Suchergebnisse

The prevalence of child undernutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS)program, India's main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s

It has been over twenty years since the Brazilian Sistema Único de Saúde (Unified Health System or SUS) was formally established by the 1988 Constitution. The impetus for the SUS came in part from rising costs and a crisis in the social security system that preceded the reforms, but also from a broad-based political movement calling for democratization and improved social rights. Building on reforms that started in the 1980s, the SUS was based on three overarching principles: (i) universal access to health services, with health defined as a citizen's right and an obligation of the state; (ii) equality of access to health care; and (iii) integrality (comprehensiveness) and continuity of care; along with several other guiding ideas, including decentralization, increased participation, and evidence-based prioritization. The SUS reform established health a fundamental right and duty of the state, and started a process of fundamentally transforming Brazil's health system to achieve this goal. So, what has been achieved since the SUS was established? And what challenges remain in achieving the goals that were established in 1988? These questions are the focus of this report. Specifically, it seeks to assess whether the SUS reforms have managed to transform the health system as envisaged more than 20 years ago, and whether the reforms have led to improved outcomes in terms of access to services, financial protection, and health status.Any effort to assess the performance of a health system runs into a host of challenges concerning the definition of boundaries of the "health system", the outcomes that the assessment should focus on, data sources and quality, and the role of policies and reforms in understanding how the performance of the health system has changed over time. Building on an extensive literature on health system assessment, this report is

This paper uses the 1995 Guatemalan Survey of Family Health (EGSF) to analyze the relationship between child illness and health seeking behavior. The EGSF contains detailed calendar data on the nature and timing of illness and treatment behavior for children age five and below; extensive information about the characteristics of mothers, families and communities; and data on the accessibility of traditional and biomedical providers within and near the community. The analysis is based on 870 children who began a diarrheal or respiratory illness during a two-week period prior to interview. Estimates are derived from a multinomial model of the probability of seeing a specific type of provider on a given day of illness, as a function of characteristics of the illness, child, mother, and community. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala. The symptoms associated with the illness, their perceived severity, and mother's beliefs about their causes are important determinants of whether a child is brought to a provider and the type of provider visited. Poverty is a serious constraint on a family's choices about how to treat children's illnesses, whereas education and ethnicity have little effect on treatment behavior when income is held constant. In addition, the availability of modern health facilities within the community – both government-sponsored facilities and private doctors – has a substantial impact on the type of providers sought to treat children's illnesses.

AbstractLevels of child malnutrition in India have fallen only slowly during the 1990s, despite significant economic growth and considerable expenditure on the Integrated Child Development Services (ICDS) programme, of which the major component is supplementary feeding for malnourished children. To begin to unravel this puzzle, this article assesses the programme's placement and its outcomes, using NFHS data from 1992 and 1998. The authors find that programme placement is clearly regressive across states. The states with the greatest need for the programme — the poor Northern states which account for nearly half of India's population and which suffer from high levels of child malnutrition — have the lowest programme coverage and the lowest budgetary allocations from the central government. Programme placement within states is more progressive: poorer and larger villages have a higher probability of having an ICDS centre, as do those with other development programmes or community associations. In terms of outcomes, the authors find little evidence of programme impact on child nutrition status in villages with ICDS centres.

The extensive literature on population and development yielded few policy-relevant results before the discovery of the demographic dividend. This dividend refers to a rise in per capita income that results from an increase in workers per capita as a population's fertility declines. This paper describes the role of the demographic dividend in economic development in developing countries and summarizes policy options for strengthening the dividend. The first section reviews the demographic transition with an emphasis on its later phases when declining fertility and a changing population age structure produce the dividend. Next, the demographic drivers of the dividend and its potential impact on economic growth are examined. The last sections discuss policy options. Special attention is given to the role of voluntary family planning programs to meet rising demand for contraception thus accelerating the fertility decline and increasing the dividend when demand for smaller families is growing. The focus throughout is on sub-Saharan Africa (SSA), the region that has experienced little demographic dividend but where the potential for a future dividend is greatest.

Introduction and overview -- Population dynamics in Brazil -- Old-age social protection programs and the aging challenge -- Health and long-term care -- Education and productivity -- Public finance implications of population aging: 2005-50 -- Financing Brazil's aging population : implications for saving and growth