peasant movements) in order to foster self development and a better balance of resources and power. These principles are not without important repercussions for both donor agencies and recipient countries. Recent experiences confirm the need to compromise and adapt the donor's organizational and political restrictions as well as the requirements of the recipient governments. If managing rural development is complex and difficult for a donor agency, it is often equally so for a local technical department. In sum, rural development is a social project involving the transformation of the human, economic, political, ecological, and institutional aspects of the rural society of a specific area. Rural development is an ambitious undertaking, and it has become increasingly evident that rural development is incompatible with classical planning approaches.
Tellus. 1984 Jul; 5(2):8-11, 25-8.Since the formulation of the World Population Plan of Action (WPPA) in Bucharest in 1974, about 80% of governments have endorsed family planning and fertility control. There has been a growing awareness by governments that population planning must be an integral part of general policy formulation. This article describes the issues of central concern to the 1984 International Population Conference in Mexico, highlighting those which result from new global developments over the past decade. Immigration, particularly by exiles and refugees from political persecution, are contributing much more to population instability than foreseen by the WPPA. Internal migration and massive population shifts from rural to urban areas are of increasing concern to governments in developing nations. In developed countries, there has been an emergence of anxiety over zero population growth. The role of privately sponsored programs for population control is much less prominent, as governments take more responsibility for formulating population policy. A report from a meeting of 90 such nongovernmental organizations held in 1983 was reluctantly accepted as an official document at the conference in Mexico. The Canadian Task Force on Population has identified 5 issues of special concern: status of women, the environment, aging, immigration, and family planning. The Task Force includes among its objectives the encouragement of a comprehensive population policy for Canada, focussing both on Canada's special concerns and on its place in the global community. For example, acid rain and improper soil conservation are threatening Canada's status as one of the few viable "bread baskets" for the world. The growing bulge in the population over age 65 will impose economic strain in the future. Sex education for adolescents in inadequate, with only 1/2 of Canadian schools addressing sex and sexuality in the curriculum.
[Unpublished] 1984. i, 15, 5 p.This report ist presented in response to a United States Agency for International Development (USAID) /Sri Lanka request for a review of the population and family planning program in the country and for recommentdations on the future role of UASID in support of the Sri Lanka program. It is intended to help the USAID Mission to make decisions regarding both the substance of population program assistance and the manner in which it is provided. The central recommendation is that the Mission undertake bilateral support of both public and private sector programs as soon as possible. This report is organized into 3 parts: 1)a brief overview of the demographic situation; 2) a review of the present national program, both public and private; and 3) recommendations for future program directions. The report was prepared during a 3-week visit to Sri Lanka. The relatively high rate of population growth will become an even greater factor in Sri Lanka's development equation than it has been in the past, and unless there is a significant and rapid decrease in fertility, population growth will diminish development prospeccts for the remainder of the century. USAID currently provides about US$0.5 to US$0.7 million of annual support to Sri Lanka family planning services programs through 9 intermediaries. This does not include the annual assistance provided by the United Nations Fund for Population Activites and International Planned Parenthood Federation which total approximately US$1.5 million. The Family Health Bureau of the Ministry of Health is responsible for managing the Government's family planning program. The Family Planning Association of Sri Lanka currently manages 2 large family planning service projects. USAID should begin high-level discussions in earnest with the Sri Lanka government.