**PHN 1992 Sector Review**

**12**

used, FY92's total would have been $125 million.) This change has been introduced as part of the effort to track the subsectoral thrust of human resource lending, which increasingly integrates activities in several sectors into one project. Thus, the loan amount for a population project with maternal and child health (MCH) or women in development (WID) components is no longer quantified as 100 percent population. The increasingly diverse nature of Bank population projects reflects the effort to address not only the unmet need for contraception that exists in most countries, but to stimulate the demand for family planning that derives from better infant, child and maternal health, and from improved women's status. Programs that used primarily to provide family planning services are moving to provide maternal and child health, including nutrition interventions (India Family Welfare) and WID components (Mauritania and Niger projects). Often projects involve local communities or NGOs in these activities. Indeed, moves towards including NGOs and the private sector in general, and towards decentralizing control in public programs, are frequently features of current population and PHN projects, reflecting the search for ways to improve access of vulnerable groups.

2.40 The Niger Population project, for example, establishes a Population Fund to finance private sector, NGO, and community involvement in service delivery and information, education and communication (IEC) activities. In addition, the India Family Welfare project will put forth "concerted effort" to include private voluntary organizations (PVOs) and private medical practitioners (PMPs) in the delivery of services and IEC. The Innovative Schemes component of this project establishes a revolving fund used to finance PVOs and PMPs. They will compete for the funds, proposing new interventions that involve the community directly. Suggested projects include creche programs, nutrition and environmental sanitation projects, and fermale education and training activities. This project targets involvement of PVOs because "PVOs generally take up innovative programs by adopting strategies and methodologies which are aimed at fostering social transformations, thereby generating attitudinal changes and improving quality of life of women in particular (SAR, p. 21)." 2.41 PHN sector work completed and ongoing in FY92 gave substantial attention to population issues. These studies also dealt with the themes of integration and decentralization of PHN projects, under the headings of improving the effectiveness of services delivered, the efficiency of resource allocation, and the equity of access. In addition, sector work examined the effect of population growth on other development activities - in the provision of social services, and its impact on labor markets in particular. The FY92 reports for IDA countries focussed on countries with rapid rates of population growth - in the majority of cases over 3 percent per annum, or only reduced below this level by high mortality (e.g. Guinea Bissau). Four PHN reports reached grey cover for countries in eastern Europe and the former Soviet Union, but only one, Romania, deals with population and family planning issues in any detail, although the Poland study takes up the issue of family planning's role in improving maternal and child health.

2.42 A sector report on _New Directions in the Philippines Family Planning Program_ quantified the health benefits of family planning to women and children, and its message is being increasingly noted and quoted in the Philippines. The report's key finding is that "...preliminary analyses of available data indicate that if pregnancy were avoided by women under the age of 20, over 35, with four or more children, and less than 15 months post-partum, both the infant and child mortality rates would decline by almost 25 percent and the number of infant and child deaths would decline by 35 to 50 percent.

# 2. _Health_

2.43 The main thrust of health projects approved during the year is the provision of primary health care services to those most in need: largely the poor, women of child-bearing