workers, carry out biomedical and social science research for future planning and evaluation, and demonstrate and test methods of providing services. In the future activities which help insure use of available family planning services will be expanded. Essential aspects of the overall effort will be increased interaction with other development programs (particularly health and nutrition), increased collaboration with other bilateral and multilateral donors, expanded family planning information and education programs, improved management and greater participation by other donors to meet the rapidly increasing demand for contraceptives.

RECENT PROGRESS

Over the past decade, AID has assisted 43 developing countries on a bilateral basis and another 50 through private organizations and the United Nations Fund for Population Activities (UNFPA).

There is mounting evidence that population assistance efforts have effected fertility declines in several developing countries. In the Philippines, for example, current data show that a trend of rising fertility since 1900 has now been reversed, following introduction of a broad national family planning program supported mainly by AID. Indonesia is experiencing a marked decline in fertility in East Java and Bali where the family planning program is now firmly established.

FISCAL YEAR 1976 POPULATION PROGRAM

The fiscal year 1976 population program includes $135.7 million to support country and interregional programs. These prograins concentrate on seven major

areas.

EDUCATION AND INFORMATION ($10.1 MILLION)

There is little doubt that educational and motivational efforts are needed to promote widespread voluntary acceptance of family planning services. Such efforts are complicated by the low level of literacy and limited access to low-cost communication media. Working with groups such as the International Confederation of Midwives, the American Home Economics Association and the East-West Center's Communications Institute, AID will continue to develop culturally attuned information programs in selected countries.

MANPOWER AND INSTITUTIONAL DEVELOPMENT ($14.2 MILLION)

Successful population and health programs depend on trained manpower and indigenous institutions to lead and conduct the effort. Emphasis will gradually shift to training of paramedical and nonmedical personnel capable of working at the village level with only limited facilities. For example, through Development Associates, Inc., a private nonprofit organization, various U.S. medical facilities will train female paramedical personnel qualified to teach auxiliary workers who will work in remote rural areas and poorer urban sections of their countries. Under a new program several American institutions will be selected to train community nurse administrators and educators from such countries as Kenya, Tanzania, Korea, and Afghanistan beginning in fiscal year 1976.

DEMOGRAPHIC DATA COLLECTION AND ANALYSIS ($7.8 MILLION)

Demographic and social data are needed to help officials understand population growth and its economic and social implications. Furthermore many population programs are now at a stage where measuring impact is both feasible and essential. In fiscal year 1976, AID will continue to support the World Fertility Survey which now covers 40 developing countries. Jointly funded with the UNFPA, the Survey provides basic data needed to measure fertility change and the effectiveness of family planning programs. A new project will help selected Central American countries, Pakistan, Kenya, Tanzania, and Ghana monitor demographic impact and compare family planning acceptors with nonacceptors according to a range of demographic and socioeconomic criteria.

POPULATION POLICY AND FERTILITY BEHAVIOR ($6.7 MILLION)

The complex questions of motivation and fertility determinants will be given greater attention in AID's fiscal year 1976 program. During the past year AID has prepared a social science research strategy and initiated a new research project on the social determinants of fertility. With the cooperation of other

donors, additional research will be carried out on the social, cultural, legal, religious, and other factors which influence fertility. In particular, areas which offer alternative roles to childbearing and domestic responsibilities for LDC women, such as female education and employment, will receive increased attention. Key target countries for social science research efforts include Pakistan, Philippines, Kenya, Bangladesh, Colombia, and Egypt.

FERTILITY CONTROL TECHNIQUES AND OPERATIONAL RESEARCH ($8.8 MILLION)

AID's successful biomedical research program has helped devise reasonably inexpensive and simplified fertility control techniques. However, additional methods and improvements in current methods are needed to make them more acceptable and suitable for use in developing countries.

FAMILY PLANNING DELIVERY SYSTEMS ($67.1 MILLION)

Most developing country citizens do not yet have access to even the most basic population and health services. Major emphasis will be given, therefore, to continuing expansion of service coverage to the great mass of rural and urban poor, who tend to have the highest fertility, worst diets, and poorest health. Provision of services via delivery systems is the largest single element in our proposed population budget. Included in this amount are $27.6 million for the provision of technical services and support and $39.5 million for contraceptives.

The intermediaries are a critical part of AID's population assistance effort. In fiscal year 1976, $30.6 million is allocated for programs of these organizations. For instance, the International Planned Parenthood Federation (IPPF) currently has programs in 84 LDC's. Their primarly objective is to initiate or improve existing indigenous family planning programs by providing commodities and budgetary support for projects and technical assistance in information and education and related activities. Of special interest are innovative projects in community based distribution systems which IPPF has established in such countries as Sri Lanka, Colombia, Thailand, and Ghana.

The "Pathfinder" fund is another example. It emphasizes training and motivation programs for host country personnel and provides subgrants to local programs. Projected subgrants for 1967 include paramedic IUD training in the Philippines, a commercial marketing project in Ethiopia and rural family planning clinics in Senegal, Haiti, and Bangladesh.

During the past year the demand for contraceptive supplies has markedly increased. Provision of commodities must be designed to serve as a catalyst to institutionalize public and/or private channels of supply. Over the long term, commercial distribution and indigenous production of contraceptives must be developed in order to shift the responsibility to the developing countries themselves. Pilot activities in Jamaica and Bangladesh are now testing the feasibility of commercial distribution channels. In collaboration with other donors UNFPA is surveying LDC facilities for contraceptive production.

Innovative delivery systems that combine family planning with simple health measures are required. AID will continue to support prototype integrated low cost health service programs in such countries as Thailand and Colombia.

UNITED NATIONS FUND FOR POPULATION ACTIVITIES ($21 MILLION)

Efforts to involve other donors in population activities have been highly suc cessful. For example, the number of donors to the UNFPA has increased from 2 in 1968 to 48 in 1974. LDC demands for population assistance exceed donor support. U.S. support of the UNFPA through a proposed 1976 pledge of $25 million $21 million in fiscal year 1976 and $4 million in the fifth quarter-in concert with other donors will help extend family planning services and information through nonmedical delivery systems, agricultural extension services, and village level clinics.

HEALTH

Survival is still tenuous for most people in developing countries. Infant mor tality is approximately four times higher than in United States. For the very poor, life expectancy is almost 30 years less than in the United States. Perennial breeding of insects and continued pollution of water and soil create an overwhelming environmental risk for rural families. Millions of cases of malaria, river blindness, and schistosomiasis [snail fever] occur annually. While most

LDC's seek adequate health systems, such systems are based on advanced Western medical techniques and thus are often beyond their means. Radical rethinking of existing health service concepts is needed now if the majority of people in the poor countries are to be covered at a cost LDC's can support on their own.

FISCAL YEAR 1976 PROGRAM

AID's health assistance emphasizes three areas: development of low cost integrated health delivery systems, improved health planning and management, and prevention of major rural environmental health hazards.

More than 85 percent of the people in the developing countries do not have access to basic health and family planning services. Few models of low cost health care exist. In approaching this priority, over $19 million is proposed for health delivery programs in fiscal year 1976. New rural health delivery programs in Bolivia and Nicaragua are proposed. In Afghanistan, where only 5 percent of the rural population have access to health services, a new project will design and test low cost outreach delivery systems. In Africa, programs are beginning in Liberia, Ghana, and in the Central West Africa Regional area. In total by the end of fiscal year 1976 AID will be assisting 25 programs as compared to only 1 in 1971.

A major new AID initiative is expanded support for preparation of national health plans and sector analyses in relation to overall development planning. In 1976 AID proposes to budget approximately $8 million for health planning and management. AID is now helping prepare 27 national health plans or sector analyses, up from 4 such studies in 1973. as a part of a collaborative effort with WHO. AID will also sponsor eight regional conferences on methodology of health sector planning and analysis for LDC leaders in a direct effort to help LDC's help themselves. AID has drawn on the professional resources of HEW, the University of Michigan and the Johns Hopkins School of Public Health for guideline development, analysis and training.

Environmental health is one of AID's major concerns. Approximately $39 million is proposed for environment and disease control. AID is helping poor countries find low cost methods to meet their rural water needs. Programs planned for fiscal year 1976 include a $9 million loan to Bolivia to develop a rural community potable water and waste system. This project will provide for construction of simple potable water systems, with water delivered to communities through public taps, standpipes and wells.

AID is working with the World Bank, WHO, and other donors to develop a global plan for water borne disease epidemic control. Cholera epidemics which attack all continents but the Americas is a focal point. A primary factor in this vital international search is the AID funded cholera research laboratory in Bangladesh which is field testing new vaccines for cholera control.

Cooperative efforts are also under way to study how the United States can contribute to control of snail fever (schistosomiasis), one of the greatest hazards in rural areas. AID will continue to support ($1.5 million in 1976) an international effort to control river blindness in the Volta River Basin. Kuwait, the African Development Bank and Japan have joined the United States in financing this program.

Malaria remains the most serious biological hazard to expansion of agricultural production. Despite previous major successes in reducing the impact of the disease, it has recurred in Pakistan, India, Nepal, Thailand, Indonesia, Central America and Haiti. AID will support antimalaria programs in Indonesia, Haiti, Ethiopia, and Pakistan and WHO research on methods of malaria control other than DDT. AID, in cooperation with WHO, will continue testing of biodegradable analogues of DDT in village scale tests in Indonesia.

The adverse impact of capital projects, such as roads and irrigation systems, on biological environment will be assessed and ways to reduce major environmental diseases which affect the rural majority will be identified. The U.S. Environmental Protection Agency will assess the relevance of U.S. methodologies for water pollution control to developing country needs and capabilities.

In summary, the basic groundwork for reducing birth rates, death rates, disease, and malnutrition has been laid in many countries. However, substantial population increases will continue over many years even if the two-child family becomes the norm in this century, since the bulk of LDC populations are in the youngest

age groups and still have their childbearing years ahead. Thus, major efforts are needed now if reduction in the rate of population growth is to have any chance of realization.

Moreover, it will take many years of persistent efforts to overcome the deeply ingrained dietary and other health habits and provide the necessary services to combat disease and reduce population growth. There are no short term solutions to these problems which affect the majority of people in the LDC's. Their leaders must adjust the practices of modern medicine to the complex demands of tradition, religious beliefs and social institutions.

But this long range view must not act as a deterrent to strengthening assist ance efforts now. What the United States and others do now to expand efforts at solving population and health problems will be a major determinant of whether the developing countries can effectively manage their futures.

Mr. Chairman, I appreciate your patience in letting me present this statement in support of our population planning and health program. My colleagues and I will be happy to respond to any questions you may have.

(3) Section 105: Education and Human Resources Development

AID is seeking a fiscal year 1976 authorization and appropriation of $71 million to carry out the purposes of section 105 of the Foreign Assistance Act-"... to reduce illiteracy, to extend basic education and to increase manpower training in skills related to development . . .".

The proposed fiscal year 1976 program for Education and Human Resources Development, which totals $95.3 million is apportioned as follows:

Africa

East Asia___

Latin America.

Near East South Asia_____

Centrally funded and other___.

Total

It is proposed that the program be financed as follows:

New appropriations--
Recoveries

Total

Millions

$16.7

11. 2

50.0

10.7

6.7

95. 3

Millions $71.0

24. 3

95. 3

The $95.3 million proposed for fiscal year 1976 represents an increase of $14.7 million over the estimated fiscal year 1975 levels of $79.6 million. The fiscal year 1976 request is composed of $57.3 million for grants and $38 million for loans. Activities included relate to :

-Increasing the relevance and scope of education (includes curriculum reform, expanding educational opportunities, educational technology, and improve teacher training).

-Non-formal education (including literacy and low and medium level skills training).

-Support for developing national universities.

-General scholarship, training, administration and management programs. Developing countries have made extraordinary progress in expanding and improving their education systems in the past 20 years; vast numbers of schools have been built and teachers trained. Entire technical and university systems have been established and staffed and are now turning out qualified graduates. As a result, literacy rates have shown remarkable increases, opportunities for training at all levels are often available without going abroad, and the general level of useful skills has been greatly enhanced.

But many fundamental problems remain.

-Population growth has outpaced the financial and technical capacity of governments to expand the education system.

-Traditional education programs all too frequently are not relevant to basic development needs.

-Large portions of the poor majority usually fail to benefit from existing education systems.

In a world of plenty, education may connote literacy and wide learning, truth for its own sake as well as a means to progress. In a world of want, education must unfortunately of necessity be something far more restrictive and practicala means to improve living standards rather than an end in itself. AID defines "minimum practical education" to be that body of knowledge, attitudes, and skills necessary to effectively contribute to and participate in a developing society and economy. Education should help equip developing country citizens cope with their most pressing problems-hunger, ill health, and lack of more productive emploxment.