JOICFP NEWS NO. 236 FEBRUARY 1994
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- JOICFP NEWS NO. 236 FEBRUARY 1994
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No. 236 February 1994
ws
ISSN 0911-0755
JOICFP
A New Concept in Health for Laos
Regional project aims to raise health and status of women through FP/MCH services
The concept offamily planning (FP)
is still very newfor many people in Laos
where political recognition of birth
spacing only came in 1988. The relatively
recent introduction ofFP to Laos is also
reflected in the lack ofaccess to FP and
maternal and child health (MCH)
services, low standard of healthcare
facilities and shortage of trained staff.
Despite the shortfall in services and staff,
however, the country's highfertility and
mortality rates clearly demonstrate the
urgent need for access to FP/MCH
services for women.
To smooth implementation of the
UNFPA-supported regional Sustainable
Community-based FP/MCH Project with
Special Focus on Women at the country
level in Laos, the first orientation
workshop was held from December 16 17 in Vientiane. Rather than just focusing
on project methodology, the workshop
served to provide insights into humanistic
FP, to ensure that project personnel fully
grasp the concept of promoting FP as a
means to improve the health and quality
of life of the people, particularly women.
The effectiveness of integrating FP and
MCH with other healthcare and
community development components
was also emphasized at the workshop.
The workshop was held at the National
Institute for Mother and Child Health
(IMCH), Ministry of Health, the
implementing agency of the project.
The workshop was opened with a
ceremony attended by 40 people
Minister of Health Vannareth Rajpho.
Workshop participants take notes during a presentation.
including government officials, represen
tatives of international organizations and
field-level personnel. Toshikatsu Aoyama,
counselor, Embassy of Japan in Laos, also
attended the ceremony which began with
an opening address by Professor Vannareth
Rajpho, minister of health. Noting the
importance of preventive healthcare, the
minister said that projects which utilize
“bottom-up” strategies should be streng
thened. He added that government
commitment is needed to smooth
cooperation among the government, non
governmental organizations (NGOs) and
the people.
Vice Governor
About 20 of the participants were
administrators, government officers, health
personnel and representatives of the
women’s union from the three project
areas, namely Naxaithong district in
Vientiane Municipality, and Paksane and
Taphabat districts of Bolikhamsay
Province.
The vice governor of
Bolikhamsay Province was also present
at the workshop.
A detailed introduction to Japan’s
postwar experiences in community-based
FP/MCH was provided by the JOICFP
mission, using various statistics and a
documentary film to illustrate how these
activities led to raising the level of health
in Japan and thus contributed to the
development of the country. The JOICFP
mission also provided insights into the
implementation of the outreach clinic
system in Bhutan, a country with many
geographical similarities to Laos.
Following an explanation of the draft
work plan given by the director of the
IMCH, the participants agreed that a
further meeting should be held in each
district to ensure that the workplan is
tailored to meet the specific needs at the
district level. The summing-up session
provided a extremely lively end to the
workshop, with participants freely
expressing their opinions. Participants
were enthusiastic about meeting the
challenges entailed in applying the mass
approach and community participation
aspects of the project, particularly since
it involves the participation of women.
To further enhance project imple
mentation, a series of training sessions
were scheduled to be held in February for
IMCH staff, local government officials,
health workers and volunteers in
cooperation with the Ministry of Public
Health and the Population and
Community Development Association
(PDA) of Thailand.
[J
1
Opinions
UNFPA Assistance
in Laos
Bal GopalK.C., country director, UNFPA
Thailand, recently provided JOICFP NEWS
with insights into UNFPA assistance to Laos.
Below is an outline of his comments.
The Lao government’s current policy
towards population issues endorses birth
spacing as a measure to improve MCH. The
current Five-year Development Plan (19911995)covers the need fordemographic growth
to be in harmony with economic development
in order to improve people’s well-being, and
the need for comprehensive public health
services including MCH/birth-spacing
services. The plan document states that large
families can have a negative impact on the
health of women and children and impair
women’s contribution to the economy.
Since the 1970s, UNFPA has provided
assistance to the government ofLaos primarily
to help develop the country’s capacity to
collect and process demographic data. In
recent years, the Fund has supported two
major data collection efforts: the 1985 Census
and the 1988-1992 Multi-round Vital Statistics
Survey. UNFPA has also provided assistance
to help improve the delivery of MCH/birthspacing services and has worked with the
government in the ares of population and
development
policies
and
awareness
creation among
policy-makers on
population issues.
Birthspacing services
are generally
available in Laos
in a few MCH
Gopal
units and hospi
tals in Vientiane supported by UNFPA and in
a few NGO-assisted provincial health centers.
However, these units are offering a limited
range of FP services and contraceptives.
In 1993, UNFPA approved the first
UNFPA Country Program forLaos for US$3.5
million for a period of four years (19931996) . UNFPA’s new country program is
aimed to assist the government in
strengthening the country’s capacity to collect
and analyze demographic data which are
indispensable to formulate the country’s
development plan, policy and program.
Secondly, UNFPA’s assistance will also
strengthen the government’s capability in
providing better MCH/birth-spacing services
and information.
UNFPA is pleased that JOICFP is also
providing assistance to the Laos government
in improving MCH/basic health services
specifically in the rural areas where the need
for such assistance is greater than in urban
cities. I hope JOICFP assistance will
supplement the MCH/birth-spacing program
which UNFPA is currently supporting in Laos.
2
Giving Voice to Women "s Concerns
Catherine S. Pierce, chief, Women, quality of care framework has as its basis
Population and Development Branch, the establishment of rapport between
Technical Evaluation Division, UNFPA, provider and client. Following up from
spoke with JOICFP NEWS on January 14 this is providing counseling and
about issues related to women’s repro information, and listening to women. The
ductive rights and reproductive health. availability of qualified service providers
Below are highlights of her interview.
is extremely important.
UNFPA has always had a strong
Reproductive rights and reproductive
commitment to improving the situation of health will be an important topic at the
women, which is based on a commitment International Conference on Population
to women’s human
and Development.
rights.
Also,
“Reproductive
achieving sustaina
rights, reproductive
ble development is
health andFP”is one
contingent on em
of the chapters of the
powering women.
document that will be
You just simply
submitted to the
cannot have 50% of
conference. There is
human resources
also a separate
not trained to parti
chapter on gender
cipate fully in the
equality and em
development
powerment
of
process.
women. Women’s
UNFPA pro
concerns are really
gramming in the
mainstreamed quite
area of women,
well throughout the
Catherine S. Pierce
population and de
document.
velopment includes
The recently
funding women’s specific activities as well established “Japan’s Network for Women
as mainstreaming women in all areas of the and Health, Cairo ’94” is a welcome
fund mandate. Our general approach is a development and should serve as a very
“three-A” approach: advocacy for effective mechanism to put the spotlight
improving the situation of women; an on these issues in Japan. It is an important
awareness-creation function of bringing intervention also because it is not only a
to the fore the data which illustrate the network within Japan, but it can be linked
gender disparities in education, health, with NGOs in other parts of the world.
employment, etc.; and action programs The women’s network will be a very
responding to women’s needs.
helpful vehicle for assisting women’s
voices to be heard.
Reproductive Rights
I believe that women’s non
governmental organizations (NGOs) are
A reproductive rights and reproductive an effective means of articulating
health framework is a very empowering women’s needs. The NGO community
one for women. Reproductive health is a as a whole is usually a very dynamic
way of focusing on appropriate services group which is in touch with the needs
for women at various stages of their life and concerns of diverse constituencies.
cycle. It is an advocacy and an awareness The NGO community functions as a
creation approach because it calls attention linchpin between people at the grassroots
to these issues and delineates the bigger and policy-makers. NGOs promote
picture of the roles that men and women dialogue and serve as an interface between
have in human sexuality and in repro two groups which often do not get to
duction. Of course, quality family planning speak to each other directly.
UNFPA seeks women’s NGOs as one
(FP) information and services are essential
parts of this.
of its priorities in the area of women,
The FP approach that experience has population and development. At Cairo,
proven to be the most effective is one that there will be a concurrent NGO con
puts emphasis on the client. It is grounded ference entitled NGO Forum ’94. This
in a respect for the dignity of the individual, Forum will provide opportunities for
rather than driven by any kinds of provider NGOs to make presentations of their work
targets or method-specific targets. A and to network among themselves, [j]
JOICFP NEWS, February 1994
Nepal
Bringing Services to the Doorstep
Community-based approach making headway in Nepalese villages
A JOICFP mission found that each of the villages
effective management systems had been every two weeks to
set up and project activities were provide FP/MCH
progressing in areas in Nepal where the services. By selling
regional Sustainable Community-based essential drugs to the
Family Planning (FP) and Maternal and village people, the
ChildHealth(MCH) ProjectwithSpecial project staff are also
Focus on Women is being implemented contributing to the
by the Family Planning Association of sustainability of the
Nepal (FPAN). During the visit toproject activities. The money
areas, the mission was able to utilize the is put into a village
draft ofthe baseline knowledge, attitude trust fund to be used to
and practice (KAP) survey conducted at continue activities
the end of last year. The timing of the once the project period
mission also coincided with the national ends.
Thapa (right) and Basnet (left) with field staff.
The mission also
workshop on the project, held in
noted that training of health personnel and activities of the staff nurse who carries a
Kathmandu on December 17-19.
The JOICFP mission visited both the field workers had been completed and that variety of contraceptives, treats minor
new project areas in Sunsari District and information on FP/MCH had been collected diseases, and provides medical checkups
villages in Panchkhal, Kavre District, from each household. This data is being for women and antenatal checkups. The
where the project is being implemented used to identify needs and determine future mission noted the effectiveness of using
in former Integrated Project (IP) areas. strategies. The visit also provided the women to provide services since FP is
A monitoring team accompanied the mission with an opportunity to discuss still a sensitive issue for many women.
Meanwhile, the national workshop
JOICFP mission to Sunsari District and with the director of the district health office
provided technical assistance to project the possibility of collaboration among all was opened on December 17 by Dr. Ram
Baran Yadav, minister of health, who
health personnel in project areas.
personnel.
In the project villages, the mission urged that people take the lead in
In Sunsari, where the project covers
a total population of55,000 in six villages, observed FP/MCH services being solving social problems. He added that
the mission found that project activities conducted through the village outpost women need to be equipped with proper
were underway with the staff nurse and system such as infant growth monitoring. MCH knowledge.
The workshop was attended by all
community medical assistant visiting The visitors were also introduced to the
village field workers, village leaders, and
chairpersons of the village health
committees of both IP areas. The
Smoother
attendance by field-level staff not only
added a lively dimension to the workshop,
A monitoring team, dispatched to new project areas in Sunsari District by JOICFP from
but enabled these key project workers to
December 12-15, came up with a series of recommendations to establish community-based
participate in discussions on how to
quality and sustainable FP/MCH services. The mission was headed by Dr. Rita Thapa,
enhance project effectiveness. Issues
adviser, MCH/FP, UNFPA, and included Sabitri Basnet, project consultant, and the JOICFP
identified through the baseline survey
program officer in charge.
To promote the sustainability of services through fee charging, the team recommended
were also shared with the audience, along
that the initial costs for medicine be lowered through wholesale purchasing. The team also
with a general overview of the country’s
suggested that the charging and accounting procedure be simplified to free up the field
FP and MCH program.
[J
workers for IEC and counseling, and urged that IEC activities be improved to promote
public information about contraceptives and high-risk pregnancies.
Calling for the steering committees at various levels and village staff to collaborate with
the Sunsari District Health Office to mobilize governmental MCH workers’ participation
in clinics, the team also underscored the importance of better coordination of the schedules
of clinics and mobile outreach services. The team further urged that the project make the
best use of available trained human resources to introduce a few basic laboratory services
for women. These services could be provided on a fee-charged basis, the team added.
Noting the relevancy of the parasite control activities to the project, particularly to
improving the nutritional condition of women and children, the team urged that efforts be
made to mobilize the community to construct a suitable toilet in each of the six areas with
clinics. With regard to referral services, the team suggested that operational linkage be
established with the B.P. Koirala Hospital by adapting the home-based mother’s record
system for early detection of high-risk pregnancy and referral services.
It was also recommended that better storage facilities be established for medical
supplies, while a number of different income-generating ideas related to women’s health
Men gather at an FP/MCH service post
were also suggested.
to discuss the project.
Project Implementation
JOICFP NEWS, February 1994
3
In the News
Sharing the
Responsibility
“In the short span of 30 years, the
developing world has passed the halfway
mark in reducingfertility to replacement
levels,” said Dr. Sheldon J. Segal,
distinguished scientist, the Population
Council. “All this portends to further
significant declines infertility ifsufficient
investment in family planning (FP) is
made in the years ahead. ” Speaking at a
special lecture meeting ofthe Population
Forum 21 held in Tokyo on December
15, Segal noted that in most developing
countries, FP is not viewed as a concept
imported from outside, but as a wise
policy that is part of national
development. “A remarkable feature of
this contraceptive revolution is the near
universality in the developing regions in
adopting FP policies and the absence of
political risks in doing so.”
A bio-medical scientist involved in
contraceptive development, Segal was
Sheldon J. Segal
the keynote speaker at the Population
Forum 21 meeting. The lecture meeting, a
regular event, was organized by Population
Forum 21 in cooperation with the
Population Problems Research Council of
the Mainichi Shimbun and JOICFP. It was
attended by some 100 people, including
parliamentarians, officials of government
and non-governmental organizations
(NGOs) and the press.
Segal gave an overview on research
into the bio-medical aspects of fertility and
contraception and provided insights into
new and emerging contraceptive
technologies. Noting that more than two-
New Framework of Action on Population
During the new Economic Framework improving FP programs; reduce the desire for
talks between Japan and the U.S. held in large families through investments in human
Tokyo in December and in Washington D.C. development; and reduce the momentum of
in January, more effective partnerships were population growth. By combining the three
proposed to implement three broad strategies, the expected population of 12
strategies to address the problem of rapid billion by 2100 could be reduced by as much
population growth. The U.S. delegation to as 2 or 3 billion, according to the proposal.
The proposal calls on
Tokyo was headed by
the world governments
Timothy Wirth, coun
and institutions to enter
selor, United States
into more meaningful
Department ofState, who
partnerships to enable the
also held a meeting with
necessary human and
representatives of eight
financial resources to be
non-governmental
applied to the imple
organizations (NGOs)
i^r
mentation of the new
including JOICFP on
framework for slowing
December 10. During the
population growth. The
meeting with the NGO
proposed partnership
representatives, Wirth
should be a compre
stressed the effective role
hensive one, linking the
ofNGOs. Wirth,aveteran
needs in many developing
of the environment field,
countries, the expertise in
also headed the U.S.
Timothy Wirth
other developing coun
delegation at Prepcomll
held in New York ahead ofthe International tries, and the financial and technical resources
Conference on Population andDevelopment of the international development cooperation
agencies, both multilateral and bilateral. A
(ICPD) in Cairo.
The proposed new framework for action critical element of the partnership concept is
is composed of three broad and mutually that priorities must be agreed upon jointly,
reinforced strategies for governments with much of the initiative coming from the
engaged in slowing population growth rates. developing countries, according to the
The strategies are: to reduce unmet demand proposal.
for contraception by strengthening and (Photo courtesy of the Japan Press Club)
4
thirds of contraceptive use is based on
methods used by women, Segal said,
“Women mainly bear the burden of
contraceptive use and therefore face the
health risks of contraceptive use and
contraceptive failure.’’
Commenting on the wide use of the
condom in Japan, Segal said that the
reliance on male methods was more
apparent than real. What really is
happening, he said, is that couples are
using a relatively ineffectual male method
of the condom backed up by safe and
effective abortion. “So the burden still
falls on the woman,’’ he said.
Segal also had comments to make on
the human rights aspect of population
activities and noted that the right to
reproductive choice is an individual right
that should not be taken away. Citing the
involuntary sterilization program that was
conducted in India, Segal said that
“Coercive programs will bring down
governments, not birthrates.” He added,
“Our purpose in bringing about
reductions in population growth rates is
to improve the quality of life. If in the
process we trample on human rights,
then it defeats the purpose.”
[J]
NAM Countries Prepare
forlCPD
A set of issues and recommendations for
the UN International Conference on
Population and Development (ICPD) was
adopted at a ministerial-level meeting of
members of the Non-Aligned Movement
(NAM), held in Bali, Indonesia, from
November 11-13. The Ministerial Meeting
on Population of the Non-Aligned Movement
was attended by 16 ministers and 120 senior
officials from 52 NAM member countries
and 13 other countries. Participants also
agreed on a document on NAM support for
South-to-South collaboration in the field of
population and family planning (FP) and
adopted the Denpasar Declaration on
Population and Development.
Opened by President Soeharto of
Indonesia, the ministerial-level meeting
provided the participants with an opportunity
to exchange information and experiences and
promote technical cooperation among
developing countries. It was preceded by the
Senior Officials Meeting of Population, held
in Denpasar from November 9 - 10.
The ministers noted the deepening
imbalances of the global economic system
and identified numerous economic problems
as seriously undermining the development
efforts of developing countries. Calling for
developing countries to unite to tackle
population problems, the participants also
urged richer countries to provide more
resources.
[j]
JOICFP NEWS, February 1994
Brazil
Winning the Hearts of Urban Youth
CM1 offers a model for success with the adolescents in Sdo Paulo’s favelas
The 594favelas (slums) in SdoPaulo
City are home to a huge floating
population that is generally not covered
by the government health and welfare
activities. Despite the significant
challenges of promoting healthcare
among the poor of the favelas, Centro
Materno-Infantil (CMI) has made
considerable headway by utilizing the
community-based approach of the
Integrated Project (IP). To answer the
needs of the people in the favelas, CMI
has integrated a range of community
health and development components
incladingfamily planning (FP), maternal
and child health (MCH), adolescent
health, nutrition improvement and AIDS
prevention. As a result ofthis innovative
andflexible approach, CMI has accumu
lated a wealth ofexperiences over the 11
years ofproject implementation in urban
slums that it can share with other
developing countries, particularly in the
Latin American region.
A JOICFP mission gained insights
into some of CMI’s experiences while in
Brazil from December 7-14. Visiting
most of the 13 project areas in Sao Paulo
State, the team observed CMI activities
firsthand and was able to grasp some of
the keys to project success.
During its visit to thefavelas, the team
viewed some of CMI’s educational
activities for adolescents including the
use of role plays to gain the participation
of young people and stimulate open
discussions on health issues with qualified
instructors. Such activities have been
emphasized by CMI which views
adolescent health education as a key entry
point for education on such issues as
A soccer star interests youth in sport
as part of CMI’s youth activities.
JOICFP NEWS, February 1994
responsible parenthood.
CMI’s concern is
backed up by research
which indicates that
sexual activity begins in
adolescence for a lot
young people in Brazil.
In many of its acti
vities, CMI also works
closely with govern
ment organizations
(GOs) and other NGOs.
Through this network of
GOs and NGOs, CMI
has taken on the role of
an expert group of
adolescent health. For Children at the Ana Rosa Institute’s day care center
example, CMI works enjoy nutritional supplements.
closely with the State
Secretariat of Sports and Tourism to link mothers.
educational activities with sports events, a
As CMI looks to the future, the
very effective means of reaching young concept of self-reliance is taking on
people. Utilizing such sports activities as increasing importance. To achieve this
soccer, basketball and volleyball, the NGO aim, the organization has already
uses well-known sports personalities to established a fee system for services
reach out to adolescents with education including FP and adolescent health
about such subjects as drug abuse, AIDS education.
prevention and sex-related issues.
Recognizing the serious social
problems facing young people in Sao
A Personal Mission
Paulo, the organization also recently set
up a pilot “adolescent house.” A multi
In Monte Azul, the JOICFP team got a purpose center geared to serving the needs
glimpse of the human side of some of of young people, the facility’s staff are
CMI’s activities in a clinic run by a providing practical education, training
German-bom midwife. Inspired by the and medical services to adolescents. [5]
work of a German teacher in the favela,
Angela Gehrke da Silva sold all her
belongings in 1983 and moved to Monte
Japanese Women’s NGO
Azul to take part in MCH promotion.
Formed for Cairo
Thanks to her efforts, a clinic was
established in the area in 1985, which she
About 100 Japanese women joined
runs with the cooperation of CMI.
hands recently to form a non-governmental
organization (NGO) ahead of the
Support from Japan has also been
International Conference on Population
utilized effectively to improve life in the
and Development (ICPD) to be held in
favelas. At the Ana Rosa Institute in Sao
September in Cairo, Egypt.
Paulo City, for example, the JOICFP team
Dubbed “Japan ’ s Network for Women
observed children using day care center
and Health, Cairo ’94,” the NGO is aimed
equipment purchased with funds allocated
at ensuring that the concerns of Japanese
through the Voluntary Deposit for
women about reproductive health are heard
International Aid (VDIA) scheme under
at the ICPD.
the Japanese Ministry of Posts and
As part of its activities leading to the
Telecommunications. The center not only
ICPD, the organization will compile reports
to present at the meeting and will urge the
takes care of the pre-schoolers to enable
government that women’s NGOs be
mothers to engage in paid employment,
included in the official delegation to Cairo.
but also provides nutritional supplements
The new women’s network is unusual
to the children. The VDIA funds have also
in Japan where there are few effective,
been used to provide paramedical training
nationwide NGOs that deal exclusively
to primary health care volunteers and to
with women’s reproductive issues.
cover the costs of nutrition classes for
5
Zambia
Revitalizing
Healthcare
Infrastructure
The IP in Zambia utilizes the
existing health advisory
committees to spur community
participation in activities
When the Integrated Project (IP)
was first introduced to Zambia in 1984,
it faced significant challenges. In all
three project areas, not only was
socioeconomic status low and family
planning (FP) acceptance negligible,
but the local healthcare facilities and
administration were not functioning
efficiently. For people at the grassroots,
this meant that badly needed primary
healthcare services were not available.
To tackle the obvious shortfall in
services, one of the first steps for the IP
was to establish an effective system of
management from the local village level
up to the central level to ensure full use
of existing facilities, social organizations
and human resources. This was
accomplished by revitalizing the
existing healthcare administrative
system. At the village level, the health
advisory committee was given a new
orientation as the local steering com
mittee and was incorporated within the
tiered IP infrastructure, which is
governed by the National IP Steering
Committee.
As a result of this reorganization, the
implementing agencies of the project,
the Planned Parenthood Association of
Zambia (PPAZ) and Zambia Flying
Doctor Service (ZFDS), have established
an efficient bottom-up system of
BMkf
Ji
The members of a men’s club in Fiwale
wear the uniforms made by the
neigboring women’s club.
6
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M
(Photo left) Men’s club members in Fiwale make candy to generate IP funds.
(Photo right) A resident field worker stands near a new cooperative in Kapata.
management and have been able to
stimulate active community participation
in the project activities. Since the
inefficiency of healthcare systems is
recognized as a major constraint to
program promotion throughout the African
continent, the experiences gained through
the IP in Zambia are expected to serve as
an encouraging example for other
countries.
New Life for Existing Groups
At the local level, the revitalization
of existing health structures has taken on
unique characteristics to accommodate
local needs. In Kapata, a typical remote
rural area inhabited mainly by fishing
families, the local people have been
mobilized through various groups to take
part in IP activities under the guidance of
the health advisory committee. Not only
have women’s clubs been established and
multi-purpose cooperatives been rein
forced, but traditional birth attendants
(TBAs), two local health workers and 13
out of the 17 community-based distribu
tors (CBDs) have received training to
support IP activities. Meanwhile, the
resident field educator supervises these
groups to ensure smooth coordination of
activities, while providing education on
such subjects as FP, nutrition, primary
healthcare and environmental sanitation.
Through the network of community
groups, favorable conditions have been
created for mobilizing communities to take
part in project promotion. Some innovative
strategies have also been created to
sustain the CBDs. For example, rather
than receiving financial incentives, which
would end with the termination of the
project, the CBDs have been receiving
various other kinds of support from
community people in return for their
services. The prestige that comes with the
position of CBD has also encouraged
these people to continue their activities.
The health advisory committee has also
been effectively used in the semi-urban
area of Fiwale to stimulate the activities
of community groups. To actively
mobilize the community, the eight clubs
that existed at the early stage of the
project were divided into a variety of
smaller, more dynamic groups. With a
total membership of about 1,500 men
and women, the clubs in Fiwale are run
more efficiently and are administered
effectively through a system of monthly
management meetings. Organized by
the health advisory committee and
attended by the chairperson, secretary
and treasurer of all clubs in the area, one
CBD and one TBA, the meetings have
helped spur the simultaneous devel
opment of both men’s and women’s
clubs and enhanced mutual cooperation.
Urban Setting
The strategy of utilizing the health
advisory committee to oversee local IP
activities has also had a positive impact
in the urban setting of the third project
area of Kabushi. A sugar company
compound, the project area has been hit
with unemployment and has seen many
of its residents leave for greener pastures
in recent years. However, through the
clubs that have been established under
the project, the remaining residents of
the area have been actively disseminating
the experiences and lessons learned
through the IP to people in surrounding
communities. As a result, the project
coverage has been significantly expanded
and the club system has been replicated
in neighboring communities.
In all three project areas, the IP has
stimulated community participation in
activities to improve the health status
and raise the quality of life. The key to
this success has been the establishment
of network of community groups, which
are effectively coordinated by the health
advisory committee functioningas a local
steering committee under the IP.
[J|
JOICFP NEWS, February 1994
Thailand/Kenya
NGOs - Earning a
Place in the Community
A team that conducted a recent
independent evaluation of Japanese
bilateral official development assistance
(ODA) projects in Thailand and Kenya
was thefirst in the population andfamily
planning (FP) field to include a
representative of a non-governmental
organization (NGO). Kiyoko Ikegami,
program officer, JOICFP, was entrusted
by the Japanese Ministry of Foreign
Affairs to conduct the evaluation of the
projects with Yasuo Uchida, deputy
director, Planning and Research
Division, International Development
Center ofJapan. The team, which was in
Thailand and Kenya between November
4-19, evaluated Japan s ODA projects
in the two countries that are conducted
by the Japan International Cooperation
Agency (JICA), an executing agency of
technical cooperation. Results of the
evaluation are to be published in 1995
through the Ministry of Foreign Affairs.
The team began its activities in
Thailand where JICA was promoting FP
and population activities in collaboration
with the government. To effectively
reach the grassroots, the government of
Thailand works closely with NGOs,
including the Population and Community
Development Association (PDA), a close
collaborator of JOICFP.
In a meeting with Tavatchai
Traitongyoo, secretary-general, PDA, the
team was introduced to some of PDA’s
activities. Noting that PDA had recruited
over 10,000 FP volunteers, Tavatchai
shared some keys to PDA’s success in
increasing FP acceptance. Comparing
NGO and government efforts, he said
that PDA has the advantage of being able
A nurse displays a condom-vending
unit at the Kakamega KFPA located
above a restaurant for easy access.
JOICFP NEWS, February 1994
to cut through red tape;
use an innovative
approach; continue to be
flexible; charge fees to
promote self-reliance; and
persuade people with a
softer approach.
Tavatchai said that
PDA is engaged in three
main AIDS-prevention CBDs wear their KFPA uniforms in Kakamega.
activities: dissemination
of information; campaigns and IEC as volunteers under a community-based
material production; and advocacy. By distribution (CBD) system to promote
operating within schools and encouraging education and FP services. The training
further education and vocational training, of CBDs in Vihiga, Kakamega District,
PDA hopes to prevent young people from has been implemented by JICA, which
entering the commercial sex industry, he has also provided basic equipment for
these volunteers.
said.
The importance of focusing on male
involvement in FP was highlighted by
Increasing FP Acceptance
one of the village women in Kakamega.
Commenting on the dramatic drop in Commenting that her husband had refused
the population increase rate in Thailand to use condoms or accept a vasectomy,
from 3.3 in 1971 to 1.3 in 1993, Tavatchai the woman said that he had finally agreed
said that this was achieved by integrating for her to have a tubal ligation after being
FP with social development, rapid convinced that the move would help
economic growth and improvements in improve the quality of their lives. The
the general health conditions of the people. couple had been made aware of the cost
He said that PDA is one of the leading of more children by the CBDs who had
agencies in Thailand using this integrated made frequent visits to her home, she
[7]
approach, which it learned from JOICFP. said.
Before beginning its evaluation of
JICA’s projects in Kenya, the team visited
IPPF Africa Regional Office in Nairobi,
Japan to Boost AIDS,
where it was briefed on the population
Population Funding
issues of the continent. During the briefing,
the team learned that the major issues for
Japan is considering providing US$3
FP in Africa are to close the knowledge,
billion by the year 2000 in funds to help
attitude and practice (KAP) gap; promote
fight AIDS and tackle global population
of adolescent health; and increase male
problems, according to a recent report by
involvement. The team was also told that
Kyodo News.
the concept of children as a labor force
Quoting a Ministry of Foreign Affairs
persists in rural areas, which account for
source, the news agency said that the
80% of the continent. Another obstacle to
contribution would be part of the new
FP promotion in Africa is the widely
Japan-U.S. Economic Framework’s
practiced system of polygamy, the IPPF
common agenda for global cooperation.
officials said.
According to the report, Japan was
In its bilateral population activities in
expected to finalize the amount by February
and announce it when Prime Minister
Kenya, JICA works with the Kenyan
Morihiro Hosokawa meets U.S. President
Institute of Mass Communication and the
Bill Clinton on February 11 in Washington.
National Council on Population and
With the funds, Japan will donate
Development. In one of the project areas
condoms
to developing countries and
of the JICA project, the team observed the
provide money for AIDS vaccine
active involvement of the Kenya Family
development and education programs.
Planning Association (KFPA) in the FP
Tokyo will also contribute funds both
activities. As part of its activities to close
bilaterally and through multilateral
the KAP gap in the area, KFPA has
organizations, the report said.
mobilized the community women to serve
7
Voice of Voices
ANNOUNCEMENTS
By Chojiro Kunii
Women Head to Cairo
A close female friend of mine recently
initiated some activities in preparation for the
International Conference on Population and
Development to be held in Cairo, Egypt in
September. She is working together with
about 100 people who have formed a group to
plan new activities and to begin a new
movement in women’s health. I have been
very moved by her efforts.
Fifty years ago, I was inspired by Shidzue
Kato, a leader among Japanese women, to
create a family planning (FP) organization in
Japan. At that time, the FP movement was
purely a grassroots activity being conducted
by a group of midwives and public health
nurses concerned about the cost in lives from
induced abortion. This movement expanded
as the importance of FP was passed among
midwives by word of mouth, and the abortion
rate in Japan began to decrease gradually. As
the movement progressed, a growing emphasis
was placed on improving the health status and
educational level of children. The importance
of good health also caught on for the society
at large, and it was not long before the bulk of
Japanese people were taking preventive
measures to maintain their health.
Childhood Memories
People ask me why I got involved in these
activities, particularly since I am not a medical
doctor. I think the real reason has a lot to do
with the influence my mother had on me as a
child. I was a sickly child, and my mother was
forever encouraging me to become stronger.
Thanks to her efforts, I was eventually able to
go to school in Tokyo. However, even as an
adult she worried about my health.
I was a young man serving in the army
when my mother died. Hearing the news of
her death was one of the most heartbreaking
moments of my life. I remember running
alone into the woods where I cried in grief.
When the war ended, I looked for
something to do which I thought would have
pleased my mother. I searched for something
that would benefit the people as well as myself.
Fortunately, I was inspired by my connections
in Keio University to enter into the parasite
control field. From there, I went on to
preventive medicine including family
planning. This direction did not initially yield
any financial profit. But, as I pursued my
career, many other new paths opened up in
front of me and I was led to new fields. Now
after 50 years, I feel that the direction of my
life has been finally set.
When I think about myself as a young
man 50 years ago, I can feel the strength in my
mother’s palms as she kneaded me into the
man I am now. I hope my words of
encouragement will have the same effect on
the young women of Japan and that these
courageous women will let their voices be
heard at Cairo.
[J]
International Conference on Population and Development (ICPD) ’94
Date:
September 5-13,1994
Venue:
Cairo, Egypt
Participants: Decision-makers and political leaders from all countries and regions,
representing governments and all sectors of society
Objectives: To forge a new international consensus that population concerns
should be a the center of all economic, social, political and
environmental activities
To create a firm plan of action on population for the next 20 years, in
accordance with universally recognized principles of human rights
and national sovereignty
Organizer: UN
*
*
*
Workshop on Population Aging
March 14- 17, 1994
Date:
Singapore
Venue:
Theme:
Women in an Aging Society
Participants: Experts and senior officers responsible for policy research, planning
and implementation in the field of aging from such countries/areas as
China, Hong Kong, Indonesia, Republic of Korea, Malaysia, the
Philippines, Singapore, Sri Lanka, Thailand, and representatives of
international agencies
Objectives: 1. To review the problems and policy issues surrounding women
towards population aging in countries of Asia and to exchange
information, experiences and strategies
2. To prepare future directions and recommendations on the issue of
women in an aging society for use as background materials ahead of
the ICPD and for future policy and program formulation in Asia
Organizers: Social Work & Psychology Dept., National University of Singapore,
and JOICFP
Sponsor:
UNFPA
Note: Self-funded participants are welcome to attend the workshop. For more
information, please contact JOICFP.
DIARY
JOICJ-'P ‘Women's rteaftfi and Status Series
________ A New Animated Film_________
My Way
JOICFP program officers Sumie Ishii, Aiko
lijima, Ryoichi Suzuki and Ryoko Nishida
attended the Workshop on Effective Strategies
for Sustainable Community-based FP/MCH
Projects with Special Focus on Women, held in
Jakarta from Oct. 14 - 23. Ishii joined a JPFP
study mission in Malaysia from Oct. 24 - Nov.
1. Suzuki was in the Philippines from Oct. 24
- 29 to join the JFPA technical cooperation
mission to FISHDEV. Nishida was in Singapore
and Thailand for activities related to the regional
aging project from Oct. 24 - Nov. 4.
13 min., Color/English, Thai
^Mi^***^
.
Sexual relationships between teenagers tend to place
young women in much more serious situations, both
physically and mentally, than their partners. Four young
women are depicted in this film, each with a chance to
have a sexual relationship with her boyfriend. What
desires does each girl feel for her partner? How does
each girl make her own, personal choice?
My Way is the first film in the Women's Health and
Status Series. It was produced specifically for the Asian
region. Il is an animated film jointly produced by Japan
and Thailand, the first country in the world to promote AIDS
education on a nationwide scale.
JOICFP NEWS is a monthly newsletter
published by the Japanese Organization for
International Cooperation in Family Planning,
Inc. (JOICFP).
JOICFP NEWS welcomes your comments,
suggestions and contributions. Please mail to:
JOICFP NEWS
Hoken Kaikan Bekkan
1 -1, Sadohara-cho, Ichigaya
Shinjuku-ku, Tokyo 162 Japan
Distributed by
Sakura Motion Picture Co., Ltd.
Yoyogi Center Bldg., 57-1 Yoyogi l-chome
Shibuyo-ku, Tokyo 151, Japan
Tel: 81-3-332O6311/Fax: 81-3-3320-7666
Telex: J34799 ITCINBTH
16mm-VTR (Beta, VHS/NTSC, PAL,
Phone: 81-3-3268-5875
Telex: 2324584 JOICFP J
Cable Address: JOICFP Tokyo
Facsimile: 81-3-3235-7090
J
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JOICFP NEWS, February 1994
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