[Memisa: from medical missionary action into a medical relief organization]

In the past seventy years Memisa Medicus Mundi has grown into an organization accounting for about half the annual number of Dutch health care workers in third world countries. On top of this, it gives financial and material support to many development programmes in Africa, Asia and Latin America. Of all aid, 82% is given to so-called structural programmes and 18% to disaster relief. Physicians who return to the Dutch health care system as general practitioners after a period abroad are capable of efficient practice management.

Sterilization for family planning in a Third World country

Outpatient laparoscopy procedures have made sterilization possible for millions of women in developing countries. This report describes the experience of a team of doctors, nurses, and support staff that performed 107 laparoscopic tubal sterilizations during on eight-day sojourn in a remote north-central area of Nicaragua. Minimal analgesia (oral ibuprofen) and anesthesia (1% lidocaine) were used since most of the patients walked to and from the hospital-some up to 15 miles. Because the Nicaraguan government's support for birth-control programs is unreliable and because illegal abortion is the leading cause of maternal mortality in Nicaragua, this safe, minimally invasive surgical method is the favored means of birth control.

The voluntary community health movement in India: a strengths, weaknesses, opportunities, and threats (SWOT) analysis

There has been a prolific growth of voluntary organizations in India since independence in 1947. One of the major areas of this growth has been in the field of community health. The purpose of this article is to historically trace the voluntary movement in community health in India, analyze the current status, and predict future trends of voluntary efforts. A review of the literature in the form of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was the method of this study. Some of the key trends which emerged as the priority areas for progress and for strengthening voluntary organizations in the future were enhancing linkages between health and development; building upon collective force; greater utilization of participatory training; establishing egalitarian and effectual linkages for decision making at the international level; developing self-reliant community-based models; and the need for attaining holistic empowerment at individual, organizational, and community levels through "duty consciousness" as opposed to merely asking for rights.

Study and introduction of family planning methods in developing countries

Research in developing countries is essential for the evaluation of the safety, efficacy and acceptability of both new and already available contraceptives. Research conducted by scientists in developing countries has also played an essential role in the development of new contraceptives. The continuous delivery of progestin at a low dose, copper IUDs, contraceptive implants, monthly injectables and vaginal rings are examples of new methods developed with the input of research conducted largely in developing countries. When research in developing countries is funded or coordinated by international agencies, local scientists have to be involved not only in its implementation, but in the planning, analysis and dissemination of such research. The World Health Organization, the Population Council and Family Health International have played an important role in supporting collaborative studies for the development, introduction and evaluation of family planning methods in developing countries.

Impact of sustainability policies on sterilization services in Latin America

The Association for Voluntary Surgical Contraception retrospectively examined the impact of funding decreases on access to sterilization services at 20 nongovernmental family planning clinics in Mexico, the Dominican Republic, and Brazil. Clinic staff were asked questions about client fees, caseloads, availability of comparable low-cost or free services nearby, cost-recovery activities, and the socioeconomic profile of clients before, during the time, and after subsidies were lowered or eliminated. Funding reductions were followed by decreased caseloads at 14 of the 20 sites studied. Of the six others, four experienced an increase in caseloads, one saw no perceptible change, and one experienced a decrease only as a result of management policy to cut the caseload to improve quality. The most common response to the decrease in funding (shared by 17 sites) was an increase in client fees. In all but three of the 17 clinics, the increase in fees was met with a decline in caseloads. Moreover, at nine of these 17 sites, the fee increase effected a change in client mix; anecdotal evidence suggests that more middle-income and fewer lower-income clients were using sterilization services. Four lessons can be drawn from this study: Donors need to plan funding phase-outs carefully, in conjunction with grantees; grantees need to assess the costs of the procedure realistically, and assign fees accordingly; management needs to seek alternative funding sources in lieu of, or in addition to, increasing fees; and caseloads can be increased and costs recovered by diversifying services.