Fertility decline in Bangladesh: an emerging family planning success story

Bangladesh has a population of 115 million people, and the economic growth rate of 3.7% during the 1980s was undermined by rapid population growth. The annual population growth rate was 3% in the 1960s and early 1970s, 2.5% between 1981-91 decreasing to 2.3% in 1991. The average of number of children is 4.6/woman compared with 7 in the 1960s. Infant mortality dropped from 150/1000 births in 1976 to 118/1000 in 1991. Life expectancy rose from 47 to 54 years. The 1991 Contraceptive Prevalence Survey showed that 39.9% of married women under 50 use contraceptives in 1991 vs. 18.6% in 1981. The use of modern methods increased from 10.9% in 1981 to 31.2% in 1991, while traditional methods rose from 7.7% to 8.7%. Sterilization was most prevalent in 1981. 29,000 female family planning (FP) workers were aggressively engaged in dispensing FP services in 1990. The Social Marketing Company sells pills, condoms, and oral rehydration salts through 130,000 retail outlets. The 1989 Contraceptive Prevalence Survey showed that 40% of pill and condom users obtained them from this network, and 95.4% of women knew about 4 methods of contraception. In 1990 there were 120 private organizations providing contraceptive services. Some of the components of the government FP program include field worker distribution door-to-door of injectable contraceptives (50% injectable usage rate in the Matlab project); recordkeeping activities; a satellite clinic network with access to contraceptive services; and decentralization through the Upazila (subdistrict) approach. The logistics system of FP has improved the warehousing, transportation, and management information system. Foreign aid (mainly USAID) financing of contraceptives helped avert 14.4 million births between 1974-90. The increase of contraceptive prevalence to 50% by 1997 would avert another 21.9 million births during 1991-96 (replacement fertility requires 70% prevalence.     

Saving and consumption patterns of the elderly

The paper provides an empirical analysis of saving and consumption choices of the elderly in Germany, based on the German income and expenditure surveys 1978 and 1983. Main feature of these data is the large sample size making it possible to analyze saving and consumption patterns of the very old (aged 75 and above).The observed age-consumption profiles are very different from those predicted by the pure life-cycle theory. Although wealth is declining between age 60 and 70, it increases again after 70, such that the very old have the highest savings rates among all age groups and accumulate wealth rather than decumulate it. These profiles are not confounded by cohort effects and mortality differences. The corresponding expenditure data suggest the following explanation: due to the generous German pension system and the almost complete coverage of health expenses by the mandatory health insurance in Germany, the declining consumption n very old age cannot exhaust the annuity income of the elderly such that wealth is being accumulated in old age.Research in this paper was supported by the National Institute on Aging, grant no. 3 PO1 AG05842-01. I appreciate the helpful comments by Doug Bernheim, Angus Deaton, Daniel McFadden, Jonathan Skinner, Konrad 'Stahl and David Wise, and two anonymous referees. I am indebted to Hermann Buslei and Johannes Velling who provided most valuable and able assistance.     

Population changes and the cost of health care for the elderly in Poland

"The author...has attempted to measure the effects of population changes upon the costs of health care [in Poland] by applying a simulation model. In this model the total cost of health care is a function of the per capita cost of health care by age, sex, and place of residence (urban, rural) and population structure.... The paper includes...the results concerning population 60 years of age and over." Data are from several official health-related surveys carried out in 1989.     

Strategic planning for the board

Although the planning operation is regarded by some observers as unrealistic in conditions of rapid change and increasing competition, the discipline of strategic thinking and the need for strategic leadership continue to be of vital importance. The author examines the purpose of the Board of Directors and its role in the management of strategy.     

Population and towns in Senegal: demo-geographic growth

Using data from the 1976 and 1988 censuses, the author notes that the population of Senegal has grown by 37.6 percent over the period and that this growth is concentrated in urban areas. One feature of this trend has been the growing primacy of the capital Dakar and a decline in the relative importance of smaller towns. The need to discourage rural-urban migration by promoting socioeconomic development in rural areas is stressed. (SUMMARY IN ENG)     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

The aims of population statistics and demographic research

A detailed program for the improvement of population statistics and for the development of demographic research is presented, with particular reference to the USSR. Topics covered include global and regional population projections, special surveys on demographic behavior, and the need for improvements in migration data.