required. Funding will necessarily be governmental, 

 although actual implementation may be through 

 nongovernmental organizations. 



The scale of a given demonstration should be large 

 enough to include all elements of an effective system 

 or infrastructure, but small enough to be completed in 

 perhaps three to four years. Officials often lose 

 interest in longer projects, particularly ones with 

 highly sophisticated. Western-type evaluation systems. 

 For the scale of demonstration projects envisaged, 

 trained and experienced local leadership is essential, 

 with a carefully selected team of nationals, supported 

 where appropriate by foreign technical advisers. 



In addition to demonstration projects to strengthen 

 and test large-scale improvements in health care 

 systems, we recommend that the United States encourage 

 and support a major expansion in fast, flexible small 

 grant programs to facilitate testing and demonstrating 

 innovations in individual program elements. Such 

 innovations may cumulate to large-scale change over 

 time. 



The economic slump of the mid-1970s in developed 

 countries adversely affected private small-grant 

 programs for primary health services, and some have 

 completely disappeared. Such programs are not 

 expensive, even when they involve significant 

 administrative costs. Yet they may be just beyond the 

 capabilities of limited or highly rigid health care 

 budgets in developing countries or just outside the ken 

 of administrators who are faced with bureaucratic 

 constraints and who are unfamiliar with research and 

 experimental traditions. 



At the same time, administration of experimentally 

 oriented small grant programs may be troublesome to 

 large agencies and national governments. Accordingly, 

 small grant support may be effectively channeled 

 through universities and nongovernmental organizations 

 in some instances. One such program operating in Asia 

 and Latin America is the Population's Council 

 International Committee for Applied Research in 

 Population. 



Specific technological innovations that could be 

 developed under such grant programs and that would be 

 particularly useful at the village level include: (1) 

 a more efficient clamp for the umbilical cord, either 

 easily sterilizable or disposable and inexpensive, 

 linked with additional education for local 

 practitioners; (2) an inexpensive receiving blanket for 

 keeping newborns warm; (3) prepackaged disposable 

 needle and syringe packs with measured amounts of an 

 oxytocin to prevent postpartum hemorrhage, or vitamin 

 K, etc. ; (4) a prepackaged, fixed dosage pack for oral 

 rehydration or peritoneal fluid administration; and (5) 



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