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I have been asked to gently introduce the FWA New Tampa / Wesley Chapel (NTWC) writers group to using and creating blogs at the June 4th meeting. Of course that meant blogging the content I was going to present. This is an article series on Blogging for Writers.
We now know how to read, subscribe, and produce blogs, but how do we make it a high quality blog. In this post I present what I consider to be the discipline of blogging as I see it. This is highly opinionated and based on what I have observed as high quality in blogs I read.
The Discipline of Blogging
Blogging is a form of writing. As such, it requires much of the same discipline. I would like to share some of what I have learned, some of the rules I use when blogging, and some of the things I know I should be doing, but don't.
Dave's Rules
First, here are my golden rules. These are the maxims that I believe all successful bloggers need to understand. They are not the only ones, but the ones I have prioritized as the big three.
Rule 1: Blogging is Writing! So Blog, Blog Often, and Blog on Schedule!
This is the rule I break most often. I tend to have bursts and pauses, but a serious blogger like a serious writer will blog frequently. Blogging does give you a benefit over writing in that you can schedule a blog for publishing, so you can write seven posts on a weekend, and schedule each one of them to publish on a different day. This gives the appearance of blogging every day.
So I probably scared you into thinking you have to blog every day, well you don't have. You just need a schedule you adhere to so your readers have and expect consistency from you. The more consistent you are, the easier to retain your readership.
The key here is treat blogging professionally, like it is your writing – because it is! Your blog posts reflect upon you as an author, and you want to ensure the highest quality content. That high quality comes from practice (and a really good editor). That means write often.
Rule 2: The New York Times Rule
This is the rule you must fully internalize. You must accept that anything and everything you put on the web may end up on the front page of the New York Times. Do not assume you have full control over your work once it is on the web. If you write an inflammatory post belittling that editor that just sent you your eight rejection letter, you can be sure he will eventually read it.
Why is this true? Because the web is all about links and connections between content on the web. Someone will read your post, link to it, and then someone else will find it, and link to it, and so on. It is like the Six Degrees of Separation. It does not take long for something to be linked to a web site or blog that you did not expect. This linkage is what allows your readers to find your blog, but it also means less friendly audiences, like that editor that rejected you, will also find it.
Bottom line, always – always assume your work will be on the front page of the New York Times. If you treat everything you post on the web that way, you will often temper the most inflammatory things you say, and ensure you properly edit those sloppy scribbling's before they are seen online.
Rule 3: The Web Remembers All
This rule goes hand and hand with rule 2. The web never forgets. It is the ethereal elephant with superb memory. Even if you delete your post right after you put it up, it is possible a copy was made somewhere, and you no longer have control. I am being deliberately dishonest by saying the web remembers all. It really isn't that big-brotherish (yet), but once something is up there, you no longer know if a copy is made. Therefore you have to assume a copy is made as soon as you put it up.
Alright, it is time to move past the golden rules, and onto the actual discipline.
Plan it out
This seems pretty obvious, but too often it is ignored (I know I do all too often). Blogging is much like a periodical. It requires a certain structure based on the audience you are targeting and content you are providing. I am going to identify some of the core concepts that should be addressed in your blog plan.
Decide up front how often you want a post to show up. Will your blog be a daily, weekly, monthly, or annual? This will help you define the scheduling for your posts. You can write them all up front, or the night before, but you should schedule them to be delivered at some regular interval. If you publish too much at one time, you may overwhelm you readers, and they leave. If you take too long between posts, they may forget all about you and unsubscribe since they no longer remember why they read your blog.
This is like your literary voice. Find you style of blogging. Will you be conversational, lecturing, or questioning? Will you be narrowly focused or rambling? All of these together or apart are equally valid. However, it is jarring for a reader to have different posts being in a different style. Imagine if in the latest issue of Newsweek, half the articles was written in the style of Manga? It would be (weird, unsettling, just plain wrong?) something that the reader would not expect, and would most likely not be comfortable with. All that being said, it is possible to define you style as being a mash-up of vastly different styles, but your readers will expect that style once you have defined and demonstrated it.
Just as your style sets expectations for your readers, so does your average post length. Will you be writing 500 words per post, or a few thousand? Will each post be a random exploration in how long or short you can make it based on your mood? Try to find your consistent average length, and target for that with your posts. This is much less important than style, but should still be considered. As with most things with blogging, this is not a rule, but more of a guideline you can bend to your will as you see fit.
Pages vs. Posts
You should identify how you plan to use posts and pages. Posts are typically the more dynamic area of your blog, and contain your serialized articles over time. However, creative use of pages can be used to augment and reinforce a group of posts
A blog is a presentation, primarily, of the written word. You need to define the format in which those words are displayed. Traditional press will call this their style guide, and you will need either a formally define one, or at least a set of rules you will follow. Your goal is consistency, so make one or adopt one, and just stick to it.
Tags and Categories
Tags and categories are how blogs structure your content to allow your readers to find what they are interested in. This analogous to the index and table of contents in traditional publishing. Learn how to use them, and as always, use them consistently.
Post Types
Moving past the discipline, we get in to one of the most overlooked issue with blogging, and that is post types. There are many standard types of posts, and they each follow certain guidelines. As you grow your knowledge of the post types, you want to ensure that remain consistent in its usage over time. It will help your readers move from post to post and focus on the content instead of the structure.
Here are a few of the most common post types you will probably use.
This is the classic multi-part article or just a loosely related set of posts. The more tightly related the posts are, the more you should make an effort to link these articles to each other.
Periodic Reviews
This is a common blogging practice where once every set period of time (week, month, quarter, or year), you review the blogs you have written in a blog post. This is very helpful for new readers to find older content.
This is the classic answer to bloggers block. Just identify a list of something, such as Ten Things to do Instead of Writing the Next Chapter.
Over time, you may find that you have just finished a four part series identifying great characters for mysteries. Do you just let the last post end? No! Nada! Nyet! You need a closer or a summary post that pulls together the content of the previous posts and summarizes it to give your reader a nice clean conclusion.
Blogging Encourages Multi-Media
Moving past the act of writing blog posts, you will realize that raw text on the screen can be boring. A good visual every so often does wonders to jolt the reader and help focus their attention.
Images, Art, and Photos
You may be an artist, or have some great photos to reinforce your post, or you may decide to use the millions (possibly billions) of freely available content on the web. A quick image search on Google or Bing may yield that perfect addition to your post. Do not hesitate to use imagery. Users of the web, and your readers will expect it and be used to it.
Podcasts are the classic use case for audio in posts, but you could just as easily embed some spooky music to play while your reader reads your latest installment of Daytime Ghost Stories for the Faint of Heart.
We cannot forget our good friend video. What blog about historical fiction would be complete without a video of the authors visit to the battlefield setting of the last 9 books?
CAUTION: Watch that license
You just finished writing the perfect blog post, added the perfect images, audio and video, and posted it for the entire world to marvel at. Noon the next day a messenger appears from a law firm to deliver a cease and desist letter, and a notice of intent to sue for damages due to your use of an image that was licensed. Don't let this happen to you – check the license of all material you use in your posts.
Know what Creative Commons Is and Respect it
Since this is the web, this will be more difficult than it might seem. There are many different licenses for the content on the web. To help solve this problem, a group of licenses were created under the Creative Commons. This organization has made it easy to understand your usage rights for anything using a Creative Commons license, and just as easy for you control your content by selecting the appropriate license. The Creative Commons license is designed for content on the Internet and is globally recognized.
Authors Note: I am not a lawyer. Never even played one on TV. So my advice on legal issues is absolutely worthless, and if you use it without checking with your own REAL lawyer, then it is not my fault – IT IS YOURS! Understand? Good!
A Blog's Medium is the Web
A blog is a product of the web. Leverage that fact. Link to content from other sites or blogs on the web that are relevant to what is in your post. Don't copy the content, link to it when possible. These links between sites is what defines and reinforces the web. As the links into and out of your blog grow, you will be more deeply entrenched into the fabric of the web. This is a very rough approximation of what search engines look for in returning results. The more relevant you are, the higher up the search rankings you will be, and the easier for your readers to find you. The more content you produce for the web, the more other blogs cite your work, the more relevant you are to the web. It is that simple. One of the first maxims of blogging I ever learned was 'Content is King!' I am not sure who originally coined it, but it is true. Unless you plan to spend a lot of time optimizing for search, don't focus on concept such as Search Engine Optimization too much. Just produce quality content, frequently, and develop links in and out of your blog. That should be enough for you develop a solid presence on the web that is easily found by your target audience.


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The Monkey Trial
With The Scopes Trial or "The Monkey Trial" making waves in Dayton, Tennessee, two brothers hoped to bring their chimpanzee, Ozy, down to the festival to make some quick cash. Everyone was talking about the trial. So, they were bound to get filthy rich with a monkey, right? That was the plan anyway until the one thing that was supposed to make them rich became their worst nightmare.
The Monkey Trial is a short story.

subset: commoncrawl


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"Fur Re-Invented" is a program of the Fur Council of Canada that aims to encourage fashion design students to integrate fur into their collections and explore de creative potential of this exceptional fashion material.
2013 Participants: Nunavut Arctic College Students
This year, the Fur Council of Canada, in partnership with NAFFEM, was delighted to invite the students of Nunavut Arctic College to participate in the 2013 edition of its FUR RE-INVENTED Canadian Fur Design Competition.
Sealskin is the fur featured in the contest this year and NAFFEM is a unique occasion for Nunavut Arctic College to showcase, to the fur industry at large, the creativity and design skills of its students in creating modern fashionable garments, using this traditional material and Inuit designs and culture as inspiration.


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- 4 beds
- 2 baths
- $179,500 price
- 317990 mls id
- Year Built: 1961
- Status: Active
Great house on a hill that shows beautifully. Fabulous front porch to sit on and drink morning coffee or afternoon wine. 4BR/2BA, with 2,245 sq.ft. and the office could easily be a fourth bedroom. The entry foyer welcomes you into the livng room and dining room. And then......fabulous new kitchen with all new appliances, granite counters new cabinets and drawers overlooking spacious great/family room with vaulted ceiling (tin ceiling) and fireplace. This is a very long room featuring a wall ( floor to ceiling) of insulated windows looking out on a beautiful, large lot that is very private. Breakfast room included in kitchen. They are using the 4th bedroom as an office and that works for them because it is on the opposite end of house from the other three. . All four bedrooms are very spacious. Both bathrooms have been updated and remodeled. Master bath has a new walk-in shower and 2nd bathroom has a new deep tub. Great location - close to JA, shopping and easy access to I-55. Show it today.
- Site Link
- Property SubType Single Family Detached
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Must see this 4 bedroom / 3 full bath home on large, beautiful corner lot with side entrance driveway! With upscale shopping and dinning nearby, this is an ideal investment property. Spacious master suite with walk in closets and has great storage throughout home. Nice private patio and shaded,...
1865 E NORTHSIDE DR Jackson, MS
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Come on home to this fabulous 4 bedroom 3.5 bath home. This home has so many amenities I don't know where to start. Let me begin with the wonderful yard that offers so many landscaping possibilities for those blessed with a green thumb and that love to show it off. Adorned with majestic pines,...
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Don't miss this fantastic opportunity in desirable Belhaven, just 2 blocks from Laurel park. This home is on a large lot and has a detached garage for one, could be opened up to allow for 2 vehicles, plus lots of extra storage. The side yard is fully fenced and perfect for pets, garden or play...
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This well maintained home is located in a very desirable NE Jackson location. The front porch welcomes you to the home with beautiful brick flooring. The home features a foyer, living/dining with large windows overlooking the front yard, and a family room with built ins which is open to the...
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Come view this great home in a quiet neighborhood minutes from I55. Well taken care of 4 bedroom 2.5 bath with approximately 2,563 sq; which includes a lovely sunroom with sky lights, formal dining room and living room plus cozy family room with fireplace. 2 car enclosed garage and fully fenced...
4 beds, 2 baths, $175,000
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Come see this lovely 4 bed 3 bath home. Situated on a quiet street this house has plenty of square footage and some great features to go along with it! At the front of the house you have a beautiful dining room and formal living room perfect for lounging. In the kitchen you have a double oven,...
4 beds, 3 baths, $175,000
Listing Agent: William Fair
Courtesy of: Neighbor House, LLC
Courtesy of: nell wyatt real estate
Office Phone: 601-956-8533
Listing Agent: Harriet Brewer
Updated: 2nd April, 2020 6:19 AM.
1609 WINCHESTER ST Jackson, MS


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Need some solid firepower to take out your chosen heretics? is a regular old laspistol not doing it for you? How about something with a bit more punch? how about a triple barrelled laspistol!?!?! The design of the clip allows the bottom of the clip to also be held like a 2nd grip, allowing you to hipfire on auto or do a powerful blast firing all 3 barrells at once!
This prop prints in a single piece! and requires no support!
its big too! you may need to cut it up or scale it down if your printer is too small! prints fine on a CR-10 though
Check out my collection of Warhammer props!
Head of Design and 3D Printing Manager at Wave of the future 3D.
Facebook - https://www.facebook.com/Waveofthefuture3D/
Website - www.waveofthefuture3d.com


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Preferred Masonry Restoration Inc. has worked with hospitals, schools, and many other commercial properties in Philadelphia, New Jersey, New York, Delaware and Connecticut. Below is just a partial list of the projects that we have renovated in our service area. If you would like to discuss any one of these projects or to speak to us about your own project, please call us today at 610-849-0075 or submit the contact form on this or any page of our website.
|2 Caufield Place
|Newtown, PA
|28 West State St
|Trenton, NJ
|300 Clock Tower Dr
|Hamilton, NJ
|330 Carter Rd
|Princeton, NJ
|45 West 14th st
|7115 Stenton Ave
|Philadelphia, PA
|7165 Stenton-Ave
|Philadelphia, PA
|7180 Ogontz Ave
|Philadelphia, PA
|750 Columbus Ave
|90 Woodbridge Center
|Woodbridge, NJ
|Advanced Auto Parts
|Architects Housing Apts
|Trenton, NJ
|Bank of America
|Dover, NJ
|Bayonne Public Schools
|Bayonne, NJ
|Beneficial Bank
|Cherry Hill, NJ
|Boverini Stadium, Passaic High School
|Passaic, NJ
|Bronx Community College
|Bronx, NY
|Chester View Condominiums
|Royersford, PA
|Christopher Columbus Elementary School
|Union City, NJ
|Cobbs Creek Apartments
|Philadelphia, PA
|East Orange Community Day Center
|Bloomfield, NJ
|Fort Mott
|Pennsville, NJ
|Franklin St Train Station
|Reading, PA
|Germantown Manor Condominiums
|Philadelphia, PA
|Irvington High School Stadium
|Irvington, NJ
|Lambertville High School
|Lambertville, NJ
|Lenox Towers Condominiums
|Philadelphia, PA
|Magee Rehabilitation Hospital
|Philadelphia, PA
|New Jersey capital comples Parking Garage
|Trenton, NJ
|Newtown Athletic Club
|Newtown, PA
|NJ Transit Station
|Hoboken, NJ
|NJ Transit Transfer Garage
|Hoboken, NJ
|NJ Transit-Watsessing Train Station
|Bloomfield, NJ
|Nugent Senior Housing
|Philadelphia, PA
|Oak Lane Charter School
|Philadelphia, PA
|Ogontz Ave. Redevelopment Authority
|Paterson Post Office
|Paterson, NJ
|Pennsdale Housing
|Philadelphia, PA
|Pettys run
|Trenton, NJ
|Port Authority
|Jersey City, NJ
|Metuchen, NJ
|Public Health Management Corp
|Philadelphia, PA
|Septa Queen Lane Train Station
|Philadelphia, PA
|Stony Creek Condominuims
|Norristown, PA
|The McCallum Condominiums
|Philadelphia, PA
|The Murano Condominiums
|Philadelphia, PA
|The Philadelphia Navy Yard
|Philadelphia, PA
|The Stickley Museum
|Morris Plains, NJ
|Valley Court Condominiums
|Philadelphia, PA
|Venango House Apts
|Philadelphia, PA
|Easton, PA
|Washing Township School
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In the 1970s, the WHO embarked on an ambitious project to promote primary health care worldwide. The Expanded Programme on Immunization (EPI) was one of the most successful parts of that effort, yet some national EPIs struggled to increase vaccination coverage while others were very successful. Drawing on documentary sources from the WHO Archives and Library, this paper traces the historical development of global EPI policy and compares the development of two programs: the high-performing EPI in Malawi and the low-performing one in Cameroon. Global advisers' rigid adherence to then-current global policy and blindness to local conditions and historical legacies exacerbated problems faced by Cameroon's EPI, helping explain that program's weakness. In Malawi, in contrast, the similarity of global policy and local practices helped strengthen the EPI. Greater flexibility in pursuing program goals and attention to historical legacies could help future programs avoid similar counterproductive dynamics.
In 1978, the International Conference on Primary Health Care issued the Declaration of Alma Ata (UNICEF and WHO 1978), which affirmed the importance of health (broadly defined as "a state of complete physical, mental and social wellbeing") as a human right and called for the development of primary health care (PHC). It defined PHC as appropriate community-based care to address the main health problems faced by communities through intersectoral cooperation to promote health and to prevent and treat diseases. This vision of PHC served as the basis for the WHO's Health for All by the Year 2000 campaign, which lasted until 1994, when the WHO concluded that it couldn't achieve its goals (Chan 2008:865).
The PHC campaign was a precursor to major global development efforts that have followed, like the Millennium Development Goals (MDGs) and the Sustainability Development Goals (SDGs). Many of the goals it espoused informed subsequent efforts, including efforts to promote child and maternal health (MDGs 4 and 5), to end hunger (MDG 1 and SDG 2), and to ensure access to clean water and sanitation (SDG 6). Recent years have seen new interest in the promises of PHC; WHO director-general Margaret Chan called for a return to Alma Ata in 2008 (Chan 2008). The renewed emphasis on PHC is the foundation for new global priorities, including efforts to encourage universal health coverage and renewed interest from many donors and health organizations, like the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in strengthening health systems as a key part of promoting development.
The literature on PHC is vast, including debates about selective/vertical versus comprehensive/horizontal approaches (Gish 1982; Newell 1988; Walsh and Warren 1979), community participation (Rosato et al. 2008), and integration (Bhutta et al. 2008; Ekman, Pathmanathan, and Liljestrand 2008). However, this extensive literature does not examine how the global PHC program was implemented and the effect this had on participating countries. Instead, most examinations tend to focus on national (or even sub-national) PHC programs (see e.g. Rohde et al. 2008). This neglect continues despite growing attention to the effect global health programs and organizations have on participating communities (Biesma et al. 2009; Doyle and Patel 2008) and the impact of aid on receiving communities (OECD 2008). There is also a large literature on how the World Bank and other international financial institutions influence health and health policy in the developing world, particularly through structural adjustment programs (Babb 2005; Noy 2015, 2017), yet little attention to the WHO. Given the renewed global interest in PHC and the key role global development campaigns continue to play in promoting the development of health services worldwide, we must ask: What can global development efforts learn from previous attempts to promote PHC during the WHO's Health for All campaign?
In this paper, I address this question through an examination of one part of the Health for All effort: the Expanded Programme on Immunization (EPI). While the Health for All program ultimately failed, the EPI met its goal, "universal childhood immunization," defined as 80% global coverage ("Expanded Programme on Immunization and Vaccine Quality: Progress Report by the Director General," 1992). However, this broader success masked large differences in country experiences. I examine the implementation of the EPI in two countries: Malawi, which was particularly successful at extending immunization coverage, and Cameroon, which was not. Focusing on vaccine delivery strategies, I examine the interplay between changing global recommendations and national program development, as national EPIs strove to meet ambitious program goals.
Global-level recommendations regarding vaccine delivery strategies changed considerably between 1974, when the EPI began, and 1992, when the program achieved its target. Global-level changes profoundly influenced national-level practices, with global advisers and periodic program evaluations playing a key role in transmitting new global program recommendations to national programs. In doing so, global advisers rarely showed a deep understanding of local context or history, even when global recommendations called for radical changes in national programs. However, national legacies proved tenacious in practice, with local-level personnel resisting radical change even while national policy quickly changed to conform to global recommendations. I argue that global advisers' rigid adherence to global policy recommendations and blindness to local historical legacies exacerbated problems faced by Cameroon's EPI, helping explain that program's weak performance. In Malawi, in contrast, the fortuitous congruence of global policy and local practices created synergistic conditions that helped strengthen the EPI there.
In the following sections, I review the data and the methods I use in choosing my two cases and analyzing the development of their national EPIs. I then provide an overview of the history of vaccination services in Malawi and Cameroon prior to the EPI. Next, I examine program developments over the course of the EPI, focusing on three distinct periods of global policy recommendations. I conclude by reflecting on Malawi and Cameroon's experiences and the lessons they hold for global efforts to promote health and the development of strong health systems.
My analysis combines an examination of dynamics at the global and national levels using documentary analysis methods. For case selection, I use the nested case method (Lieberman 2005). I focus on the period from 1974, when the EPI began, to 1992, when the program met its "universal childhood immunization" goal. For the national cases, I cover the period from 1974 to 1990 due to data limitations.
The global-level analysis focuses on global-level policy changes in the EPI program and draws on five sources: official EPI progress reports; debate and resolutions concerning the EPI from the annual meetings of the World Health Assembly, which sets official WHO policy; reports from the annual meetings of the EPI's Global Advisory Group; technical documents related to the EPI; and articles related to the EPI in the Weekly Epidemiological Record.
To choose cases, I calculate regression residuals based on the results of five separate fixed effects regressions of immunization coverage in low- and middle-income countries. Quantitative analyses focused on vaccination coverage with the four vaccines targeted by the EPI (DPT, polio, measles, and BCG) and an index variable including the average of coverage with all four vaccines. Control variables include infant mortality rate (IMR), GDP per capita, population, two measures of ties to international organizations, a measure of state durability, an autocracy index, and an indicator of armed conflict.1
Based on these regressions, I calculated regression residuals and then the average residuals by country. I then created lists of the 10 countries with the largest positive and negative residuals for each regression. Table 1 lists the countries with largest positive and negative residuals for each model, respectively. Countries with large positive residuals have higher vaccination coverage, on average, than predicted by my models. Countries with large negative residuals have lower vaccination coverage than predicted.
African countries are overrepresented on lists of low-performing countries, with countries in francophone West and Central Africa performing particularly poorly. All three countries that appear on all such lists (Chad, Cameroon, and Gabon) are in this region. High-performing countries are more geographically diverse. Although several African states are included in at least one list, only Malawi and Gambia appear on all five lists. I focus on Malawi and Cameroon as my high-performing and low-performing cases, respectively. Both were early adopters of the EPI. This allows me to trace program development in both countries over the entire period and ensures that political commitment to the program is relatively similar. I draw on the WHO Archives for information about the national EPIs in Malawi and Cameroon.2 Documents come from Malawi and Cameroon EPI country files, the general Africa files, and African training files. My analysis focuses on program plans, evaluations, and correspondence from both countries.
Malawi and Cameroon were among the first countries to participate in the EPI. An experimental expanded immunization program began in Cameroon's capital city, Yaoundé, in 1975, and the program joined the global EPI effort in 1977. Malawi began its national EPI in 1978. Although both are in sub-Saharan Africa, Malawi and Cameroon differ on multiple dimensions, including their size, levels of ethnic diversity, colonial history, and governance. However, my analysis does not seek to gain analytic leverage from a strict comparison of programs in each country. Instead, each program is compared to predicted coverage based on the regression model.
Figure 1 compares predicted and actual vaccination coverage with the vaccination coverage index variable in Malawi and Cameroon for the years 1980 through 1992. We see that immunization coverage is consistently at or near the predicted levels in Malawi, although overall coverage levels stagnate around 1983 to 1984. In Cameroon, coverage is consistently below predicted levels, with distinct trends. Coverage increases rapidly in the early period before stagnating in 1983 and experiencing a major drop from 1985 to 1988. Thereafter, coverage increases rapidly, although it remains well below predicted levels.
The analysis that follows will seek to understand some of the dynamics at work to explain these trends. Before this, I provide an overview of immunization services in Malawi and Cameroon before the EPI began. Immunization services were organized along distinctly different lines in the two countries, and these historical legacies influenced the national EPIs Malawi and Cameroon developed, and continued to influence national practices in subsequent years.
Pre-EPI Immunization Services
In Malawi, public and private (mainly Christian/missionary) health providers have long cooperated extensively. In 1978, when the EPI began, private missionary groups ran almost half of Malawi's hospitals, a third of its primary health centers, and a fifth of its sub-centers (see "Expanded Programme on Immunization: Malawi," 1978, for information on immunization services in Malawi prior to 1978). Missionary health services have a long history in Malawi, as does cooperation between missionaries and government health services (Beck 1970; Good 2004; Hokkanen 2007).
As early as 1960, preventive care was available at some health centers during "under-five clinics" (geared to children under the age of five). In 1973 the Miniplan, a seven-year development plan for maternal and child health, called for the extension of under-five clinics and for an increased emphasis on preventive health, in particular "to increase the coverage of protection amongst children, especially against diseases for which effective antigens are available" ("Expanded Programme on Immunization: Malawi," 1978).
By 1977, a year before the Malawi EPI began, 50% of the country had access to under-five clinics providing vaccination with BCG, DPT, smallpox, and polio vaccines ("Expanded Programme on Immunization: Malawi," 1978; Letter dated 10/11/1978). Under-five clinics were held at some of the fixed health centers and run by mobile teams based at these centers. Malawi also ran mass immunization campaigns using specialized mobile vaccination teams to vaccinate against smallpox and tuberculosis, but these efforts were short-term, targeted campaigns, clearly distinguished from the "routine immunization" available through the under-five clinics.
Cameroon's immunization services differed from Malawi's in two major ways: how the services were provided and the groups involved. Cameroon built on the grandes endémies (major endemic diseases) system of mobile health teams that were common in francophone West and Central Africa. This excerpt from an unpublished manuscript describes how these teams worked:
In Yaoundé, as was traditional throughout urban or rural francophone Africa, vaccination services were delivered by a mobile vaccination team … which visited the city for 3 months every 2 years and attempted to vaccinate both child and adult populations against measles (6 month – 6 year age group), yellow fever (after 1 year-old), smallpox (all ages), and tuberculosis (BCG from 6 months – 20 years). ("Program of Multiple Antigen Childhood Immunization in Yaoundé, Cameroon," 1977)
Thus, in Cameroon in 1974, the government provided immunization using national vaccination teams that traveled the country in a biannual circuit. Teams were permanent but were not integrated into curative health services, instead operating out of a separate government subdepartment dedicated to public health and preventive medicine. Private, missionary groups seem to have played a much smaller role than in Malawi.
The mobile grandes endémies teams were an innovation of the renowned colonial doctor, Eugène Jamot. He first developed this approach to address a sleeping sickness epidemic in French Equatorial Africa in 1917. In 1922, he established similar services in French Cameroon, where he continued to work for a decade (Headrick 1994; Pepin 2011). This method, which relied on highly specialized mobile health teams periodically visiting the entire population to detect and treat (or prevent) diseases of major public health concern, was used to address multiple health issues over decades, including malaria, leprosy, yaws, and smallpox (Bado 1996; Pepin 2011). After independence, a regional health organization, the Organisation de Coordination pour la lutte contre les Endémies en Afrique Central (OCEAC), assured continuation of such efforts (Bado 1996:374; OCEAC 2010).
EPI policy concerning vaccine delivery strategies changed significantly as the EPI developed. My analysis reveals three distinct approaches during three distinct periods: the experimental approach from 1974 to 1981, the PHC approach from 1981 to 1985, and the coverage approach from 1985 to 1992.
The Experimental Approach
Early on, the EPI emphasized the need for innovation and experimentation to develop vaccination strategies for the developing world. This was a key recommendation from the report of the WHO's 1974 Seminar on Expansion of Immunization Services in Developing Countries. Even though EPI progress reports highlighted the connection between routine childhood immunization and PHC as early as 1976, the emphasis on the need for experimentation, particularly with "mixed strategies" (mixing mobile and fixed services), continued ("Expanded Programme on Immunization: Progress Report by the Director General," 1976:2). Even in 1977, as the EPI began its fully operational phase, the EPI simply recommended that national programs define a strategy, with little advice on what that strategy should be ("Expanded Programme on Immunization: Progress Report by the Director General," 1977:7–8)
Malawi and Cameroon both adapted existing health systems in establishing their national EPIs. In Malawi, this effort grew organically from the existing health system, while in Cameroon it consciously responded to the call for developing countries to experiment.
Malawi formally began its EPI program with its 1978 EPI Plan, which it submitted to the WHO for feedback. The plan called for expanding the under-five clinic system and adding measles vaccine to the list of antigens provided at the clinics. Under-five clinics were conducted on a weekly or monthly basis in fixed health services, or by mobile teams in areas "not easily covered by a static unit." At clinics, immunizations services were "carried out together with weight and growth monitoring, health/nutrition education, and early treatment at clinics." The plan also called for a two-year mass measles vaccination campaign using mobile teams (akin to the smallpox eradication campaign) to rapidly increase measles vaccination coverage, which was scant because that vaccine had not previously been available in under-five clinics ("Expanded Programme on Immunization: Malawi," 1978).
At first, EPI personnel at the WHO misunderstood the nature and intent of the mass measles campaign, believing it would only serve areas of the country not yet served by under-five clinics and that the campaign would be repeated on a two-year cycle. Based on this mistake, they criticized the limited number of antigens included and the two-year cycle, which wasn't sufficiently rapid to break transmission (Letter dated 17 Aug. 1978). A national-level health officer quickly clarified the plan (Letter dated 11 Oct. 1978), which received no further objections from the EPI program office in Geneva, and Malawi proceeded with the mass measles campaign. They added a second mass vaccination campaign targeting polio in 1980 ("Report on the Evaluation of the Expanded Programme on Immunization in Malawi," 1980) based on recommendations from a 1978 survey of polio prevalence (Ward and Lungu 1978).
In 1975, a team from OCEAC with extensive backing from the Centers for Disease Control and Prevention and USAID began an expanded immunization program in Cameroon's capital city, Yaoundé. Although it wasn't affiliated with the EPI, the Yaoundé program was self-consciously set up as a model and testing ground for the EPI. The new program adapted the grandes endémies system to the needs of routine childhood immunization by combining "the advantages of both mobile teams and fixed centers." A description of the program notes:
In the Yaoundé program, a mobile team circulates to 10 designated dispensaries and PMI's on a fixed calendar schedule … (e.g. each last Wednesday of the month the team will vaccinate at Centre A). These centers are situated throughout the city so that no area is more than about 1 km from a center. Only the trained team members handle vaccine, carry out technical aspects, do triage of vaccinees, etc. The chief of the team directs these activities. ("Program of Multiple Antigen Childhood Immunization in Yaoundé, Cameroon," 1977)
While the new program made vaccination regularly available at fixed sites, it still used specialized mobile teams to carry out vaccinations. Instead of traveling the country in biannual drives, the team traveled the city in a continuous circuit to run monthly vaccination sessions at the fixed health centers. It self-consciously sought to experiment with "mixed strategies" to establish routine childhood immunization services in a developing country, in answer to recommendations from the WHO.
By 1977, Cameroon was ready to expand the program nationally. To this end the Ministry of Public Health, with technical support from OCEAC, prepared a national EPI plan for 1977 to 1982. The plan called for the expansion of immunization services to cover the entire country over 10 years, so that the whole country could "profit from Yaoundé's experience," and built on the Yaoundé program, including plans to establish mobile vaccination teams in four new areas, along with a more general expansion of immunization services across the country ("Propositions et Projet de Budget, Programme de Vaccination Elargi, République Unie de Cameroun," 1977).3 The WHO's response was largely positive. A 1978 evaluation of the program, which included a close study of the Yaoundé vaccination team, praised the team's motivation, expertise, organization, and punctuality. It declared, "This independent, highly specialized mobile vaccination team … should be regarded as the nucleus for EPI expansion," and recommended that the team expand its activities to more health centers and play a key role in training personnel for the nascent national immunization program ("Review of the Expanded Programme on Immunization, Yaoundé, United Republic of Cameroon," 1978).
In sum, during this period Malawi and Cameroon both built on existing health services or practices to implement routine childhood immunization services. The programs differed substantially. Immunization services were much more extensive in Malawi, and the same health personnel carried out immunization and other well-baby examinations. In contrast, childhood immunization services only existed in Cameroon's capital, Yaoundé, and they were carried out by specialized immunization personnel. However, there were some points of similarity. In both cases, childhood immunization services were only periodically available (at weekly or monthly clinics), and in both cases services were available at a combination of fixed health centers and other sites. Plans in both countries received support from the WHO.
The PHC Approach
The Global Advisory Group (GAG), which the WHO formed in 1978, quickly established more precise recommendations for the EPI. From the start, it emphasized the EPI's key position in the WHO's broader PHC program, advocating a PHC approach to immunization. This emphasis is clear in the action plan it endorsed at its 1981 meeting, the first point of which urged, "Promote EPI within the context of primary health care," and identified two key aspects of this PHC approach: promoting community participation, and integrating immunization services into other health services, particularly maternal and child health services ("Report of the Expanded Programme on Immunization Global Advisory Group Meeting: 19-22 October 1981, Washington, D.C.," 1981).
The priority placed on integration led to a focus on fixed health centers as the key sites for immunization services. Advice on national program expansion from the EPI's first and second Medium Term Programs emphasized that regular immunization services should first be established in fixed health centers, followed by outreach services operating out of those centers ("Global Medium Term Programme: Expanded Programme on Immunization," 1980; "Global Medium Term Programme: Expanded Programme on Immunization," 1983). This emphasis on integration and the primacy of fixed health centers caused little change in Malawi but had a dramatic impact on Cameroon's EPI.
Long before Alma Ata, Malawi's immunization services were already developing in a manner that corresponded well with the PHC approach the EPI adopted in 1980: integrated with maternal and child health services and based in fixed health centers. This is not surprising. The WHO's PHC program had its origins in developments in the Christian Medical Commission (Litsios 2004), and Malawi is a country with a very strong tradition of Christian (missionary) medicine and long-standing cooperation between Christian and government medical services.
This fortuitous congruence meant that global advisers were generally pleased with Malawi's program. Only one aspect of the program caused concern: the ongoing mass campaigns against measles. While the 1980 program review expressed no disapproval of the ongoing polio and measles campaigns ("Report on the Evaluation of the Expanded Programme on Immunization in Malawi," 1980), a 1982 evaluation was more critical of new "mini-campaigns" in areas surrounding reported measles cases. The government had started these mini-campaigns in the hopes of containing outbreaks, but global advisers criticized this approach on epidemiological grounds and because it could "lead to the public expecting and waiting for vaccinators to visit their village rather than attending a clinic." Instead they recommended improving routine measles coverage through "a major propaganda campaign, through the media" in the hopes of "achieving … high coverage through under-5 clinics." They also recommended that the country develop "appropriate strategies" for reaching areas without under-five clinics, such as "a three monthly visit by a well-equipped mobile team" ("Joint Evaluation of the Expanded Programme on Immunization, Malawi: September 20-October 8 1982," 1982).
Due in large part to the program's failure to attract needed external financial support, Cameroon's attempt to expand its EPI in the late 1970s stalled, and the EPI was in crisis. In the face of this failure, the government submitted a new EPI proposal to the WHO in early 1980. Following WHO recommendations from 1978 to base its program on mobile vaccination teams and to use the Yaoundé team as "the nucleus for training to other health personnel for expansion of vaccination activities in Cameroon" ("Review of the Expanded Programme on Immunization, Yaoundé, United Republic of Cameroon," 1978), the new plan focused on perfecting the services mobile teams offered in three "demonstration zones," and then using those zones as centers for training as the program expanded throughout the country ("Projet du Programme Elargi de Vaccination du Cameroun," 1980). With UNICEF providing an important new source of external funding, the new expansion fared much better than earlier efforts. By 1982, 62% of departments had EPI services, and this rose to over 80% in 1984 and to 100% by 1986 ("Prospects for Universal Immunization by 1990 in Cameroon," 1986). Training personnel was a key priority, and at least 15 training courses were held between 1980 and 1986.
But in 1981, a new WHO-led program evaluation abruptly called the mobile-vaccination-team strategy on which the plan relied into question. It began by declaring, "The recommendation from the last evaluation concerning the reorientation of the Yaoundé vaccination team into a training team has not been realized. On the contrary, the team continues to carry out vaccinations according to the former mobile strategy system." It advised a new strategy centered on four key points:
Integrating vaccination services into the primary health services dispensed at fixed health centers,
Reorienting the mobile team toward a supervision and training role,
Establishing a calendar to suppress the mobile team's vaccination activities and replace them with vaccination at primary health centers, and
Retraining mobile team personnel in management, logistics, evaluation and supervisory methods "so that they can give the fixed center adequate technical support." ("Rapport d'une Evaluation du Programme Elargi de Vaccination (P.E.V.): République Unie du Cameroun," 1981)
In other words, the report recommended reforming Cameroon's program to conform to the PHC approach.
The 1981 evaluation is remarkable because it simultaneously calls for an unprecedented reorganization of Cameroon's EPI and suggests that it is reiterating recommendations from the last program evaluation. A close reading of the 1978 evaluation to which it refers clearly shows that evaluators in 1978 were not demanding that the Yaoundé vaccination team take on training duties in the place of their vaccination activities, as the critique suggests, but rather in addition to them. The team was meant to help in the training of new teams that were meant to begin programs using a "mobile strategy" like theirs.
While the government instituted the suggested reforms, local and regional health personnel expressed profound reservations about the new system. Personnel in OCEAC advanced four critiques of the PHC approach.
Theoretical critique: specialized teams were "more effective and efficient" than the health personnel in fixed centers.
Empirical critique: in OCEAC countries, the PHC approach was less effective at improving vaccination coverage than the grandes endémies tradition.
Humanitarian critique: the focus on fixed centers left the rural majority with no access to services.
Personnel problem: health personnel in fixed centers, overburdened with curative care, "do not welcome being additionally burdened with vaccination activities," and many staff didn't have adequate health training to undertake such duties. ("Compte-Rendu du Mission," 1982)
A series of local studies from a mix of urban and rural areas written between 1983 and 1985 echo many of these objections ("Evaluation de la Couverture Vaccinale dans la Ville de Bafoussam (Cameroun), Decembre 1983," 1983; "Evaluation de la Couverture Vaccinale dans le département du Noun en juillet 1984," 1984; "Rapport de l'Evaluation de la Couverture Vaccinale dans la Ville d'Akonolinga en Novembre 1985," 1985; "Résultats de l'Enquête Effectuée du 7 au 14 Novembre 1983 pour l'Evaluation de la Couverture Vaccinale dans le Nord-Est Benoué," 1983; Untitled Report I8 370 2CAE R84, 1984).4 Although all the studies praised the PHC approach as the "ideal strategy," they also all noted numerous ways this ideal failed in Cameroon. Studies from rural areas echoed the humanitarian critique, noting that mobile vaccination teams were necessary to reach rural populations due to lack of health centers or inadequate cold chains. Urban studies, in turn, referred to the personnel problem, noting health-center personnel's reluctance to undertake vaccination activities or incompetence in doing so. A particularly interesting series of studies from the department of Noun, including a coverage evaluation and cost-effectiveness study, addressed the empirical critique by comparing the efficiency and cost of fixed versus mobile vaccination services. They found that mobile teams were both more efficient and more cost-effective than fixed centers. Not only were children served by teams more likely to complete the full vaccination series than children served by fixed centers, but the cost per fully vaccinated child was also much lower: CFA 5,957 compared to CFA 12,354 (Untitled Report I8 370 2CAE R84, 1984).
The cost-effectiveness study also offered new theoretical justifications for mobile strategies: improved management and training and greater community mobilization. The study notes:
The mobile team doesn't only play a vaccination role but equally supervises our dispensaries and SSP centers, trains personnel in these centers, evacuates the ill, etc. Also, the arrival of a mobile team in an isolated village is a non-negligible factor in mobilizing the population. It would be foolhardy to suppress our mobile team in the long run only on financial criteria.
The focus on community mobilization is especially significant. Community participation was one of two key features of a PHC approach to immunization, according to the five-point plan developed by the GAG in 1981. However, advice from the GAG and the WHO in the early 1980s generally ignored this aspect of the PHC approach, instead focusing on integration.
In sum, during this period Malawi and Cameroon had very different experiences with global advisers. While Malawi met with praise and only modest critiques, Cameroon's program came under intense criticism, leading to a complete reorganization of the program during this period. The criticism Cameroon faced highlights global advisers' blindness to local legacies. The authors of the WHO's 1981 program evaluation were apparently unaware of (or did not care about) the long history of mobile vaccination services in Cameroon. More surprisingly, they were not fully aware of the nature of feedback Cameroon had already received from previous WHO program evaluations.
The Coverage Approach
By mid-decade, problems in increasing vaccination coverage sufficiently to meet the universal childhood immunization goal led to innovations. While reaffirming the continued relevance of the PHC approach, the 1983 GAG report called for "experimentation with innovative strategies to increase vaccine delivery" ("Report of the Expanded Programme on Immunization Global Advisory Group Meeting: 31 October - 4 November, 1983, Manila," 1982). In its 1985 meeting, the GAG issued five new recommendations concerning vaccine delivery strategies:
"Adopt a mix of complementary strategies for programme acceleration";
Sustain increases by strengthening PHC;
"Provide immunization at every contact point";
"Reduce drop-out rates between first and last immunization"; and
"Improve immunization services to the disadvantaged in urban areas." ("Report of the Expanded Programme on Immunization Global Advisory Group Meeting: 4-8 November 1985, Copenhagen," 1986)
These recommendations built on the PHC approach in important ways, including efforts to reduce the dropout rate and ensure immunization at every contact point. However, they also put new emphasis on "accelerated strategies," particularly intensive immunization drives during national (or sub-national) immunization days (NIDs), marking a significant break with the PHC approach's emphasis on immunization as part of broader integrated services based in fixed health centers. In keeping with past program practices, Malawi and Cameroon responded differently to these recommendations. Malawi favored PHC-strengthening recommendations, like immunizing at every contact point, while Cameroon continued to favor specialized, mobile approaches, eagerly adopting NIDs as a campaign tactic.
Although Malawi's EPI was performing much better than Cameroon's, the mid-1980s posed some major challenges. The period started well, with high praise from Malawi's PHC program in a 1984 evaluation of maternal and child health (MCH) services: "The coverage of MCH services and the standard of work is good. Often there is a degree of fidelity to ideals and standards which is truly an inspiration." Nevertheless, the review found that, while immunization coverage was good (55% of one-year-olds were fully immunized5), it had "plateaued," leading to the conclusion that "new approaches will … be needed before the target of 80% fully vaccinated is met" ("Report of the Joint Programme Review: Maternal and Child Health, Expanded Programme on Immunization and Other Elements of Primary Health Care," 1984). Concretely, it recommended greater community participation to encourage participation in programs, daily MCH/EPI clinics at health centers, and immunizing children who visited health centers for other reasons to reduce the dropout rate. MCH/EPI clinics had previously been held weekly or monthly, and there was no tradition of immunizing at other times. Nevertheless, all recommendations were incorporated in the 1985 to 1989 EPI Plan ("Malawi Epidemiological Quarterly: Expanded Programme on Immunization," 1985).
Despite these plans, an evaluation in 1985 found that immunization coverage had dropped significantly, with only 35% of one-year-olds fully immunized. A survey of reasons for the vaccination failure found "obstacles" as the main reason (58% of total), with lack of vaccines or vaccinators accounting for 30% of cases ("Evaluation of National Immunization Coverage, Malawi - August 1985," 1985). The 20% drop in coverage found in the 1985 evaluation was largely due to a major fuel crisis, which forced Malawi to cancel outreach services and remove vaccines from numerous fixed health centers because they lacked the kerosene needed to run their refrigerators ("Country Summary: Malawi," 1985). Evaluators were apparently unaware of this: the evaluation made no mention of the fuel crisis and recommended, among other tactics, exploring "accelerated strategies" as a possible response to program decline, despite the high fuel needs of such programs ("Evaluation of National Immunization Coverage, Malawi - August 1985," 1985).
By 1986, coverage levels had rebounded to 1984 levels or better ("E.P.I. Malawi Country Report," 1986), but evaluators were less satisfied with the program and staff performance than in 1984. The 1988 evaluation included a detailed analysis of vaccine misadministration ("National Evaluation of the Expanded Programme on Immunization," 1988). Coverage had improved since 1985, with 58% of one-year-olds fully immunized, but vaccine misadministration greatly reduced coverage, particularly with measles vaccine. Sixty-eight percent of children would have been fully immunized had health workers correctly followed the vaccination schedule. Given this finding, it recommended that staff training and supervision be improved. The evaluation also found that many health units (16 out of 27 visited as part of the review) failed to provide immunization services daily and called for investigation of the reasons for these failures. It also highlighted the need for a better system for identifying "defaulters" (children who failed to complete the necessary immunization series) as a corollary to other social mobilization activities.
With its immunization program struggling, Cameroon was a leader in implementing new "accelerated strategies." In 1986, services extended to 70% of the country, with 70% of vaccinations carried out at fixed centers and 30% by mobile teams, but only an estimated 35% of one-year-olds completed the recommended immunizations ("Plan d'Action, 1986-1990," 1986). An evaluation of the prospects for achieving universal childhood immunization by 1990 was pessimistic, concluding that Cameroon needed to "radically improve on all aspects of the entire system" to meet the goal (Lantum 1986). Pressure for change was high due to the looming deadline and continent-wide efforts to improve immunization coverage as part of the African Immunization Year.
New international recommendations suggested several new strategies for improving coverage, and program research pointed to two main ways to do it: improving community participation in programs and improving immunization services at health centers. Two studies of reasons for the low participation in Youndé's EPI in 1979 and 1982 highlighted parents' lack of knowledge about vaccines and vaccination services and indicated that outreach efforts needed to target different ethnic groups, as vaccination coverage was higher among some ethnic groups than others (Brown et al. 1982; "Expanded Programme on Immunization: Community Participation and Immunization Coverage," 1984)
Cameroon responded to the need to mobilize parents by experimenting with new "accelerated strategies." In 1984, Cameroon organized "special immunization days" in four areas. The evaluation showed a major impact on coverage in those areas (Lantum 1986), so the EPI organized a series of NIDs in 1986 for the African Immunization Year. It included substantial publicity, with the first lady starting off the campaign, and led to major improvements in coverage, although not substantial enough to reach the target of universal childhood immunization ("Rapid Assessment: Cameroon's National Vaccination Campaign," 1988). Despite some logistical problems, the 1986 NIDs were broadly successful at increasing coverage, but less successful at strengthening routine services. As one report noted, the accelerated strategy became "an end in itself, instead of [a] means to improve [the] regular EPI" ("Country Notes: Cameroon," 1988). After 1986, NIDs apparently became a regular feature of Cameroon's EPI ("République du Cameroun: Projet à 'noter' pour un financement supplémentaire," 1986).
Improving services at health centers proved more difficult. A 1983 study showed that substantial numbers of partially or unimmunized children could be reached by immunizing children appearing at health centers for other reasons, like well-baby clinics or for illness. It recommended that health centers systematically review children's immunization status, that immunization services be included at all well-baby clinics, and that children with minor illnesses be immunized ("Expanded Programme on Immunization: Sick Children: Targets for Immunization," 1983). However, acting on these recommendations would have required substantial cooperation from health center staff, and the "personnel problem" continued to be a major challenge for Cameroon's EPI. The 1986 to 1991 program plan noted that fixed-center staff "lacked motivation," and included numerous plans for improving supervision, training, and motivation of staff, but did not include plans to immunize at every contact point or recommendations regarding sick children ("Plan d'Action, 1986-1990," 1986). A 1986 study of the country's dropout rate found that illness was the main reason for failure to complete immunization series, despite recommendations to vaccinate children with minor illnesses (Keuzeta et al. 1986), and a 1988 rapid assessment noted that immunization sessions were still only held monthly and that supervision remained weak ("Rapid Assessment: Cameroon's National Vaccination Campaign," 1988).
In sum, during this period Malawi's and Cameroon's EPIs both struggled to meet the ambitious goal of 80% vaccination coverage. However, national programs drew selectively on global recommendations, choosing the strategies that best fit with national legacies. Hence, Malawi focused on strategies meant to strength routine vaccination services, while Cameroon employed new mobile "accelerated strategies," like NIDs. Despite a tepid response from global evaluators, who worried that NIDs were becoming "an end in themselves," the return to mobile strategies proved popular in Cameroon. Efforts to strengthen routine services encountered more difficulty in Malawi, where health centers struggled to implement daily MCH/EPI clinics and to immunize at every contact point. The fuel crisis that shut down many vaccination services made implementing these new strategies particularly difficult.
This paper examines the interaction between global advisers and local actors in implementing national EPIs in Malawi and Cameroon, with a focus on recommendations regarding vaccine delivery strategies. I identify three key phases of program development: the experimental phase from 1974 to 1981, the PHC phase from 1981 to 1985, and the coverage-oriented phase from 1985 to 1992. As shown in the above discussion, changes in global-level recommendations profoundly influenced national-level practices, with global advisers transmitting new policy recommendations through recommendations found in periodic program evaluations.
In Malawi the fortuitous congruence of global policy and local practices created synergistic conditions that helped strengthen the EPI there. In contrast, global policy increasingly diverged from practices in Cameroon, leading global advisers to call for radical change in Cameroon's EPI. While Cameroon quickly complied with these recommendations, national legacies proved tenacious in practice. Local-level personnel resisted radical change, calling into question the appropriateness of global advice when it diverged from historical practices.
These different dynamics help explain the relative strength of Malawi's EPI and the relative weakness of Cameroon's. A closer examination of how changing global–local tensions map onto program performance highlights this. In Figure 1 we saw that Malawi's EPI consistently had coverage near or above predicted levels. Similarly, there was consistently a good fit between global advisers' recommendations and existing strategies. Even when advisers' recommendations proved difficult to implement, as seen in the mid-1980s, the advice at least supported existing strategies or involved a sensible intensification of them. The worst moment for Malawi's EPI resulted from an acute external crisis: archival sources indicate that a fuel crisis in 1985 resulted in a precipitous drop in coverage. The record suggests that global evaluators were unaware of the cause of the drop and offered no advice on how to confront it.
In contrast, Cameroon's EPI never performed as well as expected. However, the degree to which it underperformed differed substantially across the period considered here. Early in the EPI, coverage was increasing rapidly, approaching predicted levels. However, around 1983 the trend changed, with coverage first plateauing and then dropping substantially until 1988. Finally, at the end of the period, coverage began increasing again, although it remained below predicted levels. This pattern maps onto changes in global-level recommendations, with a lag of approximately two years. During the experimental period (1974–1981), coverage increased and approached expectations. During the PHC period (1981–1985), coverage stagnated and then decreased, diverging sharply from predicted levels. Finally, during the coverage period (1985–1992), coverage again began to increase and approach expectations. These periods differed substantially in their openness to mobile strategies, such as those that had long been used in Cameroon. When mobile strategies were encouraged or tolerated (the experimental and coverage periods), Cameroon's program performed better. When they were anathema (the PHC period), the program performed worse.
Alternative Explanations
Could other factors explain the different experiences of these two countries? One possibility is that different political or economic developments in the countries provide a better explanation. We saw, for example, that an economic crisis, in the form of a fuel crisis, had a profound effect on Malawi's program. Economic crises were common in Africa in the 1980s, and both Malawi and Cameroon faced economic crises during these periods. In theory, the predicted values account for this, as the regressions control for GDP per capita. Also, economic crisis seems unlikely to explain the dynamics in Cameroon, as the timing does not fit the observed trends well. Cameroon faced a severe economic crisis beginning in the mid-1980s, admitting to the crisis and introducing budget restrictions in 1987 (Delancey and Delancey 2000:104–05), just as vaccination coverage began to rebound. Perhaps general economic crisis was not a driver of poor performance but rather funding problems within the program itself. Cameroon's EPI had trouble attracting outside support early in the program, while Malawi's program benefitted from substantial outside support from the start. However, program problems deepened just as funding difficulties became less acute. UNICEF began supporting Cameroon's EPI in 1982, just as the program began to falter.
Another possibility is that the system in Malawi simply was better than Cameroon's. And this is undoubtedly the case. Malawi's EPI was stronger than Cameroon's from the very beginning. Services were much more widely available, government commitment to the program was higher, and supervision and training were better. And the integrated PHC approach Malawi favored had clear advantages over the mobile approaches Cameroon generally preferred. In particular, it was much easier to establish frequent (daily) services and to immunize at every contact point based on that approach. However, the regressions used to guide case selection also take this into account by including country fixed effects. Hence, Malawi's predicted and actual vaccination coverage are both higher than Cameroon's (Figure 1). Cameroon's program faced its severest problems when trying to establish a program like Malawi's. It was during the PHC period, when Cameroon attempted to replace mobile teams with vaccinations at fixed centers, that performance was worst. As locally produced documents suggest, the PHC approach may have been better in theory, but in practice, in Cameroon, it was not. Local pushback rooted in the long legacy of mobile services in Cameroon may be why.
The key lesson from the above analysis is: historical legacies matter. Even for new programs, as childhood immunization was in 1974, developing countries draw on their experience and adapt existing institutions to new needs. These differences mean that one-size-fits-all approaches are inappropriate. While they may be well adapted to some cases, they could be counter-productive in others.
Research on the World Bank has shown that international organizations can be flexible in their advice to nation-states, adapting advice to local contexts and concerns (Noy 2017). Similarly, for the EPI, program performance was strongest when global recommendations offered the most flexibility, such as during the first, experimental period and the third, coverage-oriented period. This flexibility enabled global advisers to work with national programs to find the approaches that worked best for them, without demanding an unrealistic degree of expertise in the history of health services in each country.
- © 2019 by the Regents of the University of California. All rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press's Reprints and Permissions web page, https://www.ucpress.edu/journals/reprints-permissions.


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Unlike medical schools, law schools do not require a set of "pre-law" prerequisites. If you are considering law school, we encourage you to take a variety of courses to sharpen your relevant skills:
- Critical thinking
- Reading and writing
- Oral communication and performance
- Analytic problem-solving
- Research
Extracurricular activities and internships can give you insight into the practice of law and an opportunity to develop your leadership skills.
Is Law School for You?
Before you decide to go to law school, it's a good idea to get to know what law school entails to determine if it really appeals to you. Now is a good time to think seriously about whether you really want to practice law and if so, what you might do with your degree.
Some Things to Consider
What kind of law do you want to practice and do you have the kind of personality that does well in that field?
Are you ready for another three years in a demanding academic program?
Do you have a plan for covering the cost of law school?
Does your interest in law school come from a genuine interest, or are you doing it for your parents or friends?
Would you get more out of law school if you took a year or two to know yourself better?


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The Female Equation is a series highlighting female change-makers within their fields, their entrepreneurial journeys as well as what they believe makes up the ultimate "Positive Equation."
Today I wanted to introduce you Kendra Bracken-Ferguson, Founder and CEO of BrainTrust.
Watch an excerpt from my Instagram Live With conversation with Kendra discussing the taboo word: money. As female entrepreneurs, it's extremely important to be aware of your finances, how to properly scale and grow your business, and lean on experts to help you monitor your accounting. Click HERE to watch!
Are you a believer that sometimes you're just in the right place at the right time? That's exactly how I feel about my meeting with Kendra Bracken-Ferguson.
We were both attending an intimate Facebook Spring event where they invited companies to learn about new platform features. I had just started Positive Equation and moved to Los Angeles. We connected towards the end of the event by a mutual friend, exchanged business cards and I didn't think much of it. A couple of weeks later I had an email from Kendra following up about working together. I traveled with her team to multiple cities across the US producing digital content on a Sally Beauty influencer tour.
I love her tenaciously and drive in business. I'm thrilled to be able to share her story with you!
Q1: When did you decide to start your biz? Was there an "aha" moment?
A1: I launched my first business when I was working at Ralph Lauren as the first director of digital media when I had the idea to manage bloggers in 2009. I had recently met Karen Robinovitz and I texted her one Saturday morning, she called me and we both had the same idea and vision for the future of bloggers as influencers. She already had a company name – Digital Brand Architects ready to go and we put up a website that same day, got our husbands together on Sunday to share our idea and filed for an LLC on Monday!
Q2: What challenge(s) have you overcome and how?
A2: Starting a company while rewarding is hard work. There are ups and downs and highs and lows. The biggest challenge for both of my start-ups was and is cash flow. As a service-based business, you are constantly at the mercy of your clients "paying" on time. We are very judicious with spending and our P&L to manage cash flow and revenue.
Q3: Who's an inspiration or mentor to you in this rollercoaster ride of owning your own biz + one piece of advice they've shared with you.
A3: My mother, Teresa has been the biggest source of inspiration in my entire life. She continues to cheer me on and always has advice to share or even just a listening ear. She recently sent me this email about a business deal I am working on that helped me power through: "I support whatever decision you make because I truly believe that you have a heart for God and that you truly listen and seek his guidance. What he has in store for you is greater than you can ever imagine. Take care of your team, do what is right, do your best and treat people right. "
Q4: We all need fuel! What's your current go-to podcast or book right now?
A4: Becoming by Michelle Obama
Q5: What does a "positive equation" look like to you?
A5: In the words of Michelle Obama, "There is no limit to what we, as women, can accomplish."


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IPB was built on 1 September 1963 for strengthening food security, bioenergy, job creation, poverty alleviation, and preserving the environment. The IPB has a Faculty of Veterinary Medicine offering a DVM program at level of Bachelor of Veterinary Science and Doctor of Veterinary Medicine (DVM).The Faculty of Veterinary Medicine also offers Postgraduate Study at master and PhD levels in majors: Animal Anatomy and Development, Physiology and Pharmacology, Animal Biomedical Sciences, Reproductive Biology, Veterinary Public Health, Medical Microbiology, Parasitology and Medical Entomology.
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|Sorin Mihalache
|Iphone 7plus
|17th October 2019
|7th April 2019
|Keith Knowles
|I Phone Xr
|19th July 2019
The 4Smarts 2play Eara Wireless Earphones feature Bluetooth 4.2 technology, meaning you'll benefit from improved connectivity and easy connection of your devices. With a 10 metre range there is no need for wires or to sit directly next to your music source.
The vast majority of devices (smartphones, tablets, laptops and more) currently on the market are fully compatible with these earphones - ensuring that no matter what phone you use, these earphones will enhance both your music and your life.
Unlike other headphones on the market, the 2play Eara True Wireless Earphones are cable free, meaning that you don't need to worry about cables getting tangled or getting caught while your on the move.
Enjoy a superior audio listening experience with the 4Smarts 2play Eara Earphones, which feature independent drivers to deliver HD audio with crisp trebles, punchy mids and deep bass.
With a 4 built-in microphones, the 4Smarts Eara Wireless Earphones make hands-free calls simple, meaning you'll be able to leave your phone in your pocket while you take your call.
Incorporated onto the earphones the easy to use multifunction button allows you to answer / end calls, play / pause music and forward music.
With up to 12 hours of audio play back time with the charging case, you'll be able to listen for longer without having to constantly charge your headphones. On a single charge, the FreeBuds provide up to 2 hours of play time. When it comes charging, the battery goes from flat to full in approximately 2 hours.
To avoid losing your earphones, 4Smarts have included a silicone band allowing you to wear your earphones around your neck, if you wish to do so.
|Part No
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Mobile Fun are still open online and shipping orders. All product stock messages are up to date and as accurate as possible, with delivery times quoted at the checkout remaining accurate also.
These estimated time of arrival dates are constantly look at and refresh to ensure that you can purchase with confidence during this difficult time
Royal Mail's reliable economy postal service aims to deliver within 2-3 working days including Saturdays but may take longer. We guarantee to dispatch in-stock items on the same day (Monday to Friday) if you order before 6pm.*
*Please note orders for batteries and power banks may be subject to delays due to dangerous goods shipping requirements.
DPD Next Day Parcel guarantees next working day delivery and will take two days for the Northern Highlands, Northern Ireland and other distant areas. For DPD deliveries, we guarantee to dispatch in-stock items on the same day (Monday to Friday) if you order before 6pm.*
provides a comprehensive tracking system, including a live driver tracker and a 1 hour delivery window. *Delivery
*Please note orders for batteries and power banks may be subject to delays due to dangerous goods shipping requirements.
*Please note next day delivery times may be affected during National Bank Holidays.
A low cost, reliable international posting service, suitable for your less urgent orders. This service is untracked and is usually delivered within 4-8 working days, or up to 20 working days (depending on location).
Order before 6pm UK time for a fast, secure and reliable worldwide delivery. Your item will receive priority handling, and benefit from a full on-line tracking facility so you can check your mail's progress along the way. Usually takes 1-3 working days.
*Please note orders for batteries and power banks may be subject to delays due to dangerous goods shipping requirements.
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Monday, July 31, 2017
Chesnok Red Garlic Harvest
Not too much to report in the harvest department this week. I did harvest my "Chesnok Red" garlic plants this past week. I was worried about the bulb size becasue they looked so much smaller than the "Music" bulbs did when they were lifted. Well they are a lot smaller, but I think they are more "normal" garlic sized. My average bulb size was 2.6 oz. The smallest bulb was 1.8 oz and the largest came in at 3.4 oz. My total "Chesnok Red" this year was 2 lbs. 4.0 oz.
Posted by Lexa at 3:00 AM 1 comments
Labels: Garlic
Thursday, July 27, 2017
Green Patty Pan Squash
Yesterday I had the first male and female blossom open on the "Green Patty Pan" Summer Squash plant that I purchased at the Farmer's Market. The blooms opened while I was gone all day at work, so I can only hope that an industrious bee found its way to the plant and did a little pollination for me. I have been slowly gathering recipe ideas from the internet for patty pan squash, so I am hoping for a good harvest that will allow me to try a variety of new kitchen ideas.
Posted by Lexa at 9:08 PM 0 comments
Labels: Summer Squash
Monday, July 24, 2017
Music Garlic Harvest and the Last of the Sweet Peas
Yesterday I processed the "Music" garlic that I harvested back on Wednesday. Normally I like to have them cure for a week before I clean the bulbs and store them, but I am leaving on vacation soon and am in a bit of a time crunch.
I am so pleased with this harvest. This is my second year growing this variety. I first purchased my stock at the Common Ground Fair in Maine, in September of 2015. So this is my second year with "Music" and it really performed well. Pictured above, my biggest bulb weighing in at 7.5 oz.
I ended up harvested 17 bulbs. The average bulb size was 6.2 oz. The largest bulb was 7.5 oz. and the smallest came in at a healthy 5.0 oz. My total "Music" harvest for 2017 was 6 lbs. 9.8 oz. In comparison, the 2016 harvest was also 17 bulbs. But the average bulb size was 4.8 oz. and the total harvest was 5 lbs. 1.0 oz.
After cleaning the "Music" bulbs, I dug up my "Chesnook Red" garlic. I am not happy with this variety this year. I know that "Music" produces larger bulbs, but the "Chesnook Red" bulbs look really small. I will wait to process and weight them, but I think it might be time to order some new stock to plant this Fall.
"Wiltshire Ripple"
I also cut what are probably the last 2 sweet pea bouquets of the year. After a cooler May, a wet and cool June, and a cooler July, Summer decided to show up. These 90 degree days the last few days have taken a toll on the 2 sweet pea towers. But what a year they had. They absolutely thrived in the cooler weather. The "Wiltshire Ripple" produced more blooms than any sweet pea variety that I have ever grown. And the Royal Family" Mix did well too, after a tough start becasue of rabbit damage. Until next year.
Posted by Lexa at 5:00 AM 7 comments
Labels: Garlic, Sweet Peas
Tuesday, July 18, 2017
First Tiny Titus Cannellini Beans
The "Titus" Cannellini bush beans down in the Big Garden began to bloom about a week ago. Soon the snow white blossoms began to drop and tiny, immature beans were revealed. It's hard to tell at this point what kind of harvest its going to be this year, as the plants have really just begun blooming. But the plants look healthy and are continuing to produce new, leafy growth so I am optimistic about the a nice long spell of bean production.
Posted by Lexa at 9:20 PM 0 comments
Labels: beans
Sunday, July 16, 2017
Golden Celebration Rose
Our "Golden Celebration" rose opened its first blooms this weekend. It was the last of the 5 new roses that we planted this Spring to bloom. Since we didn't expect any of the roses to bloom this first year, these displays, although small, have been a real bonus.
This award wining variety from David Austin, released in 1992, has lovely golden-yellow blooms. They don't appear to be as cupped in shape with this first flush as they were described in the catalog. But that might change as the plant matures. They do have a very soft, floral scent. It will be fun to watch as this plant grows to reach its final 4.5' by 4.5' size.
Posted by Lexa at 4:14 PM 0 comments
Labels: Rose
Wednesday, July 5, 2017
Rose Birthday Girl
The first bloom opened this past weekend on the "Birthday Girl" floribunda rose. This rose is one of the 5 new roses that we purchased this Spring for one of our new flowerbeds. "Birthday Girl" has semi-double flowers with cream centers and pink and yellow edges. It is a repeat bloomer throughout the Summer and Fall. It should be a knock-out bush after it matures in a few year and gets covered in these vivid blooms.
Posted by Lexa at 1:05 PM 0 comments
Labels: Rose
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A network is the pictorial representation of the Project Plan which shows the inter-relationships and inter-dependencies of the component tasks. It is sometimes known as a 'logic diagram' or 'arrow diagram', however the term 'critical path network' is more commonly used throughout industry and will be used for this paper.
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Entering a race abroad has become an increasingly popular activity - events such as New York, Berlin and Paris marathons now attract thousands of international participants each year. As a leading specialist travel company, Sports Tours International offers runners travel packages and guaranteed race entry to major events around the globe. The company is currently looking at how international travel services are being provided and is asking runners to complete a survey to help.
If you complete the survey you will be entered into a competition offering the chance to win a pair of grandstand tickets - worth £500 - on the Champs Elysees in Paris for the final stage of the Tour de France on 21 July 2013. Alternatively winners can claim one of five £100 Sports Tours International gift vouchers, which can be used against a trip in 2013 or towards a holiday at Club La Santa in Lanzarote.
The survey ends on Friday (18 January). To complete it, click on this link.


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At the Formula Student, 1,200 students from all over the world competed in 42 teams and seven categories on at the Red Bull Ring in Spielberg/Austria with their home-manufactured racing cars. The race for the most sustainable vehicle concept was won by the team e-gnition of the University of Technology Hamburg (TUHH). It was named winner of the Clean Mobility Award in the category "Eco Design". The award granted by the Styrian automotive cluster ACstyria in co-operation with Magna Steyr is endowed with 1,000 euro.
Honours for most sustainable vehicle concept
Formula Student is much more than a competition of students enthusiastic about racing, because it allows young engineers to gain important practical experience for future careers while still studying. This concept also convinced companies such as Magna Steyr. The Styrian business unit of the automotive supplier thus took over the patronage of the "Eco Design" category of Clean Mobility Awards. Launched by the Styrian automotive cluster ACstyria, the award has been granted for the third time to the most sustainable vehicle concept developed by universities and colleges.
Lightweight and fast: Hamburg's electric racing car
"Eng14" is the third vehicle of the racer's forge at TUHH Hamburg. Running at up to 130 km/h, the electric car accelerates from 0 to 100 in 3.1 seconds. Constructed in collaboration with partners from industry and research, the team behind the racing car includes 56 students from all disciplines and semesters. TUHH's e-gnition team convinced the five-member jury in the category "Eco Design" both by the innovative use of materials from wood, flax, aluminum, and magnesium and their most sustainable overall concept. "We are very happy that our new concept allowed to further reduce weight, which, in the end, accounted for our victory", said Etienne Müller, team leader of e-gnition.
source and further details:
- Das Siegerfahrzeug © e-gnition


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Click here to print the obituary below
Annie "Nancy" (Mackay) ROSS
ROSS Annie (Nancy)
(nee MacKay) On Friday, December 14, 2018, Cnoc Aluinn, Croft-na-Creich, North Kessock, formerly of Forres and Esbank, Dalkeith, at the age of 98. Loving wife of the late Charlie, dear mother to Mary, Iain, Fiona and Donald. Funeral service on Thursday, January 10, at 12 noon, in Inverness Crematorium. Donations for Urray House. Enquiries to William T. Fraser and Son, Inverness.
Funeral Home
William T. Fraser & Son
Culduthel Road
Inverness, Inverness-shire IV2 6AB
01463 243232
Published in The Scotsman on Dec. 21, 2018


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Get Set Blush is the place where I write. I have started this blog in July 2012. This blog has anything and everything related to a girl. That includes beauty,fashion,health,fitness,diy and lots more. I am a software engineer by profession though I hardly like the coding part. lol. I decided to write about the fitness and lifestyle of an ordinary lazy Hyderabadi girl but ended up drowning into a huge world of makeup. I used to be a lover of eye makeup that includes everything related to eye makeup (eye shadows, palettes the most, colored eye pencils, thick eye lashes..literally everything) later on I started falling for lipsticks that has the colour just like my lips (n*de lipsticks, few turned out to be my mlbb lipsticks).. Once I am over with the mauvy,browny lipsticks I am all set to be bold and try out some shades of RED lipsticks. I was bowled over by the colour and eversince I started wearing red lipstick, I was thrilled to try the other shades, especially the orange.
by the end of 2013.. I am in love with Red/Orange lipsticks, lightly lined eyes and cute korean hair styles. Update! 2014-15 is all about MAC lipsticks for me lol
Coming to the word Korean,
Gosh everything related to Korea excites me.. I love their culture, their skincare, their fashion, lifestyle, makeup, ombre lips, thick eye brows, hair buns everything.. So, I am going to add some blogposts exclusive to my love for Korea!
About my skin:
I'm NC 44-45 according to MAC.
I have oily combination skin which is prone to unconditional breakouts.
I have shoulder length hair. I coloured it. Straightened it. I streaked, bleached and put it under all the tortures you can name. I have an oily scalp.
So, most of the product reviews will be related to this combination of my skin/hair/body.
I love anything related to Lipsticks,Smokey eyes,Jeans and tees,Tattoos,Hyderabad and South Korea. I think I can write a book on the above topics lol.
Contact me at :


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Living paycheck-to-paycheck is a difficult and stressful situation. Your paycheck arrives. Bills are due the next day. You divide your paycheck, and like an onion sliced into pieces, it just makes you cry. OUDS discusses and gives advice on smart rules for creating a successful budget.
Of course, nobody deliberately wants to be trapped in this cycle, yet 80 percent of people in the South Africa are in it, unable to get themselves out of the situation.
Now is the time to break free from this stressful cycle, save more, and get more sleep.
How to do that? The simple and boring answer is "budget."
Create a Successful Budget
You're probably tired of hearing the word "budget" from friends and financial advisers. The word has become a cliché that you would probably take for granted, or write off as one of those things that people rave about but don't actually work.
"I know, I know but budgeting doesn't work for me. All the time."
Wrong! Boring as it sounds; the budget is the most powerful tool available for you to escape the paycheck-to-paycheck cycle.
Here are some rules to make budgeting really work.
Tips to Consider for a Successful Budget
1. Be flexible
The reason why many people fail at budgeting is because their budget is too restrictive. Do you start picking at your hair or biting your nails when you exceed your budget? Then budgeting is making you nuts and will never ever work. You'll simply throw in the towel and forget about it.
Give your budget some wiggle room by having a set amount for every possible expense in a month. Have a budget for birthday gifts or leisure activities. If you didn't use it, then roll it over to the next month, or transfer it to another expense category.
2. Break down large expenses
Take for example life insurance premiums that are due every 6 months. If your premium costs R20, 000 a year, that's R10, 000 semi-annually (every 6 months). That's a shock expense if you do not prepare for it. And it eats up a large portion of your paycheck. As a result, you'll be scraping by the next couple weeks.
Swiping your card or getting a cash advance for it will only put a band aid to your problem. But when the bills arrive, have you got the R10, 000 ready?
Prepare for your large expenses by breaking it down to a few Rands every month. Large expenses are less frequent so you have enough time to save for them before they arrive. And because you're breaking it down to smaller expenses, you won't feel its pressure on your budget.
3. Budget for every possible expense you may have
Expenses have lots of categories. Examples: groceries, mortgage/bond, medical/dental checkups; then there are utilities such as telephone, water, electricity, Satellite T.V., propane gas, and internet. To top it off, there are credit card bills, car loans, and insurance premiums.
Listing all your possible expense categories is an eye-opening exercise. It gives you a clear picture of where you are actually spending your hard-earned money.
Now what you need to do here is to assign a value to every expense category you have. Of course, you should also have a category for "savings" and/or "investments" too.
By doing this, you won't be caught by surprise when an expense suddenly pops up. Running out of propane gas while cooking pasta? No worries. You have a successful budget for that.
What if I run out of money for a certain category? You might ask.
Simple and stress-free approach is to transfer some of your budget to another category. For example, you may want to transfer some money for "fun" to your budget for daily expenses. Having done that, you also have to limit your fun activities to adjust to your budget capacity. You may want to postpone that movie date or dine out until next month. Doing this makes your budget more flexible and less stressful for you, that's the key to developing a successful budget.
Again, a budget that is too restrictive will only make you complain right away and give up on budgeting. And that is, for the most part, the reason why people say budgeting doesn't work. They quit right away because they can't make it work!
4. Use your last month's paycheck
Individuals who live paycheck to paycheck receive their salary, divide their income, and "POOF", it's gone! Imagine not having to do that. Imagine not having to spend your paycheck for the month. Isn't it liberating?
Now that's the ultimate goal for your successful budget. It should gradually allow you to live on last month's income – or even income 6 months ago, why not. When you have that money sitting on your account, stress flies out of the window. You don't need to time your bills with your paycheck. You're basically free of those kinds of worry.
Find a way to be able to save an amount equivalent to a whole month's income. You can do it slowly but surely by keeping part of your income or you can do it fast by working extra or selling stuff. When you are able to live on last month's income, you have arrived at the sweet spot – you're out of the paycheck-to-paycheck cycle.
If you are finding yourself in this situation and unsure as to how to proceed
With over 11 years of specialized experience in the debt & legal field Oyisa United Debt Specialists is committed to assisting South African consumers in this regard.
Remember above all else that you are not alone out there. Contact OUDS directly for more information on our effective Prescription Debt Investigation process OR any of our other offered Phalanx© services.


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U.S. Navy Reserve
Advanced Pay Grade
Enhance your skills! Advance your career!! Serve Your Country!!!
"Ask not what your country can do for you, but what you can do for your country"
President John F. Kennedy
Navy Veterans
The Navy Reserve is open to all prior active duty or reserve commissioned naval officers (including Warrant Officers), with any designator (i.e., Surface Warfare Officers, Aviators, Naval Flight Officers, General URL, Meteorologists, Medical, JAG, etc).
The Navy Reserve offers you the opportunity to maintain your specialty, promote on schedule, and work towards a retirement (prior service time counts for this), all on a part-time basis!
You can also maintain SGLI benefits, NEX/Commissary privileges, limited health and dental coverage, and the pride of wearing the Navy uniform and serving your country.
There are units throughout Southern
California, including Los Angeles with which you can affiliate. Individual
Ready Reserve (IRR) members are also highly sought.
NCC Jon Delmundo, USN
Reserve Officer Programs
Los Angeles, California
Tel: (323) 574-0845
LT Patrick Bell
Navy Medical Officer Recruiter
Navy Recruiting District, Los Angeles
El Segundo, California 90245
Cell: (805) 390-0844
LTJG Thomas Britt
Reserve Medical Officer Programs
Los Angeles, California
Tel: (310) 383-6749
If you live outside Southern California, please call (800) USA-USNR for your nearest USNR recruiter!


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The Cameron leopard joggers are now available in khaki!
They are a relaxed fit with drop crotch and black tie. Super soft with stretch so you will look cool but be so comfy at the same time.
Pair them with a simple tee for effortless chic!
Fit tip: size down if you range between two bottom sizes.
95% Polyester
5% Elastane


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Olivia came into my life when I needed her the most. She helped me with the grieving process of losing my first fur baby. Olivia was being fostered by Susie's Senior Dogs when I met her at a senior adoption event. I did not let age or her medical history deter my thoughts of adopting her. I fell instantly in love and adopted her immediately through Pupstarz Rescue.
Since then, Olivia and I have been inseparable. She comes to work with me and when she is not working, she is getting spoiled by her grandparents. She has truly become a different dog, who is more adventurous and spunky! She is the apple of my eye, she is FoxyOlivia! xo