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WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(2):59-63.The Expanded Programme on Immunization (EPI) was established in 1974 to develop and expand immunization programs throughout the world. In 1977, the goal was set to make immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis available to every child in the world by 1990. Problems encountered by the Program have included: lack of public and governmental awareness of the scope and seriousness of the target diseases; ineffective program management; inadequate equipment and skills for vaccine storage and handling; and insufficient means for monitoring program impact as reflected by increasing immunization coverage levels and decreasing incidence of the target diseases. When the EPI was initiated in 1974, fewer than 5% of children in developing countries were receiving a 3rd dose of DPT and poliomyelitis vaccines in their 1st year of life. These coverage levels have now surpassed 50% in developing countries, and millions of cases of the target disease have been prevented. Over 700,000 measles deaths were prevented by immunization in developing countries in 1987, and an increasing number of neonatal tetanus deaths is now being prevented by maternal immunization and improved childbirth conditions. Poliomyelitis immunization efforts have been so successful that the Pan American Health Organization is leading a drive to eradicate poliomyelitis from the Americas by 1990. The successes of the Program represent a major public health achievement, but much remains to be done. Measles still kills nearly 2 million children each year, neonatal tetanus kills some 800,000 newborns, and pertussis nearly 600,000 children. 250,000 cases of paralytic poliomyelitis still occur annually. The major challenges now facing the EPI are accelerating and sustaining national immunization efforts. (Summaries in ENG, FRE)
Methodological problems in evaluation of family planning impact of programmes that are integrated with other development sectors.
In: Studies to enhance the evaluation of family planning programmes by United Nations Department of International Economic and Social Affairs. Population Division [DIESA] New York, New York, United Nations, 1985. 108-110. (Population Studies No. 87 ST/ESA/SER.A/87)Governments of developing countries began to undertake family planning in the 1960s thanks to a sudden availability of funds for programs exaggerating an already existing cleavage between program and general demography professionals. Discussion at the World Population Conference (WPC) in Bucharest recognized social and economic factors as an important element in the use of family planning and attempted to encourage better cooperation between program evaluators and demographers. Separation of family planning effects from development effects has been difficult. The WPC's World Population Plan of Action (WPPA) reiterated that population and population policies were interrelated with and should not be considered substitutes for socioeconomic development policies. Increasingly, governments have been integrating family planning with education and health programs as recommended by the WPPA. Family planning being a relatively new venture, it is necessary to develop a theoretical framework to justify assumptions that family planning and development are productively integrable and synergistic, determining demographic effects and their causal mechanisms, whether social or program related. A careful record of program inputs must be kept. Important issues in education, which generally speaking has an inverse effect on fertility, are: in which sex and age group of the population is education most effective for fertility control allowing for lag time; and what are the intervening effects--age at marriage, better knowledge, or change of attitudes? Some of the simplest integrated programs combine family planning with educational programs in schools, health programs, and agricultural programs. Thus teachers are trained to educate pupils in population problems; health workers educate family health consumers a logical diversity of function that is however limited by the scope of the health program. The benefits of small family size may be incorporated into rural development ideology. Critical evaluation will necessitate demonstration of integration's beneficial effects.