The Inter-American Development Bank is aware of the interrelationship between population growth and of the fact that demographic trends in Latin America comprise one of the major variables to be considered in any estimate of medium and long-run prospects for economic and social development. The Bank recognizes, however, that growth is a complex process and that no isolated factor can be singled out as the predominant input which will make growth possible, or which of itself will impede growth.
The Bank wished to avoid an oversimplification of the population problem which would lead to the conclusion that a reduction in the rate of population growth will in itself bring about social and economic development. The Bank then will continue to stress its primary objective--development--and will continue to emphasize the need for substantial investments in social fields as a concomitant of economic progress. It will continue its efforts to improve the quality of growing populations. Within this context, upon member country request the Bank will attempt, by means of individual projects, to support population policies which form an integral part of a social development policy and which have as their primary objective improvement of family welfare.
In this respect, there are five areas of concern for Latin America:
1. Productive employment must be available in the city and countryside.
2. It is of greatest importance to expand and improve the effectiveness of investments made in human beings if population is actually to become a dynamic factor of development.
3. More intensive efforts must be made to integrate vast areas in the interior of the Latin American continent, abundant in undeveloped reserves of natural resources.
4. Differences in development levels between areas in a single country and between countries have produced heavy migratory waves that must be channeled in terms of development. Population, therefore, appears to be a factor within the context of national integration. It is probable that decentralizing investments for the creation of new industrial poles is central to the definition of future development strategies.
5. In addition to being a component in national integration, population movements between bordering countries and the so called brain and talent drain make it necessary to consider population as one of the major factors in the process of regional integration.
The Bank's member countries, although differing on individual approaches to the population problem, have on the whole reached a consensus in acknowledging the importance of the population dimension in shaping development plans. Governments, the academic community, and other vital social and political institutions in the region have generally expressed concern over population growth and the urgent need for joint action.
The Bank will be willing to support a variety of measures directed at the population problem: training in demography for national planners, conferences on population problems, socio-economic and biomedical research, training of public health and medical professionals, and construction and equipping of health facilities for maternal-child health care as a component of broader health programs. The Bank is prepared at this time to consolidate and accelerate its work in these areas.
In so doing, however, the Bank will bear in mind that programs designed to alter in a positive or negative way the present birth rate of a country have complex social, cultural and religious implications, and that political and personal decisions are involved. The Bank recognizes the basic human right to have access to information which will enable the individual to make responsible decisions concerning family size. Moreover, the Bank recognizes the complete independence of a country to reach its own decisions concerning population goals and policies. This institution should not involve itself in any program which is not completely voluntary and which is not based on the desire of families to improve the quality of their own lives.
Fields of Activity
1. DEMOGRAPHIC ANALYSIS. Demographic analysis is an indispensable component of development planning. Population trends, including age and occupational characteristics, as well as geographic distribution, are important factors in projecting economic and social investment goals--involving as they do estimates of future financial needs for additional education and health facilities, employment opportunities, food production and requirements for rural and urban development.
This means that Bank staff must actively seek ways to incorporate the population perspective into activities of national and regional organizations with which it has contact, as well as into activities for which the Bank has direct responsibility:
a) Internal Activities: i) internally conducted sectoral studies and projections of development goals should consider implications of present and future demographic trends; and ii) demographic data should be used in evaluating proposed loan and technical assistance operations where relevant, particularly in those projects dealing with food production, education, health employment and urban, rural and regional development.
b) Field Projects: i) as well as in other fields of activity, IDB should seek to improve collection and presentation of statistical data in demography and related social areas. It is imperative that concrete projects be promoted at the national level to develop statistical information systems, with the cooperation of specialized technical agencies and other sources of international assistance; and ii) the IDB should promote periodic national census programs over a broader range of countries.
The technical assistance and loan resources of the Bank are available for these purposes, subject to the terms and conditions of current Bank policy in each specific field.
2. HEALTH. The Board of Executive Directors some years ago authorized management to broaden its activities in the field of health beyond its earlier concern for potable water and sanitation. The expanded health policy recognizes the relationship between improved health and attainment of economic and social progress. The policy is designed to promote preventive measures in those countries whose overall health conditions are unsatisfactory.
The Bank emphasizes the importance of setting up comprehensive mother-child care services within health institutions or of modernizing them where they are already available. But above all, this institution is interested in supporting integrated health systems that meet the needs of people, particularly "campesinos" and marginal urban groups.
A major criterion for Bank support is that proposed projects form part of a national health plan, following generally the guidelines established by the Pan-American Health Organization. Further, projects should emphasize preventive health measures, rather than "curative" needs of more advanced countries. Certain programs reflecting a national need can be supported even though they are not incorporated within a national health plan.
The health policy incorporates the following categories of activities:
a) Health components of rural development, including establishment of rural health centers, with adequate services and facilities;
b) Health centers for urban areas, as above;
c) Construction or expansion and modernization of hospital, but only if proposed hospitals are components of an integrated national health program, or will be used as an adjunct to a training program for professional, auxiliary and medical personnel required to implement a national health plan;
d) Education and training of health manpower (physicians, nurses, laboratory technicians, and related auxiliary staff) for urban and rural service. A vital segment of this activity is in the area of curriculum reform for medical and auxiliary personnel. Bank assistance includes provision for facilities and equipment;
e) Support for pharmaceutical, biological, nutritional and medical equipment enterprises, both public and private; and
f) Support for public health and biomedical research.
Within the above authorities, the Bank can support a wide range of activities relating to the population problem. The type and range of activities depend on a country's general acceptance of maternal and child welfare programs, including family planning, within the scope of a reasonable wide spread of health services. In all cases, activities supported by the Bank should be designed to improve family welfare and should be a part of programs providing continuing and comprehensive health programs.
In summary, on the basis of a request for such services, the Bank can, within existing policies, extend assistance on population matters through the following activities:
- Facilities and equipment for publicly supported health units and hospitals;
- Education and training for professional and auxiliary personnel engaged in publicly supported programs;
- Support for public health and biomedical research;
- Promotion of pharmaceutical, biological and medical equipment industries.
The instruments available for extending support to the above activities consist of:
- Preinvestment resources;
- Technical assistance, loans and grants; and
- Direct loans.
The external facilities for extending the services of the Bank consist of:
- National, regional or other specialized health organizations and/or national social security institutions. Both may be necessary to obtain fuller coverage, especially of lower income groups and the rural sector.
- The advisory assistance of the Pan-American Health Organization (PAHO), Pan-American Association of Medical Schools, the Population Council, and selected national associations of medical faculties.
Although direct action in the population field must be in response to national attitudes, the Bank can take steps to create a public sector awareness of the problem and its relationship to economic and social progress.
The Bank can promote scientific and technical discussions within the region concerning the relationship between population problems and fundamental development objectives. To this end the Bank should:
a) Promote regional seminars and conferences for planners and specialists in development problems to analyze relationship among demographic variables, economic growth and social transformation.
If possible, the Bank should collaborate with national and regional institutions in promoting such activities.
b) Foster research which analyzes reciprocal relationships between development problems and demographic trends. In addition, the Bank should encourage the use of programming methods for social development which include demographic variables.
c) Promote training activities in these subjects, in collaboration with other national and regional organizations.
The Bank is willing to coordinate its activities with other regional and world agencies and to seek the most expeditious means for cooperating with national research and development institutions. To date, we have maintained in our health operations a special relationship with the Pan-American Health Organization and collaborated closely with the United Nations agencies, primarily those operating in the region. We are aware of the fact that the prospective level of activity calls for further progress in this direction. We propose to establish functional working relations with the United Nations Fund for Population Activities, perhaps along similar lines to those currently governing our relations with the United Nations Development Program. We should also like to participate in a continuing system of inter-agency consultations for the region in order to standardize criteria and prevent unnecessary duplication.
Prevailing Reference Document: GN-1068, May 1975.
* The operational policies of the Inter-American Development Bank are intended to provide operational guidance to staff in assisting the Bank's borrowing member countries. Over the course of the Bank's more than 40 years of operations, the approach to developing operational policies has taken various forms, ranging from the preparation of detailed guidelines to broad statements of principle and intent. Many policies have not been updated since they were originally issued, and a few reflect emphases and approaches of earlier years which have been superseded by specific mandates of the Bank's Governors, the most recent being the Eighth Replenishment mandates of 1994.
In accordance with the Bank's information disclosure policy, the Bank is making all of its operational policies available to the public through the Public Information Center. Users please note that the Bank's operational policies are under a process of continuous review. This review process includes preparation of best practice papers summarizing experience at the Bank and other similar institutions, and sector strategy papers.