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In This Issue:

  1. Letter from the Adapting to Change Team
  2. Report back from the October 2000 Core Course on Population, Reproductive Health, and Health Sector Reform
  3. Francophone Core Course on Population Reproductive Health and Health Sector Reform
  4. Distance Learning Activities on "New Agendas for Poverty Reduction Strategies: Integrating Gender and Health"
  5. Sharing Knowledge of Effective AIDS Leadership: Uganda's Success in Building Social Cohesion to Slow the AIDS Epidemic

  6. WHO's Reproductive Health Library - Free Information in Electronic Format
  7. Document Mailback
  8. How to Subscribe/Unsubscribe

  9. I.  Letter from the Adapting to Change Team

    Dear Friends,
    HAPPY NEW YEAR to all our colleagues, alumni and friends! As we come to the end of 2000, we look back on the events of the last 12 months with a sense of achievement. In 2000, the following training events were conducted in support of the Program:


    In addition, we issued a third CD ROM, improved our website design and began preparation for a new Distance Learning Course, 'New Agendas for Poverty Reduction Strategies: Integrating Gender and Health'. Please see below for more details on all of these activities. Thank you for your interest in the Adapting to Change program. We welcome your comments and suggestions. Please send them to

    We wish you a happy and prosperous 2001.

    Arlette and the Adapting to Change Team


    II.  Report back from the October 2000 Core Course on Population, Reproductive Health, and Health Sector Reform

    The Adapting to Change Learning Program on Population, Reproductive Health and Health Sector Reform held its second annual Core Course in Washington, DC 2-20 October 2000. The three-week course was very successful and we would like to thank our participants as well as our resource persons for all of their efforts and contributions that made it such a success. The Core Course 2000 brought together 74 participants from 29 countries - from Albania to Zimbabwe. They came from the following countries:

    • Africa - Benin, Ethiopia, Guinea, Malawi, Niger, Nigeria, Togo, Zambia, Zimbabwe (21)
    • Middle East - Egypt, Jordan, Lebanon, Morocco, Oman, Tunisia (12)
    • Latin America - Guatemala, Haiti, Nicaragua (7)
    • South Asia - India, Nepal, Pakistan (13)
    • East Asia - Cambodia, China, Indonesia (6)
    • North America - Canada, US (7)
    • Europe - Albania, Armenia, Finland, Sweden (8)


    Forty participants represented their national governments, 13 represented international organizations (UNFPA, USAID, UNICEF, World Bank), seven represented non-government organizations (NGOs), another six represented donor countries, and three were from development organizations. Additionally, six observers attended from the Canadian International Development Agency (CIDA), the United Kingdom's Department For International Development (DFID), and the Swiss Agency for Development and Cooperation (SDC).

    We were particularly pleased to have three of our Partner Institutes participating in the course, representing the Centre d'Etudes de la Famille Africaine (CEFA) of Togo, the Pan American Health Organization (PAHO), and the Queen Zein Al-Sharaf Institute for Development of Jordan. (See below for our upcoming Francophone Core Course in Dakar, Senegal, co-sponsored by the Francophone Network of African Partners in Population and Reproductive Health, of which CEFA is a member).

    As a factor influencing their decision to participate in the Core Course 2000, 95 percent cited the content of the course from a professional viewpoint. Other factors were the training's potential effect on their current work performance (91percent), and the potential effect on their career (86 percent). The opportunity to interact with other professionals from around the globe was also a positive draw (70 percent). Over half of the participants (50 percent) said that comments from others positively influenced their decision to attend the Core Course: comments from previous participants (52 percent), comments from people in other organizations (53 percent), and comments from World Bank staff (53 percent).

    The Core Course's 44 resource persons came from Bolivia, Burkina Faso, Canada, Columbia, Egypt, Denmark, Ghana, India, Ivory Coast, Lebanon, Mexico, Senegal, Sri Lanka, Switzerland, UK, USA, They represented international organizations (World Bank, WHO, UNAIDS), universities (Harvard School of Public Health, London School of Hygiene and Tropical Medicine, Université Cheikh Anta Diop/Senegal), and development organizations (The Ford Foundation, International Center for Research on Women, Human Rights Watch, The Alan Guttmacher Institute, Women's Health Exchange), as well as private-for-profit (John Snow, Inc.).

    The Core Course was designed in three week modules: Week I: Key Concepts Underlying the New Vision for Population and Reproductive Health; Week II: Design and Delivery of Reproductive Health Services; and Week III: Reproductive Health and Health Sector Reform.

    The agendas for each week as well as many of the papers and materials presented during the course are available on this website. See also the Document Mailback option below.

    Participants reported that the most useful tools gained from the course were:

    • Priority setting tools/matrix
    • Political mapping
    • Costing tools
    • Increased Performance of Health Workers
    • Resource Allocation
    • Safe Motherhood
    • Epidemiological tools


    At the end of the second week, participants were asked to reflect on the knowledge, materials and tools presented. They gave feedback to the trainers, reporting their potential applications of tools, which included the following:

    • Prioritization in my work
    • Plan/analyze policies in view of equity and efficiency
    • Advocacy in policy decision-making (RH logistics, Maternal Health)
    • Political mapping in donor coordination and planning policy
    • Add RH training curriculum for medical students and others
    • Consider/link many dimensions of RH to ensure success
    • Incentives for new graduates to work in RH needy areas
    • Share with colleagues
    • Go beyond the health system
    • Define district services


    At the end of Week III participants were asked to draw up action plans. These action plans included training, policy formation, advocacy/policy dialogue, assessment, monitoring and evaluation, planning and pilot programs. Some examples are below:

    • Engage in better advocacy (e.g., link RH to poverty reduction)
    • Increase resources for RH (financial and political)
    • Orient others (transfer knowledge when I go back)
    • Involve stakeholders in a workshop/dialogue to build consensus
    • Develop action plans (using political mapping)
    • Incorporate RH aspects in training curricula (e.g. gender and violence, RH, HIV/AIDS, financing)
    • Pilot test the RH framework with basic package
    • Incorporate technical, ethical, and political analysis in planning
    • Operationalize national policy in districts
    • Write evidence-based analysis to support RH
    • Change the financing payment structure (e.g., introduce user fees, provider payment capitation, etc.)
    • Integrate RH in health reform
    • Develop norms and standards
    • Develop a budget line item for procurement of family planning supplies
    • Hold workshops to strengthen partnerships (e.g., government, NGOs, and private sector)
    • Initiate post abortion care
    • Pilot to increase literacy among women/focus on girls' education


    Quotes from participants:

    Participants were asked if they would recommend this course to someone else, and what is it about the course that they would really want a potential participant to know:

    "The best thing about this course is that one gets an insight into many issues related to RH and how to implement the Cairo agenda, and learns about many tools, e.g. costing tools, prioritization tools, political analysis tool." - Dr. Ravi Anand, Reproductive Health Advisor, The Centre for Development and Population Activities, Lucknow, India

    "It provided the opportunity to get a 'reality check' on aspects of health sector reform through participatory exercises. It also provided opportunities for people from poor countries (e.g. in Africa) to learn from developments in middle-income countries (e.g., in Latin America)." Miriam Temin, Assistant Health Advisor, DFID/Central Africa.

    "I would let them know that it is highly demanding and that they should be psychologically and physically well prepared and they have to employ maximum efforts to optimally utilize the opportunity. Moreover I would orient them to the fact that the course is comprehensive and embraces areas like demography, economics, poverty and education, and health sector reform in matters relating to reproductive health. The course is up to date, and delivered by high caliber professionals with long years of experiences in different countries, and designed so the materials used are diverse, relevant and clear, and useful for future references. The course is quite instrumental for proper understanding of RH concepts, poverty reduction and health sector reform. It is of paramount importance that the course be give to those in the service delivery policy formation, and planners in health service programmes in both governmental and non-governmental organizations." Hakim Yusuf Lukman, MD, PhD, Associate Professor in Ob-Gyn, Assiut University, Faculty of Medicine, Egypt.

    "A participant can learn so many things in this intensive three weeks, not only from lectures but also from outstanding colleagues from all over the world." Motoko Seko, Professional Officer, UNFPA Cambodia

    "It is a very comprehensive and informative course and covers all the aspects needed for health sector reform. After this course it will be easier to better implement the RH package. Our views have become clearer in terms of developing the service delivery matrices." Dr. Azmat Waseem, Deputy Director, Population Welfare Department, Karachi, Pakistan.

    "It gives you the necessary background on HSR that you need to improve (advocacy) strategies to make reproductive health policies more responsive to the demand that they be designed and implemented in ways that empower (all) women." Astrid Bant, Senior Program Officer for Latin America, International Women's Health Coalition, New York.

    "Being posted at a higher policy level and mandated to deal with women's health rights and gender issues, I have found the course to be relevant, practical, analytical, timely, and applicable to my work. It has given me the knowledge, skills and tools to assess the health sector reform in my country from a wider perspective, especially in regard to reproductive health." Tsigeroman Aberra, Head of Women's Affairs Department, MOH, Ethiopia.

    "The best thing about the course is that it is participatory and emphasizes sharing of experiences and networking." Dr. Olayinka A. Abosede, Special Assistant to the Chairman, National Action Committee on AIDS, The Presidency, Federal Secretariat, Nigeria.

    "The quality of the presenters is very high, so it is difficult not to learn. Well synthesized by WBI staff with each module closure. We meet so many inspiring health activists and specialists from our partner countries, all in a setting of collegial interest. (Very good for us donors!)." Judith Sullivan, Health Specialist, Americas Branch, Canadian International Development Agency.

    To learn more, please contact Arlette Campbell White at

    III.  Francophone Core Course on Population, Reproductive Health and Health
    Sector Reform

    The Francophone Core Course will be held from 22 January - 2 February 2001 in Dakar, Sénégal. This course, the first in French, is being organized in collaboration with the Francophone Network of African Partners in Population and Reproductive Health. The Partners are:

    • Canadian Public Health Association;
    • Centre Africain d'Etudes Supérieures en Gestion (CESAG), Senegal;
    • Centre de Formation et de Recherce en Matière de Population (CEFORP), Benin;
    • Centre d'Etudes de la Famille Africaine (CEFA), Togo;
    • Centre d'Etudes et de Recherche sur la Population pour le Développement, (CERPOD), Mali;
    • Harvard School of Public Health, Harvard University, USA;
    • Institut de Santé et Développement (ISED) at the Université Cheikh Anta Diop, Sénégal;
    • International Planned Parenthood Federation (IPPF), Kenya;
    • United Nations Population Fund (UNFPA), Cameroon;
    • University of Montreal, Canada;
    • World Bank Regional Office, Côte d'Ivoire; and
    • World Health Organization, Geneva.


    The Francophone Core Course on Population, Reproductive Health and Health Sector Reform aims to build a constituency of reproductive health service providers and decision-makers in Francophone Africa who share a common understanding of the challenges and paradigms of population, reproductive health and health sector reform.

    The long-term objective of the Francophone Core Course is to improve population and reproductive health outcomes in developing countries by:

    • providing participants with an understanding of the changing national and international policy and program environment for their work in population and reproductive health;
    • sharing knowledge and tools that help participants effectively design and deliver reproductive health services in their countries; and
    • informing participants working in national health systems as to how the delivery of reproductive health is influenced by and can be supported by health sector reforms.


    Participants: The course is designed for French-speaking West and Central African public and private sector professionals involved in the financing, planning, implementation, and evaluation of reproductive health services in WB client countries; staff from the WB, donor agencies, international organizations, and NGOs who are working with countries to implement the reproductive health approach called for in the ICPD Programme of Action; trainers from regionally-based training and research institutions working in population and reproductive health who conduct training in this area, and wish to strengthen their capacity to do so; and academics and researchers working in the areas of reproductive health, public administration, or the social sectors. We expect to welcome about 65 participants from 16 countries.

    If you would like information on this course please contact Mamadou Dicko, CAFS, Togo, at or Caroline Zwicker, World Bank Institute, at

    IV. Distance Learning Activities on "New Agendas for Poverty Reduction
    Strategies: Integrating Gender and Health"

    While gender and poverty are known to be linked to health outcomes, the connections among them are not always well understood. For a country to effectively promote human development, policy makers must take into account the reality of asymmetrical relationships between men and women in society. These include gender bias in how men's and women's contributions to society are perceived; the structural roles of men and women in the formal economy; women's roles in the informal sector, and the contributions made by the informal sector to health and health care. A greater awareness of these issues can help policy makers in designing and developing gender sensitive poverty reduction policies and programs related to health.

    The Adapting to Change Learning Program is launching two eight-week distance learning (DL) courses titled "New Agendas for Poverty Reduction Strategies: Integrating Gender and Health" aimed at high level officials and policy makers working in national governments, local and international NGOs, international agencies, and academic institutions. The course is highly recommended for government officials and others involved in developing Poverty Reduction Strategy Papers (PRSPs) for PRS. The DL courses will be offered once a week for four hours (one hour on-site off line, and three hours videoconferencing between multiple sites) and will use material directly relevant to sub-Saharan Africa. The first course will be offered in English in Ethiopia, Ghana, Tanzania and Uganda over eight weeks from 20 February to 10 April 2001. The second course will be offered in French in Benin, Guinea, Ivory Coast and Senegal from 23 April to 11 June 2001.

    The success of the DL courses will depend on having skilled and trained facilitators to ensure familiarity with moderating DL training and an understanding of the course material presented in each of the countries where the DL course will be offered. In order to achieve this, a Training of Trainers Workshop (TOT) will be conducted from 15 - 19 January, 2001 in Kampala, Uganda.

    For more information, please contact Marguerite Monnet at or Marilyn Lauglo at

    V.  Sharing Knowledge of Effective AIDS Leadership: Uganda's Success in
    Building Social Cohesion to Slow the AIDS Epidemic

    Two learning events were convened recently at the World Bank (24 October and 15 November 2000) on Uganda's success in slowing the AIDS Epidemic. The latter event used the Global Development Learning Network (GDLN) to promote a videoconference discussion of Uganda's progress in preventing HIV, with special emphasis on the role of social cohesion. The distance learning technology mobilized several high level policy makers and over 50 managers from government and civil society in Ghana, Switzerland, Uganda and the United Kingdom to review and discuss Uganda's dramatic drop in HIV prevalence. Guest speakers included Dr. Ruhakana Rugunda, Minister of the Presidency, Uganda; Ms Noerine Kaleeba, UNAIDS Community Mobilization Advisor and founder of The AIDS Support Organization (TASO); and Dr. Rand Stoneburner, University of Cambridge; Arlette Campbell-White, WBIHD; Wendy Roseberry, AFTH1 and Betty Bigombe, SDVPC chaired the session from World Bank headquarters in Washington.

    Optimism now exists in the fight against AIDS in sub-Saharan Africa, due to the dramatic declines in HIV prevalence observed in Uganda. From 1991-98, Uganda's HIV prevalence rates in pregnant women declined 54%, with rates in 15-19 year olds (a proxy for incidence) decreasing from 20.9% to 5.2%. HIV prevalence declines of similar magnitude are observed in male military recruits and in other population groups. The declines are increasingly attributed to changes in sexual behavior -- particularly a delay in sexual debut among the youth and a decrease in number of sexual partners among sexually active adults.

    What led to this change in behavior in Uganda? Some evidence suggests that in addition to the prevention and care interventions commonly supported by national AIDS control programs throughout the continent, there existed in Uganda positive elements of social cohesion. Social cohesion is defined as the norms and social relations embedded in the social structures of societies that enable people to coordinate action to achieve desired goals.

    Positive elements of social cohesion may have served as catalysts to affect change in Uganda. One element, supported in preliminary study findings, could be that in Uganda information about AIDS and about persons affected by AIDS is more likely to be transferred through personal communication networks, compared to other countries in East and Southern Africa. Another important facilitating element in this process may have been a high-level of government and civil society leadership, to openly communicate the facts about AIDS risk and prevention to the population. These positive elements of social change also might help to explain why there is little or no evidence for similar behavior change or prevalence declines in neighboring countries even at similar stages of the epidemic (and associated high mortality rates).

    To lead off the discussion, brief presentations were made that a) highlighted the data demonstrating the increase in protective sexual behaviors and frequent use of personal communication networks, and b) summarized the role played during the last decade by Ugandan government and civil society leaders. These were followed by comments by colleagues involved in the Ugandan national AIDS response. An open discussion among participants from the viewing countries followed.

    For more information, please contact Wendy Roseberry at For more information about future sessions of the Health Issues Series, please contact Dr. Boostrom at or Prita Chathoth at

    VI.  See the next issue of the newsletter (March 2001) for information on WHO's Reproductive Health Library - Free Information in Electronic Format


    VII.  Document Mailback

    As a continuing service to our subscribers, we are offering document mailback whereby you can have a copy of any of the documents on our website sent to you by email. Simply send an email to: with **only** the URL of the document in the body of the email, for example, which is the URL for the first paper below that is on our website in our Document Library. Alternately, to view the selected publications, simply cut and paste the URL address into your browser.

    In this issue, we highlight publications and materials from the Core Course 2000. There are many other documents available in our Document Library and in the agenda for the Core Course:

    1. "Delivering Reproductive Health Services in Health Reform Settings: Challenges and Opportunities" by Thomas Merrick:

    2. "La prestation de service de santé de la reproduction dans le contexte d'une réforme du secteur de la santé: Défis et opportunités" par Thomas Merrick:

    3. "The Design and Delivery of Reproductive Health Services" by Marc Mitchell and Arlette Campbell White:

    4. "Les instruments de l'adaptation au changement" par by Marc Mitchell and Arlette Campbell White:

    5. "Methods for Evaluating Effects of Health Reforms: Current Concerns" by Barbara McPake and Joseph Kutzin:

    6. "Resource Mobilization and Health Sector Reform In Bolivia: The Prosalud Experience" by Carlos J. Cuéllar:

    7. "The Nature of Health Sector Reform in the Americas and its Significance for PAHO's Technical Cooperation" by Dr. Daniel López-Acuña:

    VIII.   How to Subscribe/Unsubscribe

    Please circulate this message to other interested people and encourage them to register for their own copy on the Web at or by sending email to
    If you would like to be removed from this mailing list, please send a blank email to

    Thank you for your interest in the Adapting to Change program. We welcome your comments and suggestions. Please send them to We wish you a happy and prosperous 2001.