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Tropical Doctor. 1984 Jan; 14(1):8.Enormous problems in developing countries concerning drug supply, such as inadequate control of money spent on drugs, insufficient government supervision of the importation and distribution of drugs, dumping, and so on, prompted the World Health Organization to set up an expert committee to compile a list of drugs which would provide adequate health care. This Essential Drug list is intended to extend the accessibility of the most necessary drugs to those populations whose basic health needs could not be met by the existing supply system. In cooperation with Medicus Mundi Nederland the use of this basic list is investigated in a population of medical doctors in Africa, sent out by Medicus Mundi. Investigated were: actual use of the essential drug; use of other drugs in the same pharmacotherapeutical group; priority; availability; and suppliers. In addition, insight into a number of other factors, such as the number of patients, beds, stocklists, local production, and supply of information, was obtained. The total number of patients in the combined areas was about 3,500,000. It was found that 3% of WHO's suggested drugs were not used at all, 22 essential drugs were used by only 5% of the doctors, and 41 essential drugs were used by more than 95% of the doctors. In the 1979 Revised List 25 drugs had been added and 10 deleted, compared with the 1st list, although it should be remembered that the differences were not always great. Several essential drugs mentioned for the 1st time in the Revised List are little used. Some complementary drugs scored better than the essential drugs from the same group. A number of drugs not mentioned in the List of Essential Drugs have a high priority. The results of the inquiry will be useful to evaluate the list further.
Tropical Doctor. 1984 Jan; 14(1):34-40.A description of the Dominican Child Health Passport (CHP) and its clinic-based counterpart are presented. These are adaptions of the World Health Organization (WHO) growth chart. A prototype of the chart was introduced in June, 1980 for a pilot project in the town of Portsmouth. At 7 consequtive child welfare clinics all parents who received a CHP at an earlier visit were interviewed. Questions were asked about some aspects of clinic attendance, the use of and attitude towards the CHP; and understanding of it. The children ranged in age from 1-21 months with a mean of 7 months. 31 parents (61%) had visited the clinic 4 weeks ago (the usual period between visits) and the average was 5 weeks. Weighing was the reason that 49% of the mothers brought their children to the clinic. This could mean that there is already an awareness of the importance of weighing for monitoring child health. Of the 51 parents, only 1 had forgotten the CHP. 10 children possessing a CHP were taken to a doctor. 6 mothers took the CHP along, and on 5 occasions the doctor showed an interest. Opinions on various aspects of the CHP are given. The price--60 cents Eastern Caribbean Currency (=US $0.22) was considered acceptable. Almost all mothers liked to have the CHP at home. However, a substantial % did not like the idea of having child spacing methods entered on the card. 4 CHPs with different weight curves were shown to mothers, who were asked if they would worry about a child who showed the growth pattern indicated. Severe underweight with loss of weight was recognized by 51% of the interviewees. Obesity was not usually considered something to worry about; this is understandable in a place where undernourishment is common in infants. About 1/3 of the respondents recognized the danger if an infant was still in the normal range of weight-for-age but was losing weight.
A comparison of anthropometric methods for assessing nutritional status of preschool children: the Philippines Study.
Journal of Tropical Pediatrics. 1984 Apr; 30(2):95-103.Anthropometric measurement of children for assessing their nutritional status is a widely used procedure in developing countries. The purpose of this study is to identify the most reliable anthropometric measurements that reflect nutritional status and to test a few well-established formulas or methods of assessing growth and development of children. In this study, 810 preschool Filipino children were measured for height, weight, head circumference, arm circumference and skinfold thickness. These measurements were compared to WHO international standards and the Philippines standards and the degree of malnutrition was established. Various combinations of measurements were also calculated and assessed for reliability in identifying malnutrition. The results showed that many of the children were in poor nutritional status. Using the Philippines standard as a basis for comparison, the WHO international standards needed some modifications. For example, the standard for arm circumference did not reflect the degree of malnutrition present in the children. However Dugdale's nutritional index, weight/height, was a reliable measurement for malnutrition. (author's modified)
Evaluation of the Population Council's International Awards Program on the Determinants of Fertility.
[Unpublished] 1984. 51 p.This evaluation of the effectiveness of the International Awards Program on the Determinants of Fertility, administered by the Population Council and funded by the US Agency for International Development, Office of Population, addresses 8 aspects of the Awards Program: the review process, solicitation and development proposals, orientation of approved projects, AID's role in the Awards Program, management, dissemination, and funding. Also considered is AID's potential role in population policy research. Recommendations are made about AID's role in social science research on population, the participation of the Population Council in such research, and specific aspects of the present program. It is concluded that AID should continue to support social science research which focuses on the determinants of fertility in developing countries and which is relevant to population policies in developing countries. This research should be administered by an independent organization. AID should also commission an account of social science research projects which have been important in providing direction for population policies. The Population Council is best suited to direct a program on the determinants of fertility in developing countries and a continuation of the present awards program should be administered by them. In order to improve the contribution of social science research, it is recommended that the Council take steps to increase the pool of applicants for the Awards Program and establish regular contact with AID regional population officers. The Council should also prepare plans for the dissemination of results of projects supported by the Awards Program. Finally, it is recommended that AID and the Council try to coordinate future data collection activities with the research activities supported by the Council's Awards Program.
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. New York, N.Y., United Nations, 1984. 67-74. (Population Studies, No. 83; ST/ESA/SER.A/83)This paper draws attention to the large variation in national practices to determine localities and to classify urban populations which has serious implicatons for any projections of urban and city populations, no matter what specific methodology is being used. There are many criteria by whichlocalities can be defined as urban: population size, population density, % labor force in non-agriucltural activities, function of the city, some other unspecified "urban" characteristics or a combination of several of these criteria. Population size is deemed the preferable criterion for designating localities as urban. This criterion is consistent with one of the classic definitions of urbanization: "Urbanization is a process of population concenttration. It proceeds in 2 ways: the multiplication of points of concentration and the increase in size of individual concentration." Population size is also the most widely available criteria for localities. Procedures used by the UN to estimate and project urban and city population are given. The UN utilizes a measure of urbanization called the urban-rural ratio (URR), which is defined as the ratio of the urban to the rural population for a country at a given point in time. While attempts are being made to provide as complete a coverage of cities as possible, no standard guidelines have so far been used to systematically include all cities that will reach 100,000 population during the projection period. It is hoped that detailed discussion of the data and the conceptual and procedural problems will lead users of the estimates and projections to carefully consult the respective sources and definitions when they use these results for comparative purposes.
Shared sexual responsibility: a strategy for male involvement in United States Family Planning clinics.
In: International Planned Parenthood Federation [IPPF]. Male involvement in family planning: programme initiatives. London, England, IPPF, . 167-76.Reviewed here are the efforts of the Planned Parenthood affiliates in the United States, showing that their focus is on female contraception. The author argues that if family planning is to be seen as a basic human right, then far more attention needs to be given to shared sexual responsibility. Although major strides have been made through federal grants and education programs, the history of meaningful male involvement has been a feeble one. It is argues that the alarming rate of teenage pregnancies, the falling statistics in vasectomy services across the country and the overall image of family planning programs, are indicative of the need for a new strategy. The little research data that is available shows that the earlier young men and boys are reached with accurate sexuality information, the more successful family planning and education services will be. The most successful sex education programs seem to be those which see sexuality education as a life-long process. More recently, research has concluded that programs working with parents and children are by far the most successful in ensuring ongoing dialogue and most meaningful behavior change. An important strategy for reaching males, partucularly with condoms, is to build on current strength in reaching female populations. Active promotion of vasectomy services, increased availability of comdom products suitably packaged and promoted, and attention-getting public service announcements, have combined to help change the image of a family planning program too often thought of as exclusively female. A representative sample of educational materials for men is included in the appendix.
[Unpublished] 1984. Paper prepared for the International Conference on Population held in Mexico City, August 6-13, 1984. 138 p.The World Population Plan of Action (WPPA), which was adopted by consensus at the UN World Population Conference held at Bucharest in 1974, recommended that a comprehensive and thorough review towards achieving the goals and recommendations of the Plan of Action should be done every 5 years. The goals and recommendations of the Plan could then be modified. An International Conference was to be held in 1984 so that selected issues of the highest priority could be discussed. The aim was to contribute to the process of review and appraisal of the WPPA and to further its implementation. The present report is before the conference for consideration. It provides the rationale for the further implementation of the Plan of Action. Its purpose is to facilitate the deliberations of the Conference by providing appropriate background information on population trends and policies and assessing the progress made in achieving the goals and objectives of the Plan. This report is organized into 6 major chapters: 1) socioeconomic development and population; 2) development of population policies; 3) population trends, prospects, goals and policies; 4) promotion of knowledge; 5) role of national governments and the international community; and 6) monitoring, review and appraisal of the WPPA. Each chapter includes a summary of the major trends observed in the past decade and where appropriate, the most probable future prospects. This is followed by an assessment of the level of implementation of the Plan. This report has been prepared by the Population Division of the Department of International Economic and Social Affairs, in cooperation with the Department of Technical Cooperation for Development, the UN Fund for Population Activities, the regional commissions, specialized agencies and other bodies of the UN systems, as well as several nongovernmental organizations.
[Unpublished] 1984. v, 37,  p.This is an evaluation of the Rural Health Systems Project funded in 1979 through a contract between AID, the Rural Health Development Staff of the University of Hawaii and the government of Guyana. The goal of the project is to improve and expand primary care services to rural areas of Guyana through training community health workers and medexes, and utilizing them in an interlocking, tiered, supervisory and referral structure. The evaluation team was to assess the adequacy and relevancy of medex training; the performance of graduates, the adequacy of support and management systems for medexes, and the ability and commitment to continue the training by the government of Guyana. The evluation team visited a large number of health facilities staffed by medexes, interviewed key persons in the Ministry of Health, AID, and the Health Manpower Developement Staff of the University of Hawaii. The team's findings show that the Medex Training Program is of high quality. Medex are working effectively in medically underserved areas; progress is being made in financial information, 2-way radio and supply systems, this despite severe economic difficulties. The development of transportation systems has been extremely slow and difficult and contracts for building housing have not been completed. The team offers a number of recommendations which include the continuation of the Medex Training Program in order to maintain a steady supply of trained personnel; the need to develop a comprehensive career structure and professional incentive program; the regionalization of the expanded 2-way radio system as a continuing education medium; the immediate implementation and careful monitoring of the new financial managements information system; and the necessity for further action to improve the transportation systems. Furthermore, the team's recommendations emphasize that AID expedite its approval of documents necessary for housing contracts to be negotiated; that responsibility for supervisory medexes in rural health centers be gradually transferred to the regional health teams and that Medex headquarters and training staff be more closely integrated. The report includes various appendices: a map of the country, a list of persons interviewed by the team; training and education manuals for diabetes; samples of the system for teaching essentials to medex (e.g., clinical practice, history taking and physical examination) and the declaration of Alma Ata on primary health care.
Washington, D.C., Heritage Foundation, 1984 Aug 27. 16 p. (Backgrounder No. 376)The United Nations' 2nd World Population Conference (Mexico City, 1984) called for greatly expanding funding for family planning assistance worldwide. The United Nations Fund for Population Activities (UNFPA), the conference's chief sponsor, will no doubt receive the largest portion of any assistance increase. UNFPA plays a critical role in population-related programs worldwide. The central debate on population policy should be over the extent and adequacy of the natural resources base and how countries can humanely and voluntarily change family size preferences. In countries like Singapore and South Korea, success has been achieved by combining social and economic incentives to discourage large families. Although couples in developing countries report wanting contraceptive service programs, they also want families of 4 to 6 children. So far UNFPA has been ineffective in changing the population situation. This overview of its activities reveals that UNFPA loses ultimate reponsibility for implementation of many of its own programs. UNFPA does not advocate a reduction in population growth within a single country, but rather helps couples have the number of children they desire. UNFPA's specific population and family programs are divided into functional areas: basic data collection, population change study, formulation and implementation of population policies, support for family planning/maternal child health programs and educational and communication programs. UNFPA stresses the importance of using contraceptives but not of achieving the small family norm. UNFPA's projects in some of the largest less developed nations are described, illustrating how the UN agency spends its assistance funds. From 1971 to 1982, the UNFPA spent almost US $230 million in the 10 largest less developed countries without any significant change in population growth. UNFPA program administrators are far from resolving the serious population problems facing developing countries and generally oblivious to new directions in which population policies should move. No progress will be made until UNFPA recognizes the need to approach the problem from a different perspective, working to change attitudes toward small families.
Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
World Health Organization evaluates NORPLANT subdermal implants as effective, reversible, long-term contraceptive. News release.
New York, Population Council, 1985 Feb 22. 5 p.A World Health Organization (WHO) review of animal and human data on Norplant subdermal implants, convened at the request of the United Nations Fund for Population Activities, has determined that this contraceptive system is an "effective and reversible long term method of fertility regulation" and recommended that it be made available through family planning programs. George Zeidenstein, president of the Pouplation Council, which developed the Norplant system, has termed the WHO report "a giant step toward worldwide acceptance and availability." So far, extensive clinical trails have noted no adverse side effects of this contraceptive system, and animal studies on levonorgestrel suggest the drug is safe for use in humans. Clinical trial data on more than 4000 women have indicated continuation rates of 60-95% at the end of the 1st year and about 50% at the end of the 5th year. The annual pregnancy rate is 0.2-1.3/100 women over a 5 year period. Disturbance of the menstrual cycle, including increased frequency and number of bleeding days as well as irregular bleeding or spotting, occurs in the majority of women who use this method; however, bleeding problems tend to diminish with increased duration of use. The Norplant implant system is particularly suitable fo r women who seek extended contraceptive protection but either do not wish to undergo sterilization or who desire a child in the future. Norplant is currently a vailable in Finland and has just been granted registration in Sweden. Over the next 2 years, regulatory approval will be sought in 40 additional countries including the US, where the Norplant system is in clinical trials at 3 sites.
Population and Development Review. 1984 Mar; 10(1):103-26.This paper presents some of the results of projections prepared by the World Bank in 1983 for all the world's countries. The projections (presented against a background of recent demographic trends as estimated by the United Nations) trace the approach of each individual country to a stationary state. Implications of the underlying fertility and mortality assumptions are shown mainly in terms of time trends of total population to the year 2100, annual rates of growth, and absolute annual increments. These indices are shown for the largest individual countries, for world regions, and for country groupings according to economic criteria. The detailed predictive performance of such projections is likely to be poor but the projections indicate orders of magnitude characterizing certain aggregate demographic phenomena whose occurrence is highly probable and set clearly interpretable reference points useful in discussing contemporary issues of policy. (author's)
[Reconciling censal and inter-censal data and determination of the population base] Conciliacion censal y determinacion de la poblacion base.
In: Metodos para proyecciones demograficas [compiled by] United Nations. Centro Latinoamericano de Demografia [CELADE]. San Jose, Costa Rica, Centro Latinoamericano de Demografia, 1984 Nov. 13-42. (Centro Latinoamericano de Demografia [CELADE] Series E, No. 1003)This work describes procedures used by the Latin American Demographic Center (CELADE) for establishing a base population for projection in quinquennial age groups by means of evaluation of population censuses and reconciliation of demographic data for 2 or more intercensal periods. Demographic reconciliation refers to the array of procedures through which the degree of coverage of successive censuses is evaluated; age and sex distributions resulting from incomplete coverage, differential omission, and poor age reporting are corrected; the demographic dynamics of intercensal periods are made coherent with estimates of mortality, fertility, and migration from all available sources; and a base population for population projection is established. There are no fixed rules for evaluation and reconciliation of census data, because the history and quality of data collection in each country are unique. The compensatory equation, in which 2 or more population censuses are reconciled in regard to fertility, mortality, and international migration in intermediate years usually in terms of age cohorts, is an indispensable tool for demographers in developing countries. The need to add children born in the years between censuses and the different types of errors typifying different age groups means that the process of census reconciliation should be carried out separately for at least 3 age groups: children under 5, the 5-9 year cohort, and those over 10 years of age. The age group 0-4 is often the most seriously underestimated. Because the age group 5-9 years is often the best enumerated in Latin American population censuses, it can serve as the basis for correction of the population aged 0-4. The data required include the population aged 5-9 in single years in the last census, the deaths in children under 10 by year of birth and age at death in single years, and the annual number of births in the 10 years preceding the last census. Data from Panama illustrate that the results of this technique are not always acceptable, in which case correction of the 0-4 cohort may be accomplished by means of correction of births and deaths using indirect methods. Corrections for the 5-9 cohort, if required, can be made in a similar manner to that for the youngest group. Evaluation and correction of errors of omission and misreporting of age of the population over 10 is the most difficult because data sources are most often inadequate, these age groups have the greatest age and sex differentials and poorest age reporting, and are most likely to be effected by emigration. All available data should be utilized to produce a group of alternative estimates for each cohort based on diverse basic data and assumptions about such variables as the sex ratios for age agroups. The most likely values must then be selected or calculated. The process by which census results from 1950-80 were used to estimate the base population for a projection by components in Panama illustrates the procedure used by CELADE.
A summary of the report on the evaluation of MEX/79/P04 "Integration of population policy with development plans and programmes".
New York, New York, UNFPA, 1984 Jul. 19,  p.The objective of this UNFPA project was to build the institutional and methodological base for integration of population policy into and its harmonization with national, sectoral and state policies or socioeconomic development in Mexico. More specifically, the project was to achieve integration of population policy with 6 sectoral plans, 24 state plans and the Master Development Plan within 3 years. Although the Mission considers it an achievement that the project signed agreements with all 31 states and the Federal District, no formal contacts had been made with the 6 sectors. Mexico's National Population Council (CONAPO) coordinated the project. The Mission recommended that support to integration activities be continued on the basis of the experience that has been acquired. Therefore it is necessary 1) to strengthen the activities at the state level; 2) to support the development of methodologies considering the impact of socioeconomic plans and programs on demographic variables and to provide a comprehensive program of international technical experience; 3) to recognize that responses to ad hoc support activities are an important integration instrument for both sectors and states; and 4) to exact greater clarity concerning the role of the project in the National Population Program. A lack of aedquately trained personnel proved to be a continual obstacle to implementation. The Mission recommends that at an early stage in the development of such projects a thorough assessment of the human resource requirements and existing capacity for integration of demographic and socioeconomic variables be made and that, based on this assessment, a specific training strategy be developed and incorporated in the project's design. In addition to training, the project also included research support activities; the outputs, however, were descriptive rather than analytical, which can be traced to both the design and execution of the work plan for research activities. The UNFPA's funding constraints and its management of reduced funds further complicated the project's execution, which suffered from high personnel turnover and lack of coordination of project activities.
Report on the evaluation of UNFPA-sponsored country programme in Democratic Yemen, 1979-1984 and role of women in it.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Apr. xiii, 101 p.The United Nations Fund for Population Activities (UNFPA)-sponsored Country Program was the 1st comprehensive effort in the field of population in Democratic Yemen, following earlier sub-sectoral interventions which benefitted from UNFPA assistance. This evaluation covers 1) the country program as such, focusing on the results achieved in terms of building national capacity for formulating and implementing population policies and programs; 2) the 7 component projects, one in data collection and analysis, a maternal child health/family planning project, and 5 in population education for different audiences; and 3) the women's dimension of the program. At the end of the 4th year of implementation, little had been done by the Country Program in terms of institution building and population policy. The program's achievements were hindered by factors such as an extreme shortage of national qualified staff, training facilities, poor program design, insufficient technical leadership and support, as well as unrealistic objectives. The 7 component projects were plagued with similar problems and made only modest acheivements. The Evaluation Mission expressed the view that long term international expertise to serve all projects would have been advisable as well as long term training abroad for a few people who could become leaders/advisors/administrators. In evaluating the role of women, the Mission found that women had participated in the implementation of all the projects evaluated but were mainly to be found in junior positions. The program as a whole contained a substantial portion of women among its direct beneficiaries comprising those who had been trained, employed and targeted as recipients of the services of the projects, although this varied considerably between projects. In general, the Mission was of the view that in the future a country program document should be prepared specifying the long term and immediate objectives for the population program as a whole.
Report on the evaluation of UNFPA assistance to the family health programme of Zambia: project ZAM/74/PO2 (February - March 1984).
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Sep. x, 38,  p.The objective of the Family Health Program of Zambia is to enhance the health and welfare of Zambians, particularly mothers and children, through an increase in coverage of the population served through under-5s clinics, pre- and post-natal services and child spacing activities. The Mission found that the strong points of the project are the increasing commitment of the Government to incorporate family planning activities as an essential component of its family health and primary health care programs; the training and health education components of the program; and the enthusiasm and ability of the Zambian Enrolled Nurse/Midwives in organizing maternal child health/family planning services at service delivery points. Factors which appear to have hindered a more effective project performance have been the restriction on prescribing contraceptives by anyone but physicians; the imbalance in implementation among the project components; the failure to appoint international and national staff to key positions and with a timing that would have enabled staff members to support each other as members of a coordinated team; weak supervision; no research and evaluation activities; transport problems; the lack of use of, and updating of, the project plans; and the absence of a tripartite review early in the project's life to address implementation problems.
Report on the evaluation of CPR/80/P14: population education in the secondary schools and teachers training of the People's Republic of China.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. iv, 49 p.The objectives of the Population Education in Secondary Schools and Teachers Training of the People's Republic of China Projects were to provide the Chinese people, including young students, with the basic knowledge of population science and an understanding of why the Government considers family planning a fundamental national policy and why it is implementing the policy of controlling the number of the population and raising its quality. The 2 distinguishing features of this project are that the target group are middle school students rather than students of all grade levels, and that the existence of an established system for in-service training in the form of pedagogical institutes provides a fast and effective mechanism to introduce population education into the 2ndary school curriculum. The overall assessment of the Mission is that this project has been highly successful. The Mission's main recommendations are: 1) that the United Nations Fund for Population Activities and the Government increase their financial assistance; 2) future objectives be stated in terms that emphasize educational outcomes rather than operational tasks to permit objective monitoring and evaluation; 3) that a moratorium be place on the revision of population education curricula in order to concentrate on its diffusion; 4) that the posters and commentary be considered as a basis for instruction of junior middle school students as well as out-of-school youth and adults; 5) that questions on population content be included in the national examinations for university admission; 6) that a program for pre-service education in population education be initiated to supplement the in-service training; and 7) that substantial attention be given to different modes of training.
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.
Subregional Workshop on Planning, Formulating and Evaluating of MCH-FP/PHC Projects, Nairobi, 15-19 October 1984. Final report.
Brazzaville, Congo, WHO, Regional Office for Africa, 1984. 27 p. (AFR/MCH/81)The objective of the Subregional Workshop on Planning, Formulating and Evaluating Maternal and Child Health-Family Planning/Primary Health Care (MCH-FP/PHC) Projects, held in Nairobi, Kenya, during October 1984, was to train national personnel so that they would be prepared to formulate, implement, monitor, and evaluate MCH-FP/PHC projects in the context of primary health care. These proceedings cover the 5 workshop sessions: mandates, roles and activities of the UN Fund for Population Activities (UNFPA) and the World Health Organization (WHO); planning and program development of both the UNFPA and WHO; project formulation and appraisal; practical information and procedures important for both the formulation and implementation of MCH/FP projects by the executing agency; and a project appraisal exercise. Also included is a project formulation exercise and a project monitoring and evaluation exercise. An evaluation of the workshop by participants also is included. Appendixes contain a list of participants, the opening address, the program of work, and reference documents.
In: Tras nuevas raices: migraciones internas y colonizacion en Bolivia [by] Carlos Garcia-Tornell, Maria Elena Querejazu, Jose Blanes, Fernando Calderon, Jorge Dandler, Julio Prudencio, Luis Lanza, Giovanni Carnibella, Gloria Ardaya, Gonzalo Flores [and] Alberto Rivera. La Paz, Bolivia, Ministerio de Planeamiento y Coordinacion, Direccion de Planeamiento Social, Proyecto de Politicas de Poblacion, 1984 Apr. 51-251.A study of colonization programs in Bolivia was conducted as part of a larger evaluation of population policy. The 1st of 8 chapters examines the history of colonization programs in Bolivia and the role of state and international development agencies. It sketches the disintegration of the peasant economy, and presents 5 variables that appear to be central to colonization processes: the directedness or spontaneity of the colonization, the distance to urban centers and markets, the diversification of production, the length of time settled, and the origin of the migrants. The 2nd chapter describes the study methodology. The major objective was to evaluate government policies and plans in terms of the realistic possibilities of settlement in colonies for peasants expelled from areas of traditional agriculture. Interviews and the existing literature were the major sources used to identify the basic features and problems of colonization programs. 140 structured interviews were held with colonists in the Chapare zone, 43 in Yapacari, and 51 in San Julian. The 3 zones were selected because of their diversity, but the sample was not statistically representative and the findings were essentially qualitative. The 3rd chapter examines the relationships between the place of origin and the stages of settlement. The chapter emphasizes the influence of place of origin and other factors on the processes of differentiation, proletarianization, and pauperization. The 4th chapter examines the productive process, profitability of farming, the market, and reproductive diversification. The next chapter analyzes the technology and the market system of the colonists, the dynamics of the unequal exchange system in which they operate, and aspects related to ecological equilibrium and environmental conservation. The 6th chapter concentrates on family relationships and the role played by the family in colonization. Some features of the population structure of the colonies are described. The 7th chapter assesses forms of organization, mechanisms of social legitimation, and the important role of peasant syndicates. The final chapter summarizes the principal trends encountered in each of the themes analyzed and makes some recommendations concerning the colonization program, especially in reference to the family economy and labor organizations.
[Unpublished] 1984. 27 p.The current status of the Control of Diarrhoeal Diseases (CDD) Program was reviewed, and activities related to the evaluation of country control programs, the assessment of potential diarrheal disease control interventions, and the program's operational research activities were examined. In the health services component, ciontinued efforts to promote the preparation of plans of operation for national CDD programs is recommended, as is continued use of the national CDD program managers training course. Concern was expressed that the level of use of oral rehydration therapy (ORT) appeared to be modest. Case management was endorsed as the major program strategy. The series of studies on interventions for reducing diarrhea's mortality and morbidity were welcomed. For evaluation purposes, it is recommended that the program develop additional criteria for monitoring increased access to and usage of oral rehydration salts (ORS) and the reduction of diarrheal mortality. Continued accumulaton and publication of information yielded by the program's survey of the impact of ORT in hospitals was recommended. In the research component, the growth of research activities is satisfying. While biomedical aspects have developed well, it might be necessary to relate them gradually to specific control interventions in the future. Further studies of improved ORS formulatons were recommended. High priority should also be given to the promotion of breast feeding, immunization, and water supply and sanitation. The underlying mechanisms that cause the intervention to reduce diarrheal morbidity or mortality should be clarified. Research is recommended on the promotion of personal and domestic hygiene, food hygiene, and improved weaning practices. Emphasis on the development and evaluation of vaccines against the causes of diarrhea is supported. Some changes in the balance of research activities should be made. Epidemiological weak.
Statement of the International Movement ATD Fourth World, an NGO in consultative status category ii with ECOSOC.
[Unpublished] 1984 Aug. Background note prepared for the International Conference on Population, held in Mexico City, August 6-13, 1984. 4 p. (E/CONF.76/NGO/15)This appeal on behalf of the world's poorest families seeks: the destruction of misery in order to build peace and ensure dignity; fair distribution of resources; guarantees of freedom and the right to self-determination for all, especially the poorest; the widest possible choices for all in family planning; and regular public evaluation of demographic policies and programs, especially for the most deprived.
Who Chronicle. 1984; 38(5):212-6.This article highlights the conclusions and recommendations of the 5th meeting of the Technical Advisory Group of the World Health Organization (WHO) Diarrheal Diseases Control (CDD) Program held in March 1984. On the basis of clinical trials supported by the CDD Program, WHO has endorsed use of oral rehydration salts (ORS) containing trisodium citrate dihydrate in place of sodium bicarbonate. Although the bicarbonate formulation remains highly effective and may continue to be used, the citrate formula results in less stool output and is more stable under tropical climatic conditions. At its meeting, the Technical Advisory Group expressed satisfaction with progress in the health services and research components of the program's activities. By 1983, 72 countries or areas had formulated plans of operation for national CDD programs and 52 had actually implemented programs. Training courses directed at program managers, first-line supervisors, and middle-level health workers are held on a regular basis. 38 developing countries are now producing ORS. Another area of activity has involved development of a management information system to monitor progress toward the target of increased access to and use of oral rehydration therapy for diarrhea in children under 1 year of age. Data from 40 countries indicate that access to ORS was 6-10% in 1982 and usage was 1-4%. There have been reviews of 10 national CDD programs, 7 of which utilized a joint national-external team to collect and analyze information on the management and impact of the CDD program. During 1983, 71 new research projects were funded by the CDD program, bringing the total number of projects supported to 231 (59% in developing countries). Biomedical research has focused on development of more stable and effective ORS; the etiology and epidemiology of acute diarrhea: and development and evaluation of new diagnostic tests, vaccines, and antidiarrheal drugs. In 1982-83, the CDD program received US$1.4 million from WHO and about US$11 million from voluntary contributors. The 1984-85 budget has been set at US$19.7 million.
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.