RESUMO

PIP: This article describes the operations of soup kitchens in Peru for low-income women and their families; it is based on interviews with leaders and members of 12 soup kitchens in Lima, 21 women who took part in a workshop, and interviews with leaders of the Federation of Organizations of Self-Managed Soup Kitchens of Lima and Callao. Soup kitchens may be self-managed or started by women's groups and later recognized and funded by government programs. Government programs usually include a range of support services, such as daycare. More recent changes in both types of programs include provision of income generation or social service activity to help families increase income and cut household expenses. Kitchens operate with a governing board and a decision-making assembly. Soup kitchens are located in rented, borrowed, or owned properties. Self-managed kitchens can have 35-100 members. Active members cook and receive a set amount in return. Kitchens prepare about 100-560 meals/day and charge less than 1 new sol. The law requires the state to cover 65% of food costs. Kitchens begin operations at 5:30 AM. Soup kitchens operate connected activities depending upon member's age, their children's ages, family size, and commitment. There are many benefits and sacrifices. Members gain confidence, self-assurance, knowledge, and self-esteem due to capacity building, skills acquired, and social recognition. Women's participation affects gender relations in their family, sometimes including domestic tension and conflict. Soup kitchens are valued for the improvement they foster in living standards of members and their families.^ieng

Assuntos

Programas Governamentais , Instituições Privadas de Saúde , Planejamento em Saúde , Pobreza , Mudança Social , Seguridade Social , Mulheres , América , Atenção à Saúde , Países em Desenvolvimento , Economia , Saúde , Serviços de Saúde , América Latina , Organização e Administração , Peru , Política , Atenção Primária à Saúde , Opinião Pública , Pesquisa , Classe Social , Fatores Socioeconômicos , América do Sul

RESUMO

PIP: In 1991-1992, Via Libre, a nongovernmental organization (NGO), developed an information program for the general public in Lima using a portable pavilion. The metallic structure is 32 square meters and houses 30 posters with prevention messages. Collaboration with another NGO, Instituto Generacion, resulted in the production of a 7 minute video of basic information that is shown continuously at the pavilion. Facilitators distribute printed materials. Occasionally, a third NGO, Asociacion Germinal, provides street clowns who carry prevention messages to accompany the exhibit. Due to positive public response, the exhibit became "The Information Traveling Pavilion" in 1993; the exhibit has traveled to more than seven cities throughout Peru. Via Libre staff provide local health workers with information update courses and counseling workshops in order to respond to increased public demands for information and support following the activities. 75 private enterprises have provided support for the program. Radio and television collaborate in publicizing the activities.^ieng

Assuntos

Educação , Educação em Saúde , Instituições Privadas de Saúde , Pessoal de Saúde , Serviços de Informação , Meios de Comunicação de Massa , Organização e Administração , Organizações , Gravação de Videoteipe , América , Comunicação , Atenção à Saúde , Países em Desenvolvimento , Saúde , Planejamento em Saúde , América Latina , Peru , América do Sul , Gravação em Fita

RESUMO

PIP: Culturally appropriate health messages can make a huge difference in conveying health information on, for instance, acute respiratory diseases (ARI). In Bolivia, PLAN health projects are devoted to developing and implementing effective strategies to reduce infant and child morbidity and mortality. Acute respiratory disease are a major contributory cause. Health messages emphasize recognition by mothers of symptoms, such as prolonged coughing and fever and rapid breathing. The usual strategy promoted by the World Health Organization is to translate the messages into Spanish and print posters and training manuals. However, ARI has not been affected by such efforts. In Altiplano, a rural Aymara community, the community health workers receive this training in Spanish, but the Aymara idiom is used in this rural area. PLAN conducted an ethnographic study which revealed that pneumonia does not translate well into Aymara, and other less serious folk illnesses have similar symptoms. The solution was to promote the notion that rapid breathing was a serious problem, a solution not possible without linking indigenous and biomedical perspectives.^ieng

Assuntos

Serviços de Saúde da Criança , Proteção da Criança , Criança , Comunicação , Cultura , Programas Governamentais , Educação em Saúde , Instituições Privadas de Saúde , Medicina Tradicional , Desenvolvimento de Programas , Infecções Respiratórias , Adolescente , Fatores Etários , América , Bolívia , Atenção à Saúde , Demografia , Países em Desenvolvimento , Doença , Educação , Saúde , Serviços de Saúde , Infecções , América Latina , Centros de Saúde Materno-Infantil , Medicina , Organização e Administração , População , Características da População , Atenção Primária à Saúde , América do Sul

RESUMO

PIP: By October 1992, the government's Special Program to Control AIDS (PECOS) registered 717 cases of the disease in Peru; however, the number of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) cases could number thousands. PECOS estimates that the number of cases of HIV is doubling every 2 years. One of the main reasons for the continued spread of HIV is the common perception that the pink plague, as AIDS is called here, affects only homosexuals. While 85% of sexually transmitted HIV and AIDS cases are among gay and bisexual men, in the past 4 years a large number of new cases has been registered among heterosexuals, especially women. In 1987, the ratio of AIDS cases among men and women was approximately 15 to 1. Today, the male to female ratio is 7 to 1. Most people working on AIDS say that the changing profile of the epidemic in Peru is caused by the high costs of prevention programs and the lack of information on the disease, which drastically raise the number of people in high risk groups. Peru's ongoing economic crisis has eaten into the budgets of nongovernment organization's (NGOs) AIDS prevention campaigns and has pushed treatment out of the reach of many people. In 1991, 3 television commercials developed by PECOS to promote the use of condoms were blocked by the Health Ministry. One of the groups that fought against campaigns promoting condom use was the Association of Catholic Doctors. The only way to organize an effective program is through a joint effort that brings together the government, NGOs, and other private and public institutions. Cooperation was demonstrated through the actions carried out for World AIDS Day, when more than 16 public, NGO, and government organizations were involved in a variety of AIDS information activities. In 1993, about 30 NGOs will begin actively working with Peru's Health Ministry to coordinate activities.^ieng

Assuntos

Síndrome da Imunodeficiência Adquirida , Catolicismo , Economia , Programas Governamentais , Infecções por HIV , Instituições Privadas de Saúde , Educação Sexual , América , Comportamento , Cristianismo , Países em Desenvolvimento , Doença , Educação , América Latina , Organização e Administração , Peru , Religião , Comportamento Sexual , América do Sul , Viroses

RESUMO

PIP: The views of a geographer, agricultural scientist, and women's activist focused on the importance of improving women's status and involvement in development. Women in Burkina Faso have shown an ability to organize themselves, but there was insufficient coordination among aid organizations. Researchers and development professionals must broaden and deepen their knowledge about climate, farming methods and traditional natural resource management methods, and women's concerns and occupations. Women need to be engaged in the planning and implementation of natural resource management strategies and in learning about appropriate training and information dissemination methods. The expertise in environmental disciplines is concentrated in developed nations and is needed by Sahelian women. Burkina's environment is replete with droughts, lack of forested areas, and dependence on subsistence farming. Famine and mass migration of men to urban areas have left women in poverty. Women must work 14-16 hours a day to provide food for their families and help husbands with cash crops. About 25% of women die from malnutrition, anemia, repeated pregnancies, malaria, and overexertion, as reported in a 1987 UNICEF study. The literature on women in Burkina Faso has focused only on broad issues of women's status. The few studies of local conditions conducted on a small scale by nongovernmental organizations have revealed that women were 60-80% of the labor force on anti-desertification projects. Women's overwhelming work load prevented even greater participation in environmental protection. Property laws gave land titles to men or the state. Women's groups have set up cereal banks, village pharmacies, and other self help projects pertaining to health, the environment, and agriculture. Women in development individual programs have not sufficiently integrated women and programs were archaic and dispersed. Environmental enforcement was limited.^ieng

Assuntos

Participação da Comunidade , Economia , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Pobreza , Direitos da Mulher , Mulheres , África , África Subsaariana , África do Norte , África Ocidental , Burkina Faso , Países em Desenvolvimento , Meio Ambiente , Organização e Administração , Pesquisa , Fatores Socioeconômicos

RESUMO

PIP: During the 1960s, when family planning services were institutionalized in Colombia by PROFAMILIA, abundant foreign assistance was readily available. Few questions were asked about the longterm funding of family planning programs or the need for financial self-sufficiency. The emphasis was on program development without great attention to costs. Beginning around the early 1980s, international donors began to place a higher priority and greater investment in the incipient family planning programs of less developed countries. At present a greater number and higher quality of services are being demanded from PROFAMILIA at the lowest possible cost. Efficiency has replaced efficacy as the overriding goal. PROFAMILIA, due to its excellent results, has lost priority in the eyes of international donors. It has therefore reoriented its financing strategies toward a short, medium, and long term plan to reduce its financial dependence on international donor agencies. Self-sufficiency could be increased through various means, including total government subsidy, charging fees for services and materials sufficient to cover program costs, establishing services and marketing programs aside from family planning programs for the specific purpose of obtaining funds to cover program deficits, or establishing accounting and operational controls to reduce costs through greater efficiency. But large government subsidies are unlikely in a time of budgetary constraints, and raising fees for family planning users would exclude a large number of low-income clients from the family planning program. Cost reduction and implementation of diversified programs should therefore be emphasized for the present. The diversified program should be related to family planning so that use can be made of idle resources. PROFAMILIA has emphasized surgical procedures and medical consultations to utilize clinic facilities more fully and to increase income without increasing fixed costs. In 1990, foreign donations accounted for 47.3% of PROFAMILIA income and PROFAMILIA contributed the rest. 18.1% came from family planning activities, 20.2% from surgical procedures, consultations, sales of medications, and laboratory services, and 20.2% from service contracts, national donations, interest, and other sources. In the same year, family planning programs accounted for 68.9% of expenditures, diversification programs for 11.5%, technical assistance for 8.6%, and administration for 11%. The income and expenditure data indicate that the diversification programs make a significant financial contribution to the family planning program, at the same time reducing dependency on international donor agencies.^ieng

Assuntos

Administração Financeira , Instituições Privadas de Saúde , Planejamento em Saúde , Renda , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países em Desenvolvimento , Economia , Serviços de Planejamento Familiar , América Latina , Organização e Administração , Fatores Socioeconômicos , América do Sul

RESUMO

PIP: 3 small scale sex education programs developed in recent years by nongovernmental organizations in Chile are described. In 1 case, PAESMI cooperated with the Organization of American States to develop a sex education program for schools in the municipality of Estacion Central. The 1st phase involved training of 40 teacher-monitors who attended a 3-day workshop during the 1988 summer vacation. They later served as instructors for the remaining teachers in the 12 participating schools. Saturday workshops were held over 4 months to familiarize teachers with the program and its objectives. No specific curriculum was established; teachers were to introduce the topics at their discretion into the existing program. A methodological guide was prepared for preschool and primary children in 1988, and in 1989 the program was extended to older children. The majority of participating teachers were enthusiastic, but at present the Biomedical Extension Center of the University of Chile is teaching a course on foundations for human sexuality for educators. It provides teachers with an improved factual basis to complement the stress on attitudes and ethics of the earlier course. A segment of the original course dealing with attitudes toward pornography is included. The 2nd program was a 10-session workshop organized by 4 psychologists, 2 teachers, and a midwife belonging to the Father Andre Jarlan Center for Research and Action in People's Health (CIASPO) for students in 4 intermediate schools in the commune of Santiago. The objective of CIASPO, a nongovernmental organization founded in 1985, is to provide sex education from a multidisciplinary perspective to enable students to assume responsibility for their own sexuality and improve attitudes. The workshop stressed the importance of the body, sentiments, and emotions, examined culture and sex roles, and contraceptive methods. A preworkshop evaluation questionnaire indicated that the participants had a deficient knowledge of sexuality. Workshop organizers emphasized the need for support from school authorities in implementing sex education programs. The final sex education initiative consisted of a mental health program developed by a group of professional women who worked with lower class urban women. The Center for Development of Women (DOMOS) began its work in the area of female sexuality, but by 1987 had become specialized in the mental health of women. DOMOS has a program of shortterm individual psychotherapy and a program of preventive education consisting of workshops on different themes lasting 4-12 weeks each. A sexuality workshop was held to help participants understand their sexuality as a natural function and an important part of human life.^ieng

Assuntos

Cultura , Docentes , Identidade de Gênero , Instituições Privadas de Saúde , Instituições Acadêmicas , Educação Sexual , América , Chile , Países em Desenvolvimento , Educação , América Latina , Organização e Administração , América do Sul

RESUMO

PIP: In late 1965, when he presented himself to the International Planned Parenthood Federation headquarters in London weeks after founding the Profamilia Foundation, Dr. Fernando Tamayo was an unknown Colombian physician with a mission to modify Colombia's very rapid rate of population growth. Colombia in 1964 has a population of 17.5 million growing at an annual rate of 3.4%. By 1973, the population was 22.9 million and growing at 2.7%. Cultural, religious, and moral obstacles precluded an aggressive family planning campaign, which would have aroused violent resistance. Profamilia personnel worked discreetly but persistently, convinced that they would see few short term results but that their effect would be immense in the long run. Family planning is partly a process of educating families in the health, socioeconomic, and psychological benefits of smaller families. Profamilia has a centralized organization which administers 3 main programs, the clinical program with 40 traditional clinics in major cities and 8 well-accepted male clinics, the sterilization program in clinics and mobile units, and the community-based distribution program which distributes pills, condoms, and IUDs through 3000 community posts under the direction of 120 instructors. Between 1964-90, Colombia's total fertility rate declined from 9.2 to 4.4 in rural areas, from 5.2 to 2.2 in urban areas, and from 7.0 to 2.8 overall. The rate of population growth declined from 3.4 to 1.8%. It has been estimated that over half the decline is due to Profamilia services. The total investment by Profamilia during its history was US $100 million. The average cost of protecting a couple against unwanted pregnancy is US $5.26 per year. Colombia's population is projected to increase from 30 to 54 million between 1985 and 2025 even if the growth rate declines from 1.8% in 1990 to 1.3% in 2025. The most worrisome aspect of the projected growth is its concentration in urban areas, which are already beset by poverty, inadequate basic services, and a limited potential water supply already threatened by deforestation. It is clear that the work of family planning in Colombia is not done and that much remains to be accomplished.^ieng

Assuntos

Instituições de Assistência Ambulatorial , Coeficiente de Natalidade , Conservação dos Recursos Naturais , Previsões , Instituições Privadas de Saúde , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Densidade Demográfica , Crescimento Demográfico , América , Colômbia , Atenção à Saúde , Demografia , Países em Desenvolvimento , Meio Ambiente , Serviços de Planejamento Familiar , Fertilidade , Saúde , Instalações de Saúde , América Latina , Organização e Administração , População , Dinâmica Populacional , Pesquisa , América do Sul , Estatística como Assunto

RESUMO

A two-week health study tour in Nicaragua in 1987 organized by the Health Network of the (British) Nicaragua Solidarity Campaign afforded the author of this report access to health service planning, first-hand observation of the immunization programme, and visits to centres for rehabilitation of the disabled, both from the war and civil causes. The efficacy of the low technology immunization and oral rehydration programmes is contrasted with the struggle to rehabilitate the war disabled with grossly inadequate resources.

---

PIP: Health care in post war Nicaragua, specifically interventions directed at infant and child mortality, rehabilitation of war disabled and counseling of the aggrieved, was surveyed in a 2-week study tour by the Health Network of the (British) Nicaragua Solidarity Campaign in 1987. There has been a grassroots health program initiated by the Government to use a system of health "briagadistas" and "multipliers" whereby volunteers train others in immunization and oral rehydration. The workers who have only some primary education receive 2 weeks intensive training followed by 1 day per month. In the last 4 years 70 of these workers have been killed by Contras. The infant mortality rate was cut from 120/1000 live births in 1977 to 75 by 1983. Mass immunizations were held on special health weekends. Poliomyelitis has been eradicated; no cases of diphtheria have been reported since 1985; and the incidence of measles has fallen. Rehabilitation of persons disabled by loss of limbs is limited by facilities: only 1 42-bed rehabilitation hospital with 1 orthopedic surgeon donating a few hours per week is available for a population of 3.3 million. Outside donors have set up prosthetics and wheelchair workshops, using local materials as much as possible. There is also a center in Managua teaching manual trades to 75 disabled. About 65,000 people have died in the civil and Contra wars, about 3 times the death rate in Britain in World War II. Caregivers are being trained in grief counseling by teams from Mexico at Nicaragua's 2 medical schools.

Assuntos

Atenção à Saúde , Guerra , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Nicarágua , Reabilitação

RESUMO

PIP: The 5-year-old community contraceptive distribution program developed by PROFAMILIA, Colombia's private family planning organization, has given excellent results, but several cost-effectiveness comparisons with social marketing programs have suggested that commercial distribution programs are superior. The community contraceptive distribution program has a high content of information and education activities, which produced significant increases in knowledge and use of contraception in the communities covered. It has been a fundamental support for the social marketing program, creating much of the demand for contraceptive products that the social marketing program has filled. The social marketing program has given good results in terms of volume of sales and in cost-effectiveness since 1976, prompting calls for replacement of the community contraceptive distribution program by the social marketing program in those sectors where knowledge and use of contraception have achieved acceptable levels. An experiment in the Department of Santander in 1984 and 1985 gave very favorable results, suggesting that community contraceptive distribution programs should be replaced by social marketing programs in all more developed markets. But economic problems in 1985 and the decision of manufacturers to decrease the profit margin for PROFAMILIA jeopardized the social marketing program. The community distribution program covered about 20% of the market. Reduced profits in the social marketing program threatened its continued expansion, at the same time that potential demand was growing because of increases in the fertile aged population and increased use of contraception. To meet the need, PROFAMILIA combined the community contraceptive distribution and social marketing programs into a new entity to be called community marketing. The strategy of the community marketing program will be to maintain PROFAMILIA's participation in the market and aid the growth of demand for contraceptives through educational and informational activities. The distribution scheme must continue to cover all the established points of sale in pharmacies despite the reduced profit margins.^ieng

Assuntos

Custos e Análise de Custo , Atenção à Saúde , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Planejamento em Saúde , Administração de Serviços de Saúde , Serviços de Saúde , Marketing de Serviços de Saúde , Medicina , Organização e Administração , Farmácias , América , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Economia , Saúde , América Latina , América do Sul

RESUMO

PIP: Preliminary results are presented from the Third National Contraceptive Prevalence Survey of Colombia, which took place in 1986. The sample of about 4500 households was representative on the national, urban, rural, and regional levels. The total fertility rate for 1986 was estimated at 4.9 in rural areas, 2.8 in urban areas including Bogota, and 3.2 for the country as a whole, compared to 4.4 in 1976 and 6.7 in 1969. Fertility changes in women over 30 have been particularly important in the past 10 years. The number of live births per 1000 women declined from 233 in 1971-75 to 183 in 1981-86 for women aged 20-24, from 227 to 173 for women aged 25-29, from 176 to 122 for women aged 30-34, from 131 to 79 for women aged 35-39, and from 67 to 30 for women aged 40-44. 69% of women in unions did not want more children. 30% of those aged 15-19 did not want more children and 29% did not want more for at least 2 years. 98% of Colombian women knew of some contraceptive method. 82.6% of women currently in union have used a method and 63.2% were using a method at the time of the interview. 51% used a modern method. The pill was most often used by younger women, the IUD by slightly older women, and voluntary sterilization was preferred by women over 30. Women using IUDs tended to be better educated and to live in urban areas. 24% of women in union in Bogota used IUDs in 1986. Sterilization was more prevalent in the Atlantic region and in less educated women. Contraceptive usage increased from 43% to 63% of women in union between 1976-86. 18% of Colombian women were sterilized as of 1986. PROFAMILIA clinics are the most important source of IUDs and female sterilization, while drugstores and pharmacies are the most important source for pills, vaginal spermicides, condoms, and injectables. 31% of women who stated they wanted no more children were not using any family planning method. The unsatisfied need was greater for younger women, the less educated, rural women, and those in the Atlantic region.^ieng

Assuntos

Fatores Etários , Coeficiente de Natalidade , Comportamento Contraceptivo , Coleta de Dados , Demografia , Características da Família , Serviços de Planejamento Familiar , Idade Materna , Características da População , População , Pesquisa , População Rural , Comportamento Sexual , População Urbana , América , Colômbia , Anticoncepção , Atenção à Saúde , Países Desenvolvidos , Países em Desenvolvimento , Fertilidade , Objetivos , Programas Governamentais , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Administração de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , América Latina , Medicina , Dinâmica Populacional , Estudos de Amostragem , América do Sul

RESUMO

PIP: The question of whether family planning programs should be integrated with other activities or limited strictly to contraception has been debated for years without achievement of consensus. Profamilia, the Colombian family planning organization, has been a firm advocate of a vertical program without other activities. A large body of economic and demographic data and evaluations of numerous programs in numerous places support the Profamilia position that both economic development and family planning programs are important in achieving demographic objectives, but if only 1 is possible in a given country, a good family planning program gives better results. Profamilia, a private, nonprofit organization, is responsible for 2/3 of the contraception practiced in Colombia. Profamilia's success appears to demonstrate that an effective program, even in a country no more promising otherwise than any of its neighbors, can achieve excellent results. For government-run programs, it may be politically impossible to avoid an integrated family planning program; the public is likely to question the emphasis on family planning if other urgent health needs go unattended. But even government-run programs may create separate structures with separate funding and personnel for specific problems such as malaria control, suggesting recognition of their greater efficiency. A nongovernmental organization such as Profamilia, faced with a continuing struggle for funding, must concentrate its resources on fulfilling its mission of allowing couples to decide freely on the timing and extent of their reproduction. Vertical programs, tolerant if not enthusiastic governments, and abundant demand are the 3 factors that have led to high rates of contraceptive usage in some countries; sthe contraceptive prevalence rate is 60% in Colombia. A number of studies in the late 1970s and early 1980s have shown that funds directed to family planning have a far greater demographic impact than do equal amounts directed to rural female education, nutrition, or control of infant mortality. Verticality in a family planning program should be understood to include all activities that attract potential family planning acceptors, as well as all services which generate funds that can be channeled to family planning programs and that contribute to program efficiency. Pregnancy tests, Pap smears, gynecological or urological consultations, social marketing, antiparasite campaigns, and treatments of infertility, sexually transmitted diseases, or sexual dysfunctions are all appropriate components of a vertical family planning program. True and unacceptable integration views contraception as a remote and secondary goal, while the type of "false" integration described above views family planning as its epicenter and does everything possible to promote and facilitate contraception.^ieng

Assuntos

Atenção à Saúde , Estudos de Avaliação como Assunto , Instituições Privadas de Saúde , Planejamento em Saúde , Administração de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Serviços de Saúde , Medicina , Organização e Administração , Controle da População , Avaliação de Programas e Projetos de Saúde , América , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Programas Governamentais , Saúde , América Latina , Política , Política Pública , América do Sul

RESUMO

PIP: A nonrepresentative sample of 207 women aged 15-35 living in the city of Tijuana were surveyed in 1985 to determine attitudes toward maternal and child health in a Mexican border city. The women were stratified by neighborhood of residence and housing type. 65 were classified in the upper, 80 in the middle, and 62 in the lower socioeconomic strata. 60% of the women surveyed had migrated to Tijuana. They represented 22 Mexican states of origin, not counting other parts of Baja California. 80% lived in extended families and the average household size was 5 persons. 56.5% were married. 51 were economically active, with proportionately more upper status women employed. The average educational level was 8.8 years. 21.5% were students at the time of the survey. 6.3% of the births to upper stratum women, 8.2% to middle stratum women, and none to lower stratum women occurred in the US. 72.3% of upper stratum women, 82.5% of middle stratum women, and 88.7% of lower stratum women stated they preferred birth to occur in Mexico. 27.7% of upper stratum, 17.5% of middle stratum, and 9.7% of lower stratum women would prefer to give birth in the US. The reason most commonly given for preferring birth in the US was superior medical attention. 80% of the births in Mexico were in private hospitals and the rest in public. The upper stratum women had the most prenatal visits and the smallest families. 20% of the middle and lower strata women who had ever been pregnant received no prenatal care. Middle and lower strata women were less informed about the importance of prenatal care. Traditional beliefs about pregnancy and the perinatal period were strongest among middle stratum women. Upper status women were the most likely to enter the US for short visits. 1/3 of middle status women and 70% of lower status women reported they never entered the US, primarily because they lacked documents. Lower stratum women tended to seek medical care late in pregnancy. Home remedies and the advice of relatives and neighbors constitute an option for prenatal care for these impoverished women. The tradition of breast feeding on demand is apparently being lost among women in Tijuana. 34% of the mothers declared they had never breast fed a child, and most of the rest discontinued breast feeding after a very short time. 53% of the 187 women who reported they were sexually active did not use contraception. 19% used oral contraceptives, 14% used IUDs, and 5% were sterilized. Although study results showed that socioeconomic status was related to the use of prenatal and obstetric services, there were no significant differences among socioeconomic groups in infant feeding or family planning practices.^ieng

Assuntos

Serviços de Saúde da Criança , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Planejamento Familiar , Feminino , Humanos , Cuidado do Lactente , Serviços de Saúde Materna/estatística & dados numéricos , México , Gravidez , Fatores Socioeconômicos , Viagem , Estados Unidos

RESUMO

PIP: In 1940, Chile had a population of slightly over 5 million, a crude birth rate of 36.4/1000, a death rate of 21.3/1000, and a natural increase of 1.5%. Between 1940-65, birth rates remained stable and high while the death rate declined steadily, so that the rate of natural increase gradually rose to 2.6%. After 1965, the birth rate declined faster than the death rate, and the natural increase rate slowly returned to its 1940 level--this due to lower fertility rather than high mortality. A slight increase in fertility rates followed a pronatalist campaign launched in 1978, but another slight decline began in 1982. The natural increase rate in 1985 was 1.6%. A private family planning organization was started in chile in the early 1960s to respond to the problem of illegal abortion. Studies had shown that 80% of Chilean women seeking abortion were married or in stable unions with 3 or more living children. In 1965, Chile's new family planning organization reached an agreement with the Ministry of Health whereby free family planning information and services would be offered in Ministry of Health facilities facilities to all women seeking them. The association also became a member of the International Planned Parenthood Federation, enabling it to receive external aid in the form of modern contraceptives and gynecological equipment. In its 21 years of existence, the family planning associated has maintained its agreement with the Ministry of Health and initiated others. Between 1960-84, with availability of family planning services, age specific fertility rates declined slightly for women aged 15-19 and very greatly for older women. In 1960 and 1984 respectively, age specific rates were 72.6 and 64.0 for women aged 15-19, 211.1 and 141.1 for women 20-24, 240.9 and 127.6 for those 25-05.5 and 90.8 for those 30-34, 141.4 and 45.0 for those 35-39, and 62.2 and 14.4 for those 40-44. The total fertility rate was 4.7 in 1960 and 2.4 in 1984. The family planning program has greatly reduced health risks from multiparity, but adolescent pregnancy continues to pose a threat for mothers and children, especially since over half of births to women under 20 are illegitimate. Chile's infant mortality rates were 192.8 1940, 120.3 in 1960, and 19.7 in 1985. Between 1960-85, the neonatal rate declined from 35.2 to 10.4. It is possible that decline in late infant mortality was relative to the declining proportion of unwanted births made possible by availability of family planning services. It has been estimated that 30% of the decline in infant mortality between 1972-82 was due to the decline in high order births made possible by family planning. Maternal mortality has declined due to better care during pregnancy and delivery, decline in illegal abortions, and decreased fertility among women over 35.^ieng

Assuntos

Aspirantes a Aborto , Coeficiente de Natalidade , Causas de Morte , Atenção à Saúde , Demografia , Fertilidade , Programas Governamentais , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Mortalidade Infantil , Idade Materna , Mortalidade Materna , Medicina , Mortalidade , Dinâmica Populacional , Crescimento Demográfico , População , Projetos de Pesquisa , Aborto Criminoso , Aborto Induzido , América , Chile , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , América Latina , Organização e Administração , Gravidez , Gravidez na Adolescência , Reprodução , Pesquisa , América do Sul

RESUMO

Health services in Brazil are characterized by a multiplicity of providers. While many are ultimately funded from public sources, notably the National Social Security Scheme, a large proportion are provided by the private sector. This variety of providers of health care has hindered the development of comprehensive care and the coverage of those in greatest need. In recent years increasing attention has been given to ways of reducing the undesirable aspects of this situation. The Federal and State Governments have established committees to improve coordination between services and set up several pilot programmes. One concerned with improving the effective coverage of maternal and child services has been established in Sorocaba. Sorocaba is a medium-sized city which is typical of the many urban centres in the state of São Paulo. This paper describes a study which has provided information from a representative sample of women, who had recently had a baby, on their eligibility for care from the various health services available in the city and on their actual use of those services. This information has been used in the implementation of a pilot programme. Most mothers attended some service for antenatal care. Almost 20% used several services because their entitlement varied from scheme to scheme and some services provided only specific components of care. This applied also to preventive and curative infant care.

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PIP: A survey of 296 mothers, with children born in March 1979, was conducted in Sorocaba, Sao Paulo State, Brazil, to describe the use and payment of health care, for baseline data for a maternal-child health program. Sorocaba, 96 km northwest of Sao Paulo, has 260,000 people and an infant mortality of 70/1000. Health care is dominated by private physicians and hospitals, and is largely reimbursed by public sources through the INAMPS social security payroll taxes, federal, state and municipal funds. There are also organized physician co-ops, and prepaid health plans. Because of diversity funding and services, there is an emphasis on curative medicine, duplication, and inequity of care. Extensive information is included in tables on socioeconomic, education, medical, insurance coverage, type of care received and residence characteristics of the subjects, expressed as percentages. Most (83%) mothers belonged to the Federal Social Security plan, and a third also belonged to a private insurance plan, usually through the husband's employment. Only 4% were not covered, except State and Municipal providers. Only 1.7% had no prenatal care. Any drugs needed were paid in part, although 17% had to go to more than one provider to get them. 98% were delivered in hospitals, 30% by Cesarean section, for which doctors receive higher fees. Many (62%) took their children for care by 2 months of age. Equal numbers used private or state health centers, while 14% used several sources. For infants' curative services 56% used private physicians or hospitals, 17% paid for care and 86% paid for drugs. Women in lower socioeconomic groups or with less education began prenatal care later and made significantly fewer visits for prenatal or infant care (p.001). The study has prompted discussions on coordination of outpatient services and identification of high risk patients.

Assuntos

Serviços de Saúde da Criança/provisão & distribuição , Serviços de Saúde Materna/provisão & distribuição , Brasil , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , População Urbana

RESUMO

PIP: The Hope Foundation, a private organization founded in the Amazon town of Santarem, Brazil, by the American Franciscan Father Luke Tupper,has provided health services to be dispersed population of the rural zones of the central Amazon basin for 15 years. The 1st activities were centered on a hospital ship. In its 1st decade the foundation vaccinated 150,000 persons and provided medical and surgical services to countless others, but in the late 1970s the program personnel began to doubt whether the program was having lasting effects. In 1979 the foundation decided that the health of the population could be improved if rural communities could be induced to improve their nutritional and sanitary practices and if extensive vaccinations campaigns were carried out. A preliminary health survey indicated that 1/3 of children under 6 in the area were malnourished, 2/3 of the 10,000 inhabitants examined showed evidence of parasite infection, and the infant mortality rate was very high. The predominantly illiterate population tended to live in isolated river communities without potable water or sewage systems, and with no regular access to medical care. The foundation sent health auxiliaries from their office in Santarem to visit the rural settlements, organize local health committees, plan vaccination campaigns, and plant small communal gardens. The hospital ship continued to make periodic trips for more specialized problems. Very soon, however, the program encountered difficulties because of the remoteness of the villages, the difficult access, and the problems of organizing and motivating local health committees among persons with little relevant experience. It was decided that literate persons from each community should be trained to carry out basic treatments and to launch public health campaigns. The strategy would provide a number of paramedics disposed to remain in their communities and would assure close working relationships with the local health committee. The health workers were given intensive courses over 12 weeks in the dispensary in Santarem, where they learned to do basic laboratory examinations to identify the 9 most common intestinal parasites in the region, to organize vaccination campaigns including record keeping, to provide prenatal care and attend deliveries, to recognize a variety of diseases, and to refer doubtful cases to the dispensary in Santarem along with complete medical histories. They also provided follow-up care for surgical patients. A program to dig wells provided the benefits of clean water, a reduction of parasite infections, increased prestige for the health workers who were active in the campaign, and more free time for the women and children who had previously carried water from the rivers. The Hope Foundation cooperated with the medical faculty of a nearby university to train medical personnel for community health in the Amazon basin, but found little interest among new graduates. The foundation recently contracted to train health promoters to serve other regions of the state of Para.^ieng

Assuntos

Pessoal Técnico de Saúde , Agentes Comunitários de Saúde , Atenção à Saúde , Fundações , Instituições Privadas de Saúde , Pessoal de Saúde , Serviços de Saúde , Medicina , Organizações , Política , Atenção Primária à Saúde , Serviços de Saúde Rural , América , Brasil , Participação da Comunidade , Países Desenvolvidos , Países em Desenvolvimento , Educação , Saúde , Planejamento em Saúde , Administração de Serviços de Saúde , Serviços de Informação , América Latina , Organização e Administração , Desenvolvimento de Programas , América do Sul

RESUMO

PIP: The Colombian Association for Family Welfare (PROFAMILIA) and Indonesia's Community Development Association (PDA) operate social marketing projects which might more appropriately be called social sales projects. Unlike other social marketing projects, these 2 projects seek profits from their contraceptive sales. The profits are then used to subsidize other programs operated by these 2 nonprofit organizations. Indonesia's PDA initiated its sales project in 1974. It operates both an urban contraceptive retail sales (CRS) program and a rural community-based distribution sales (CBD) program. The CRS program sells 3 types of condoms, which it delivers directly to the 1750 retailers involved in the program. The condoms sell for US$.03-US$.07, somewhat more than condoms sold in most social marketing projects. The CBD project covers 10,200 villages in 157 of Indonesia's 620 districts. Each village has a CBD volunteer who sells oral contraceptives (OCs) and condoms and also promotes family planning and rural development. The program sells Norinyl, Ovostat, and Eugynon for US$.19-US$.30/cycle. PDA runs other profit-making projects. For example, it sells promotional T-shirts and calendars at its vasectomy clinics and through its CBD program. PDA also established the taxable Population and Development Corporation, which engages in marketing activities. Profits from the corporation are channeled back to PDA. PROFAMILIA also operates both an urban sales program and a rural community-based distribution program. In the urban program, condoms are sold at normal retail prices and OCs at prices 30% below retail prices. The profits derived form the urban sales are used to subsidize the rural project. In 1981, the urban program began selling 6 noncontraceptive products, e.g., distilled water and disposable diapers. Currently, the program sells only distilled water, as the other products failed to yield a profit. A table provides sales information for both the PDA and PROFAMILIA programs.^ieng

Assuntos

Comércio , Preservativos , Anticoncepção , Anticoncepcionais Orais , Atenção à Saúde , Economia , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Marketing de Serviços de Saúde , América , Ásia , Sudeste Asiático , Colômbia , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Indonésia , América Latina , Organização e Administração , População Rural , América do Sul , População Urbana

RESUMO

PIP: Guatemala's family planning association, the Asociacion Pro-Bienestar de la Familia (APROFAM) recently cut its ties with the nation's contraceptive social marketing program. The announced reasons for the disassociation was APROFAM's concerns about the legality of selling donated commodities. APROFAM helped create the program served as a member of the marketing program's board of directors, and was expected to function as the channel for the commidities donated by the US Agency for International Development (USAID). The marketing program will now be managed by the newly created Importadora de Farmaceuticos (IPROFA), a for-profit organization. This alters the legal status of the marketing program, and as a result, the program will be required to pay duties on USAID donated contraceptives. USAID cannot legally pay duties on its own contributions. Instead, the duies will be paid by IPROFA out of the revenues generated by the project. IPROFA will finance the 1st consignment of products with a bank loan, and the loan and duties on subsequent shipments will be paid out of the program's revenues. This strategy is not expected to pose legal problems for USAID, since the agency has no control over how programs use the revenues generated by selling the agency's commodities. As a result of the changed status, the marketing program must acquire it own storage and packaging facilities. According to Manuel DeLucca, the program's resident advisor, these problems will not delay the launch of the program's products scheduled for early 1985. The program plans to sell an oral contraceptive, a vaginal spermicidal tablet, and a condom. Orginal plans called for selling the low dose OC, Norminest; however, Norminest may not be approved for distribution in Guatemala, and USAID may replace Norminest with another product. As a result, the program may market Noriday, a normal dose pill instead of Norminest. Guatemalan registration of the spermicidal tablet the program is planning to sell is pending. The program is engendering considerable interest because of its unique legal status as a commercial enterprise and its freedom from bureaucractic constraints.^ieng

Assuntos

Comércio , Preservativos , Anticoncepção , Anticoncepcionais Femininos , Anticoncepcionais Masculinos , Anticoncepcionais Orais , Economia , Administração Financeira , Instituições Privadas de Saúde , Planejamento em Saúde , Marketing de Serviços de Saúde , Organização e Administração , Espermicidas , Cremes, Espumas e Géis Vaginais , América , América Central , Anticoncepcionais , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Guatemala , América Latina , América do Norte

RESUMO

PIP: Attitudes toward population growth and family planning in Brazil were discussed from a historical perspective and reasons for the government's failure to institute an efective family planning program were examined. During the colonial period, Portugal encouraged population growth in order to exert firm control over Brazil's vast and sparsely populated regions. A large number of African slaves were introduced, and the country's expanding population became recially mixed. Following independence in 1822, Brazilian governments continued to stress the need to expand the population. European immigration was vigorously promoted in order to dilute the population's African ancestry. During the 1900s, population growth became increasingly identified with the nation's destiny. In the 1950s and 1960s, despite the continuing pronatalist attitudes of the government, Brazil's middle and upper classes began to practice family planning. By 1965, the fertility rate began to decline. Between 1970-78 the total fertility rate declined from 4.911-3.983; however, the rate among the poor remained high. In 1965, the medical profession established the Brazilian Society of Family Welfare (BEMFAM) to promote and provide family planning services, especially for the poor. The organization provides these services through the existing network of private and municipal health facilities and works in cooperation with many local and state governments. BEMFAM's goal is to promote individual and family well-being, and BEMFAM strongly believes that the national government should assume responsibility for providing these services to the Brazilian population. In 1974 the Brazilian government presented a statement at the World Population Conference in Bucharest that lead many to believe that government's attitude toward population growth had changed. The statement recognized the right of all couples to have the number of children they wanted and the responsibility of the government to ensure that the poor also had this right. Futhermore, in 1978, President Geisel expressed fear of the consequences of continued population growth, and the current president, Figueiredo, recently noted that progress in family planning was a prerequisite for the continued social and economic development of the country. Despite these public statements, the government faled to implement effective population policies. The government now provides limited family planning services through the exisiting network of private hospitals and clinics. These servies are provided in the context of the government's maternal and child health program. The program is understaffed and underfinanced. As a result, the family planning component is frequently ignored. The programs lack of support stems from the pronatalist views still held by many government officials. The program is also resisted by national level officials of the Catholic Church. Brazil's population was 119 million in 1980 and is expected to increase to 185 million by the year 2000. If raid population continues, Brazil will not attain its desired status as a major developed country in the near future.^ieng

Assuntos

Atitude , Atenção à Saúde , Política de Planejamento Familiar , Serviços de Planejamento Familiar , Programas Governamentais , Instituições Privadas de Saúde , Planejamento em Saúde , Serviços de Saúde , Política Pública , América , Comportamento , Brasil , Países Desenvolvidos , Países em Desenvolvimento , Economia , Saúde , Pessoal de Saúde , América Latina , Organização e Administração , Médicos , Dinâmica Populacional , Crescimento Demográfico , Psicologia , América do Sul

RESUMO

PIP: Lessons learned from Haiti's integration of a training program for traditional birth attendants with the maternal and child health and family planning program are reported. The available data on illness and deaths reveal that Haiti has continuing problems of gastroenteritis, malnutrition, tuberculosis, malaria, and tetanus. The latter is of particular interest since neonatal tetanus derived from umbilical cord contamination continues to affect up to 10-20% of Haitian newborns in rural areas lacking health programs. Neonatal tetanus has largely disappeared in the Artibonite Valley due to a mass immunization program for the entire population, including young women, against tetanus. In the Albert Schweitzer Hospital program for indigenous midwives in Artibonite Valley, at least 36 midwives were reached on a regular basis in 1968 -- less than 1/3 of the midwives operating in the Artibonite Valley. There was a rapid decline in neonatal tetanus admissions during the period following 1968. This decline has been attributed to the use of rural health auxiliaries in immunizing the women in the hospital district, but indigenous midwives may have played a role. By 1970, the Albert Schweitzer Hospital program had grown from 36 midwives regularly attending midwife classes to 175 registered with the program during 1970. Although direct supervision proved difficult due to lack of communication and transport to the scene of delivery, some deliveries were observed and indirect supervision by the community became evident. An important finding of the traditional midwife training program of the Albert Schweitzer Hospital was the amount of time required for an indigenous midwife to have referred 50 newborns to the hospital for BCG vaccination. At the end of the 1st year of this program, only 2 midwives reached this goal. Another surprise was the increase in demand for "cord cut" services at the outpatient clinic rather than increased use of the nearby maternity unit. The elimination of neonatal tetanus as a cause of infant mortality was the most important outcome of the maternal and child health component of the community health program.^ieng

Assuntos

Mortalidade Infantil , Tocologia , Tétano/prevenção & controle , Haiti , Humanos , Imunização , Lactente , Mortalidade Materna , População Rural , Tétano/mortalidade