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Decree No. 896, Law on transferring rural state property suitable for agriculture and livestock to the beneficiaries of agrarian reform, 18 February 1988.

This Law creates a Special Technical Commission in El Salvador to collect information, investigate, and make decisions on the transfer of property belonging to the State. State property includes property belonging to the State at the national, regional, and local levels as well as land belonging to official autonomous institutions and public law corporations. Such property is eligible for transfer if it is not indispensable for state activities and if it is suitable for agriculture. Under the Law, all government bodies, official autonomous institutions, and public law corporations have the duty to report to the Commission the status of their property. After the Executive determines which properties are to be transferred, the property will be paid for through agrarian reform bonds. The property will be transferred to farmers with no land or with insufficient land and to farming cooperatives. Preference will be given to farmers without land and to those who have been exploiting the land subject to transfer. Persons acquiring land will pay for it through mortgages in favor of state agrarian reform agencies.

Agriculture↗

[Demographic variables and social dependency: annual and intergenerational comparisons].

"Drawing on a profile of age-specific expenditures for selected [Canadian] Government programmes (services and transfers), we examine the effect of demographic changes and labour force participation on social expenditures in the upcoming decades. In terms of cross-sectional analysis, increased activity rates and particularly a postponed retirement age would exercise a major impact.... Using a different approach, it is possible to distinguish for each generation the social benefits received and corresponding contributions. Whereas the amount of benefits received by a specific cohort essentially depends on its size, contributions vary according to annual social expenditures. The demographic structures are such that the generations born before 1991 will profit from an excess in benefits...while for the following generations the situation will be reversed.... For all scenarios with negative population growth, future generations may expect to incur a deficit in terms of social expenses." (SUMMARY IN ENG AND SPA)

Age Factors↗

The secondary importance of primary health care in South Cameroon.

Primary health care in Cameroon meets with serious obstacles. The state gives it a low priority in its budget and over-all policy. The health institutions are rarely active in this field. Institutions which do practice some primary health care are usually foreign. The villagers, finally, are little interested. They insist only on improvement of curative services and material life conditions. The conclusion is that primary health care is regarded as something of secondary importance. First comes a better life. The research for this paper was conducted in 1980 in the South of Cameroon.

Cameroon↗

Primary health care is not cheap: a case study from Guinea Bissau.

In 1977 the Ministry of Health in Guinea Bissau started two regional community health projects. In this article we describe the progress of the Tombali project. Three aspects are discussed: the "Learning Process Approach" used in the project; measurement of the effectiveness of the project and the problems of collecting and interpreting these data; and the ratio of investment to recurrent costs and the proportions borne by government and by villagers. Primary health care projects evolve slowly, and the importance of the willingness of project workers, donor agencies, and the national government to work without a blueprint plan is emphasized. We discuss ways of evaluating the success of primary health care schemes; the measurement of any change in health status is difficult and discounts other benefits that may result, such as encouraging community participation and involving villagers in government activities. Both government and villagers contribute significantly to the scheme, the government and donors bearing most of the investment costs, while most of the recurrent costs fall on the villagers. The data show that for neither government nor villagers is the scheme a cheap option to secure health care for rural populations. Finally, we discuss the lessons to be learned by national governments, donor agencies, and health workers from this attempt to implement a primary health care program.

Budgets↗

Law No. 88-16, 5 January 1988.

Among other things, this Law extends the scope of social protection granted to mothers In France. It seeks to ensure that women who stay at home to bring up their families are not penalized in any way and to encourage such women to have a third child. The following are among measures of the Law: 1) entitlement to receive benefits in kind from the sickness insurance scheme in the event of divorce or the death of the spouse was previously restricted to a limited period (one year, extended until the date of the third birthday of the last child); it is now granted without limit of time and without charge, in the event of either contingency, to single parents aged 45 or over who have, or have had, three or more dependent children; 2) the possibility for any parent with dependent children residing in France and not engaging in any occupational activity to join the voluntary old-age pension scheme has now been extended to cover invalidity; the contributions payable (which may be deducted from family allowances) will be calculated on the basis of the minimum guaranteed wage (SMIC); 3) reversionary pensions of widows between ages 55 and 65 who have dependent children are to be increased by a uniform amount, set at 400 francs per month and adjustable; and 4) periods of maternity leave will be taken into account in the determination of seniority rights within an enterprise, particularly in the context of notice of dismissal (half of all periods of parental educational leave were already taken into account).

Aid to Families with Dependent Children↗

Globalisation of international health.

40 years ago, activities in international health were the domain of WHO, governments (based on bilateral agreements), and non-governmental organisations. This has changed. Today, new players (such as the World Bank and, increasingly, the World Trade Organisation) have an influence on international health. As globalisation of trade and markets takes hold, new coalitions and alliances are forming to examine and deal with the direct and indirect consequences on health. This paper examines the changing context of cooperation in international health, and voices concerns about rising potential inequalities in health, both within and between countries. The question of how such changes will affect the actions of organisations working in international health is also addressed.

Global Health↗

Family planning: sudden infant death syndrome bills.

Family planning, sudden infant death syndrome (SIDS) bills approved by the Senate Child Health and Human Development Subcommittee authorize $2.5 billion over 1979-1983 for family planning and $49 million over the same period for SIDS. The Human Resources Committee is expected to mark-up both bills May 3, 1978. The SIDS bill includes funds for expansion of counseling and information services, improving reporting requirements, and upgrading the SIDS unit in the Office of Maternal and Child Health. A total of $7 million is autorized for 1979. The Administration's SIDS bill includes only $3 million for 1979 and "such sums as necessary" for 1980-1981. The family planning bill authorizes $169 million for 1979, $197 million for 1980, $228 million for 1981, $263 million for 1982, and $300 million for 1983 to expand basic family planning services to adults and adolescents. It authorizes $42.5 million for 1979, $72 million for 1980, $105 million for 1981, $142 million for 1982, and $183 million for 1983 to provide services specifically to sexually active adolescents, plus $5 million in 1979, $7.5 million in 1980, $10 million in 1981, $12.5 million in 1982, and $15 million in 1983 for demonstration programs in infertility and to increase research in the biomedical, contraceptive development, and behavioral fields. The measure also provides $100 million in 1979, $125 million in 1980, $150 million in 1981, $175 million in 1982, and $200 million in 1983 for population research and reemphasizes the administrative functions of the deputy assistant secretary for population affairs and the Office of Population Affairs. The Department of Health, Education, and Welfare is currently looking for someone to fill the post, the duties of which are now performed by Deputy Assistant Secretary for Health Programs J. Lashof. The Administration's family planning bill requests $145 million for 1979 and "such sums as necessary" for 1980 and 1981.

Americas↗

External assistance to the health sector in developing countries: a detailed analysis, 1972-90.

This study, which was conducted for the World Bank's World development report 1993: investing in health, provides an objective analysis of the external assistance to the health sector by quantifying in detail the sources and recipients of such assistance in 1990, by analysing time trends for external assistance to the health sector over the last two decades, and, to the extent possible, by describing the allocation of resources to specific activities in the health sector. The main findings of the study are that total external assistance to the health sector in 1990 was US$ 4800 million, or only 2.9% of total health expenditures in developing countries. After stagnation in real terms during the first half of the 1980s, health sector assistance has been increasing since 1986. Despite their small volume, external assistance at the margins may play a critical role in capital investment, research and strategic planning. The study confirms prior findings that health status variables per se are not related to the amount of aid received. Comparing investments to the burden of disease shows tremendous differences in the funding for different health problems. A number of conditions are comparatively under-financed, particularly noncommunicable diseases and injuries.

Communicable Disease Control↗

Family planning funding through four federal-state programs, FY 1997.

CONTEXT: The maternal and child health (MCH) and the social services block grants have long played an important role in the provision of family planning services in the United States. The extent to which states have incorporated family planning services into the newer federally funded, but state-controlled, programs--Temporary Aid to Needy Families (TANF) and the State Children's Health Insurance Program (CHIP)--has yet to be identified. METHODS: The health and social services agencies in all U.S. states, the District of Columbia and five federal jurisdictions were queried regarding their family planning expenditures and activities through the MCH and social services block grants and the TANF program in FY 1997. In addition, the states' CHIP plans were analyzed following their approval by the federal government. Because of differences in methodology, these findings cannot be compared with those of previous attempts to determine public expenditures for contraceptive services and supplies. RESULTS: In FY 1997, 42 states, the District of Columbia and two federal jurisdictions spent $41 million on family planning through the MCH program. Fifteen states reported spending $27 million through the social services block grant. Most of these jurisdictions indicated that they provide direct patient care services, most frequently contraceptive services and supplies. Indirect services--most often population-based efforts such as outreach and public education--were reported to have been provided more often through the MCH program than through the social services program. MCH block grant funds were more likely to go to local health departments, while social services block grant funds were more likely to be channeled through Planned Parenthood affiliates. Four states reported family planning activities funded under TANF in FY 1997, the first year of the program's operation. Virtually all state plans for the implementation of the CHIP program appear to include coverage of family planning services and supplies for the adolescents covered under the program, even when not specifically required to do so by federal law. CONCLUSIONS: Joining two existing--but frequently overlooked--block grants, two new, largely state-controlled programs are poised to become important sources of support for publicly funded family planning services. Now more than ever, supporters of family planning services need to look beyond the traditional sources of support--Title X and Medicaid--as well as beyond the federal level to the states, where important program decisions are increasingly being made.

Adolescent↗

Australia to fund HIV / AIDS projects in Southeast Asia.

Australia will fund 23 new HIV-AIDS projects in Southeast Asian countries, the government announced. "Asia is predicted to be the major growth area for human immunodeficiency virus (HIV) infections over the next decade, " Minister for Development Cooperation Gordon Bilney said. "These projects, worth some $4.35 million over three years, will help meet the challenge of preventing the spread of the disease in the region." The projects--in Thailand, Vietnam, the Philippines, Indonesia, Malaysia and Cambodia--emphasize education and prevention activities as well as programs which focus on the care and support of people living with HIV, Bilney said. He also said a variety of Australian and overseas organizations will implement the projects, many of which will feature the significant involvement of communities at risk and people with HIV. "It is in keeping with the fundamental spirit of the aid program that we should seek to share this expertise with our neighbors in the region." Bilney said one Australian success story--the creative "Streetwize comics" (publications in Australia which help street kids and under privileged kids understand HIV/AIDS problems)--will be piloted in Vietnam in conjunction with the Vietnam Youth Federation. He said Vietnamese staff will be trained in the production of a series of bilingual mini-comics on HIV-AIDS prevention for youth. "This project will receive funding of $187,500 over three years," Bilney said. Bilney said the projects would help minimize the individual and social impact of the epidemic in the targeted countries.

Asia↗

More agencies want to help. Directory of funders.

If you want to know who might be willing to fund your safe motherhood project, write to WHO's Maternal Health and Safe Motherhood Program for our new directory. Produced in collaboration with the UK-based development agency, AHRTAG, the Directory of funders of maternal health and safe motherhood projects has more than 70 entries, including the World Bank and many UNICEF national offices. UNDP and UNFPA wrote to us indicating that they can only respond to government requests for assistance. The directory is intended for the use of non-governmental organizations planning to extend or start safe motherhood activities. WHO regularly receives requests for support which it is unable to assist because it is not a funding agency. It was in response to this evident need that the directory was prepared. Each entry in the directory contains the name, address, telephone and fax details of the funder. One agency has indicated that it may fund a project valued at as much as US$2 million while another would consider grants for as little as US$1000. Where available, details of the types of projects considered are also included. The most popular areas of support are health education, training and community-level maternity services. Some agencies have said that they are interested in supporting national safe motherhood newsletters. If you would like to receive a free copy of the directory, or if your agency would like to be included in the next edition, please write to the Maternal Health and Safe Motherhood Program, Division of Family Health, WHO, 1211 Geneva 27, Switzerland. Good luck in finding funding for your project]

Delivery of Health Care↗

Financing mechanisms for village activities in The Gambia and their implications for financing insecticide for bednet impregnation.

The recent enthusiasm for impregnated bednets as a malaria control measure leaves unresolved the question of how to finance them. The National Impregnated Bednet Programme in The Gambia faced the question of how to obtain funds from villages to finance the cost of insecticide, but knew very little about current village fundraising for development purposes. A survey was conducted of such fundraising, and questions also asked about willingness to pay for insecticide and preferred means of paying. All 53 villages surveyed paid taxes/rates, but 34% of villages reported no voluntary fundraising. The most common reason for collecting money was for the maintenance of wells (40% of villages). Collective farming was used as a means of raising money in 32% of villages. There was some variation in the type and extent of fundraising by region and also by the predominant ethnic groups of the village. Villages with voluntary fundraising activities seemed to have well established collective mechanisms for agreeing on sums to be collected and their use, and for collecting and recording income and expenditure. Non-payment was rare, and misuse of funds was not reported. Respondents were asked how much compounds might be willing to pay for insecticide impregnantion: the most frequently cited maximum amounts were D5 and 10, and minimum D1 and 5 (D15 = 1 pound). The paper discusses payment options for insecticide, such as whether the village should be allowed to decide itself how to raise funds, and whether the payment should be made only by households with nets or by a village-wide mechanism such as collective farming.(ABSTRACT TRUNCATED AT 250 WORDS)

Agriculture↗

Law No. 30 modifying and amending Laws No. 135 of 1961, 1a of 1968, and 4a of 1973 and conferring certain competencies on the President of the Republic, 18 March 1988.

This Law and regulatory Decree No. 2017 of 12 October 1988 (Diario Oficial, No. 38531, 12 October 1988, pp. 1-7) establish new procedures for the distribution of rural land in Colombia. A major aspect of these laws is the incorporation of the National Council of Economic and Social Policy (CONPES) into the planning and control of the agriculture reform scheme. According to these regulations, the Colombian Institute for Agriculture Reform (INCORA) will be in charge of the creation of the Annual Plan of Activities which establishes the regions subject to a land distribution plan under the supervision of CONPES. Once the Annual Plan of Activities is formulated, the regulations authorize INCORA to negotiate directly with the owners of the lands covered by the regional plan. For this purpose, the land is subject to technical analysis consisting of an on-site visit during which the quality, improvement, and value of the machinery attached to the land are assessed. After the analysis is completed, an offer will be made to the owner, who has a period of 15 days to accept or reject it. If the offer is rejected, INCORA will initiate an expropriation proceeding. Payment will be made in government bonds, maturing in five years. The owners have a right to seek the exclusion of their lots from regional plans. A second major aspect of these laws is that their objectives include not only the redistribution of the land but also the creation of adequate infrastructure for the development of regions subject to agrarian reform. Projects for the construction of railroads or other means of transportation, public service facilities, and cultural centers will be carried out keeping in mind the principle that respect for environmental concerns be maintained.

Americas↗

Primary health care, community participation and community-financing: experiences of two middle hill villages in Nepal.

Although community involvement in health related activities is generally acknowledged by international and national health planners to be the key to the successful organization of primary health care, comparatively little is known about its potential and limitations. Drawing on the experiences of two middle hill villages in Nepal, this paper reports on research undertaken to compare and contrast the scope and extent of community participation in the delivery of primary health care in a community run and financed health post and a state run and financed health post. Unlike many other health posts in Nepal these facilities do provide effective curative services, and neither of them suffer from chronic shortage of drugs. However, community-financing did not appear to widen the scope and the extent of participation. Villagers in both communities relied on the health post for the treatment of less than one-third of symptoms, and despite the planners' intentions, community involvement outside participation in benefits was found to be very limited.

Allied Health Personnel↗

Correlates of condom failure in a sexually active cohort of men who have sex with men.

Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment, condom failure was reported by 16.6%, with failure rates of 2.1/100 episodes of condom usage (2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex). In separate multivariate models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a decreased per-condom failure rate and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for >80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. Safer sex counseling should particularly target men of lower socioeconomic status, promote proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use, especially amphetamines and alcohol, on condom failure.

Adult↗

Public Law 100-202, Joint Resolution making further continuing appropriations for the fiscal year 1988, and for other purposes, 22 December 1987.

This US Act provides the following with respect to universal access to child immunization: "The Congress calls upon the President to direct the Agency for International Development, working through the Centers for Disease Control and other appropriate Federal agencies, to work in a global effort to provide enhanced support towards achieving the goal of universal access to childhood immunization by 1990 by 1) assisting in the delivery, distribution, and use of vaccines, including a) the building of locally sustainable systems and technical capacities in developing countries to reach, by the appropriate age, not less than 80% of their annually projected target population with the full schedule of required immunizations and b) the development of a sufficient network of indigenous professionals and institutions with responsibility for developing, monitoring, and assessing immunization program and continually adapting strategies to reach the goal of preventing immunizable diseases and 2) performing, supporting, and encouraging research and development activities, in both the public and the private sector, that will be targeted at developing new vaccines and at modifying and improving existing vaccines to make them more appropriate for use in developing countries. In support of this global effort, the President should appeal to the people of the US and the US private sector to support public and private efforts to provide the resources necessary to achieve universal access to childhood immunization by 1990." The Act also does the following with respect to various forms of bilateral assistance: 1) prohibits the use of funds for an organization or program that supports coercive abortion or involuntary sterilization; 2) prohibits the use of funds for the performance of abortion as a method of family planning (FP); 3) provides that in awarding grants for natural FP under section 104 of the Foreign Assistance Act no applicant shall be discriminated against because of such applicant's religious or conscientious commitment to offer only natural FP. In addition, the Act stipulates that with respect to appropriations for the Department of Health and Human Services no funds will be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term.

Abortion, Induced↗

Towards a national AIDS-control program in Uganda.

A national AIDS-control program was developed in Uganda to deal with a potentially serious epidemic of the acquired immunodeficiency syndrome (AIDS). A cumulative total of 1,138 cases of AIDS has been reported in Uganda between 1983-since AIDS was introduced into the country-and March 1987. More than 80% of the victims are sexually active persons whereas less than 10% are infants and children younger than 5 years. Virtually no cases or seropositivity is reported in persons between the ages of 5 and 14 years or after the age of 60 years. Most transmission has been through the heterosexual route, and, unlike in the United States, the male-female ratio is 1:1. Heterosexual high-risk behavior is cited as an important mode of transmission. A survey of household contacts showed that despite the closeness, only the sexual partners were seropositive.A five-year plan of action has been developed, and health education is the main thrust. It also includes blood screening, improved sterile procedures, improved surveillance and notification, research and terminal patient care. The plan stresses integration based on primary health care. There are unresolved moral issues of whether or not to tell the truth to an AIDS victim or any healthy seropositive person in developing countries, especially unstable persons. The best approach is to sensitize everyone so that they become guardians of their lives because sexual behavior is an issue of individual responsibility.

Acquired Immunodeficiency Syndrome↗

America's elderly.

The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The view that the young and old simply compete for fixed resources is misleading. It ignores the interdependence among generations, and the burdens and benefits of intergenerational transfers at all stages of the life course.

Adult↗