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  1. 201

    Evaluation report on the Philippines diarrhea clinical training program. Part A.

    Casazza LJ; Newman JS

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991. [7], 14, [50] p. (USAID Contract No. DPE-5969-Z-00-7064-00)

    In September 1991, 2 consulting groups, WHO, and the Department of Health of the Philippines collaborated in a study to determine the quality of the diarrheal training unit (DTU) courses at various hospitals in Manila, Cebu, Zamboanga, and Tacloban, the Philippines and the ability of the DTU trainees to apply what they learned. The evaluation team observed 2 courses in diarrheal case management at the National Rehydration, Treatment, and Training Center (NRTTC) in Manila and at the Southern Islands Medical Center (SIMC) in Cebu presented simultaneously between September 2-6, 1991. During the course, trainees at NRTTC were able to observe 54 diarrhea cases while those at SIMC were able to observe 8. The simulation testing showed that trainees of the NRTTC course were better able to assess and manage diarrhea cases at the end of the course than were those of the SIMC course. This was because NRTTC participants had had more extensive practical training. This finding suggested that the best training method consisted of experience and confidence acquired in actually managing cases. Case simulation was valuable in identifying deficiencies in trainee knowledge and skills that would have otherwise been missed. In fact, facilitators at SIMC observed trainee problems in all 3 major skill areas: assessment, treatment, and counseling. The evaluation of participant postcourse knowledge and skills and of content and teaching methods of the training courses should prove useful to the DTU faculty and the Control of Diarrheal Disease program in planning for future DTU training. Further it provided a base to measure ensuing participant performance in the field. The team arranged for administration of part B of the study which is to identify strengths and weaknesses of the trainees.
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  2. 202

    A strategy for reducing numbers? Response.

    Rohde JE

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):24-5.

    While there may be no documented evidence that mortality decline is a causative factor in demographic transition, there is a close association between reductions in mortality and fertility. The Indian experience of more than 40 years shows that consistent efforts in the promotion of family planning will be rewarded with demographic transition. In the Indian state of Kerala, population 30 million, improving child survival, female literacy, strict child labor laws, and effective high coverage primary health care reduced mortality and fertility. Its infant mortality rate is 22/100 births, which is 25% of the national average. Its birth rate is 20/1000 and is continuing to fall. In the past decade population growth was only 14% compared to 25% nationally and 28% in the northern states. If Kerala's figures were applied to all of India, there would be 2 million less infant deaths and 8 million less births. The impact of reducing infant mortality on population growth in raw numbers in insignificant. With a mortality rate of 150/1000 there are 850 survivors. If the mortality rate is cut in half there will be only a .18% increase in population, but with a 50% reduction in infant suffering and death. Historically such mortality declines are associated with a 25% or more decline in fertility. This is the reason that UNICEF has been a long-time advocate of child survival programs as an integral part of population control measures. Euthanasia is surely not the solution to the population problem. The daily loss of 40,000 childhood lives is a tragic part of the human experience. However, helping these children to become and stay healthy is the best method of reducing population.
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  3. 203

    UNICEF annual report 1991.


    New York, New York, UNICEF, 1991. 60 p.

    The 1991 UNICEF annual report contains an introduction written by the Executive Director, James P. Grant. In it he outlines the goals of the World Summit for Children which include: initiatives to save an additional 50 million children, reduce childhood malnutrition by 50%, reduce female illiteracy by 50% , and eradicate polio and guinea worm from the planet. The report discusses the programs conducted during 1991 including: the World Summit for Children, child survival and development, basic education, water supply and sanitation, sustainable development, urban basic services, childhood disability, women in development, social mobilization, emergency relief, monitoring and evaluation, inter-agency cooperation. The report also outlines UNICEF's external relations, resources, and provides several profiles including Africa's AIDS orphans. Income for 1990 totaled US$821 million for 1990, and estimated at US$858 million for 1991. Expenditures for 1989 were US$633 million, US$738 million for 1990, and estimated at US$847 million for 1991.
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  4. 204

    The state of the world's children 1991.

    Grant JP

    Oxford, England, Oxford University Press, 1991. [8], 128 p.

    The State of the World's Children for 1991 begins with a promise by world leaders to adopt an ambitious series of goals for 2000 with an objective to end child death and child malnutrition at today's levels. Keeping the promise will not be easy since raising the resources to meet this goal will mean giving children a new, higher priority. Success will only be achieved by following certain principles, for example, reaching the immunization goals for the year 2000 will require almost every organization and person in both developing and developed countries to work hard. In order to succeed in only 10 years, a new ethic must develop which gives children a number 1 priority even in bad times. Reducing child deaths by 33% during this decade will mean essential steps must be taken in the process of reducing births and slowing population growth. The current generation will be charged with caring for the largest generation of children ever. Their performance will ultimately be judged according to the outcome of the children of the 1990s.
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  5. 205

    Population: more than a numbers game.

    Walker A

    BMJ. British Medical Journal. 1991 Nov 9; 303(6811):1194-7.

    World population reached 5 billion on July 11, 1987. Current UNFPA projections predict world population stabilization at 10 billion by 2050. However, the current population is already exerting a tremendous amount of pressure on the carrying capacity of the planet. Ozone depletion, global warming, and acid rain are all the result of human activity at a level of half the current projection. World food production stabilized in 1988 and fell 5% in both 1987 and 1988. In both those years, world population grew 3.6% annually. Every year 14 million tons of grain production are lost to soil erosion, irrigation damage, poor land management, air pollution, flooding, acid rain, and increased ultraviolet radiation. Controlling population growth is not an easy task because of the complexities involved. Increasing female literacy and reducing infant mortality rates are very powerful means of controlling growth. China has served as the best example by reducing its growth rate from 4.75 in the early 70s to 2.36 in just 10 years. They accomplished this in a homogeneous society by making population control a civic duty. They provided rewards for small families and penalties for large ones. Family planning need is still very high, although it ranges from 12% in the Ivory Coast to 77% in the Republic of Korea. The UNFPA goal is to make family planning available to 59% os the world is couples by 2000. To do this, an additional US$9 billion needs to be spent which is a tiny fraction of total development aid to the 3rd world. In 1990 .9% of the total amount of development aid went to population and family planning programs.
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  6. 206

    Why Nicaraguan children survive. Moving beyond scenario thinking.

    Sandiford P; Coyle E; Smith GD


    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.
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  7. 207

    Population and the environment: the challenges ahead.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 1991. 44 p.

    When discussing issues of population and the environment, 2 factors stand out: 1) poverty is continuing to grow, rather than shrink. Worldwide over 1 billion people live in absolute poverty and the total international debt of low-income countries is over $1,000 billion and growing; 2) social sector programs designed to maintain health, family planning services, housing, and education are constantly underfunded and do not receive the priority that they merit in national and international development programs. This report from the UNFPA contains discussions of sustainable development, the problem of growing urban populations, the balance between population and resources, land degradation, tropical forest destruction, loss of biodiversity, water shortages, population impacts on quality of life, and policy considerations.
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  8. 208
    Peer Reviewed

    Perspectives on rapid elimination and ultimate global eradication of paralytic poliomyelitis caused by polioviruses.

    Sabin AB

    EUROPEAN JOURNAL OF EPIDEMIOLOGY. 1991 Mar; 7(2):95-120.

    Paralytic poliomyelitis caused by the poliovirus has been almost completely eradicated in many countries. This was achieved by a maximal break in the chain of transmission through mass vaccinations. Strategies in the poor subtropical and tropical climates of Asia and Africa where annual estimates of paralysis are 250,000 cases must be adapted to countries characterized as having year-round fecal born infectious agents, including paralyzing polioviruses and other enteric viruses, and inadequate health facilities, poor sanitation and hygiene, and high levels of poverty. A virologic study in Mexico City and the Soviet experience lead to the successful Cuban strategy in 1962 of 2 annual, national days (2 months apart) of mass administration of OPV to all children in a specified age group, regardless of how many doses of OPV already had been received. The implementation by independently organized well-trained nonprofessional community volunteers is provided in detail. It is this strategy that is recommended for a WHO EPI group and Pan American Health Organization effort to eradicate poliomyelitis worldwide. The discussion of the worldwide effort to eradicate smallpox points out that the methods, used for smallpox eradication would be ineffective because poliomyelitis infections are clinically inapparent and vaccination around recognized cases is insufficient to break the chain of transmission. Problems arise due to the misdiagnosis of acute paralytic diseases which pathologically are not poliomyelitis. The distinction between paralytic poliomyelitis caused by polioviruses and paralytic poliomyelitis is made and discussed. The experiences of eradicating paralytic poliomyelitis in economically developed, temperate climate countries and rapid elimination in underdeveloped subtropical and tropical countries is described in some detail. The OPV programs and lessons learned in Cuba (1962), Brazil (1980), the Dominican Republic (1983), Nicaragua (1981), Paraguay (1985), and Mexico (1986) are included. Inadequate mass campaigns which did not work to break the chain of wild polioviruses but reduced the disease level were Columbia (1984), El Salvador (1985), and Turkey (1985). Measures of achievement in Latin American are identified, and recommendations for worldwide eradication are given.
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  9. 209

    The approach of monitoring and surveillance in EPI.

    Abeyesundere AN

    IN TOUCH 1991 Jun; 10(99):18-20.

    The Bangladesh collaborative effort with WHO in strengthening monitoring procedures, developing disease surveillance, and evaluating periodically for the Expanded Program on Immunization (EPI) is discussed. Field data are gathered in periodic reviews and there are routine supervisory visits. The supervisory network i strengthened by the supervision of the consultation with local WHO Divisional Operational Officers. A routine reporting system provides data on immunization coverage by age and dose and number of vaccinations. Each form has 1) the annual targets for eligible women and children, 2) the cumulative vaccinations for the year, and 3) % of the target reached. Wall charts in the Upazila Health Complex and district health office also provide these data. 36 samples surveys have been conducted by local officers trained by WHO experts. 210 children are studied in clusters of 30 to provide 95% accuracy within 10 points of the true value. The vaccination reports are thus validated, and additional information provided on the number of fully immunized children dropout rates, reasons for partial immunization, and source of immunization. Disease surveillance is weak. Annual workshops have been held in 1986-90 to advance correct diagnoses and provide sentinel site data. 15 sentinel hospitals how provide admission data on diphtheria, tetanus, and poliomyelitis cases. Field-based epidemiological teams are being created. These steps are necessary to reach disease prevention goals. Special surveys have been conducted periodically to estimate the magnitude of the problem. In 1983, a lameness survey was conducted. The findings were that 61.3% of the poliomyelitis children became lame at <3 years, and 33% of lameness among 0-4 year olds was caused by poliomyelitis in 1983. A measles survey in 1985 in urban areas found an incidence of 2.6 million <5 years and 45,000 deaths annually. Case fatality was 1.74%. Diarrhea occurred in 38-75.5% of the measles cases; pneumonia in 2.2-11.7%. In 1986 in rural areas, neonatal tetanus had a mortality rate of 41/1000 live births, and 50% of neonatal deaths. In 1989 there was a reduction to 7-12/1000 live births. A computerized EPI information system (CEIS) is in place with computers and equipment at headquarters and in all 4 divisions. Monthly analysis is made at the national level. Current review has revealed high vaccination coverage. The focus for the future must be changed from vaccination coverage (at a cost for 1989-90 of Taka 202 or US$5.79 to disease reduction.
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  10. 210

    Governing Council: all eyes on "the field".

    POPULATION. 1991 Aug; 17(8):1.

    UNFPA's Governing Council has authorized the Fund to spend up to US$201.3 million during 1992 on programs designed to strengthen the Fund's programs and country programs assisted by the Fund. The Council also adopted a resolution in support of the UNFPA 1992-95 intercountry program, as well as regional programs in sub-Saharan Africa, the Arab States and Europe, Asia and the Pacific, and Latin America and the Caribbean. Furthermore, the Council also gave approval to 15 country and sub-regional programs in the following places: Albania, Bangladesh, Bolivia, Burkina Faso, Cape Verde, Congo, Dominican Republic, Honduras, India, Malaysia, Mauritania, Morocco, Niger, Tunisia, and the English-speaking Caribbean sub-region. One of the resolutions adopted by the Council calls for an increase in the number of staff members active in the Fund's field activities. This resolution establishes 7 new posts for international professionals and 90 new regular posts. The Council also called for increased cooperation with other international agencies. Another significant decision, the Council has allocated US$130.3 million (or a sum not to exceed 13.8% of programmable resources) for technical support, administrative, and operational services for 1992-95. The Council praised UNFPA's efforts at promoting awareness of the connections between population, the environment, and development, Moreover, the Council has asked the Fund to help set up contraceptive factories in individual countries for the purpose of containing the spread of AIDS. Finally, the Council discussed funding for the 1994 International Conference on Population.
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  11. 211

    World urbanization prospects 1990. Estimates and projections of urban and rural populations and of urban agglomerations.

    United Nations. Department of International Economic and Social Affairs. Population Division

    New York, New York, United Nations, 1991. viii, 223 p. (ST/ESA/SER.A/121)

    This statistical compendium provides revised UN estimates and projections of urban and rural population and urban agglomerations (UAs) for countries, regions, and major areas in the world. Less developed and more developed regions have data on the size and diversity of the urban population, urban and rural growth rates, and the rate of urbanization. The 10 largest UAs (Mexico City, tokyo, Sao Paulo, New York, Shanghai, Los Angeles, Calcutta, Buenos Aires, Bombay, and Seoul in ranked order from high to low in 1990) are discussed in terms of population and rate of change with 8 million or more people as well as % population in UAs. Sources of data by country and data access information are identified. Tables include % of population living in urban areas and urban population, in less developed regions, and in urban areas in Asia for 1990, 2000, and 2025. Also included are data on the annual urban population increase in Latin America, between 1975-90, 1990-2000, and 2000-25; and countries with 75% or greater urban population. The 10 largest UAs are ranked by size decennially 1950-2000, and regional distribution of UAs with 5 million and 8 million or more people. UAs with 8 million or more people are ranked by size decennially 1950-2000 and include average annual rate of change. % of the urban population living in UAs is given by city and region decennially 1950-2000. Tables on the distribution of the population among urban and rural areas by major area, region, and country, every 5 years between 1950-2025, as well as the growth rates and the average annual rate of change urban or rural are also included. The world's 30 largest UAs are ranked by population size decennially 1950-2000. Population and average annual rate of change of UAs of >1 million by country, every 5 years 1950-2000, and the % of the total population residing in UAs, followed by population of capital cities for 1990 are given. Figures show various dimensions of growth rate and mega-city growth rates. The overview is that at mid-1990 45% (2.4 billion) lived in urban areas with 37% in less developed and 735 in more developed areas, with projected increases to 51% in 2000.
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  12. 212

    Contraceptive source and the for-profit private sector in Third World family planning. Evidence and implications from trends in private sector use in the 1980s.

    Cross HE; Poole VH; Levine RE; Cornelius RM

    [Unpublished] 1991. Presented at the Annual Meeting of the Population Association of America, Washington, D.C., March 21-23, 1991. [63] p.

    Estimates by Family Health International and UNFPA predict that the annual cost of modern family planning in meeting the target overall contraceptive prevalence level of 52% will be between $5-9 billion by the year 2000. The number of couples using modern methods of contraception will increase dramatically in future years, incurring great cost to donors, governments, and users. Urbanization, rising incomes, and higher education levels are generally seen as positive factors in permitting an expanded private sector role in the provision of modern contraceptives, providing an alternative source to donor and government programs. The for-profit concerns within the private sector of developing countries, were studied using available 1978-89 data from 26 countries to examine private family planning sources of contraceptives. Also, hypothetical determinants of private family planning use are established and their interrelationship with the use of for-profit family planning services, is investigated. Contrary to result expectations, it was found that use of the major provider for-profit private sector is declining in the face of rising incomes, urbanization, and better education. Government services are crowding out the private sector. Additionally, results indicate a strong user desire for longer-term methods. Full comprehension of the private sector and the factors governing choice of contraceptive source should lead to more effective use of donor and government funding in efforts to achieve set population objectives. Policy and program development will more accurately reflect social needs. Policy implications of the results are discussed.
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  13. 213

    Child care: meeting the needs of working mothers and their children. Introduction.

    Leonard A; Landers C

    In: Child care: meeting the needs of working mothers and their children, edited by Ann Leonard and Cassie Landers. New York, New York, SEEDS, 1991. 1-4. (SEEDS No. 13)

    The overwhelming majority of women in the world work to make a living. In 1985 the female labor force amounted to 32%. In the developing world industrialization, urbanization, migration, and recession in the 1980's forced women to seek employment. In Ghana over 29% of households are headed by women. In the US 57% of women with children under 6 are employed. In Bangkok, Thailand, 1/3 of mothers were back to work within the 1st year of after childbirth. In Nairobi, Kenya, 25% of mothers were working when their child was 6 months old. Availability of child care is often scarce: in Mexico City during the recession of 1982 mothers were forced to take their child to work, or left them with neighbors or older children. Grandmothers live in only 15% of homes and extended family members in only 10.8%. A serious problem arises when older siblings drop out of school to take care of the young. Organized child care programs vary: in India a nonformal preschool program covers 25% of children aged 3-6. However, inadequate resources often result in operation of only 3-4 hours a day, no provisions for breast feeding, and custodial care instead of nutrition and health benefits. In India mobile creches at construction sites provide child care for female workers. The International Labour Organization fostered the classic factory day care facility, but transportation distances and costs have diminished the popularity of these. The community-supported model in Ethiopia has been successful, and similar projects are tried in Mexico. Child care workers are paid little: in Ecuador trained preschool teachers make 40% of the salary of primary school teachers; and in the US in 1989 they were earning only 30% of the salary of elementary school teachers. Better options for child care are needed for the safe and normal development of children.
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  14. 214

    Report. Seminar on Maternal and Child Health / Family Planning Programme Management, convened by the Regional Office for the Western Pacific of the World Health Organization, Nadi, Fiji, 29 April - 10 May 1991.

    World Health Organization [WHO]. Regional Office for the Western Pacific

    Manila, Philippines, WHO, Regional Office for the Western Pacific, 1991 Jul. [3], 67 p. (Report Series No. RS/91/GE/08(FIJ); (WP)MCH/ICP/MCH/001-E)

    12 national coordinators of UNFPA funded maternal and child health/family planning projects attended the Seminar on Maternal and Child Health/Family Planning Programme Management in Nadi, Fiji between April 19-May 10, 1991. The Regional Office for the Western Pacific of Who organized the seminar. Participants came from Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Papua New Guinea, Republic or Marshall Islands, Republic of Palua, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu. Seminar leaders concentrated on having participants use the UNFPA project formulation guidelines and evaluation procedures. Participants learned about project formulation, target setting, project management (personnel, time, and logistics), management information systems (MIS), and project strategies especially community participation. At the end of the seminar, they applied their new knowledge and skills in developing workable country plans of action. Resource personnel helped each participant with preparing the country plans. Overall the participants considered the seminar to have been a success. Yet, even though UNFPA laid out the guidelines logically, participants found them to be complex and difficult to understand. They also expressed the need for training after the seminar to make it more effective. Participants acknowledged the importance of MIS and that MIS must be developed further in participating countries. Further they mentioned the value of community based data in effectively managing projects. A sample country plan of the Federated States of Micronesia and the Kingdom of Tonga follows the report.
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  15. 215

    Progress report on UNRISD activities 1990/1991.

    United Nations Research Institute for Social Development [UNRISD]

    Geneva, Switzerland, UNRISD, 1991. [6], 61 p.

    Progress in implementing the research program and related activities of the UN Research Institute for Social Development (UNRISD) between July 1990 through June 1991 is described. An autonomous institution within the UN, UNRISD seeks to promote research on pressing problems and contemporary social issues associated with development. UNRISD Director Dharam Ghai explains that the Institute takes a holistic, interdisciplinary, and political economy approach in its research programs. Some of the highlights of 1990-91 are described, as well as UNRISD's progress in 8 general areas of research. The first category of research is that of 1) environment, sustainable development and social change, and area that includes the following subtopics: resource management, deforestation, women and their environment, and the socioeconomic dimensions of environment and sustainable development. The remaining general categories include: 2) crisis, adjustment, and social change; 3) participation and changes in property relations in communist and postcommunist societies; 4) ethnic conflict and development; and 5) political violence and social movements; 6) refugees, returnees, and local society: interaction and development; 7) socioeconomic and political impact of production, trade, and use of illicit narcotic drugs; and 8) patterns of consumption: qualitative indicators of development. A list of all publications during the year is included as well as a list of all board and staff members.
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  16. 216

    Tackling Africa's slums.

    Egunjobi L

    WORLD HEALTH. 1991 Mar-Apr; 14-5.

    Less developed countries are undergoing rapid, unplanned, and uncontrolled urbanization at the expense of their populations' health. Physical expansion of cities has outpaced the abilities of city planners and management and has contributed to the spread of tuberculosis, pneumonia, influenza, threadworm, cholera, dysentery, and other diarrheal diseases. Overcrowding, lack of access roads, dangerous roads, drinking water scarcity, frequently collapsing buildings, uncollected garbage, lack of sewers, inadequate air space, and houses littered with human feces are common conditions contributing to high mortality rates especially among children. In this context, the World Health Organization's Environmental Health in Rural and Urban Development Program, which is designed to promote awareness about the association between health and planning, is noted. Guidelines for change are also a component of the program, and are encouraged for adoption by planners of less developed countries, especially Africa. Urban rehabilitation and upgrading are recommended in the guidelines while maintaining central focus upon promoting the population's health. While examples of rampant urbanization are drawn primarily from Nigeria, ancient Greek and Roman societies as well as the UK are mentioned in the context of urban planning with a view to health.
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  17. 217

    Managing external collaboration in family planning.

    Yang JM

    In: Korean experience with population control policy and family planning program management and operation, edited by Nam-Hoon Cho, Hyun-Oak Kim. [Seoul], Korea, Republic of, Korea Institute for Health and Social Affairs, 1991 Sep. 311-27.

    The Korean experience with collaboration in family planning (FP) is explored in this chapter. Attention is paid to the nature of the decision, external resources (International Planned Parenthood Federation (IPPF) in detail and the following in brief: the UN Economic and Social Commission (UNECOSOC) and the UN Fund for Population Activities (UNFPA), the Population Council of New York (PC), the Swedish International Development Authority (SIDA), the US Agency for International Development (USAID), and the Japanese Organization for International Cooperation (JOICFP)). Suggested criteria for FP projects include, community concern, prevalence, seriousness of unmet need, and manageability, but with external collaboration, consideration should be given to whether domestic resources are insufficient, the priorities of potential donors, expected problems with compliance with the grant, and government commitment to the project. External collaboration can take the form of moral support, technical cooperation, or financial support. The nature of the project as well as the expected achievements of the project need to be identified. Resources may be manpower, facilities, commodities, money, and/or time. The Korean experience with IPPF began with a visit by IPPF in 1960. In 1961, the Planned Parenthood Federation of Korea (PPFK) was accepted as a member of IPPF. Support which began in 1961 has reached over 16 million dollars cumulatively. At present about 25% of support for FP comes form IPPF. The author's experience as a representative of PPFK to IPPF and other groups is described. Tables provide information on commodities supplied by year and dollar amount, and allotment of UNFPA Assistance to Ministries and Institutions between 1973-86 by the number of projects and the dollar amount; types of program activity and dollar amount from UNFPA is also provided.
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  18. 218

    International assistance and health sector development in Nigeria.

    Parker DA

    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)
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  19. 219

    A strategy for reducing numbers? Response.

    Jolly R

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):28.

    UNICEF advocates the reduction of infant/child mortality because it feels that such an action will reduce both fertility and human suffering. It was feared in the beginning, and today as well, that increasing the survival rate for children would cause rapid population growth. However, there is a large body of evidence to the contrary. When such measures are combined with measures to promote and support family planning there are even greater reductions in fertility levels. This is why such organizations as UNFPA, WHO, and UNICEF have advocated this course of action. This strategy is also present in the Declaration of the World Summit for Children. Anyone advocating the reduction in support for programs designed to enhance child survival as a method of population control is confusing the issues, misdirecting environmental attention, and stirring up the debate about international mortality. The evidence clearly shows that family planning without family health, including child health, is much less successful. Further, child mortality, even at high levels does little to slow population growth while such death and suffering greatly burden women and families. While rapid population growth and high population densities in developing countries present serious problems, both are much less important than the high levels of consumption in developed nations. Each child in the industrialized world will, at present levels of consumption, be expected to consume 30 to 100 times more than a child born in the poorest nations. Such suggestions in a time of instant global communication only attempt to set back international morality and tempt those in the international intellectual community to embrace ideas similar to the eugenic principles that led to the holocaust.
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  20. 220

    A strategy for reducing numbers? Response.

    Banerji D

    HEALTH FOR THE MILLIONS. 1991 Dec; 17(5):25-7.

    The article on human entrapment in India by Maurice King is just another example of the dogmatic, simplistic and reckless way in which the white scholars of the North formulate their ideas. It is these people who are responsible for the opium wars, programs against Jews, and carpet bombing, defoliation, and massacres in Vietnam. King's idea os using UNICEF and the WHO to kill the non white children of the South is just another example of this kind of racist brutality. It is based only upon the written opinions of other white scholars. In 1991 King produced no data about human entrapment in India. King ignores the writing of non whites like Ashish Bose who presided over the International Population Conference in 1989. Other mistakes that King makes include a failure to understand the applications of immunization (EPI) and oral rehydration programs (ORT). The EPI was implemented without ever taking baseline data, so that its effectiveness is impossible to determine with any accuracy. And nowhere in the world has ORT worked as well as UNICEF claimed it would. Further proof that King advocates genocide is his labeling of the insecticide-impregnated bednets as a dangerous technology in increasing entrapment. King fails to acknowledge the overwhelming influence of white consultants on the policies and planning strategies of family planning programs in India. Their list of failures includes: the clinic and extension approach, popularization of the IUD, mass communication, target orientation, sterilization camps, and giving primacy to generalists administrators. They should be held accountable for the 406 million people added to the base population between 1961-91 It should also be noted that India had the ability absorb this large number people while still maintaining a democratic structure, gather a substantial buffer stock of food grains, consistently increasing its per capita income while decreasing its infant mortality and crude death rates, increase its life expectancy at birth and improve the level of literacy, especially for females.
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  21. 221

    Child's right to special care.

    Sharma A; Gupta S

    ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.

    In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.
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  22. 222

    Maternal mortality and the right of the child to survival, protection and development. Perspectives on southern and eastern Africa in light of international law.

    Nurkse D

    In: The effects of maternal mortality on children in Africa: an exploratory report on Kenya, Namibia, Tanzania, Zambia, and Zimbabwe, [compiled by] Defense for Children International-USA. New York, New York, Defense for Children International-USA, 1991. 97-143.

    How international law documents such as the Convention on the Rights of the Child establish a legal framework within which to promote child survival in Southern and Eastern Africa, emphasizing the documents' significance for maternal mortality, the most important factor affecting child survival, is examined. In November 1989, the UN General Assembly unanimously adopted the Convention, a comprehensive treaty that establishes the rights of children and their families, outlining the responsibilities of governments and adults in securing those rights. By September 1990, most countries in Southern and Eastern Africa had ratified the treaty; the remaining countries had pledged to approve it. The Convention not only obligates governments to allocate greater resources to the most vulnerable members of society, but also requires a higher level of international cooperation, including greater commitment from industrialized countries and greater participation at the grassroots level. The economic, social, and cultural dimensions of maternal mortality and its impact on child survival are discussed, as well as the maternal and child survival issues addressed by the Convention: 1) maternal-child health services; 2) traditional practices harmful to the mother and child (in this case, female circumcision and child marriage); and 3) survival and development through international cooperation. The implications of the Convention on the primary health care model are also discussed. The impact of other international documents on maternal mortality and child health is examined.
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  23. 223

    Senate votes to fund UNFPA, reverse Mexico City policy.

    WASHINGTON MEMO. 1991 Aug 9; (13-14):2-4.

    The US Senate has voted to restore funding to UNFPA and reverse the administration's Mexico City policy by passing a fiscal 1992-93 foreign aid authorization bill containing both provisions. The UNFPA issue has also been linked to the debate of the most favored nations (MFN) bill for China. Sen. Paul Simon introduced a floor amendment stipulating that none of the US aid could be used for UNFPA's China program; if this occurred, the full US contribution would have to be refunded. The Bush administration policy of boycotting UNFPA because of China's population policy is holding UNFPA hostage. Sens. Barbara Mikulski and Tim Wirth added another condition to the China MFN bill that would force the president to certify that the Chinese government does not support coercive abortion. The president has threatened to veto any bill that puts conditions on China's MFN status. However, evidence suggests that even Bush is uncomfortable with his own reasoning being used against him. He is condemning UNFPA for having the same policy toward China that he does. Both bills call for $20 million for UNFPA for fiscal 1992 and reverse the Mexico City policy. Both bills raise the ceiling for fiscal 1992 to $300 million for population aid. There would have to be some debate to reconcile the fiscal 1993 ceiling of $350 million passed by the House and the $300 million passed by the Senate. The president has threatened to veto both bills because of the family planning provisions.
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  24. 224
    Peer Reviewed

    Poliomyelitis: what are the prospects for eradication and rehabilitation?

    Jamison DT; Torres AM; Chen LC; Melnick JL

    HEALTH POLICY AND PLANNING. 1991 Jun; 6(2):107-18.

    The WHO estimates that 74% of the world's children were fully immunized against poliomyelitis by early 1990. Despite this, the disease is still paralyzing almost 1/4 of a million individuals each year and killing perhaps 25,000. This paper, 1 of a series undertaken on specific diseases for the World Bank's Health Sector Priorities Review on disease of major importance in the developing world, reviews available evidence on the cost effectiveness of polio prevention. This prevention would take the form of either immunization or case management of polio to minimize and rehabilitate disabilities. The power of available vaccines and the characteristics of disease suggest the technical feasibility of eradication of disease from polio (but not the polio virus) as a goal for the year 2000. With sustained national and international support, it is thus reasonable to hope for eradication by that year or soon thereafter. Rehabilitation of those disabled by polio (and other causes) has been neglected both by governments and by the international community. Although hard evidence on cost and effectiveness remains to be gathered, what is know strongly suggests that effective rehabilitation programs could be implemented at low cost and with the economic and welfare benefits far exceeding the expenditures. (author's modified)
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  25. 225

    Bangladesh national immunization cluster survey: 1991.

    De Silva R; Herm H; Khan M; Chowdhury JH

    In: Near miracle in Bangladesh, edited by Mujibul Huq. Dhaka, Bangladesh, University Press Limited, 1991. 85-96.

    The WHO standard national immunization coverage evaluation survey of Bangladesh, which was independent of EPI reporting or the Ministry of Health service delivery system, is presented. Included are observations from the field. Multistage sampling techniques were used to identify at the divisional and national level 30 clusters from 11,000 villages and 30 from the 5 metropolitan areas. 7 children ages 12-17 months who were born between August 1989 and January 1990 were selected from each cluster. The immunization record was used where possible. Enumerators were selected from each cluster. The immunization record was used where possible. Enumerators were selected form outside the government immunization or health worker population. The results of the histograms indicate high levels of coverage of region Rajshahi and low coverage for Chittagong, a pattern typical of contraceptive prevalence, Vitamin A distribution, and literacy. Bar graphs distinguish between the fully immunized child (3 doses of DPT and OPV, 1 dose of BCG, and 1 dose of measles) at <1 year and 12-17 months, based solely on immunization record data. Dropout rates are compared between those receiving BCG and the measles vaccination. The high dropout rate means greater effort in order to maintain 80% coverage. The bar chart on reasons for not continuing immunization shows time/place unknown and unaware of the immediate need were the 2 most reported reasons at 12.2% and 11.9%. Motivation was not a reason. It is suggested that health workers did not sufficiently stress the importance of continuing vaccination. The WHO reported coverage figures did not correspond to regular reports, which overestimated; the estimated number of births may be too low, or WHO figures did not include the mop-up program begun in the last quarter of 1990, or those receiving the 3rd dose even if older than 12 months. The urban reports were lower than the WHO reports perhaps because of reporting error between hospitals and private physicians and NGOs. Reported figures for DPT/OPV3 were significantly higher than WHO figures and assumptions cannot be made that coverage is high enough to offer disease protection and mortality reduction. TT coverage was 74%, but again there was a problem obtaining records. There was a lack of antenatal care. Recommendations were, for instance, that HAs, TBAs, and FPAs emphasize the importance of follow-up coverage and antenatal care, and that the Chittagong area receive more attention. The integration of immunization with family planning and the considerable coverage in such a short time are accomplishments to be proud of.
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