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WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA

PROPOSED PROGRAMME BUDGET FOR 1986-1987

NEW DELHI JUNE 1984-

PROPOSED PROGRAMME BUDGET FOR 1986-1987

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA

PROPOSED PROGRAMME BUDGET FOR 1986-1987

NEW DELHI JUNE 1984

CONTENTS Page Explanatory Notes Regional Director's Programme Statement Summary of Regional Health Programme by Source of Funds Regular Budget Estimates by Appropriation Section Summary by Programme and Organizational Level Summary by Programme Programme Analyses (See Index for Programmes on Page 31) Information Annexes: Annex 1: Annex 2: Regional Office V

- Budget Proposals - Country Statements and

Country Programmes Budget Proposals

: Annex 3 Annex 4:

Inter-country Programmes Abbreviations

Budget Proposals

EXPLANATORY NOTES 1 Development of the Proposed Programme Budget The Regional Director's Proposed Programme Budget for 1986-1987 has been formulated in accordance with the Seventh General Programme of Work and reflects linkages between the medium-term programme for the Seventh General Programme of Work and the programme budget proposals for the financial period 1986-1987. The proposals for the inter-country programme included in the document are those which have been recommended by the Consultative Committee for Programme Development and Management (CCPDM). The conclusions from the programming process carried out with national authorities have been summarized in the form of narrative country programme statements. They set out the broad programe trends, objectives and modes of action, giving a breakdown of the country planning figures by programme, but not details of staff, supplies and equipment, fellowships and other budgetary components. For the Regional Office, however, the budget details have, in accordance with the usual practice, been worked out and shown in the document. After these proposals have been reviewed by the Regional Committee, they will be consolidated by the Director-General into the WHO Proposed Programme Budget for 1986-1987, which will be submitted to the Executive Board. The Executive Board considers the proposed programme budget and submits it, together with its recommendations, to the World Health Assembly. The World Health Assembly reviews the proposed programme budget and the Executive Board's recommendations and adopts an appropriate resolution.

2 Form of Presentation The programme budget proposals have been prepared and presented in accordance with the WHO programme classification structure set out in the Seventh General Programme of Work. Thus follow the basic three-tier structure as illustrated below: Appropriation Section 3 3.9.0 3.9.1 Health Science and Technology Promotion and Care

- Health

Protection and Promotion of the Health of Specific Population Groups Maternal and Child Health, including Family Planning

In this presentation, the proposed budget for 1986-1987 is shown alongside the approved provisions for 1984-1985 (which are also reflected in accordance with the programme classification structure of the Seventh General Programme of Work), with the comparative increasejdecrease and percentage thereof shown for each programme. 3 Contents The Regional Director's programme statement on pages 1 to 12 is followed by various budgetary tables indicating the budgetary provisions for 1984-1985 (approved budget) and the proposals for 1986-1987 under the regular budget as well as under other sources of funds, including the summary of direct technical cooperation with, and services to, governments.

The programme analyses are given on pages 33 to 133. Under each heading of the programme classification there is a statement setting out as specifically as possible the objectives, targets by 1989, situation analysis, proposed programme activities and budgetary implications of the proposed programme activities. These statements cover country, intercountry and Regional Office activities and are followed by supporting tables showing the approved budget for 1984-1985 and the proposed budget for 1986-1987. The programme analyses are followed by information annexes. Annex 1 shows in detail the proposals for the Regional Office for 1986-1987. In Annex 2 follow the country statements indicating the Plan of Action, supported by budgetary tables by programme. Annex 3 shows the budget provisions for proposed inter-country activities as approved by the CCPDM and Annex 4 explains the various abbreviations used in the document. 4 Funding The proposed programme budget for 1986-1987 has been prepared within the regular budget allocation estimated at $50 896 000 for country activities. The increase for country activities is 17.5 per cent over the 1984-1985 approved budget, constituting 4 per cent for real increase and 13.5 per cent for cost increases. However, any real increase for 1986-1987 will depend upon prevailing economic factors and the ability to maintain cost increases below the amount for which provision is made. The allocation for the Regional Office and inter-country activities has been established at $18 977 200 which represents an increase of 13.5 per cent to be used only for cost increases. With regard to activities under the United Nations Development Programme (UNDP) and the United Nations Fund for Population Activities (UNFPA), the proposed programme budget includes, as in previous years, funds for all projects for which financing may reasonably be assured. As the funding position for 1986-1987 is, in many cases, not yet clear, the inputs for UNDP and UNFPA and other extra-budgetary sources show, at this stage, a decrease compared with the current biennium 1984-1985. It is expected that further financing will be approved closer to the biennium 1986-1987. 5 Cost Factor and Budgetary Concepts The budget for WHO is prepared on a full-cost basis and expressed in US dollars. This means that at the time of preparation, consideration is given to reasonably expected cost variation as a result of inflation and currency fluctuation. In the budget estimates for the Regional Office, which have been worked out in detail, an exchange rate of Indian Rs.10 to 1 US dollar has been applied for 1986-1987, as against Indian Rs.8.50 to 1 US dollar that was applied for 1984-1985.

REGIONAL DIRECTOR'S PROGRAMME STATEMENT Development of the programme budget proposals for the biennium 1986-1987 started with a critical review of the current health situations and an assessment of trends during the period 1984-1985. Taking into account the results of these analyses, a pragmatic projection of the broad health programme needs of the Member States for 1986-1987 was made. The potentials of the Organization to meet these needs in the most effective manner within its available resources were then explored through an analysis of various options. In this process, a series of free and frank dialogues between the countries and the Crqanization took place at various levels. The basis for these discussions were the national health policies and priorities, medium-term/ long-term national health plans and programmes and the national strategies for "health for all" on the one hand, and the regional and global "health for all" strategies, the Seventh General Programme of Work, the Regional Medium-Term Programme and the new "Managerial Framework for the Optimal Use of WHO's Resources in Direct Support of the Member States", on the other. The analytical review undertaken by the Regional Committee in 1983, based on the monitoring of the implementation of the national and regional "health for all" strategies, was also used as an input to this process. Thus the biennial programme budget proposals for 19861987 reflect the results of a valid synthesis of the policy decisions collectively taken by the governing bodies of the Organization at various levels with the national decisions taken by the countries individually according to their own socioeconomic situations and perceived needs. Appreciating the crucial role of the catalytic input of WHO in the national efforts for achieving the "health for all" goals, the countries are making serious efforts to use the Organization's limited resources optimally in order to derive the maximum benefit. As a result, they are taking keen interest in the management of WHO'S collaborative programmes at all stages of planning, implementation, monitoring and evaluation. The Consultative Committee for Programme Development and Management (CCPDM), consisting of a representative from each country of the Region, has not only been deeply involved in the development and scrutiny of the programme budget and its monitoring every six months, but has also been engaged in developing methods and modalities of evaluating a priority collaborative programme in each country in the context of the national programme. This is a welcome trend, as this will facilitate optimal utilization of WHO's resources in direct support of the health development efforts of Member States. While the Member States in the South-East Asia Region are using the mechanism of CCPDM at the regional level for the better management of WHO's resources for developing collaborative activities, they have also been actively applying many innovative approaches for the better utilization of the Organization's resources at country level in support of national health development. One of the most useful innovations in this regard has been the Joint Government-WHO Coordination Committee or similar mechanism which was first established in Thailand and subsequently in a number of other countries. The Thai model, which has been

functioning for several years, has undertaken the Programme Budgeting Exercise (PBE), which is characterized by flexibility and decentralization of authority, coupled with adequate accountability. An evaluation of the Thai PBE has been completed. In the meantime, efforts have been initiated in other countries to introduce gradually the new managerial framework for the optimal use of WHO resources. In Indonesia, another joint committee of high level national and WHO officials undertook an in-depth retrospective analysis of the process and procedures as well as the nature and content of the WHO collaborative activities, followed by a prospective study of the national needs and priorities, in order to identify the most appropriate areas for WHO's intensive support to achieve health for all. The implementation of WHO'S collaborative activities in the identified areas has started with a built-in mechanism for monitoring and evaluation. In India, a high level Joint Government-WHO Programme Development and Coordination Committee has been established with supporting task forces in identified programme areas of priority. This committee has been involved in developing the programme budget for both the current and the 1986-1987 biennium and is undertaking periodic reviews of programme implementation - both technical and financial - with the involvement of Regional Office staff. In Bhutan, the Government is keen to develop a decentralized health planning process, through the Dzonglak Plan, starting from district planning to national planning, using a "bottom-up" approach in which the Government has used WHO collaborative support intensively. In Sri Lanka, a Health Development Council has been established to make policy decisions regarding "health for all" activities together with a number of Health Development Committees as its working arms. JCHP studies aimed at coordinating the resources of WHO and UNICEF with those of the countries in the efforts to achieve "health for all" goals have started well in Burma and Nepal. In Burma, the three areas identified for this study are community participation, intersectoral collaboration and coordination, and resource mobilization. In Nepal, alternative approaches for the management and extension of PHC coverage will be implemented in four identified districts. The other joint WHO-UNICEF activity is the development of a five-year time bound nutrition programme updertaken in Burma and Nepal for which preparatory activities h&ve been completed. On completion of these activities, it is expected that there will be a measurable improvement in the nutritional status of the target populations in both countries. In Mongolia, where a scattered population and difficult communications are a problem, the Government is developing, with WHO's technical and financial support, a model PHC package in Huvsgul Aimak in order to provide integrated primary health care. Preparations for launching this programme have just been completed. Another important activity, undertaken by Bangladesh, Bhutan, Maldives, Nepal and Sri Lanka, is the Health Resource Group/ Country Resource Utilization (HRG/CRU) exercise as their first step towards further resource mobilization in support of the

implementation of "health for all" strategies. The findings of these exercises are in different stages of being processed and some of them have already been used not only fcr resource mobilization but also for the planning and management of national health programmes. The programme proposals for 1986-1907 have to be viewed in the context of these events and activities. The major thrust of the budget proposals for the 1906-1907 biennium, which have been influenced by the experiences gained through these activities, is directed towards (i) further development of health infrastructure with the objective of providing universal primary health care, (ii) application of the principles of the managerial processes for national health development as applicable to the various levels of health services, (iii) formulation and implementation of health manpower development policies and programmes commensurate with the actual needs of the health services, (iv) integration of the processes of health situation and trend analysis on a sound epidemiological base, (v) application of cost-effective and appropriate technology in the control of major communicable diseases, (vi) implementation of need-based programmes in support of the International Drinking Water Supply and Sanitation Decade balancing the two components, (vii) further development of national research capabilities, particularly health services research, for facilitating the application of known and emerging scientific knowledge for health development, and (viii) interagency cooperation and coordination and mobilization of external resources for health development. While the foregoing provides a compact view of the processes for the development and management of collaborative activities in general as well as the major programme thrusts for the biennium 1986-1987, a broad picture of the total country and intercountry programmes incorporated in the programme budget for the biennium is given in the following paragraphs; The health situation and trend assessment programme is a combination of epidemiological surveillance, health statistics and health information systems development programmes with the objective of sharply focusing the activities under these programmes on health situation and trend assessment as an integral process for health planning and management. The amalgamation of these activities and their reorientation towards the defined objective have been started during the current biennium (19841985), and based on the experience gained, detailed activities will be drawn up in 1985 for the coming biennium. It is envisaged, however, that the emphasis of the programme will be on the strengthening of the national health information system for needbased, management-oriented information generation and utilization and manpower training in epidemiological practices through field-oriented training programmes for improving the surveillance system. The programme on the managerial process for national health development has been receiving priority in most countries and its major effort will be directed towards the development and maintenance of a core group of multi-disciplinary expertise

required for supporting the national managerial processes in the health sector. Since there is a dearth of trained manpower in this area at present, WHO will continue to support and participate, through its country and intercountry programmes, in all planning, programming, monitoring and evaluation activities as may be needed for health development in Member States. One of the major points of WHO input will be the government-WHO joint mechanism for collaborative activities. Health systems research, which is popularly known as health services research in the South-East Asia Region, has been given the highest priority with twin objectives: first, providing research support for health infrastructure development and, secondly, undertaking research for the application of known and emerging valid information and knowledge for the improvement of services through the existing infrastructure. The South-East Asia Advisory Committee on Medical Research (SEA-ACMR) has already developed guidelines for health services research which will be the basis for developing this programme. Training in research methodology and exchange of information will be two important components in addition to support for actual research. Health legislation, although having a small input, has been identified as important in a number of countries. The major thrust of this programme will be to review the existing legislative support to health development .and the delivery of health services, especially in the context of primary health care. This may involve possible changes in the current laws relating to the functions of auxiliaries vis-a-vis doctors, food and drugs management and laws related to occupational and industrial health and communicable diseases control, e.g., leprosy, immunization, etc. The most crucial programme in all countries as well as at the regional level is the one on the organization of health systems based on primary health care. The basic need is the appropriate reorientation of the existing hospital-based, curative-oriented health system that devotes priority attention to urban areas, towards a really community-based, balanced health scrvice with promotive, preventive, curative and rehabilitative components and priority attention to rural people and the urban poor. Thus, development of the infrastructure, both in terms of institutions and manpower, will have a bias towards the community level with appropriate referral services at upper echelons. Health infrastructure development, therefore, will be coordinated with manpower development in order to achieve the much needed expansion of health service coverage. While health manpower development is a priority, it must be done in consonance with the actual requirement of the health services. The programme will thus aim at the integration of planning, production and utilization of health manpower, both at policy and implementation levels. The programme envisages provision of support for national health manpower planning with the HSMD approach, actual implementation of the plan, development of teaching/learning methods and materials, curricula development, and health manpower research. The Regional Office has now brought the two programmes, viz.,

Organization of Health Systems based on Primary Health Care and Health Manpower Development, under the same programme group, to facilitate implementation of the HSMD concept in the collaborative programmes and respond effectively in an integrated manner to national programmes. Public information and education for health is now a combined programme - during the Sixth General Programme these two components were separate programmes. The rationale behind the amalgamation of the two programmes is that they are closely interrelated and, once properly coordinated, are likely to have an impact with a multiplier effect. However, in the national context, public information media and mechanisms and the health education units of the ministries have been functioning under two completely different systems. Hence major efforts will be needed even to coordinate their activities and establish their complementarity at the national level in informing and educating the lay public in regard to priority health matters. WHO'S collaborative programme will undertake reorientation activities to achieve this coordination in order to increase the effectiveness of the ongoing programmes. Research promotion and development continues to be one of high priority, the quantum of financial support provided to this programme at the intercountry level being 5 per cent of the total regional budget in pursuance of the Regional Committee's resolution S E A / R C ~ ~ / R ~ The . SEA/ACMR has already developed a clear guideline on research needs for "health for all". The regional research programme is developed according to this guideline and is monitored by the SEA/ACMR periodically. The programme, as stated earlier, lays emphasis, and is based, on the broad concepts of health services research. However, there is a balance between applied and basic research, the main principle of guidance being the health needs of the countries of the Region. Strengthening of institutions and further development of national research capabilities are two other components that have received emphasis in the national and regional research activities. In the programme of general health protection and promotion, the nutrition sub-programme is a high priority in all countries. There are, of course, provisions for two other sub-programmes, Oral Health and Accident Prevention. Since malnutrition is not only a problem in itself but also contributes to infection and disease leading to a vicious cycle affecting productivity adversely, it has received close attention in most countries. The principal areas of action in this field will continue to be nutrition surveillance to identify target groups, prevalence rates, types of malnutrition and their underlying causes as well as formula,tion and implementation of cost-effective alternative intervention activities as appropriate. In order to train appropriate manpower in support of the implementation of national nutrition strategies, nutrition monitoring and nutrition education in the countries will be an important facet of the programme. Research to assess nutritional status, develop indicators according to specific country situations on various aspects of nutrition activities for monitoring and evaluation, and evolve alternative approaches for interventions will be

supported. The joint UNICEF-WHO programme on nutrition (supported by funds from Italy) has begun and is progressing well in Burma and Nepal. Its first phase is expected to be completed in five years, producing a major impact on the morbidity and mortality due to malnutrition on a national scale. Similarly, WHO and UNICEF will continue their efforts to support, at national and regional levels, the control of iodine-deficiency disorders (including goitre/cretinism), so that a major measurable reduction is expected, a significant step towards their eradication by the year 2000. The programme on oral health, which has been included in the proposals of a few countries, envisages training of manpower, improvement of services, strengthening of the promotive and preventive aspects, and integration of oral health with the general health services. Accident Prevention has been identified as an emerging problem by some of the countries of the Region. The programme envisages support to epidemiological assessment of the problem and determination of its magnitude as well as dissemination of information on the prevention of accidents and the preparation of technical guidelines for programme development. Under the programme on promotion of the health of specific population groups, while maternal and child health, including family planning, has received high priority in the programme budget proposals, Workers' Health and Health of the Elderly have also been included as emerging problems by some countries and have received modest allocations. There is an urgent need for developing a balanced programme with appropriate attention to both maternal and child health and family planning. The infant mortality rate continues to be quite high in most countries of the Region, indicating the low state of health and pointing to the need for strengthening MCH and family planning services. The major thrust of the collaborative programme is on the development of a sound institutional framework and appropriate manpower to support it in order to provide MCH and FP services to rural people and the urban poor. Thus, training of peripheral and middle-level MCH workers including traditional birth attendants is a priority. Promotion of breast-feeding and appropriate weaning foods will also receive attention. Family planning activities will be supported as an integral part of MCH care, and MCH/FP research will be supported mainly in regard to the operational aspects. The programme on Workers' Health will focus on the protection and promotion of the health of workers in various industries and in agriculture. Prevention of occupational diseases and monitoring of occupational health hazards along with health education of the workers will receive emphasis in the programme. Support will be provided for undertaking epidemiological studies on the hazards of indiscriminate use of pesticides and fertilizers in agriculture, in order to define the extent of the problem and to design remedial activities. Studies on the health of the elderly will be supported in order to identify the nature and extent of the problem and to develop alternative intervention measures. In the field of mental health, the main thrust will be directed towards the development of an organized community-based mental health programme. Support will be provided to the development of

mental health indicators and a monitoring system to assess the mental health status using the indicators especially monitoring child mental health. Thus the training of PHC workers in mental health will be an area of major input. Support for the early detection of acute mental health problems, institutional care of the acutely ill, training of personnel for treating mentally ill patients and rehabilitation of the mentally ill in the community will be continued. Health education and promotion of social action against drug abuse and alcoholism will be important components of the programme in some countries. The environmental health programme in this region will primarily concentrate on the implementation of the activities planned for the International Drinking Water Supply and Sanitation Decade. The four main areas in which the activities will be supported are programme planning, monitoring of implementation, institution development and manpower training. These activities will include the promotion of IDWSSD plans and programmes, support for developing a management information system, promotion of intersectoral collaboration, training of community-oriented manpower through the improvement of training institutions and support to actual training programmes and, finally, promotion of the exchange of information. Efforts will also be made to ensure the protection and maintenance of existing facilities, greater attention being paid to rural areas and balanced attention to both the water supply and sanitation components. Socio-behavioural studies, community participation and community education will receive special attention in order to achieve necessary health impacts. Measures against environmental health hazards, promotion of environmental health in rural and urban development, and the food safety programme will be supported in some countries. The programme in clinical, laboratory and radiological technology for health systems based on primary health care has been proposed by most countries along with that on essential drugs and vaccines. As for clinical and laboratory technology, a number of countries have taken steps to develop a network of laboratory facilities at primary health centres linked with referral laboratories. Quality control of laboratory services, training of technicians, preparation of manuals, development of and training in rapid diagnostic techniques, and the production and supply of reagents are areas in which WHO will provide support. Development of basic radiological services in the context of primary health care will be another area of WHO collaboration with the countries. As for essential drugs and vaccines, it is gratifying that more than 50 per cent of the countries in this region have by now acquired the basic capacity for the production of some of the essential drugs and vaccines; most of them have adopted lists of essential drugs which are being implemented at least in the public sector health institutions as far as practicable. However, there are areas where further improvement is necessary, and WHO'S technical support will be directed towards further development of drug policy and management and the quality control of drugs and vaccines. In selected countries, technical support will also be provided for manufacturing some of the essential drugs and their management along with improvement of the logistic system.

The programme on traditional medicine, proposed by a number of countries, envisages promotion and development of already known indigenous drugs and the use of practitioners of traditional medicine in primary health care. The rehabilitation programme will promote the use of rehabilitative technology appropriate for specific situations in order to provide a productive life to the affected people. However, major emphasis will be on the prevention of disabilities through health education and the promotion of precautionary measures. Communicable diseases continue to cause high morbidity and mortality in the countries of the Region, consuming a large proportion of health budgets. All the countries of the Region except the Democratic People's Republic of Korea have allocated funds for this programme according to their priority. In spite of the availability of potent immunizing agents, a large number of infants and children are still suffering from neonatal tetanus, whooping cough, measles, poliomyelitis, diphtheria and tuberculosis. As a result, the infant and child (one to five years of age) mortality rates continue to be quite high in all countries of the Region except the Democratic People's Republic of Korea and to a great extent in Mongolia and Sri Lanka. Keeping this situation in view, WHO'S collaborative programme will support activities of the expanded programme on immunization in ten countries, with the major emphasis on three aspects. First, support will be given in strengthening the technical and managerial aspects of the programme by giving programme managers and field staff task-based technical and management training. Second, WHO will collaborate in establishing and maintaining the cold chain by supplying equipment and spare parts, training staff in the maintenance of cold chain equipment, promoting the production of cold chain equipment locally, and developing maintenance workshops in the countries. Third, WHO will assist governments in ensuring the supply of potent vaccines in which UNICEF is playing a commendable role. The Organization will also provide technical assistance in actual programme planning, monitoring and evaluation. It is gratifying that the results of the persistent efforts that are going on in the development of the EPI during the past years have borne fruit in terms of increasing coverage, improvement of the cold chain system, better quality of managerial performance and, above all, some positive impact on the control or the target diseases in limited areas where service coverage is consistently high. The problem of malaria has defied solution so far. On the contrary, the problem is now no longer only technical; ~hnagerial, financial and manpower difficulties have become equally acute. The technical problem of the resistance of parasites to drugs and of vectors to pesticides is being addressed through intense research, and efforts are being made to develop antimalaria vaccines under the TDR Programme. There is, however, an immediate need for accelerating efforts to apply the existing technology efficiently and rapidly by intensifying and expanding training programmes for enhancing the managerial and technical skills of the managers and field workers and by mobilizing sufficient resources to maintain

the efficiency of the antimalaria activities. Thus, WHO'S collaborative programme, as proposed, will provide support for stimulating and enhancing operational efficiency through training programmes for malaria workers in epidemiological practices and managerial skills needed in the field. Cevelopment of training facilities for epidemiology and entomology, involvement of the community through health education and motivation in appropriate antimalaria activities, intensification of spraying, case-finding and treatment activities, interdepartmental and intercountry border coordination and, finally, mobilization of resources through clear definition of the extent, nature and gravity of the problem will receive WHO support. Research will continue to receive urgent attention. While disease vector control is a part of the existing vector borne disease control activities in most countries, there is an effort in some countries to develop, with WHO collaboration, an integrated and coordinated approach for vector control using not only pesticides but also other techniques and methods including bio-environmental methods. While two countries have proposed activities of this type under their country budgets, the intercountry programme will also support this activity wherever feasible. As for parasitic diseases other than malaria, such as filariasis, leishmaniasis, intestinal helminthic diseases, guineaworm and schistosomiasis, these are matters of concern in some of the countries. Due to the increasing problem in this respect, the Regional Office has developed an intercountry programme to stimulate and promote appropriate activities. The major efforts will be to provide technical support to the countries in the epidemiological assessment of these diseases in order to develop appropriate intervention programmes for their control. The immediate objective of the diarrhoeal disease control programmes in the Region is the reduction of mortality by prompt oral rehydration therapy (ORT) along with health education and the promotion of personal hygiene. Since the method of treatment is simple, the strategy is to make oral rehydration salts (ORS) easily available to the community and the family and to train the members of the community and the family in the methods of using ORS. The success of the programme depends on managerial efficiency and active community action rather than on technical capability, since ORT is a very simple technology. WHO'S collaborative effort, therefore, will be directed towards training programmes for managers and field workers in the management of oral rehydration therapy and the distribution of oral rehydration salts, development of handbooks on the application of ORT, training of mothers and other members of the community in the use of ORS, and health education. WHO will also provide technical support in the production of ORS packets of a reasonably long life either on a large or a small scale. Operational research for the application of the technology for diarrhoea1 diseases control in specific situations will also be promoted and supported. The Regional Committee at its thirty-sixth session recognized acute respiratory infections ( A R I ) as an important contributor to

infant and child mortality and urged the Member States to organize programmes against ARI. Accordingly, epidemiological reviews of the problem have been initiated in some countries to assess the extent, nature and gravity of the problem. The Organization will support the continuation of these epidemiological studies with a view to defining the problem. Based on the results of the review, appropriate intervention programmes within the framework of primary health care will. be developed and supported both at country and intercountry levels. In spite of the availability of BCG vaccine and chemotherapy as well as antibiotics to fight tuberculosis, the disease continues to be a prominent cause of morbidity and mortality in a number of countries. While the value of BCC in the age group above five years has been questioned, the efficacy of the existing drugs is often hampered on account of the phenomenon of drug resistance. The major problem, however, is managerial rather than technical. WHO'S collaborative effort will be directed towards the training of manpower in the managerial and technical aspects of programme development and management as an integral part of general health services, promotion of BCC vaccination at an early age and further research on BCG, including field research, surveys and evaluation. Leprosy continues to be a problem in nine countries. The emergence of primary and secondary resistance to dapsone, the common antileprosy drug, has aggravated the situation. In view of this, while research to develop a vaccine has raised some hope and newer drugs for more effective treatment are being explored, existing technology, in spite of the countries' limitations, must be applied with adequate rapidity and efficiency in order to control the disease. Keeping this in mind, WHO'S collaborative programme will focus on improved case-identification and case-holding, operational research and the promotion of multidrug therapy. support will also be provided for training manpower and instituting health education and fie]-d-oriented research for the development/improvement of antileprosy programmes. WHO will also assist in procuring antileprosy drugs for multidrug therapy through voluntary agencies. Of the zoonotic diseases, rabies is the most important and pressing health problem at present in almost all countries of the Region. Comprehensive control programmes involving other healthrelated sectors have been developed in some countries. The major effort in most countries, however, is limited to post-exposure vaccination against rabies in humans. There is no systematic effort to register or vaccinate pets against rabies. The proposed activities will support the governments in developing policies and plans for rabies control in a comprehensive manner, including coordination among relevant departments, promotion of epidemiological studies in both man and animal, production and quality control of vaccine, rapid diagnosis of rabid dogs, preventive pre- and post-exposure vaccination of dogs, preventive postexposure vaccination of man, and the maintenance of records for retrospective analysis. Support will also be provided for the development of antirabies vaccine using modern techniques. Efforts will continue for the training of laboratory workers in the production of cell-culture antirabies vaccine at the Pasteur

Institute, Coonoor (1ndia). where training facilities have been developed under a UNDP-supported project executed by WHO. Sexually-transmitted diseases (STD) are countries although their prevalance is countries. The prevalence of the resistant has further aggravated the problem. WHO epidemiological surveillance, training of education for STD control. prevalent in all high only in some strain of gonococcus will collaborate in manpower and health

In the group of other communicable diseases, the Organization will support activities related to the control of dengue haemorrhagic fever (DHF) and acute hepatitis of viral or nonviral origin. WHO support will continue to be given to programmes against DHF in regard to epidemiological studies, the development of improved treatment regimen and the development of vaccine against DHF. As for acute hepatitis, the WHO programme will emphasize training in rapid diagnostic techniques for early diagnosis, epidemiological studies and implementation of control programmes. Blindness due to vitamin A deficiency, cataract, glaucoma, trachoma and trauma is common in at least nine countries of the Region. Governments have developed national programmes on control of blindness and impairment of vision with support mostly from voluntary agencies. WHO'S collaboration will continue in the field of planning and management, training of manpower, and assistance in holding eye camps and in mobilizing resources. In the field of cancer and cardiovascular diseases, which are emerging health problems in some of the countries, WHO will collaborate, particularly in epidemiological surveillance, planning and management of national programmes, early detection of cases, education of the community and the training of manpower, to enable an integrated approach through PtiC that is practical and feasible. Under the programme area, "other noncommunicable diseases", support will be provided in controlling chronic respiratory diseases, diabetes mellitus and other related diseases through community-oriented activities. In regard to health information support, the SEA Region of WHO has developed a network of health literature and library services, popularly known as the HeLLIS network. The programme has already developed a number of indices of available published and unpublished research papers. The network also provides routine library and reference services to health and research workers. WHO will continue to support this activity in 1986-1987 also. As for the financial aspects of the programme, it should be mentioned that the proposed programme budget for 1986-1987 has been prepared within the regular budget allocation estimated at $50 896 000 for country activities. The increase in the allocation for these activities is 17.5 per cent over the approved budget for 1984-1985, constituting 13.5 per cent for cost increases and 4 per cent as a real increase. However, this real increase (which amounts to $1 733 0 0 0 ) is likely to be reduced significantly or completely eliminated, depending on the latest situation regarding

the preparation of the programme budget proposals for the Organization as a whole, which will be finalized in October 1984. The reductions, if any, will be effected taking into account the quality and relevance of the priority programme activities in the countries. Since the changes due to possible reduction will, as stated above, be made only after October this year, the actual adjustments will be shown when the detailed budget is prepared for consideration by the 38th Regional Committee next year. The above summarizes the programme proposals for WHO'S collaboration with the Member States during the 1986-1987 biennium. It is obvious that WHO'S financial support is only a small fraction of the total national investment. However, the technical and catalytic nature of the WHO input continues to be unique in its multiplier effect. In any case, it is an undeniable fact that the countries of the Region, with very meagre resources but with a firm commitment to achieving the goal of "health for all by the year 200OU, are bravely fighting against innumerable health problems. The Ministers of Health of the countries of the SouthEast Asia, in an effort to mobilize resources through mutual cooperation, have already taken the initiative for developing a technical cooperation programme among the countries of the Region, especially in seven identified areas of priority. However, even this effort will not be able to bridge the resource gap. It is urgent, therefore, that every agency concerned with funding for health development should contribute adequately towards reducing this wide resource gap in support of the billion people of the South-East Asia Region in their effort to achieve Health for All.

S W Y OF REGIONAL HEALTH PROGRAMME BY SOURCE OF FUNDS

Approved Budget 1984-1985

Proposals

1986-1987

Regular Budget Other Sources Voluntary Funds for Health Promotion United Nations Development Programme United Nations Funds for Population Activities Trust and Other Funds Total - Other Sources

61 309 000

69 873 200

18 537 400 13 144 300

4 093 000

4 676 700 1 009 400 581 300 10 360 400

2 150 700 2 336 300 36 168 700

Grand Total

----------

97 477 700

-------------------

80 233 600

REGULAR BUDGET ESTIMATES BY APPROPRIATION SECTION

Appropriation Section

Approved Budget Purpose of Appropriation 1984-1985

Proposals -

1986-1987

Direction, Coordination and Management Health System Infrastructure Health Science and Technology - Health Promotion and Care Health Science and Technology - Disease Prevention and Control Programme Support

2 183 500 28 380 100

2 463 500 29 420 200

15 635 300

19 315 500

10 174 900

13 418 800

4 935 200

5 255 200

Total

----------

61 309 000 .

----------

69 873 200

SUMMARY BY P R O G W 4 AND ORGANIZATIONAL LEVEL r

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1937 Increase1 (Decrease)

Other Sources Approved Budget 1984-1985 Proposed Budget 1986-1987

us 1. 1.1.0 DIRECTION, COORDINATION AND MANAGEMENT Governing Bodies Regional 1.2.0 WHO'S General Programme Development and Management Regional Inter-country

62 400

150 000

87 600 140.3

1 660 800 460 300 2 121 100

1 765 600 547 900 2 313 500

104 800 87 600 192 400

6.3 19.0 9.1

297 000 297 000

362 400 362 400

2. 2.3.0

HEALTH SYSTEMS INFRASTRUCTURE Health System Development Country Inter-country 8 069 600 1 575 900 9 645 500 10 202 800 1 731 400 11 934 200 2 133 200 155 500 2 288 700 26.4 9.9 23.7 625 600 72 900 698 500 37 000

37 000

2.4.0

Organization of Health Systems based on Primary Health Care

Inter-country

2.5.0

Health Manpower

Inter-country

2.6.0

Public Information and Education for Health

Inter-country

R e g u l a r Budget Approved Budget 1984-1985 us $ Proposed Budget 1986-1987 us $ Increase/ (Decrease)

Other Sources Approved Budget 1984-1985 us $ Proposed Budget 1986-1987 us $

HEALTH SCIENCE AND TECHNOL O G Y - HEALTH PROMOTION AND CARE R e s e a r c h Promotion and Development Country Inter-country 1 341 200 2 811 900 1 644 100 3 380 900 302900 569 000 22.6 20.2 12 100 5 000

3.7.0

4 1 5 3 100

5 025 000

871 900

21.0

17 100

3.8.0

General Health P r o t e c t i o n and Promotion Country Inter-country 1 1 8 3 500 283 900

1 230 800 1 7 1 100 1 401 900

47 300 4.0 (112 800) (39.7)

185 200 53 500

1 667 400

( 6 5 500)

(4.5)

238 700

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources Approved Budget 1984-1985 Proposed Budget 1986-1987

us 3.9.0 Protection and Promotion of the Health of Specific Population Groups Country Inter-country

1 825 200 509 800 2 335 000

3 074 200 376 300 3 450 500

1 249 000 68.4 (133 500) (26.2) 1 115 500 47.8

1 703 500 857 200 2 560 700

5 900 1 000 000 1 005 900

3.10.0

Protection and Promotion of Mental Health Country Inter-country 587 600 241 800 829 400 481 900 171 100 653 000 (105 700) (18.0) (70 700) (29.2) (176 400) (21.3) 220 500

220 500

Regular Budget Approved Budget 1984-1985 U S $ Proposed Budget 1986-1987 U S $ Increase1 (Decrease) U S $

Other Sources Approved Budget 1984-1985 U S $ Proposed Budget 1986-1987 U S $

3.11.0

Promotion of E n v i r o n m e n t a l Health Country Inter-country 3 003 300 1 063 200 3 697 500 1 006 200 694 200 ( 5 7 000) 23.1 (5.4) 15.7 2 882 600 325 300 533 000 1 0 9 500

4 066 500

4 703 700

637 200

3 207 900

642 500

3.12.0

D i a g n o s t i c , T h e r a p e u t i c and R e h a b i l i t a t i v e Technology Country Inter-country 2 500 800 283 100 3 503 300 578 1 0 0 1 002 500 295 000 40.1 104.2 2 862 200 400 500 838 800

2 783 900

4 081 400

1 297 500

46.6

3 262 700

838 800

Approved Budget 1984-1985 us $

Regular Budget Proposed Budget 1986-1987 us $ Increase/ (Decrease)

Other Sources Approved Budget 1984-1985 %

Proposed Budget 1986-1987 us $

HEALTH SCIENCE AND TECHNOLOGY - DISEASE PREVENTION AND CONTROL D i s e a s e P r e v e n t i o n and Control Country Inter-country 8 515 600 1 659 300 11 634 700 1 784 100 3 119 100 124 800 36.6 7.5 14 634 700 4 1 2 1 200 4 093 000

4.13.0

1 0 174 900

1 3 418 800

3 243 900

31.9

1 8 755 900

4 093 000

5. 5.14.0

P R O G R A M M E SUPPORT H e a l t h I n f o r m a t i o n Support Regional Country Inter-country 406 300 85 200 87 700 418 600 106 900 50 000

1 2 300 3.0 21 700 25.5 ( 3 7 700) ( 4 3 . 0 ) ( 3 700)

38 8 0 0

40 400

579 200

575 500

(0.6)

38 800

40 400

R e g u l a r Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 us $ Increase/ (Decrease)

Other S o u r c e s Approved Budget 1984-1985 %

us 5.15.0 Support S e r v i c e s Regional Total: Regional Country Inter-country Grand T o t a l

Proposed Budget 1986-1987 us $

4 356 000 6 642 700 43 315 000 11 351 300 6 1 309 000

4 679 700 7 1 8 3 100 50 896 000 11 794 1 0 0

323 700 540 400 7 5 8 1 000 442 800

7.4 8.1 17.5 3.9 14.0

162 000 200 800 29 459 100 6 508 8 0 0 36 168 700

1 7 8 500 218 900 8 669 600 1 4 7 1 900 1 0 360 400

.---------------------- ------.-------------=------------==----------==-------=-------------=---------===-

------------

69 873 200

8 564 200

------------- ---------

SUMMARY BY PROGRAMME

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources Approved Budget 1984-1985 9 0

Proposed Budget 1986-1987

us 1. 1.1.0 1.1.3 1.2.0 1.2.1 1.2.2 DIRECTION, COORDINATION AND MANAGEMENT Governing Bodies Regional Committees WHO'S General Programme Development and Management Executive Management Director-General's and Regional Director's Development Programme General Programme Development External Coordination for Health and Social Development

62 400

150 000

87 600 140.3

368 400

400 300

31 900

8.7

275 000 1 292 400 185 300 2 121 100

325 000 1 365 300

50 000 72 900 37 600 192 400

18.1 5.6 20.3 9.1 297 000 297 000 362 400 362 400

1.2.3 1.2.4

222 900 2 313 500

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources Approved Budget 1984-1985 %

Proposed Budget 1986-1987

us 2 . 2.3.0 2.3.1 2.3.2 2.3.3 2.3.4 HEALTH SYSTEM INFRASTRUCTURE Health System Development Health Situation and Trend Assessment Managerial Process for National Health Development Health Systems Research Health Legislation

$ 4

3 692 000 5 549 900 367 400 36 200 9 645 500

3 314 500 8 176 400 344 100 99 200 11 934 200

(377 500) (10.2) 2 626 500 (23 300) 47.3 (6.3)

595 200 103 300

37 000

63 000 174.0 2 288 700 23.7 698 500 37 000

2.4.0

Organization of Health Systems based on Primary Health Care Health Manpower Public Information and Education for Health

8 486 700 9 204 400 1 043 500

7 359 700 8 820 700 1 305 600

(1 127 000) (13.3) (383 700) 262 100 (4.2) 25.1

1 979 000 4 345 500 384 400

547 200

2.5.0 2.6.0

1 932 700 682 000

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources Approved Budget 1984-1985 %

Proposed Budget 1986-1987

us 3. HEALTH SCIENCE AND TECHNOLOGY - HEALTH PROMOTION AND CARE Research Promotion and Development General Health Protection and Promotion Nutrition Oral Health Accident Prevention

3.7.0 3.8.0 3.8.1 3.8.2 3.8.3

4 153 100

5 025 000

871 900

21.0

17 100

697 700 699 700 70 000 1 467 400

1 002 600 255 000 144 300 1 401 900

304 900

43.7

238 700

(444 700) (63.5) 74 300 106.1 (65 500) (4.5) 238 700

3.9.0

Protection and Promotion of the Health of Specific Population Groups Maternal and Child Health, including Family Planning 2 205 300 3 017 400 812 100 36.8 2 355 500 1 005 900

3.9.1

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources Approved Budget 1984-1985 Proposed Budget 1986-1987

us 3.9.2 3.9.3 3.9.4 Human Reproduction and Research Workers' Health Health of the Elderly

us 0

$ -

67 000 79 600 50 100 2 335 000 3

300 200 132 900 450 500

220 600 277.1 82 800 165.3 1 115 500 47.8

134 200

4 000 2 560 700 1 005 900

3.10.0 3.10.1

Protection and Promotion of Mental Health Psychosocial Factors in the Promotion of Health and Human Development Prevention and Control of Alcohol and Drug Abuse Prevention and Treatment of Mental and Neurological Disorders

357 300

221 100

(136 200) (38.1) 220 500

3.10.2 3.10.3

472 100 829 400

431 900 653 0 0 0

(40 200)

(8.5) 220 500

p p

(176 400) (21.3)

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources Approved Budget 1984-1985 %

Proposed Budget 1986-1987

us 3.11.0 3.11.1 3.11.2 Promotion of Environmental Health Community Water Supply and Sanitation Environmental Health in Rural and Urban Development and Housing Control of Environmental Health Hazards Food Safety

3 320 000

3 958 600

638 600

19.2

3 168 500

642 500

350 200 124 500 271 800 4 066 500

50 200 384 000 310 900

(300 000) (85.7) 259 500 208.4 39 100 637 200 14.4 15.7

39 boo

3.11.3 3.11.4

4 703 700

3 207 900

642 500

3.12.0 3.12.1

Diagnostic, Therapeutic and Rehabilitative Technology Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care Essential Drugs and Vaccines

1 296 600 675 700

1 562 600 719 500

266000 43 800

20.5

1 452 900 189 000

3.12.2

6.5

R e g u l a r Budget Approved Budget 1984-1985 us $ Proposed Budget 1986-1987 us $ Increase/ (Decrease)

Other Sources Approved Budget 1984- 1985 %

Proposed Budget 1986-1987

us 5

3.12.3 3.12.4 3.12.5

Drug and Vaccine Q u a l i t y , S a f e t y and E f f i c a c y T r a d i t i o n a l Medicine Rehabilitation

415 200 196 300 200 100 2 783 900

584 200 840 500 374 600

169 000 644 200 174 500 1 297 500

40.7 328.2 87.2

334 900 1 033 000

781 800 57 000

252 900

4 081 400

46.6

3 262 700

838 800

HEALTH SCIENCE AND TECHNOL O G Y - DISEASE PREVENTION AND CONTROL D i s e a s e P r e v e n t i o n and Control Immunization Disease Vector Control Malaria P a r a s i t i c Diseases 1 333 900

4.13.0 4.13.1 4.13.2 4.13.3 4.13.4

2 058 300 991 900 2 887 700 255 100

724 400 306 600 ( 3 1 5 600) 4600

54.3 44.7 (9.8) 1.8

816 400 2 766 100

685 300 3 203 300 250 500

6 645 600

3 557 000

Regular Budget

Other Sources Proposed Budget 1986-1987

Budget 1984-1985 -

4.13.5 4.13.6 4.13.7 4.13.8 4.13.9

Tropical Disease Research Diarrhoea1 Diseases Acute Respiratory Infections Tuberculosis Leprosy

4.13.10 Zoonoses 4.13.11 Sexually-Transmitted Diseases Smallpox Eradication Surveillance

4.13.12

4.13.13 Other Communicable Disease Prevention and Control Activities .4.13.14 Blindness 4.13.15 Cancer

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources Approved Budget 1984-1985 a, Proposed Budget 1986-1987

us 4.13.16 Cardiovascular Diseases 4.13.17 Other Noncommunicable Disease Prevention and Control Activities

790 600

709 000

(81 600) (10.3)

529 900 10 174 900

746 900 13 418 800

217 000 3 243 900

40.9 31.9 18 755 900 4 093 000

5. 5.14.0 5.15.0 5.15.1 5.15.2 5.15.3

PROGRAMME SUPPORT Health Information Support Support Services Personnel General Administration and Services Budget and Finance 364 600 3 110 800 623 900 381 900 3 395 200 636 300 17300 284 400 12400 4.7 9.1 2.0 35 000 127 000 38 500 140 000 579 200 575 500 (3 700) (0.6) 38 800 40 400

Regular Budget Approved Budget 1984-1985 us $ Proposed Budget 1986-1987 us $ Increase1 (Decrease)

Other Sources Approved Budget 1984-1985 us $ Proposed Budget 1986-1987 us $

5.15.4

Equipment and S u p p l i e s f o r Member S t a t e s

256 700

266 300

9600

3.7

4 356 000

4 679 700

323 700

7.4

162 000

178 500

Grand T o t a l

6 1 309 000

69 873 200

=-------------.------------==-----------=-------=-------------c-------------

----------- ------- ------------- -------------

8 564 200

14.0

36 168 700

10 360 400

PROGRAMME ANALYSES Programme Regional Committees WHO'S General Programme Development and Management Executive Management Director General's and Regional Directors' Development Programme General Programme Development External Coordination for Health and Social Development Health System Development Health Situation and Trend Assessment Managerial Process for National Health Development Health Systems Research Health Legislation Organization of Health Systems based on Primary Health Care Health Manpower Public Information and Education for Health Research Promotion and Development General Health Protection and Promotion Nutrition Oral Health Accident Prevention Protection and Promotion of the Health of Specific Population Groups Maternal and Child Health, including Family Planning Human Reproduction Research Workers' Health Health of the Elderly Protection and Promotion of Mental Health Psychosocial Factors in the Promotion of Health and Human Development Prevention and Control of Alcohol and Drug Abuse Prevention and Treatment of Mental and Neurological Disorders Promotion of Environmental Health Community Water Supply and Sanitation Environmental Health in Rural and Urban Development and Housing Title -

Programme 3.11.3 3.11.4 3.12.0 3.12.1

Title Control of Environmental Health Hazards Food Safety Diagnostic, Therapeutic and Rehabilitative Technology Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care Essential Drugs and Vaccines Drug and Vaccine Quality, Safety and Efficacy Traditional Medicine Rehabilitation Disease Prevention and Control Immunization Disease Vector Control Malaria Parasitic Diseases Tropical Disease Research Diarrhoea1 Diseases Acute Respiratory Infections Tuberculosis Leprosy Zoonoses Sexually Transmitted Diseases Smallpox Eradication Surveillance Other Communicable Disease Prevention and Control Activities Blindness Cancer Cardiovascular Diseases Other Noncommunicable Disease Prevention and Control Activities Health Information Support Support Services Personnel General Administration and Services Budget and Finance Equipment and Supplies for Member States

PROGWE

1.1.3

REGIONAL COMMITTEES

The Regional Committee is composed of representatives of Member States assigned to the South-East Asia Region. It normally meets once a year either in the regional headquarters or elsewhere in the Region as it may decide in advance. The functions of the Regional Committee are to formulate policies covering matters of an exclusively regional character and to supervise the activities of WHO in the Region. The Committee reviews the proposed regional programme budget and makes suggestions regarding the implementation of health activities of common interest to Member States. It also provides guidance to the Regional Directer in matters concerning cooperation at the regional level between the United Nations and the Specialized Agencies and with other regional international organizations having interests in common with the Organization. Furthermore, it can advise the Organization, through the Regional Director, who is the Secretary of the Regional Committee, and the Director-General, on international health matters which have wider than regional significance. The Regional Committee may also give preliminary consideration to questions likely to be taken up by the following World Health Assembly and sessions of the Executive Board. Pursuant to resolution SEA/RC34/R11, a Committee consisting of a representative from each of the Member States, has been appointed to carry out in-depth review of issues connected with programme development and make recommendations to the Regional Director who may submit these for the consideration and approval of the Regional Committee. This Committee has been institutionalized by the 36th session of the Regional Committee which renamed it as Consultative Committee for Programme Development and Management. It will, inter alia, review the WHO collaborative programme implementation four times in a biennium and also review the Regional Director's Annual Report and submit its findings to the Regional Committee. Activities for 1986-1987 Two meetings of the Regional Committee for the South-East Asia Region will take place during the biennium for which necessary provision has been proposed. Budgetary Implications The increase in allocations is mainly to provide for resources for the biannual meetings of the Consultative Committee for Programme Development and Management (CCPDM)

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease) Other Sources 1984-1985 1986-1987

us Regional

62 400

150 000

87 600

140.3

PROGRAMME Objectives

1.2.0

WHO'S GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

develop WHO'S collaborative programme to promote Member States' efforts towards realization of the goal of "Health For All by the Year 2000", and national levels.

- strengthen WHO's coordinating role in the field of health at regional and Sub-objective To implement medium-term programmes for WHO'S collaborative activities pertaining to the Seventh General Programme of Work for the period 1984-1989. Activities for 1986-1987 This programme consists of four sub-programmes, namely, 1.2.1 Executive Management, 1.2.2 Director-General's and Regional Directors' Development Programme, 1.2.3 General Programme Development and 1.2.4 External Coordination for Heaith and Socio-economic Development. Detailed plan of action indicating the main thrust of WHO'S support during the Seventh General Programme of Work period as also the activities that are proposed to be carried out in 1986-1987 are indicated in the programme statements that follow.

PROGRAMME

1.2.1

EXECUTIVE MANAGEMENT

The Regional Director is the chief technical and administrative officer of the Regional Office and, subject to the general authority of the Director-General of the Organization, has the overall responsibility for the planning, execution and evaluation of WHO'S programme at the regional level as well as for the management of the supporting administrative services. He is the secretary of the Regional Committee, and consults directly with the governments of Member

States of the Region. He takes decisions on regional policy matters and ensures coordination with WHO headquarters, with local or regional offices of other international or national, governmental and non-governmental organizations and institutions, as well as with other international organizations of regional scope. He keeps the Director-General informed of major health developments in the Region, and participates in Organization-wide discussions and consultations on policy matters relating to the work of WHO. The Regional Director also provides technical and policy guidance to all staff in the Region. Activities for 1986-1987 The Regional Director will be assisted by an administrative officer and secretariat staff to carry out the above-mentioned functions during the biennium.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

us $ 400 300

368 400

31 900

8.7

PROGRAMME Objective

1..2.2

DIRECTOR GENERAL'S AND REGIONAL DIRECTORS' DEVELOPMENT PROGRAMME

To collaborate with the Member Countries in meeting their special needs in areas not covered by specific programme activities, especially those with a potential for further development. These will also include needs arising from health emergency situations as a result of natural disasters. Situation Analysis The Regional Director's Development Programme has been utilized to meet emergent situations created by natural calamities such as floods, cyclones and outbreaks of epidemics. It also provides supplies critical for the implementation of various programmes in the countries of the Region, particularly the least developed countries. In addition to organizing important workshops/ meetings under the aegis of this programme, necessary consultancy services in areas of priority concern to the Member Countries, are being provided. Proposed Programme Activities WHO will support the governments in formulating and implementing programmes of an urgent nature in priority areas and help in resolving unpredictable and emergency health problems.

. Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources 1984-1985 1986-1987

us Inter-Country

z 18.1

275000

325000

50000

PROGRAMME Objectives To: -

1.2.3

GENERAL PROGRAMME DEVELOPMENT

provide the full range of technical support for the formulation and management of WHO's collaborative programmes with Member States, and ensure efficient development, implementation and evaluation of the regional medium-term programme based on the General Programme of work covering a Specific Period.

Sub-objectives To:

- update and implement the regional medium-term programme for WHO's collaborative activities, keeping in view the long-term perspective, in conformity with tho Seventh General Programme of Work;

- ensure that WHO'S collaborative programmes in 1986-1987 will further enhance technical cooperation among countries of the Region for the realization of the goal of health for all by the year 2000;

- ensure that the monitoring and evaluation of WHO'S collaborative programmes will be carried out at regional and country levels at regular intervals in order to maximize the impact of WHO's collaboration, and -

coordinate the regional programme budgeting process, based on its mediumterm programmes.

Situation Analysis The Seventh General Programme of Work became operational effective 1984. In order to implement the Programme, a Regional Medium-term Programme covering the period 1984-1989 has been formulated in collaboration with the Member Countries. This Medium-term Programme forms the basis for the formulation of the WHO collaborative programme for the three biennia of the Seventh General Programme of Work.

Monitoring of WHO activities in the countries is being carried out regularly. The Consultative Committee for Programme Development and Management, set up in pursuance of a resolution by the Regional Committee, undertakes periodic reviews of WHO programme implementation in the countries. Modalities for joint national/WHO evaluation of priority programmes have been identified. Integrated monitoring process with the involvement of Member Countries in the process ranging from formulation through implementation to monitoring and evaluation is being applied. Joint GovernmentIWHO coordinating bodies are active in many countries. Activities for 1986-1987 The regional medium-term programmes for WHO collaborative activities will be implemented in conformity with the Seventh General Programme of Work. The WHO collaborative programmes in 1986-1987 will be so aligned as to facilitate the attainment of the goal of health for all by the year 2000 with PHC as the key approach. Monitoring and evaluation of WHO collaborative programmes within the Region will be carried out at all levels. Such evaluation will be undertaken jointly by the countries and WHO. The mechanism for coordination of collaborative activities will be further streamlined and strengthened at all levels. Close liaison and support will continue to be provided to the Regional Committee and its sub-committees in the planning, implementation and evaluation of WHO collaborative programmes to support the strategy for the attainment of the goal of health for all by the year 2000.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

a 5.6

1 292 400

1 365 300

72 900

PROGRAMME Objectives To:

1.2.4

EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT

- coordinate with the specialized agencies of the United Nations as well as

with inter-governmental, international, national and non-governmental organizations engaged in health and health-related development activities;

- coordinate with multilateral and bilateral agencies involved in the health and socio-economic fields;

- collaborate with Member Countries in attracting increased extra-budgetary resources for their efforts to achieve the objective of health for all by the year 2000; and

- promote disaster preparedness and emergency relief for the Member States in order that the national capacity for disaster and relief management is strengthened with particular reference to health aspects at all levels. Situation Analysis Member States have adopted the social goal of health for all by the year 2000 as the national health policy and have formulated their strategies in pursuit thereof. The UN and its specialized Agencies as well as inter-governmental, national, international and non-governmental organizations in the field of health are evincing interest in participating in the activities of the governments geared to achieve this goal. WHO is supporting the governments in defining and systematizing the role and tasks of the collaborative agencies. After the first WHO/SEARO Workshop on Health Aspects and Relief Management of Natural Disasters was held in New Delhl in December 1983, an increased interest has emerged among the Member States to improve the national and regional emergency relief operations. There were also recommendations that a focal point in the Regional Office be made responsible for regional disaster management on a continuous basis including availability of staff and equipment, and that the first exercise he followed by regional and country workshops. Under the Cooperative Action for the International Drinking Water Supply and Sanitation Decade (IDWSSD), the 'Donor Catalogue' issued in 1981 has been updated, enlarged and reissued under the title 'Catalogue of External Support'. This has been selectively distributed by UNDP and WHO to relevant ministries and agencies in Member states. The Project and Programme Information System is also being followed up. Proposed Programme Activities Selective collaborative arrangements will continue to be made with other organizations concerned in order to promote inter-sectoral action in support of national and regional strategies for health for all. Some of these collaborative efforts include other UN Agencies individually or in groups as for example, the coordinated programming effort in Indonesia involves the majority of the UN organizations engaged in activities aiming at health and socio-economic development. WHO and UNICEF will continue their collaboration in many common fields of interest as for example, the joint planning for PHC and nutrition. The collaboration with non-governmental organizations is an important approach both in general and for those programmes dealing with specific health aspects in modern society: prevention and rehabilitation of handicaps, problems of youth and ageing, women's role in health and development, etc. Also, the Regional Office will participate more actively in the special programme for research and training in tropical diseases and further develop network

activities in statistics/information, research and training in collaboration with other agencies. The descriptive national documents resulting from country resource utilization (CRU) reviews will be a useful basis for dialogue and discussion with bilateral, multilateral and other funding agencies with a view to mobilizing additional resources for implementing national health strategies and priority programmes for health development. Admittedly, the review of health resource use and requirement, as we1 as rationalization and mobilization are mainly national efforts; the WPCR and the Regional Office will provide technical and other cooperation in these important follow-up actions. Additionally, the CRU review documents provide a sound basis for national endeavours for coordination of external resources for health development efforts. If necessary, support from the Regional Office and WPCR will be provided to these national activities. TCDC as well as regional and national training programmes will be improved. National focal points will be established. Collaboration on legislation and funding will be undertaken. Exchange and sharing of experiences and national plans will be promoted. Coordination and optimal use of all health-related resources within and between countries, such as those provided by UN Agencies concerned, Red Cross/Red Crescent Societies and other NGOs will be strengthened. Budgetary Implications The increase of 20% in the budget allocations indicates the continued emphasis being given to external coordination for health and social development.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Inter-Country

185 300

222 900

37 600

20.3

297 000

362 400

PROGRAMME Oh jective

2.3.0

HEALTH SYSTEM DEVELOPMENT

To collaborate with the Member Countries in the progressive development of their health systems based on primary health care. Proposed Programme Activities Health This programme consists of four suh-programmes, namely, 2.3.1 Situation and Trend Assessment, 2.3.2 - Managerial Process for National Health Development, 2.3.3 - Health Systems Research, and 2.3.4 - Health Legislation. Detailed activities that are proposed to he undertaken in 1986-87 are indicated in the programme statements that follow.

PROGRAMME Objectives

2.3.1

HEALTH SITUATION AND TREND ASSESSMENT

To collaborate with the Member Countries in:

- the progressive development of relevant health information support to the management of their health systems based on primary health care, and -

the development of epidemiological services network to undertake surveillance of diseases and health hazards as part of national health systems.

Targets By 1989:

- All countries in the Region will have developed a mechanism for collecting relevant information and using it to assess their health systems, health situations and trends, thus providing a sound basis for epidemiological surveillance and for decision making for health development;

- All countries in the Region will have established a mechanism for monitoring the progress towards the goal of health for all, which includes health and related socio-economic indicators and epidemiological surveillance data on communicable and non-communicable diseases and environmental hazards; and

- Most countries will have developed mechanisms for measurement of health progress and health impact. WHO will have established sound mechanisms for information exchange with countries for monitoring health progress towards the goal of HFA. This will include:

- health status and related socio-economic indicators; health and epidemiological surveillance information, and

- environmental hazards to health. Situation Analysis Efficient and effective planning and management of health services requires the proper utilization of a broad range of information. Whilst this fact is well recognized, most Member Countries will require to strengthen their health information systems infrastructure effectively in order to support their health management adequately at all levels. Some of the fundamental obstacles encountered are the tendency for health information systems to be developed in a vertical manner without coordination and collaboration with other information systems, and lack of motivation for improvement of the quantity and quality of information due to inadequate use. However, as a result of the Member Countries' commitment to implement the strategies for achieving health for all by the year 2000 and the need for the monitoring and evaluation of these, the importance of improving information support has been highlighted. This urgency is further strengthened as a result of the countries' obligation to adhere to a scheduled time-frame to review the results of these efforts through specific indicators at national, regional and global levels using the common framework and format for collection and review of information. It is hoped that this would provide a good motivation for major improvements in the health information support infrastructure development in all the Member Countries of the Region. All Member Countries of the Region have established epidemiological units in their ministries or departments of Health. However, the functional scope and efficiency of the units vary. There have been difficulties mainly in regard to full surveillance coverage of all geographical areas in the countries, as well as of diseases that are of public health importance. This particular inadequacy is due, in part, to the shortage of well-trained and active staff with the required expertise in epidemiology. Thus, there is a need for developing competent staff in larger numbers. In addition, the epidemiological surveillance work needs to be closely linked with the network of public health laboratories which, in turn, require further extension and expansion at intermediate and peripheral levels in particular. Proposed Programme Activities The major strategy for implementing the HSTA programme in the Region is to intensify the strengthening of national capabilities for developing their health information support programmes in order to support their health management and health system infrastructures adequately. As an initial step towards this, the programme envisages, through active collaboration, the identification of the strength and weaknesses of existing systems and promoting activities which would strengthen the needed areas appropriately.

The HSTA programme activities will thus be guided by the results of these assessments and the broad activities for promotion of the programme that will be supported by WHO will be as follows:

- The review and systematic strengthening of health information support systems for surveillance; national health management, including epidemiological

- Collaboration

in epidemiological surveillance of communicable and non-communicable diseases at national and regional levels through continued review of health situations and trends; The training of staff in the field of epidemiology and statistics and health information development at all levels; for promoting practical and appropriate methods for information generation, collection, processing and analysis, including the conduct of simple surveys and studies;

- Collaboration

- The development of appropriate standard statistical and epidemiological tools such as classification of health and disease for use in primary health care, development of lay reporting systems and health records procedures, and promoting the use of appropriate processing technology including the use of computers;

- The development of national and regional mechanisms for information development and collection for the monitoring and evaluation of national and regional HFA strategies, and -

Promote inter-sectoral coordination for development of health and health related information, especially on the development of basic health indicators.

WLiO will also collaborate with the countries in establishing mechanisms for

the epidemiological surveillance of communicable and non-communicable diseases; nutritional and mental health status; conditions of social pathology such as alcoholism and drug abuse, occupational and environmental hazards, as well as support regional training programmes by supplying suitable training material and consultants for conducting courses, and organize national training courses/seminars in order to disperse the expertise to all levels and sectors of health services. Budgetary Implications Overall emphasis continues to be laid on this programme. Two countries have substantially increased their allocation to this programme area and one country will be initiating activities with WHO support in 1986-1987. However, seven countries have reduced their allocation to this programme area.

PROGRAMME Objectives

2.3.2

MANAGERIAL PROCESS FOR NATIONAL HEALTH DEVELOPMENT

To collaborate with the Member Countries in:

progressive development of their health systems through strengthening their ability to assess the health situation and trends, and apply this information through an integrated managerial process; promoting and supporting, in the countries of the South-East Asia Region, balanced development of all phases of the health management process, with particular emphasis upon programme implementation, operations management and programme evaluation; fostering the integration of managerial process development into national health administrations; for national health

searching for solutions of critical management problems through practical problem-oriented research; the designing of improved organizational structures, procedures and support systems, especially in support of primary health care, and promoting and supporting practical and effective management training that responds to relevant management needs and fosters national self-reliance.

Targets

By 1989, all countries of the Region:

will have established or strengthened their health management system integrating all phases of the management process; will have set up mechanisms for intersectoral coordination in planning, resource allocation and implementation management at all levels of the health system;

- will have achieved substantial progress in resolving problems pertaining to programme budgeting and financial control, supply and logistics, health personnel administration, and in integrating the health information system within operating procedures at each level of the health system, and

- will have established their own management training systems and be well on the way to having trained a critical mass of people in the application of the total managerial process. Situation Analysis Over the years, WHO collaboration in health management development has employed a variety of approaches ranging from courses in national health planning, through a variety of types of methodology development (project systems analysis, country health programming, mathematical modelling) progressing to the current promotion and support of overall managerial process development. Throughout the three decades of collaboration in the South-East Asia Region, WHO has attempted to focus its support on the managerial problems and development requirements felt by the countries themselves to be most important. In the early years, this meant exposing a large number of staff to basic management concepts and methods through fellowships and regional courses. However, such general educational approaches were not enough to change managerial behaviour and practice. Therefore, planning methodology development ensued, which attempted to operationalize management concepts within workable health project and sector planning procedures. The application of health project formulation and country health programming throughout the countries of the Region greatly increased the awareness of national health administrations of the potential benefits of management system improvement including the prerequisite development of national health information systems and health services research. The global promotion of the goal of Health for All by the Year 2000 has encouraged more countries to embark on extensive long-term health policy and plan formulation. Such planning efforts have often included a basic redesigning of the national health systems and sometimes a reorganization of the government health sector. Other types of management system development occurring in most countries of the Region include the setting up of high-level decision-making and coordination bodies such as health development councils and networks of health development centres, designing and implementing systems for monitoring and evaluation, undertaking improvements in information systems and budgeting procedures, conducting policy-oriented studies and carrying out a variety of management training, particularly for staff at middle and lower management levels. Thus, it is seen that most countries are addressing the various phases of the managerial process, extending beyond broad programming and detailed formulation. During recent years, the problems identified by national health administrators relate chiefly to personnel administration, supply systems, linkage between plans and budgets, manpower development, organization structures and management procedures. These problems have grown as national policies and programmes endeavour to provide essential health care to ever-expanding target populations. These problems are most noticeable at provincial, district and local levels, where health development programmes are actually implemented and managed. The Seventh General Programme of Work calls for greater attention to the resolution of these health management system problems, particularly at all operating levels.

Proposed Programme Activities The following activities will he undertaken in the South-East Asia Region: Promotion: Promotion will be directed toward the under-emphasized phases of management (implementation, evaluation and support system development), and practical management research. Promotion of the managerial process for national health development (MPNHD) will be selectively directed to those countries which have expressed the need in the context of the stage of development of such a process. Technical Cooperation: In the past years, WHO collaboration in sector programming, project formulation and programme evaluation led to improved planning and management. WHO technical expertise, supplies, documentation and financing, coupled with national working groups, have succeeded in establishing national capabilities. It is now intended to intensify collaboration in policy analysis and formulation, management system and procedure development, monitoring and evaluation, and applied management research. Such collaboration will be extended to result in the formulation of national guidelines describing the managerial process. Applied Management Research: Collaboration will address practical, problemoriented research designed to determine the effectiveness of health development strategies, improve management of operations, and solve problems impeding plan implementation. Management Training: Staff development will continue to be a major approach in MPNHD. WHO collaboration will address the development of effective training methods and materials, strengthening of training institutions, and implementation of well-coordinated management training programmes for selected target groups to improve the overall managerial performance. In addition, short courses and fellowships will be arranged on specialized managerial subjects. Information Exchange: As each country develops its health management system further, it gains experience, which is likely to be of interest to other countries. Efforts will be made for exchanging such experiences through networks of health management institutions and agencies, visits by staff and through document clearing mechanisms by which planning procedures, products, national guidelines, research results and training materials can be shared. Budgetary Implications The resource allocation to country programmes varies according to the specific project for managerial process development that is in existence. In a number of countries, such activities are integrated within primary health care and health systems research projects. In addition, these activities often appear in the project for the operation of the WPCR's office. Other countries devote a specific project for managerial process development and, therefore, a sizeable amount may appear. Overall, because of the increasing importance attached to the improvement of health management processes, an increasing amount of resources is being directed for the support of such activities. The same is not true at the regional level where, because of limits on resource growth, the allocated budget is in fact declining. Four countries of the Region continue to request long-term staff support in this programme area. All the countries are utilizing the services of short-term consultants. The inter-country project continues to contain professional staff who devote their attention to the support of national managerial activities and assist in the inter-change of national experiences through the convening of inter-country group educational activities.

PROGRAMME Objective

2.3.3

HEALTH SYSTEMS RESEARCH

To promote such research activities that directly support the essential elements and the relevant supporting elements in the PHC approach keeping in view the national strategies for HFA/2000. Targets By the end of 1987, most countries in the Region will have an increased capability for health systems research; will have undertaken relevant health systems research; and will be using results to improve the development, organization and functioning of health systems. Situation Analysis At the beginning of 1984, almost all countries in the Region have strengthened the functioning of national HSR focal points as part of the national research mechanism. Several activities, both ad-hoc and on continuing basis, would be undertaken to create and sustain awareness of the HSR concepts for policymakers, administrators, health services research scientists and other relevant health and non-health personnel. National inventories on HSR activities/ projects are being updated regularly and a regional inventory of such information has been prepared. This would be updated at regular intervals through information received from the countries. National workshops on health services research methodologies have been conducted in most countries and as an expected output of these workshops, research proposals on subjects of national priority would be supported. Regional and national assessments of HSR activities were carried out in Sri Lanka and Thailand, Bangladesh, Burma, India, Indonesia, Mongolia, ~ep'al, through their national focal points, and the results of these assessments have been disseminated to the countries for further updating on regular and continuing basis. Research institutes as well as other institutions have been strengthened and research workers are being trained through problem-solving and learning-by-doing approach.

Collaboration with the HeLLIS focal points in the countries has been established while guidelines developed for the standardization of health services research information through a consultative meeting of the national focal points on HSR and HeLLIS, are being tested in some selected countries. Guidelines for policy-makers, planners, programme managers, researchers and others to identify researchable problems encountered in health systems research, including guidelines for evaluation of planning and administration of national HSR efforts and guidelines for methodology to ensure utilization of HSR results in health planning process, have been developed. These guidelines would be distributed to the countries for dissemination and testing for adoption. These guidelines would help improve the operational management of the health system. Guidelines for the identification of behavioural research areas, approach and methodologies have also been produced in various programme areas, viz., malaria control, EPI, dengue haemorrhagic fever, MCH, family planning, water supply, health education, community diagnosis, etc. Pilot studies have been carried out in India, Mongolia, Sri Lanka and Thailand for the strengthening of health systems based on primary health care in order to achieve the goal of HFAf2000. It is expected that appropriate technologies to improve the planning, organization and operation of health systems research would emerge. Intersectoral planning and management in health systems research is being encouraged. Studies would also be undertaken for the identification of interaction between the health system and socio-economic, cultural and political factors as well as for the assessment of the quality of health care. Proposed Programme Activities WHO will support countries in developing guidelines/criteria for screening and developing research methodology for better:

- utilization of the research resources; - collection of global HSR expert list in different disciplines, and disseminating it to all SEAR countries, and

- evaluation and monitoring by development and designing of indicators of HSR results and their utilization by consumers such as public health managers, decision-makers, etc. It will also organize inter-country workshops in order to share experiences and discuss problems being faced by different countries and work out solutions to overcome the common problems; assist collaborating centres in the overall management including the network information, for the benefit of centres of excellence in that country and in other countries and of WHO; establish guidelines with focus on research activities, along the HFA priorities, to support the country and its neighbouring countries; strengthen the national focal points in health services research and augment their capability in collecting data and analysing them before submission to HeLLIS and other consumers, if necessary; organize meetings of scientific working groups in order to achieve better results in specific areas, especially in the development of strategies, programme implementation and monitoring; assist in the development of HSR training institutions in the countries of the Region at the national level, and subsequently develop similar institutions at the lower level in order to afford opportunity to HSR workers to increase their knowledge and skill for conducting HSR activities, and assist in organizing study tours of scientists in HSR in order for them to share information and experiences.

Budgetary Implications While two countries have earmarked resources for this programme for the first time, one country has increased its allocation. However, two countries have included funds for HSR activities under MPNHD and PHC programmes.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Country ;

a (6.3)

367 400

344 100

(23 300)

PROGRAMME Objective

2.3.4

HEALTH LEGISLATION

To support and foster national efforts to formulate and implement health legislation that is in harmony with, and supportive of, national strategies for health for all. Targets By 1987, most countries would be in the process of introducing appropriate legislation so as to facilitate the attainment of health objectives through the development of primary health care and other supporting elements of a comprehensive health system. Situation Analysis At the beginning of 1984, there was gradual progress in health legislation development in Member Countries. Countries like Burma, DPR Korea and Mongolia have enacted appropriate health legislations in support of strategies for HFA/2000 including primary health care. These legislations cover the overall health policy and specific areas such as essential drugs, food safety, breast-milk substitutes, workers' health, environmental health, disease control, drug addiction and alcoholism. Thailand, Bangladesh and Sri Lanka have drafted health legislation to support the ongoing "health for all" activities which are under consideration by the governments concerned and will be applied in the beginning of 1986. The Bangladesh health legislation in support of primary health care was published in the International Digest of Health Legislation for further distribution and dissemination in Member Countries. A review of the implementation will be undertaken in 1986. In Indonesia, health legislation is one of the priorities identified during the process of developing the Indonesian Covernment/WHO innovative programme in achieving HFA/2000.

In Thailand, WHO support has been provided in formulating and publishing health legislation in the form of Public Health Act, Rabies Control Act, Health Facilities Act, Health Professional Licensure Act, Medical Professional Act, Disease and Venom Act. These Acts will be sanctioned by the House of Representatives' Ad hoc Committee. WHO has also supported in strengthening the capacity of the Legal Affairs Division in the health legislation area which involves 15 ministerial regulations. At the beginning of 1985, these activities will be in the process of implementation and in the beginning of 1986, effectively implemented. Many countries in the Region still need support in these areas for reviewing the existing health legislation, identifying the areas and revising or establishing the new health legislation in support of HFA 2000. Proposed Programme Activities WHO will support countries in strengthening their national capacities in the health legislation sector; identification of national needs, and encouragement of cooperation in health legislation between countries and groups of countries. It will also support inter-country collaboration in health legislation, particularly in the formulation and exchange of experience in regard to application of laws supportive of PHC, and in carrying out surveys and reviews of health legislation in the Region. Budgetary Implications Only one country, namely, Indonesia continues to have a separate allocation under this Programme.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Country

36 200

99200

63000

174.0

PROGRAMME Objective

2.4.0

ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

To promote and support the appropriate organization and effective operation of comprehensive health systems that provide the essential elements of primary health care to the entire population, along with referral and specialized support, and which involve communities and health-related sectors in the planning, implementation and operation of health programmes and creation of the proper infrastructure required for their delivery.

Targets By the beginning of 1988, most countries will have made organizational plans for their health systems based on primary health care and for providing the necessary support to make them readily accessible and their services equitably distributed to the entire population so that:

primary health care at the local level is fully developed with participation of the community and that relevant development sectors the community have an ability to plan and implement health programmes create the proper infrastructure for their delivery so as to meet priority health needs;

the and and the

- health system at the intermediate level, including the first line hospitals, is strengthened through reorientation, reorganization, more effective and efficient functioning of health services systems, and

- the national capabilities are supported to organize and develop health systems and introduce modifications in policies, structures, mechanisms and resource allocation aiming at equity, implementation, monitoring and evaluation of primary health care approach. Situation Analysis Reorientation and restructuring of health systems based on primary health care approach is receiving greater attention in the countries and signs of rapid progress in this direction are now visible. Most of the countries have established new health facilities, extending them to rural and remote areas. Stress is also being laid on the strengthening of health referral support at primary and secondary levels of health care, especially at sub-district and district level facilities, in Bangladesh, Bhutan, Burma, Mongolia, India, Nepal, Sri Lanka and Thailand. Physical infrastructure and manpower are the main constraints. Logistics of health facilities and drugs achieved satisfactory progress in Burma, Bangladesh and Thailand; Nepal is undertaking the logistics support programme in drugs in a big way and expects good progress in the next 3-4 years. Evaluation of PHC elements, including sub-elements such as oral hygiene and radio diagnostic therapy for tuberculosis and other respiratory diseases is planned for the next two years in Bhutan. Efforts to maximize utilization of referral health services are receiving priority attention in the Sri Lanka health development programme. Efforts to train and retrain the new and the existing community health workers have been given sufficient attention in Burma and Thailand. Nepal and Bhutan are trying to lay a sound foundation for further development of the community health worker as part of their efforts to increase community involvement. In Bangladesh, the strengthening of thana health complex as part of the Government's thrust towards the strengthening and extension of upa-zila administration is going on in a phased manner. Efforts are being made to reorient training of upa-zila health administration and community leaders, including involvement of Islamic priests in the primary health care development at upa-zila and primary levels. The Government is also taking steps to strengthen the monitoring and evaluation process for better utilization of community health workers. In Burma, community participation in PHC is being supported through a motivational programme to sensitize community leaders and members of people's councils. The progress of the infrastructural development is quite fast and the community health workers' training programme is going ahead of the targets

set for the purpose. All health posts and station hospitals are being constructed through community efforts and resources. In the year 1984, the Government has started a new model scheme called the Ten Household Community Scheme with the aim of covering PHC programme by 50 per cent by 1986. The intersectoral coordination including intersectoral mechanisms have been clearly defined at almost all levels - central, township and village - of administration. In India, efforts to strengthen health systems based on PHC approach are in full swing. Training activities especially in the planning and management of district health workers and those involved in health systems research are receiving priority attention. In Indonesia, PELITA IV specifically aims at strengthening the regency health system. Training, recruitment and development of paramedical personnel to fill the needs of PHC centres at puskesmas and sub-puskesmas levels are in progress. Programmes aiming at improvement of urban areas and those with relatively high rate of infant mortality are given special attention. Family package integrating MCH care, family planning, nutrition, EPI, diarrhoea1 diseases control, etc., is given priority importance in the Pelita 1984-1989. In Mongolia, the promotion and development of primary health care in Huvsgul aimak continues. Baseline studies pertaining to morbidity, mortality, identification of population needs and requirements in PHC and for utilization of different categories of health personnel are in progress. The study on the utilization of health personnel covers brigade staff and personnel at somon, intersomon and aimak levels as well as the mobile units. Results of this study will be applied to health personnel in other aimaks. Development of detailed research designs is also under way. In Sri Lanka, the role and functions of district health committees are being strengthened and extended to all the districts in the country. Community-based programmes aimed at solving health and health-related problems of the urban poor are being started in most countries of the Region. Studies in PHC for urban poor have been undertaken in collaboration with UNICEF and information on the extent and distribution of health problems and the coverage of low-income population by health and health-related services is being sought from the Member Countries. Countries are giving specific attention to intersectoral coordination and continuous efforts are made towards effective intersectoral coordination, especially at the district level. Several workshops and seminars have been organized for the purpose. Development and utilization of appropriate technology such as the use of oral rehydration therapy by CHW received special attention in Burma, Thailand, Bhutan and Nepal.

A programme to integrate PHC activities into national basic minimum needs and national anti-poverty programe in Thailand, which is under NESDB and the Ministry of Interior, is one of the greatest achievements in the strengthening of intersectoral coordination. Integration of vertical programmes such as malaria and other communicable diseases is under way in many countries. The overall general policy for decentralization in Thailand, Burma, India, Nepal and Bhutan would be helpful in reorienting and restructuring of the health infrastructure based on PHC approach. It is expected that all Member Countries in the Region would have achieved significant progress in PHC development by the end of 1985 and the programmes would have a solid base to start with from 1986.

Proposed Programme Activities At the Community Level

Organization and management support to the development of PHC support to countries to develop approaches, methods, contents and skills for the organization and management of PHC at THE country level, including financing, information and communication, and emphasizing a problemsolving approach; and collaboration with countries in the formulation and implementation of local PHC programmes and plans of action. Intersectoral action for health collaboration with countries in their reviews of current intersectoral efforts and policy analysis and in the strengthening of such efforts. Community involvement in PHC decision-making and implementation support countries to develop and review experiences in community involvement; and policies, programmes and

support to the development of skills of communities in community diagnosis, mobilization, including health education and organization, interaction with local staff and health-related sectors. At the Intermediate Level

Organization and management of the health services at the intermediate level in collaboration with management, education and research institutions, and through NHDNS, where established, support will be provided for the improvement of health services at the intermediate level through research, development and training. Promotion and development of primary health care in urban areas support to studies of urban health needs of different population groups to identify problems, constraints and the different ways in which these are overcome in order to clarify constraints and identify promising solutions; and collaboration in the reorientation and strengthening of urban health systems, including the structure and functioning of municipal health departments, legislation, involvement of other sectors, utilization and coverage of primary health care services, referral systems and the role of community organizations. At the National Level

Promotion and development of appropriate mechanisms for decision-making on health systems further promote and support overall national reviews of existing policies, legislation and plans of action, and of the changes necessary for the organization of health systems based on PHC;

joint support (together with UNICEF) to the implementation of PHC in countries; support to the strengthening and establishment of National Health Development Networks/Centres, National Health Councils, national PHC task forces, and other advisory or decision-making mechanisms that will mobilize and coordinate health action, and support research on the organization of health systems based on PHC as required for decision-making, using NHDNS and similar mechanisms as appropriate. Promotion and support of health sector development Reorientation of the health sector and integration of health care delivery support national effort to develop innovative patterns of organization and better functioning of programmes, ensuring intersectoral coordination; and support to national efforts in the extension and improvement of coverage including related research. Monitoring and evaluation of health sector development provision of information on experiences in the review, selection and social control of appropriate technologies to meet identified needs. Economic Support to health systems support countries to develop their methods and skills in costing, financing and equitable allocation of financial resources in the health sector. Development and operation of health care facilities and logistics support to the development of comprehensive logistics systems at all levels through information, training and research to ensure provision of drugs, equipment and equipment facilities, etc. Budgetary Implications For the Region as a whole, this programme continues to receive high priority. However, Burma and Thailand have earmarked considerably more resources for activities under PHC than in the current biennium.

Other Sources

Inter-country

PROGRAMME Objective

2.5.0

HEALTH MANPOWER

To collaborate with the Member Countries in planning for the training and development of the number and types of health personnel required by them, and to help ensure that such personnel are socially responsible and possess appropriate technical expertise and managerial competence so as to develop and maintain comprehensive national health systems based on primary health care. Sub-objective To promote the development of health manpower policies which are consistent with national health policies and to collaborate in developing and implementing plans based on these policies; T O promote the development of managerial capabilities in the countries to ensure optimum utilization of the available human resources; to cooperate with them in developing training programmes required by their national health manpower plans, and to strengthen those institutions responsible for implementing these programmes and for maintaining and/or improving the competence of personnel, especially those involved in primary health care activities. Targets

By 1989 at least nine countries in the Region will have developed relevant health manpower development policies and formulated and implemented national health manpower plans, specifying quantitative and qualitative requirements; planned and implemented training programmes to improve the required managerial skills for optimum utilization of human resources; strengthened their policies, systems and processes for optimal deployment and utilization of trained personnel; developed appropriate information systems for monitoring and evaluating plans, training programmes and management of health manpower; strengthened national capability in health systems research for identifying and solving problems relating to improvement of relevance and effectiveness of the manpower developmental process; developed task and community-oriented educational programmes for all categories of health personnel; developed the capacity to produce, test, use and evaluate teaching/learning materials for

all health staff, and developed systems of continuing education at all levels to maintain and upgrade professional competence consistent with HFAIPHC needs. Situation Analysis The shortage of appropriately trained manpower continues to be a key obstacle to the attainment of regional goals for HFAl2000. Most countries have now developed national health plans and some countries have created mechanisms for closer integration between health service requirements and manpower development mechanisms. Nearly all countries of the Region have undertaken health manpower development planning exercises with varying degrees of comprehensiveness. Apart from the overall shortage of health personnel, the maldistribution of those that are available, and the absence of clear definition of activities and tasks they have to perform, results in the inadequacy of services and lack of team work at peripheral levels. The coverage of rural populations continues to be low and there is a lack of involvement of local populations in the planning, management and evaluation of health programmes. There is now increasing awareness that primary health care for all cannot be provided by relying on the services of doctors and nurses, and all countries recognize the need to rapidly step up the production of various types of auxiliary health workers to support the peripheral level services. There has been a strengthening of training programmes for these categories of workers including those for TBAs, and these training programmes have shifted their content from a predominantly curative bias towards more preventive and promotive-oriented activities. These trends need to be strengthened together with planned investigations to assess the level of performance of these workers in the field with a view to making corrective changes in their training programmes andlor improving existing management and supervisory functions. Few countries have developed systematic wide-ranging programmes of continuing education; those that do exist are ad hoc in nature. Urgent and sustained attention needs to be paid to the development of more systematic programmes of continuing education. All countries have undertaken activities relating to education development support including the development and improvement of teaching methods and materials, educational evaluation and teacher training. Extending the coverage of these activities to include training institutions of all health personnel needs to be supported. There continues to he a shortage of effective student-centred, problem-based, teaching and learning material, the deficiency being most serious in materials serving the needs of mid-level and auxiliary health workers, the categories for which this material is most acutely needed. Although some limited innovative efforts have been successfully introduced, the overall pattern of medical education and training of doctors continues to be predominantly patient and hospital biased. Efforts to reorient medical education to meet community needs continue to be an urgent need. Proposed Programme Activities The main activities that the Organization will collaborate in are: the promotion of mechanisms for the integration of health services and health manpower development; the promotion and development of health teams for the provision of effective primary health care; the development of systematic approaches to the planning, implementation and evaluation of programmes of continuing education for all categories of health workers; the development of systematic, competency-based, learner-centred basic training programmes for all categories of primary health care workers; the development of teacher training programmes and networks; the promotion of competency-based performance assessment procedures both in basic training programmes and in the field, and

supporting the further development of programmes of manpower management, deployment, career development and supervision. Support will be given to training institutions so as to strengthen their programmes and ensure that these are task-centred and community-oriented, with particular emphasis on the needs of primary health care. Efforts will be made to ensure that these training institutions develop their own educational units, and the existing national and regional teachers' training centres will be encouraged to extend their services to all categories of primary health care workers. Budgetary Implications There is a marginal increase in the allocation of all the countries except India and Mongolia, while the ICP resources have had to be reduced. All in all, the priority accorded to this programme continues unabated.

PROGRAMME Objective

2.6.0

PUBLIC INFOWTION AND EDUCATION FOR HEALTH

To collaborate with the Member Countries in promoting education and information activities so as to encourage individual, family and community to be healthy, and to participate appropriately in the primary health care services. Targets By 1989, in the context of PHC, to achieve the goal of Health for All by the Year 2000:

All Member Countries in the Region will have developed or expanded information on education for health as an integral part of PHC and other health services; communication services and expanded public information as an integral part of health education;

- At least eight Member Countries will have developed appropriate mass

- At least seven Member Countries will have established mechanisms for the coordination of public information and education for health;

- At least ten Member Countries in the Region will have developed and expanded education and information training programmes for different categories of health workers, including basic, post-basic and continuing education;

- At least ten Member Countries will have developed and expanded their appropriate education and information materials for different categories of health workers, and

At least seven Member Countries in the Region will have initiated behavioural sciences research on appropriate public information and education for health.

Situation Analysis Information, education, communication and community participation activities of health programmes done by public as well as by private sectors are not adequate at times. Coordination, integration and synchronization of activities which are essential elements of national health development strategies will further strengthen the health-related programmes, given the limitations of health education manpower, resources and technologies. Inappropriate/ inadequate coordinative efforts have been found within the Ministry of Health as well as in its interaction with other ministrieslpublic agencies such as education, agriculture, information and broadcasting, home affairs and NGOs. Information and education training, teaching and learning materials, curriculum development and community resources have not been appropriately managed. Lack of adequate research and study on behavioural and health-related information/ education/community participation and under-utilization of their findings, are considered to be some constraints to appropriate health education intervention. The promotion of community participation in health programmes also needs to be further strengthened based on the concept of self-reliance in the future and better utilization of existing resources and technologies. Proposed Programme Activities WHO will collaborate with Member Countries to give technical support and back-stopping in the areas of general management of information and education for health programmes with special emphasis on strengthening of policies in the context of PHC, strategies and plans. These will be supported by some national meetings to promote integration of public information and education for health and their follow up. In 1986-87, similar national meetings will also review the inclusion of behavioural science in health education within the curricula of medical and nursing schools; furthermore, the preliminary impacts of integration approach as well as community participation in PHC will also be assessed. At the country level, in addition to the above activities, the development of public information and education for health programmes will be further promoted and strengthened in the areas of health education manpower including health education specialists with special emphasis on defining the educational contentlobjectives of each component of PHC and other health programmes; community participation; school health education; training materials as well as education and information materials for individual, family and community; audio-visual aids, and assessment.

Budgetary Implications While one country is allocating the same quantum of funds as in 1984-1985, five countries have enhanced their activities, and, correspondingly the resources needed. However, one country has reduced its allocation to this programme area.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources 1984-1985 1986-1987

us t Regional Country Inter-country Total 157 200 667 500 218 800

X 7.6 37.1 1.0 25.1

169 200 915 300 221 100

12 000 247 800 2300 262 100

384 400

682 000

1 043 500 1 305 600

384 400

682 000

PROGRAMfIE

3.7.0

RESEARCH PROMOTION AND DEVELOPMENT

Oh jective

To collaborate with Member Countries in the promotion of research related to health; and coordinate the development of relevant scientific activities in the area. Sub-objectives

- promote the development of coherent national research policies based on health policies as related to the overall development of policies and the national research capability;

- promote the development of research coordination mechanisms, management procedures and information support involving medical research councils or analogous bodies, concerned ministries and non-governmental orgnizations;

- promote the effective use of available research findings as applicable to the local situation;

- promote the identification of national and regional priorities for research with the organization of mission-oriented research at national and regional levels and the dissemination and utilization of research findings, and

- promote TCDC in research.

Situation Analysis Research promotion and development is a constitutional function of the World Health Organization. In the early years, the responsibility was vested primarily in WHO headquarters. At the Eleventh World Health Assembly in 1958, intensification of this activity was recommended and a Special Account for Medical Research (SAMR) was established for receiving voluntary contributions. Thus, WHO'S intensified programme on medical research was launched by the World Health Assembly. Those intensified efforts contributed to the development of the Special Programme for Research and Training currently operated by WHO headquarters. The Twenty-seventh World Health Assembly in 1974, having considered the developments of WHO'S research promotional efforts, welcomed a proposal for greater involvement of Regional Offices in research activities with the technical guidance of WHO headquarters. The efforts of Regional Offices were to focus on the solution of major public health problems facing Member States in the Region. The Twenty-eighth World Health Assembly, in May 1975, requested the DirectorGeneral to further encourage Regional Committees and Regional Offices to implement appropriate programmes of biomedical research with the establishment and maintenance of close contacts with national and international bodies dealing with similar programmes. Following this lead, the South-East Asia Regional Committee, at its twentyeighth session in August 1975, discussed the subject of biomedical research and welcomed the establishment of a Regional Advisory Committee on Medical Research to advise the Regional Director and thereby be instrumental in furthering research activities in the Region. In pursuance of the guidance provided by the governing bodies of WHO, the Regional Director established the South-East Asia Advisory Committee on Medical Research (SEAJAQR) on 1 January 1976. This Committee identified priority areas for research and has provided overall guidance to the Regional Office in the implementation of an inter-country programme on research promotion and development. Detailed plans of action in specific research priority areas were developed through scientific working groups convened by the Regional Director. In view of the progress made through this research programme, the Regional Committee at its twenty-ninth session in 1979, by resolution SEAfRc29/~,1, requested the Regional Director to allocate 2-112 per cent of the regional budget for biomedical and health services research promotion and development under inter-country programmes, to request the Director-General to provide matching funds and to explore possible external assistance from international and bilateral sources. Accordingly, a total of 5 per cent of the regional budget was made available for research promotion and development from 1980 onwards under an inter-country programme. Thus, inter-country programmes on research promotion and development have been established on the advice of WHO governing bodies with budgetary provision being made according to the recommendation of the South-East Asia Regional Committee. In setting up the process for managing this inter-country research programme, links have been established with respective governments and the concerned

institutions, scientists and research organizations in Member States through a variety of policy and management bodies and mechanisms. These include: (1) The South-East Asia Advisory Committee on Medical Research (SEAIACNR) and sub-committees on special topics;

(2) Scientific Working Groups in specific research topics; (3) A Regional Office secretariat for management of the programme; (4) (5)

A Regional Office Research Development Committee; Regular meetings of Directors of Medical Research Councils or analogous bodies, and

(6) Links with other WHO regions and the Global ACMR. These mechanisms ensure that the governments and the scientists of the Member States actively collaborate in the implementation of the inter-country programme on research, and that it serves the needs that currently exist or are anticipated in Member States. Proposed Programme Activities

WHO will collaborate with Member Countries in:

- organizing and conducting meetings of Directors of Medical Research Councils or analogous bodies and concerned research foci in the relevant ministries;

- promoting and collaborating in periodic national meetings to follow up the recommendations of MRC meetings;

- arranging periodic meetings for the evaluation of national and regional research priorities maintaining focus on HFA needs;

- collaborating in the periodic review of the national research policy and priorities and mechanisms for coordination and management;

- collaborating in the conduct of Research Management Courses; - collaborating in the development and periodic review of national research manpower development plans including institutional strengthening;

- collaborating in the conduct of research methods training courses of a general nature as well as specific to disciplines required;

- collaborating with scientists in helping them in developing research proposals;

- arranging award of visiting scientist and research training grants to scientists engaged in projects supported by SEAR;

collaborating in strengthening MRC or analogous coordination mechanism at the country level; national priorities in Member Countries;

bodies

and

research

- promoting and collaborating in mission-oriented research programmes on

- collaborating in the development and periodic review of ethical review mechanism;

collaborating in the dissemination of information; designating a network of collaborating centres in support of the WHO research efforts; programme, and

- recognition of national centres of excellence in support of the WHO - promoting the development of mechanisms for TCDC with collaboration in such efforts. Budgetary Implications For the Region as a whole, the budget for RPD has registered an increase of 21 per cent over the 1984-1985 biennium. The country focus is on institutional strengthening and operations research related to primary health care, research promotion activities, manpower build-up and problem-solving research.

PROGRAMME Objective

3.8.0

GENERAL HEALTH PROTECTION AND PROMOTION

To collaborate with the Member Countries in the development and promotion of proper nutrition, oral health and accident prevention. Proposed Programme Activities Nutrition, This programme comprises three sub-programmes, namely, 3.8.1 Accident Prevention. Detailed activities that 3.8.2 - Oral Health, and 3.8.3 are proposed to be undertaken in 1986-87 are indicated in the programme statements that follow.

PROGWLME Objective

3.8.1

NUTRITION

To collaborate with the Member Countries in the development and implementation of the most effective methods for dealing with malnutrition (including protein energy malnutrition, iodine deficiency disorders, anaemia and vitamin A deficiency) at both country and regional levels, particularly through the development of national nutrition policy/planning capability and implementation of nutrition-effective activities at the community level through the primary health care approach. Targets By 1986:

All countries in the Region will have defined the minimum set of activities having impact on growth; and continuously and evaluate programmes which affect the growth of children.

- All countries in the Region will have a mechanism to monitor child growth Situation Analysis The WHO South-East Asia Region contains by far the world's highest numbers suffering from protein-energy malnutrition, iodine deficiency disorders (goitre/cretinism), anaemia, and vitamin A deficiency blindness. Some 30 per cent of the 35 million annual births in the Region are "low birth weight", at least 60 per cent of pre-school children are malnourished, in some areas 90-100 per cent of people have goitre, and some 60 per cent of the Region's 300 million women are anaemic. It is likely that over 50 per cent of all infant deaths are associated with malnutrition. The regional programme has been developed in ambitious goals set for the year 2000 - at least being above 2500 G, and at least 90 per cent of for age above the recognized malnutrition cut-off the light of two extremely 90 per cent of birth-weights children having their weight point.

Four major approaches characterize the thrust of the regional nutrition programme: (i) development of national nutrition capabilities, (ii) implementation of nutrition through primary health care, (iii) development of national nutrition surveillance capability, and (iv) control of specific deficiency disorders. The countries are now vigorously pursuing these approaches. Seven countries already have functioning national nutrition units, and two others have the nucleus of such a unit. Through these means, national nutrition policies are being generated and nutrition programmes implemented. The Joint WHOIUNICEF Nutrition Support Programme operative in two countries is an example of massive strengthening in nutrition through primary health care. Nine countries are already pursuing actively the development of nutritional surveillance capabilities, with significant technical and financial support from both WHO and UNICEF. The growing momentum of the GoitreICretinism Control programme both within affected countries and as a regional activity, is a significant feature of the nutrition programme. Proposed Programme Activities WHO will continue to focus support on the establishment of national nutrition units and their technical strengthening. For the same purpose, WHO will, through fellowships, contribute to the development of a critical mass of nutritionally trained persons in each country. A regional meeting on the role of national nutrition units is proposed. Through these activities, WHO will encourage the development of national food and nutrition policies. Nutrition activities through primary health care will continue to be the main thrust of the national nutrition programming encouraged by WHO. Through this approach, WHO will attempt to ensure the implementation of a minimum critical set of activities with the widest possible population coverage and community involvement, centred around growth monitoring, direct educational promotion of improved food intake and proper weaning practices, prevention and management of infections and infestations, immunization, and oral rehydration for diarrhoea. WHO will encourage special attention to nutritional condition of women during pregnancy and lactation, and will offer research support in this area. The Joint WHOIUNICEF Nutrition Support Programme will be in full implementation in Nepal and Burma throughout 1986-1987. In both countries, through this programme, substantial expansion of the supportive nutrition infrastructure from central through peripheral level, training, supplies and equipment, consultant support, and the delivery of an intense package of nutritionally relevant activities to the community, is expected to result in a demonstrable impact on malnutrition on a widespread population basis. WHO will continue to assist countries in developing nutrition surveillance capabilities. Nutrition surveillance will be used for policy planning purposes as well as evaluation of effectiveness and impact of health and development programmes and, in addition, for the prupose of early warning of impending nutritional disasters. WHO will offer continued technical and financial support in this area. It is also planned, largely through these country-level activities, to develop the WHO Regional Office for South-East Asia as a nutritional surveillance focal point for the Region. WHO will continue to work with UNICEF in developing and implementing an effective Regional Iron Deficiency Disorders (IDD) Control Programme. This

will include technical assistance for the development of regional screening1 monitoring centres for monitoring IDD control progress, for the establishment of simple iodized-salt monitoring facilities in each country, for implementing iodized salt and iodized oil programmes, and some support for research into the effectiveness of oral iodized oil. WHO will continue to support the development of nutritional competence of middle-level and field-level community healthlnutrition workers through the running of training workshops in Member Countries. The nutrition research programme will continue to support the four main thrusts of the regional nutrition programme, particularly in assisting countries in developing capability in identifying the distribution, characteristics and underlying causes of malnutrition, and the most effective methodologies for tackling it. Budgetary Implications The allocation of budgetary resources, which register a 43.7 per cent increase, denotes the continuing emphasis being laid by the countries on this programme.

PROGRAMME Objective

3.8.2

ORAL HEALTH

To collaborate with the Member Countries in:

- the development, adaptation and use of methods for promoting oral health; - maintaining DMFT at present levels, and

reducing the incidence of periodontal disease.

Targets By 1989, an oral health status of no more than three decayed, missing or filled teeth, at the age of 12 in the population of at least five countries will have been achieved.

Situation Analysis In a number of countries of the South-East Asia Region, the incidence of dental caries has been increasing - particularly in the urban population. In view of the poor situation of oral hygiene, periodontal disease is also widely prevalent.

Due to the concentration of qualified dentists in capitals and large cities, the oral health care of the rural population is poor. This situation is being met through the training of auxiliary dental health personnel in some countries of the Region. In India, a decision to introduce a new category of "Expanded Duty Dental Auxiliary" to carry out minor dental care in addition to oral health education, has been taken. In order to prevent further deterioration of the DMFT level, selective interventions through oral health programmes (including fluoride mouth rinsing) are essential. While an active oral health programme has been in progress in Sri Lanka for some years, programme activities in oral health have also been generated in Bangladesh, Burma, India, Indonesia and Thailand. The setting up of a network of oral health centres with a view to promoting primary oral health care in the countries of the Region is making progress. Proposed Programme Activities Oral health surveys to establish baseline situation of the oral health status of the population will be supported on request from countries of the Region. Assistance will be provided for the formulation of national oral health programmes in countries of the Region and, on request, in defining the needs in operation, training and research. Support will be provided in the setting up of plans for training and preparation of training modules for different categories of staff. Specific technical support will be provided for national activities in respect of training of oral health workers and evaluation of oral health programmes. Efforts will be made to establish a reliable information system and set up specific indicators for programme performance. Support will be provided to strengthen research activities in selected institutions. Programmes will be monitored and operational research stimulated. A programme of national oral health education will be developed in most countries of the Region. Support will be given to the development of school-based oral health preventive programmes consisting of fluoride mouth-rinsing, broad periodontal hygiene programme and expanded health education activities. National meetings and seminars will be supported with a view to identifying oral health programmes and stimulating research in such areas as indicated, including delivery of oral health services through mobile clinics and school/community oral health care. Countries will be assisted in the establishment of national oral health care centres. Budgetary Implications To support the ongoing activities, attempts will be made to mobilize resources other than WHO regular budget.

PROGRAMME %ectives

3.8.3

ACCIDENT PREVENTION

To collaborate with the Elember Countries in: -

the development, adaptation, and use of methods for the prevention of accidents, and accidents and for their prevention.

- encouraging formulation of a national policy and programme for monitoring Targets

By 1988, establishment of a system/mechanism for the formulation of a national policy, plan of action, implementation of activities, evaluation and monitoring, prevention and control of accidents in five countries. By 1987, organization of a national centre to provide technical leadership, training facilities, developing patterns of services including resuscitation and rehabilitation, and undertaking research on accident prevention and control in at least five countries of the Region. Situation Analysis Among the various causes of accidents are road traffic accidents, burns, drowning, poisoning, falls, animal bites, and cutting instruments. Of these, road traffic accidents have emerged as the major killer in most countries of the Region. They now account for approximately 8 per cent of the deaths due to all causes in one of the countries in the Region. The number of motor vehicles has been increasing at a rapid pace. In some large cities, these have doubled within 5 to 10 years. Road engineering has not yet developed adequately to cope with the large numbers of vehicles on the road. Furthermore, the maintenance and repair of vehicles is rather poor, resulting in larger number of accidents. Enforcement of traffic laws needs much to be desired in several countries of the Region. Research into the epidemiology of road traffic accidents has yet to be carried out in several countries. There is also under-reporting of such

accidents. Overcrowding in vehicles is a major hazard. There are scarce emergency medical services, which also lead to a higher fatality rate. Little effort has been made towards public information and education in preventing road traffic accidents. Similarly, much needs to be desired in the appropriate training of drivers and in the enforcement of the relevant laws. Proposed Programme Activities Countries will be supported in formulating national policies and plans of action. Protocols will he developed for epidemiologic investigations on accidents. Support will be given for the development of school health education programmes on accident prevention. Countries will be encouraged in the use of mass media for accident prevention and management. Support will be provided for the training of trainers in health, allied sectors in accident prevention and management. Support will be provided to the conduct of national research studies on accidents. Assistance will be given in the preparation of suitable educational material and training curricula for the lay public. Countries will be stimulated to establish a national centrelinstitution for assessing existing technologies and developing new ones. National guidelines for the prevention of accidents and integration of services into primary health care will be formulated. Assistance will be provided for the dissemination of information on prevention of accidents. Consideration will be given for the development of a standard method for surveillance and monitoring of accidents. Efforts will be made for the creation of a task force in the Region for the prevention and control of accidents. Budgetary Implications The increasing importance of "Accident Prevention" is recognized by the countries, four of which have earmarked a budget-line for this programme. There is more than a 100 per cent increase in the 1986-1987 biennium.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Country

z 106.1

70 000

144 300

74 300

. PROGRAMME Objective To collaborate with the Member Countries in the continuous evolution and adaptation of technologies and approaches aimed at protecting and promoting 3.9.0 PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS

the health of specific population groups, particularly women of child-bearing age, workers and elderly people, and to identify the best ways for the application of these technologies by the health system infrastructure. Proposed Programme Activities This programme consists of sub-programme areas: 3.9.1 - Maternal and Child Health, Including Family Planning, 3.9.2 - Human Reproduction Research, 3.9.3 - Workers' Health, and 3.9.4 - Health of the Elderly. Detailed activities that are proposed to be undertaken in 1986-1987 are indicated in the programme statements that follow.

PROGWIME Objectives -

3.9.1

MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING

To collaborate with the Elember Countries in:

- the continuous evolution and adaptation of technologies aimed at protecting and promoting the health of women of child-bearing age and children;

- improving the coverage, efficiency and effectiveness of integrated family care, in particular maternal and child health and family planning; -

developing intervention strategies for social action based on awareness of the particular health problems affecting women, infants, children and adolescents in the family context as a whole, and infancy and childhood development.

- preventing and managing the problems relating to pregnancy, childbirth, Targets By 1989:

All countries will have strengthened or expanded the programme for health care during pregnancy, childbirth, infancy, childhood and adolescence, including family planning;

- At least two-thirds of births will be attended to by trained health workers, (including trained traditional birth attendants) and at least 80 per cent of all children will have access to preventive and curative care in all countries;

All countries will have been encouraged to include appropriate training in maternal and child health and family planning in the educational curricula of health workers and a majority of those in the health-related sectors such as school teachers and social workers; technologies addressed to at least four major health problems specific to maternal and child health such as complications of childbirth, hypertensive disease of pregnancy, low birth weight, and perinatal infection; available to the entire population, especially mothers, in all countries, and

- WHO will have developed or adapted appropriate health

- Information on family health, including family planning, will be readily

- Suitable indicators for monitoring maternal and child health, and in particular growth and development of children will be selected and used in all countries. Situation Analysis Maternal mortality rates are high in most of the countries of the Region ranging from 1.2 in Sri Lanka to 30 per thousand live births in Bangladesh the main causes of death being haemorrhage, sepsis and toxaemia of pregnancy, predisposed by anaemia and high parity. Infant mortality rates are high, ranging from 183 in Nepal to 22.5 in Thailand. Neonatal deaths constitute 50 to 60 per cent of total deaths. All countries of the Region have a high rate of population growth. In all countries of the Region, maternal and child health has been given high priority. Education and training of health workers including medical undergraduates and interns in maternal and child health to provide MCH care has received particular attention. In this context, the need for orientation and refresher training of teachers in maternal and child health has also been considered essential. With a view to expanding coverage through primary health care, education and training of peripheral level workers, including traditional birth attendants, and workers of health-related sectors, in maternal and child care is to be supported. In compliance with the resolutions of the governing bodies of WHO, emphasis is being laid on the revision of training programme curricula in maternal and child health and production of educational materials.

A general decline in breastfeeding in urban populations has been noted and a regional programme in support of country programmes to promote infant and young child feeding is called for. School health programmes are getting fresh attention from national governments and their development in the context of primary health care is being encouraged. Reproductive health of adolescents too needs greater attention and support. Monitoring and evaluation of services and research in MCH in order to improve coordination of training and supervision, expand coverage by better use of resources and devise intervention strategies based on risk approach is getting due attention.

Proposed Programme Activities Training of appropriate manpower for the expansion of MCHIFP services as a part of primary health care is necessary. Towards that end, the following activities will be undertaken;

Review and development of curricula in MCH/FP for both basic and continuing education programmes in MCH/FP for all levels of health and health-related workers; Strengthening of national training institutions in MCHIFP; Development of appropriate teaching/education material in MCH/FP for all levels of health personnel, and Development of service manuals and guidelines in MCHIFP for all levels of health personnel.

Research activities will include:

Studies in the Risk Approach to the delivery of MCH care, and Ad hoc survey on infant and young maternal mortality and morbidity. child mortality and morbidity and

Suitable measures for the implementation of the International Code of Marketing of Breast-milk Substitutes such as surveys, national consultations, etc., will be underraken. Inter-sectoral activities related to day care, school health services, and reproductive health of adolescents will be supported. Budgetary Implications The increase of 36.8 per cent in the budgetary allocation is a reflection of the priority being given to the Maternal and Child Health Programme. Five countries of the Region have increased their allocation for this area.

PROGRAMME Objective

3.9.2

HUMAN REPRODUCTION RESEARCH

To support the continuous evolution and adaptation of technologies and approaches aimed at protecting and promoting the health status of individuals and couples of reproductive age, and of children by:

- devising improved approaches to the delivery of family planning care in the primary health care context;

- assessing the safety of existing methods of fertility regulation; - developing new birth control technology; - generating the knowledge and technology required for the prevention and treatment of infertility and other disorders of reproduction. Attaining this objective also involves promoting national self-reliance for research in family planning by collaborating with national authorities in building up manpower and facilities that will enable developing countries to plan and carry out research, adapt technology, and contribute fully to the advancement and application of science. Targets Subject to the availability of funds, by 1989 the Special Programme will have:

- Devised, through service and psychosocial research in as many countries as have requested collaboration, the means of integrating family planning into primary health care in the manner most appropriate to local conditions.

- Determined in different populations the safety and efficacy of methods of fertility regulation that came into use between 1970 and 1977, and assessed the acceptability and side-effects of methods introduced between 1977 and 1985.

- Brought to completion for use in family planning prograrnves at least six new methods currently being developed, reached an advanced stage of clinical testing with another three methods (including one for male users), and developed simplified methods for the diagnosis and treatment of infertility.

- Clarified the etiology of certain common diseases of reproduction (such as trophoblastic diseases), and improved approaches to their therapy.

- Strengthened, to the point of self-reliance, at least one research facility in each of those developing countries that, by 1984, will have national policies on and services for family planning. Situation Analysis The Special Programme of Research, Development and Research Training in Human Reproduction was established in 1972 as the main instrument within WHO for promoting and coordinating international research and development relating to family planning. After examining the Programme's progress during its first six years of operation, the World Health Assembly in 1978 endorsed its objectives, noted with satisfaction its structure, balance of activities and achievements, and reiterated "the need for research in reproduction taking account of the

complexity of the problem, the fact that experience in providing for fertility regulation through health services is still limited and that such activities may need to reach substantial sections of the community" (Resolution WHA31.37). The Special Programme intends to meet the challenge through the improvement of current methods of fertility regulation and the development of new ones. The side-effects of many of the current methods or their inconvenience of use are responsible to a considerable extent for failure to adopt family planning or to continue using the methods. Some types of method are entirely lacking, such as birth control drugs for men. Many forms of research are involved in developing new technology from basic investigations in reproductive biology, to chemistry, bioengineering, toxicology and clinical studies. In the 12 years since the Programme started, through collaboration with national authorities, research manpower and facilities have been built up to enable developing countries to play their part in research in this field. Some of these countries are now reaching the required degree of self-reliance; many others still lack a local resource to which national authorities can turn for advice and for research. Since its inception, the Special Programme has supported research in Bangladesh, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand. A total million 5 have been spent in these countries. In 1983, of approximately ~ ~ $ 1 funding for research and development and institution-strengthening in SEAR countries was approximately US$1.0 million, i.e., 12.8 per cent of the total human reproduction programme funding of US$13 million. The SEAR countries have contributed in a major way in achieving some of the targets through service and psychosocial research; evaluating the safety and efficacy of current methods of fertility regulation; development of new technology for family planning; and institution-strengthening for research. The Regional Office supports promotive and catalytic activities based on the needs of the countries. The management of the programme at the regional level requires promoting and initiating mechanisms to catalyze national efforts in priorities areas. In 1983, national meetings were supported in Bangladesh, Indonesia, Nepal and Thailand to identify priority areas for research. In the following years, it is proposed to support research in the areas identified. Proposed Programme Activities The Medium-Term Programme (1984-89) Regional Office activities are in accordance with global Seventh General Programme of Work objectives, targets and approaches related to human reproduction research. In the biennium 1986-87, WHO will: -

Promote Increased awareness of the aims and objectives of the Special Programme of Research, Development and Research Training in Human Reproduction among health policy planners and administrators, heads of medical research councils and analogous bodies and other institutions and scientists concerned in SEAR countries. the potential to undertake research and reproduction in SEAR countries. identification of national priorities. training activities on human

- Update information on institutions that are currently undertaking or have - Support catalytic activities for the review of ongoing activities and

- Support activities to promote collaborative and coordinated research for the development of new contraceptive methods and determination of long-term safety and efficacy of existing contraceptive methods most appropriate to local conditions.

- Promote institution-strengthening activities leading to national selfreliance for goal-oriented research and integration of family planning into primary health care.

- Support national meetings to ensure coordination of efforts among national, non-governmental and other agencies involved in research in human reproduction.

- Support catalytic activities to promote TCDC within countries of the Region. - Support promotive activities in specific areas of research concerning development of new contraceptive methods and improvement of existing methods with emphasis on health service and psychosocial research.

- Promote dissemination of research results on the safety and efficacy of specific contraceptive methods through inter-country consultative meetings involving researchers, policy makers and programme administrators, etc.

- Collaborate and participate in the overall strategy of the WHO Regional Research Promotion and Development Programme. Budgetary Implications The activities in this programme area will be supported by WHO/HQ Special Programme on Human Reproduction.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Inter-Country

67 000

PROGRAMME Objective

3.9.3

WORKERS' HEALTH

To collaborate with the Member Countries in the control of occupational health hazards, protection and promotion of the health of the working populations and promotion of the humanization of work.

Targets By 1989:

At least five countries of the Region will have developed occupational health programmes to provide preventive health care to workers at their places of work in various occupations, based on appropriate technology and workers' participation; and series of guidelines on health surveillance in work places, occuparional exposure limits, control measures, early detection and appropriate care for occupational and work-related diseases affecting various working groups will have been prepared. A

Situation Analysis Morbidity and mortality from diseases and accidents, attributable directly or indirectly to working conditions, have been increasing in countries of the South-East Asia Region as new work hazards continue to arise or require more vigorous intervention. Industrialization in developing countries and work automation, mechanization and stressful conditions of work have been associated with many physical and mental health problems. These are on the increase in the developing countries of the South-East Asia Region, where the speed of socio-economic change renders more people susceptible. Industrialization, with little attention to the control of work environment, has entailed much interactive effects which aggravate existing diseases and contribute to ill health. The number of toxic chemicals produced and handled by workers is rapidly increasing and there is a special need for action to protect workers who are daily exposed to toxic chemicals that might endanger their health or even survival. 'The statistical data available grossly underestimate the magnitude of the problem. The full impact of work environment in the etiology of cancer, chronic cardiopulmonary diseases, neurological disease and locomotor disorders has not been measured. Information is least complete in respect of workers in agriculture, transport, construction and the smaller factories where there are reasons to believe that the risks are greatest. The necessary drive toward increased food production and rapid industrialization, compounded by limited information and deficient control, inevitably expose vast populations of working men and women and their families to many hazards.

Occupational health services are provided only to those who work in large localized industries and the general health services do little to alleviate occupational diseases and accidents. It has become essential to ensure the development of community-based primary health care capable of dealing with occupational health hazards for the underserved working populations. Work-related diseases represent a much more serious problem than occupational diseases. These are the diseases that may partly be caused, but are often aggravated, by hazards in the work environment, and in all cases, they are amenable to control through occupational health intervention. There is need to identify these diseases and the role that work plays in their causation in order to develop guidelines for their control.

New areas in the field of occupational technology are assuming increased importance. They include early detection of diseases through identification of neuro-behavioural changes and the delayed effects of various health hazards, as well as the identification and control of adverse effects of occupational hazards on the reproductive functions. It is necessary to coordinate a programme aiming at the minimization of occupational injuries which inflict heavy losses of life and limb. Ergonomics aiming at humanization of work is becoming an essential component of occupational health services. Equally important is the identification and control of adverse psycho-social factors at work which lead to ill health and low productivity. Proposed Programme Activities Problems in occupational health will be identified in most countries of the Region. The Organization will assist at least five countries in developing and adopting techniques for the early detection, prevention and control of health problems of workers, including psychosocial problems related to adverse working conditions and also the health problems of special groups of workers. Special attention to occupational health problems of Member States in the early stages of industrialization will be provided on request. At least five countries of the Region will be stimulated to promote occupational health care to the underserved, such as those in agriculture, small-scale industries and construction. The Organization will collaborate with five countries of the Region with internationally coordinated programmes on occupational exposure to hazards on chemical, physical, biological, psychosocial factors as well as on work physiology and ergonomics. Countries will be assisted in developing guidelines, manuals and teaching material on occupational health as well as standards for occupational exposure limits to toxic substances and for exposure to hazardous physical factors. Countries will be supported in developing guidelines for occupational health services which ensure minimum basic protection and health care to the workers. The Organization will, on request, assist in monitoring the occupational hazards in the countries of the Region. Countries will be supported to carry out research on the hazards of indiscriminate use of pesticides and fertilizers in agriculture. Assistance will be provided in training health workers including primary health care workers in the delivery of basic occupational health services. The Organization will support the formulation of programmes for the health education of workers with a view to protecting their own health. WHO will collaborate with national administrations in planning and implementing primary health care programmes for the underserved workers. The Regional Office will support the development of appropriate occupational health technologies integrated into the primary health care system. Countries will be helped in developing suitable guidelines on primary health care for various categories of occupational health workers. The Organization will assist in the exchange of information and promotion of TCDC in training and research in the field of occupational health. Budgetary Implications The increase of more than 200 per cent in the budgetary allocation evidences the added importance that Workers' Health is gaining. Five countries will be having a new budget-line during 1986-1987.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 US $ Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Country

$ -

79 600

300 200

220 600

277.1

134 200

PROGWE Objective

3.9.4

HEALTH OF THE ELDERLY

To collaborate with the Member Countries in promoting community awareness of the specific social, physical and psychological needs and problems of the elderly in changing societies and encouraging the continuation of cultural and family traditions that favour the care of the elderly within the family. Targets By 1987, most Member States will have completed the guidelines for promotion and care of the health of the elderly population based on national policies already formulated. Situation Analysis The elderly is a fast increasing component of the total population of the Region consequent on the longer life expectancy in all Member Countries. The elderly encounter various specific psychosocial and health problems which need early detection and adequate management. Changes in the traditional family qystrm, ~conomictrends such as urbanization, emigration, etc., are an emerging problen in the care of the elderly. Economic constraints and the lack of well-defined social policies are largely responsible for the absence of an integrated plan for the care of the aged. National governments, with a few exceptions, have not formulated clear policies in the area of the care of the elderly, nor have they designated a national focal point. Community awareness too is lacking and participation of non-governmental organizations is marginal in most countries. Pesenrch in sprcifjc arras related to the psychosocial and health problems of the elderly is also lacking. Proposed Programme Activities Activities will be directed towards creating an awareness in the community of the problems of the elderly and the need to continue, as far as possible, the traditional family system with its in-built commitment to the care of the elderly.

WHO will also support the assessment of the health and psychosocial needs of the elderly in all Member States and promote and assist in the formulation of national plans for the care of the elderly. Support will be provided for the training of health personnel in the care of the aged and in the integration of health programmes for the elderly as an integral part of primary health care.

WHO will assist in the preparation andlor distribution of technical guidelines in health care of the elderly for use at various levels of the health delivery system. Research in specific aspects of the care of the aged will be promoted in selected Member Countries. Budgetary Implications Two countries have allocated resources under this programme area in the 1986-1987 biennium.

PROGRAMME Objective

3.10.0

PROTECTION AND PROMOTION OF MENTAL HEALTH

To collaborate with Member Countries in reducing problems related to mental and neurological disorders, alcohol and drug abuse, and to facilitate the incorporation of mental health knowledge and understanding in general health care and social development. Proposed Programme Activities This programme consists of sub-programme areas 3.10.1, Psychosocial Factors in the Promotion of Health and Human Development, 3.10.2 Prevention and Control of Alcohol and Drug Abuse, and 3.10.3 Prevention and Treatment of Mental and Neurological Disorders. Details of objectives and the activities that are proposed to be carried out during 1986-87 are indicated in the programme statements that follow.

P R O G W Objective

3.10.1

PSYCHOSOCIAL FACTORS IN THE PROMOTION OF HEALTH AND HUMAN DEVELOPMENT

To collaborate with the Member Countries in increasing the awareness of psychosocial aspects of health promotion, of social change and of human development and stimulating research in psychosocial factors in their relation to promotion of health and to human development. Targets By 1989, psychosocial knowledge and skills will have been incorporated into the training curricula of various categories of health workers in at least three countries of the Region. Situation Analysis Health services in several countries in the Region are yet to attain the developmental and social goals laid down as intrinsic to PHC. Community participation, self-reliance and individual self-realization remain largely outside the scope of current PHC activities which are often focused on curative activities with a relative neglect of promotive and preventive activities. Proposed Programme Activities In order to increase the social relevance of health services, training material on basic psychological and social skills will be established for the general health personnel, and its impact on parameters of health care, including the development of suitable indicators of mental health, will be evaluated. Budgetary Implications Bangladesh which had allocated resources for this programme area in 1984-1985 will be continuing the activities in 1986-1987 under other related programme areas. DPRK intends to initiate country programme in this field in 1986-1987.

PROGRAMME Objective

3.10.2

PREVENTION AhT CONTROL OF ALCOHOL AND DRUG ABUSE

To collaborate with the Member Countries in developing services and mobilizing community resources for the control of alcohol and drug abuse. Targets By 1989, a variety of technologies for prevention and control of alcohol and drug abuse problems will be evaluated, and the results disseminated to the Member Countries. Activities for 1986-1987

WHO will support the national efforts:

in the area of research on behaviourai technologies for social action, including prevention of alcohol and drug abuse; to establish a chain of institutions and services for the treatment of drug or alcohol dependent persons, and to monitor, through the institutions, the trends in abuse and to evaluate preventive and rehabilitative interventions.

Budgetary Implications No Regular Budget funds are earmarked for the activities under this programme during 1986-1987. Efforts will be made to mobilize extra-budgetary resources.

PROGRAMME Objective

3.10.3

PREVENTION AND TREATMENT OF MENTAL AND NEUROLOGICAL DISORDERS

To collaborate with the Member Countries in promoting mental health through prevention and treatment of mental and neurological disorders. Sub-objectives To:

- reduce social sequelae of severe mental disorders through extension of integrated treatment facilities; -

reduce social cost of severe mental disorders and disabilities through mobilization of community resources including self-help/rnutual aid efforts, and

- reduce social disability resulting from minor mental disorders. Targets

By 1989:

- The population coverage by integrated and community-oriented mental health care will have increased by at least 5 per cent per year, especially in countries with low rates of coverage; -

National plans on mental health will have been established in at least seven countries of the Region; and basic mental health skills including research, and mental health planning. social counselling, evaluative

- At least three regional centres will have been functioning for training of

Proposed Programme Activities In order to increase the coverage by basic community-oriented mental health care, training material on basic psychiatric and social skills, will be

established for the general health personnel, and its impact on mental health status, including the development of suitable indicators, evaluated. Operational research will be promoted on ways to optimize the use of resources and evaluate the iapact of intervention programmes. Budgetary Implications The increasing recognition of the importance of the prevention and treatment of mental and neurological disorders has led to a relative increase in allocations to this programme area.

PROGRAMME Objective

3.11.0

PROMOTION OF ENVIRONIIENTAL HEALTH

To collaborate with the Member Countries in the protection and promotion of human health through national, community, family and personal measures for the prevention and control of environmental conditions and factors that adversely affect health, and in the attainment of the HFA/2000 goal through promotion of a healthier environment. Proposed Programme Activities Community This programme consists of four sub-programmes, namely 3.11.1 Water Supply and Sanitation, 3.11.2 - Environmental Hea1:h in Rural and Urban Development and Housing, 3.11.3 - Control of Environmental Health Hazards, and 3.11.4 - Food Safety. Detailed activities that are proposed to be undertaken in 1986-1987 are indicated in the programme statements that follow.

PROGRAEfME Objective

3.11.1

COMMUNITY WATER SUPPLY AND SANITATION

To collaborate with the Member Countries in the implementation of strategies for atttaining the national targets for the IDWSS Decade. Targets It is expected that by the end of 1987;

Most countries will have completed mid-Decade reviews; At least six countries will have formulated national programmes on the basis of mid-Decade reviews; At least 50 per cent of the countries which have the national Decade plans will have formulated specific manpower development activities in accordance with this plan and initiated implementation; and At least four countries will have developed guidelines on software approach in institutional development.

Situation Analysis Seven countries have prepared Decade plans, of which two have been updated subsequently as a result of experiences gained during the initial years of implementation. Nine countries have National Action Committees or equivalent bodies to coordinate and monitor Decade activities but it cannot be said that all of them have been functioning effectively. In varying degrees, the systems implemented have not provided the expected health benefits due to deficiencies in the sector policies, strategies and approaches adopted in their implementation. Sanitation continues to lag behind water supply due to delays in the formulation of required policies, strategies and approaches.

Institutional weaknesses continue to have an adverse effect on the implementation of national Decade plans even though much of it has been corrected in the past five years. Shortage of trained manpower continues to hamper the sector development though few countries have, in some form or other, initiated training programmes. There is need to adopt a comprehensive human resource development approach involving manpower planning, manpower production and manpower utilization. Considerable activity is taking place on technology development and a system for exchange and transfer of technical information is being built up. It is becoming increasingly difficult to secure external assistance, especially for rural water supply and sanitation programmes, due to the continuing recession and competition for available resources from other sectors in which more tangible economic results may accrue. Proposed Programme Activities The mid-Decade review will have been completed in all the countries and, it is foreseen that the mid-Decade review statement will be published towards the end of 1986. An important component of this review will be the evaluation of the strategies of the Decade. The information provided by the review will be a part of the global monitoring activity of WHO. Support will be given to strengthen the institutional and educational framework for the Decade in practically all the Member States (with the possible exception of DPRK and Mongolia). The development of human resource will be taken up specifically vis-a-vis preparation or updating of human resource inventories and training materials, and building up of training institutions for the designated categories of staff. Support for these activities is foreseen in Bangladesh, Bhutan, Indonesia, Maldives, Nepal and Sri Lanka. In India and Thailand, the support activities will be related specifically to sub-items of work requested by the respective Governments. It is expected that by 1987 national institutions for the generation and dissemination of information on technology will have been established. The assistance provided for case studies and workshops through the Decade Advisory Services project is expected to help in this process. An inter-regional workshop for evaluating the Decade case studies is foreseen in 1987. Budgetary Implications The proposed budget shows an increase of 19.2 per cent. This is in fact not an increase region-wide, but is due to the amount for this programme being partially reinstated after the heavy cuts made for 1984-1985, in one country.

PROGRAMME Objective

3.11.2

ENVIRONMENTAL HEALTH IN RURAL AND URBAN DEVELOPMENT AND HOUSING

To collaborate with the Member Countries in promoting environmental health in rural and urban development and housing, and in the formulation and implementation of policies and programmes incorporating environmental health aspects in rural and urban development and housing. Targets By 1986:

A system for the collection and dissemination of information to assist countries to initiate activities relevant to their needs will have been established, and Legislation, institutional set-up and intersectoral action relating to the health aspects of urban and rural environments in most countries of the region will have been reviewed.

By 1989, national support programmes for most countries of the Region will have been developed. Situation Analysis The health hazards in indiscriminate and unplanned rural and urban development are not well-understood in Member Countries. The problems relating to health aspects of housing and physical planning have not received sufficient attention, notwithstanding the thrust of the global movement to provide space and shelter for the needy. This is because of the more urgent priorities for water and sanitation. Even the HABITAT Conference concentrated on the theme of Clean Water for All. Thus, the main emphasis has to be on the promotion and dissemination of information.

Proposed Programme Activities WHO will initiate activities for a review of regional literature on norms and codes for health protection in rural and urban development and housing, and initiate research in technical areas where operational norms are required. Budgetary Implications The proposed budget shows a decrease which is due to the fact that only one of the three countries which had earmarked resources during 1984-1985 would be carrying out activities under other related programme areas.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Country

350 200

50 200

(300 000) (85.7)

39 400

PROGRAMME Objective

3.11.3

CONTROL OF ENVIRONMENTAL HEALTH HAZARDS

To collaborate with the Member Countries in the formulation and implementation of policies and programmes for health protection against environmental hazards. Targets

- At least seven countries in the Region will have strengthened organizations for overall environmental health protection and related-training programmes, and

- At least four countries in the Region will have developed policies and programmes for Chemical Safety, and initiated related manpower training programmes. Situation Analysis In five countries of the Region, separate national Boards/Agencies have been established in recent years for environmental protection, while in some others the health ministries continue to be charged with these functions. Managerial and technical capacity for implementation vary considerably in the countries, not to mention the scarce resources generally allocated at the national level for their activities. The problems of the countries are similar but their pollution and health hazards control programmes are in varying stages of

development. Furthermore, these programmes have, in many cases, tended to remain marginal in their effectiveness as they were often patterned on the models of more developed countries without adequate attention being paid to local conditions and resource constraints. Only in recent years has there been a trend to make prior assessment of the environmental consequences of development projects by including such requirements in national and regional planning procedures. Many developing countries do not have appropriate regulatory and control measures for toxic chemicals. This has led to indiscriminate manufacture, Import, transport and use of these chemicals resulting in unknown exposure to them. The capacity to regulate the safe use of chemicals is limited mainly by shortage of trained manpower and institutions and lack of awareness on the part of the decision-makers and the general public. In all these control activities, the health ministries have a strong role to play. Proposed Programme Activities In order to assist governments of the Region in improving the situation described above, WHO will provide technical support to strengthen the managerial and technical capability of control agencies with special reference to their health concerns and their linkage with other health and developmental activities. The WHO programme will remain in step with the trend for prevention of pollution rather than through expensive treatment measures. The work programme foreseen for the period 1984-89 will, depending on specific country needs, consist of a mix of broad activities such as the following, and be phased to time with other country programmes:

- Strengthen national capabilities for undertaking chemical safety and pollution control programmes, determining health effects, and evaluating control strategies; -

Collaborate with national agencies in planning monitoring systems, collecting and analysing data and identifying high risk areas and groups; tional and managerial capabilities with due emphasis on the role of the health professionals;

- Support review and strengthening of legislation, standards and institu-

- Support

manpower development activities in selected topics;

programmes

through

group

educational

- Promote research and field investigations; - Promote community involvement and education; -

Support exchange and transfer of information, documentation of experiences, listing of pollutants and hazards, preparation of guidelines, monitoring and evaluation; and

- Assist Elember Countries in the preparation of new projects/programmes and mobilization of resources. WHO will provide consultancy support, facilitate the exchange and transfer of information and documentation, support group educational activities, and promote the use of national expertise through contractual services and TCDC as far as possible.

Budgetary Implications In view of the very modest allocation of funds for this programe, activities will be mainly implemented through the WHO inter-country programmes, except in India where separate country programme on this subject also exist. In DPR Korea, work in this field will be done mainly through the new UNDPfWHO project on Environmental Health Protection.

PROGWlE Objective

3.11.4

FOOD SAFETY

To collaborate with the Member Countries in promoting strengthening and implementation of food safety programmes. Targets By 1989, all countries in the Region would have:

the

development,

Established a focal point for implementation of the programme; Established an integrated and comprehensive food safety programme concurrently with the provision of safe water and sanitation as a part of Decade activities; Reduced morbidity/mortality food-borne diarrhoea; and from food-borne diseases, particularly

Reduced health hazards associated with chemicals in food.

Situation Analysis Food safety programmes in the countries of the Region are in varying stages of development. Even those with approved food laws and regulations lack resources for their effective implementation and enforcement.

Also, food safety programmes and activities in these countries are mainly directed to quality control and analysis of food and establishment or improvement of laboratory facilities at central and provincial levels, rather than directing activities and promoting food-related hygienic practices and health education for households in both rural and urban communities, where their population stores, handles and prepares food not subject to any form of control. Although country reports on food situation are available, there is still a need for more comprehensive baseline data and information in all related public health aspects to be able to develop an effective integrated food safety programme. A review and analysis of national needs now being planned will identify problems related to safe food. This will eventually lead to the development of national food safety policies and effective programmes. Proposed Programme Activities Efforts will be continued in supporting the formulation of a phased programme food safety, taking into account the development of a comprehensive and integrated approach which will include related aspects of environmental education, administration/legislation, etc. Some specific activities for 1986-87 will be mainly directed to the following: -

Provide inter-country programme support in manpower development through possible establishment of regional training centres and laboratories; Support to national workshops on food safety programme; research in priority areas including socio-behavioural studies, and

- Promotion of

- Collaboration in joint wHOIFAO programmes. Budgetary Implications The allocation of resources shows an overall increase of 14.4 per cent over that for 1984-1985 biennium. This is an important programme area for which resources from other sources will have to be tapped.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 US $ 1986-1987

Country Inter-country Total

US 5

246 500

290 900 20 000 310 900

44 400

18.01

25 300 271 800

(5 300) (20.9)

39 100

14.4

PROGRAMME Objective

3.12.0

DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE TECHNOLOGY

To collaborate with the Member Countries in the development and adaptation, promotion and use of diagnostic, therapeutic and rehabilitative technologies and the proper use of medicinal drugs. Proposed Programme Activities This programme consists of five sub-programmes, namely, 3.12.1 - Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care, 3.12.2 - Essential Drugs and Vaccines, 3.12.3 - Drug and Vaccine Quality, Safety and Efficacy, 3.12.4 - Traditional Medicine, and 3.12.5 Rehabilitation. Detailed activities that are proposed to be undertaken in 1986-1987 are indicated in the programme statements that follow.

PROGRAMME Objectives

3.12.1

CLINICAL, LABORATORY AND RADIOLOGICAL TECHNOLOGY FOR HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

To collaborate with the Member Countries of the Region in: -

strengthening health laboratory services in support of primary health care programmes, and both diagnostic and therapeutic country needs.

- promoting and supporting the use of appropriate clinical and radiological

technology in accordance with specific

Targets By 1989:

- All Member Countries will have introduced in-service training programme for peripheral health laboratory technology.

- Most countries will have strengthened middle and peripheral levels for clinical diagnosis and epidemiological surveillance of common diseases.

- Most countries will have introduced appropriate technologies in immunology, bacteriology and virology for diagnosis of commonly occurring communicable diseases.

- At least five countries will have developed programmes in quality control in clinical chemistry, haematology and microbiology.

- The radiodiagnostic and therapeutic facilities will have been improved so as to reach a target of one radiodiagnostic apparatus per 50 000 population and one radiotherapeutic apparatus per 2 million population in at least five countries.

- The basic radiological services (BRS) will have been set up on a pilot basis in at least three Member States of the Region. Situation Analysis Most of the countries have now developed an infrastructure on health laboratory srrvices in support of health programmes. While in most countries, the central public health laboratory has been strengthened, there is a need for developing technological competence in district, provincial and peripheral laboratories. Appropriate technology like rapid techniques in diagnosis has been introduced in some countries. Quality control in clinical chemistry has been developed in five countries and a beginning has been made to develop quality control in haematology and microbiology. Radiological services are unevenly developed, with most countries of the Region having inadequate provision of simple and appropriate diagnostic facilities and equipment at all levels of the health system, particularly at the health centre and supporting intermediate levels. Facilities for radiotherapy are even less adequate. At the same time, the preventive measures for protection aEainst radiation are either not enforced or not universally understood. Such inadequaries adversely affect the provision of minimum necessary radiodiagnostic and therapeutic services for the rural and sparse population in particular. Basic radiological services have been initiated in the past in only a few countries of the Kegion. Proposed Programme Activities Peripheral laboratories will be strengthened in support of primary health care programme. Some countries will be assisted in developing facilities for the production and standardization of microbiological reagents. The quality control programme in laboratory methodology will be further strengthened. Laboratory utilization studies will be undertaken. Rapid diagnostic techniques in bacteriology and virology will be introduced. The programme in clinical immunology will be developed and strengthened in a few countries. Countries will be assisted in carrying out situation analysis of the coverage of radiological facilities. An evaluation of the BRS project and its further applicability will be carried out in at least three countries of the Region. On request, the Organization will assist in carrying out comprehensive planning for radiological services in the countries of the Region. The Organization will also help in designing training programmes and curricula for radiological and maintenance personnel in countries where they do not exist.

Budgetary Implications While two countries will be initiating activities under this programue, two countries will be diverting funds to other areas. Overall, there is an increase in the budgetary allocation.

PROGRAMME Objective

3.12.2

ESSENTIAL DRUGS AND VACCINES

To collaborate with Member Countries in developing and strengthening drug policies with a view to ensuring supply of essential drugs of assured quality for primary health care. Targets By 1987:

All countries will have developed essential drugs lists. Most countries will have formulated drug policies. Most countries will have developed a sound procurement and supply system to ensure supply of essential drugs for prjmary health care at all timcs. All countries will have established at least stage I quality control, i.e., trained nationals for reviewing quality control protocols. Reference laboratories will have been established for vaccine testing. At least two laboratories in the Region will have been recognized as reference laboratories for quality control of essential drugs.

Situation Analysis WHO collaborated in the establishment of essential drugs lists. Several countries have now prepared a list which is being updated. At least three

countries have been assisted in developing drug policies. Nationals have been trained in quality control of vaccines and drugs. TCDC in pharmaceuticals among the ASEAN countries has been developed and strengthened. Managerial capacities for procurement and distribution in some countries have been improved. Proposed Programme Activities Countries will be assisted in the formulation, development and implementation of their drug policies. WHO will provide technical assistance for updating essential drugs list. Some of the countries will be assisted in strengthening the drug supply system; collaborating centres for training in quality control of drugs and vaccines will be established. ?latlonals will be trained in good manufacturing practices (GMP) in production and quality. Nationals from some countries will be trained in the production technology of essential drugs. Budgetary Implications The ongoing activities will be continued during 1986-1987, with budgetary allocation being at the same level as for 1984-1985.

PROCRAMIB Objective

3.12.3

DRUG AND VACCINE QUALITY, SAFETY AND EFFICACY

To collaborate with the Member Countries in developing and strengthening quality, safety and efficacy of essential drugs and vaccines. Targets

- All countries will have established at least stage I quality control, i.e., trained nationals for reviewing quality control protocols.

- Reference laboratories will have been established for vaccine testing.

At least two laboratories will have been recognized as reference laburatories for quality control of essential drugs. At least three countrie~ ir; the Region would have established advrrsc d n ~ g reaction monitoring centrzs. At least four countries information mechanics. in ti..? Region would have established drug

Situation Analysis

WHO has been collaborating with the countries of the Region in developing and strengthening capabilities for quality control of essential drugs and biologicals. Through active WHO collaboration, some of the countries of the Region like India, Indonesia and Thailand have developed and strengthened laboratory facilities as well as infrastructure for quality control of drugs and vaccines. Burma has been assisted in establishing quality control laboratories in drugs and biologicals, and in further strengthening the infrastructure for developing quality control of drugs. India, Indonesia and Thailand have developed capabilities for evaiuation of the safety of drugs. Proposed Programme Activities Countries will be assisted in the further development of quality control; reference laboratories will be established for quality control of pharmaceuticals and biologicals. Nationals would be trained in quality control programme. Countries will be assisted in developing capabilities for drug evaluation. Assistance would be provided for developing clinical and pharmacological units in some of the countries of this Region. Drug information system and drug adverse monitoring centres will be further strengthened. Budgetary Implications There is an overall increase in the allocation of resources to this progranme during 1986-1987, which reflects the interest shown by some Member Countries in strengthening laboratory facilities and the infrastructure for quality control of drugs and vaccines.

PROGWIME Objective

3.12.4

TRADITIONAL MEDICINE

To collaborate with the Member Countries in promoting the use of traditional practitioners and practices in primary health care. Targets By 1987:

- Countries with popular traditional systems of medicine will have included the use of traditional practitioners and practices in their health system for delivering essential health care.

- Research on the effective use of traditional practitioners and practices in primary health care will have been undertaken in all the interested countries of the Region.

- Research will have identified a list of safe and effective traditional medicines for selected diseases to be used in primary health care. Situation Analysis

In the South-East Asia Region, traditional medicine programmes have made steady progress in the Member Countries. It is recognized that to achieve Realth for All by the Year 2000, all available health manpower including practitioners of traditional medicine should be harnessed to deliver primary health care. Efforts were made to integrate practitioners of traditional medicine into the official health system but with only limited success so far. Research and development in traditional medicine also received some attentlon, it being recognized that the "Role of Traditional Practices and Traditional Practitioners in Primary Health Care" is the priority. However, there remain gaps in the programme that require sustained efforts to fill in future years. Medicinal herbs and plants which have long been used in the traditional practices are not systematically cultivated, harvested or exploited commercially to the full potential. There is not enough field experience on the effective use of traditional practitioners in the organization and delivery of primary health care and the integration of these practices into the government health services. Additionally, development of curricula for training traditional medical practitioners in promotive and preverltive health care has to be addressed if Lhey were to function effectively as members of the health team. With regard to traditional drug production and distribution, some countries are attempting to grow herbal plants or increasing their herbal wealth. While some countries like India have a number of production units, others have either started producing their requirements or are in the process of doing so. There is a significant trend of exchanging technical information and expertise between countries on TCDC basis in this field. In Bangladesh, two indigenous systems of medicine, viz., Ayurveda and Unani, are widely practised, particularly in rural areas. Traditional medicine plays a big role in delivering health services in Bhutan where the difficult terrain and shortage of manpower are major constraints in

organizing the health system. The Government of Bhutan had developed an indigenous medicine hospital. Traditional medicine has been practised in Burma since long. The institutions of traditional medicine in Mandalay play a leading role in training, research, supervision and direct services in the area of traditional medicine. Traditional medicine (known as Korean Medicine) in DPR Korea is well preserved and integrated with the modern medicine. Training courses offered in medical schools include Korean medicine as an elective subject. Acupunture and moxibustion are widely accepted, especially in the treatment of chronic diseases. In India, traditional systems of medicine have been playing their role in health care delivery, especially in rural areas. There are several systems practised but the most prominent among them are Ayurveda, Homoeopathy, Unani and Siddha systems. The Central Council of Indian Medicine, established by an Act of Parliament, regulates the practice as well as education in all these systems. Mongolia has an excellent network of hospitals and dispensaries of modern medicine. They also have departments of traditional medicine in them. In these departments or sections, patients are treated with medicinal plants, herbs, mud therapy, mineral water bath, acupuncture, etc. In Nepal, traditional medicine is practised widely. There are about 300 institutionally qualified practitioners of Ayurveda available in the country, out of which about 200 are employed in Government service under the Department of Ayurveda. This Department conducts a pilot scheme to utilize traditional medicine in primary health which was included as one of the components of the WHO and UNDP-assisted primary health care support services programe. In Sri Lanka, Ayurveda is part of the culture and has been practised for over 3000 years. In addition to the institutionally trained personnel, there is a large number of traditionally trained Ayurvedic practitioners. The national drug policy of Thailand aims at self-reliance in pharmaceutical raw materials and integration of traditional medicines and essential medicinal plants into primary health care programmes. It is intended to promote the availability of traditional drugs and training of Ayurvedic practitioners in villages with WHO support during the current biennium. Proposed Programme Activities WHO will collaborate in national activities by conducting a thorough situation

analysis of the traditional system of medicine and their use in the health system, and formulating policies and programmes in Member Countries in favour of involving traditional practitioners in the health system. WHO will provide direct support in the preparation of orientation guidelines in the preventive and promotive aspects and subsequent training courses. The development of country-specific training materials and phased training programmes will be supported. WHO support will be extended to develop this system also as a referral system

integrated into primary health care support services. As part of this effort, the building up of health infrastructure, logistic support, supplies and supervision for traditional medicine will also receive attention.

WHO assistance will be extended to the conduct of surveys of herbs and plants of medicinal value, promotion of improved methods of cultivation, harvesting and processing of medicinal herbs and plants, and promotion of small-scale local production of traditional drugs and designing of procedures for their standardization. Health manpower development for traditional medicine will receive priority attention in upgrading the capability of traditional practitioners in curative services as well as adding to their knowledge in preventive and promotive aspects. Technical support will be provided to improve the curricular content of training at the institutes of traditional practitioners. Support will also be extended to have a list of safe and efficacious traditional medicine practices and procedures for selected common diseases. Budgetary Implications Three countries will be initiating activities in the field of traditional medicine for the first time using WHO resources. All in all, there will be Five countries engaged in this field. The over 300 per cent increase in budgetary allocation is significant and is indicative of the important future role of traditional medicine.

PROGRAMME Objective

3.12.5

REHABILITATION

To collaborate with the Member Countries in promoting and supporting the use of rehabilitative technologies appropriate to the social, cultural and institutional conditions in countries with emphasis on the prevention of disabilities and rehabilitation of the disabled a s a n integral part of primary health care through a coordinated community based approach.

Targets By 1987:

- To achieve widespread public awareness of the causes of disablement and of preventive measures in at least four countries of the Region.

- To formulate comprehensive national plans for the prevention of disability and rehabilitation in three Member Countries of the Region.

- To foster development of community-based prevention and rehabilitation services in at least four countries.

- To have completed epidemiological studies in disabilities in at least five countries of the Region. Situation Analysis Since the UN International Year of the Disabled Persons in 1981, considerable interest has been evinced by Member Countries in the promotion and development of programmes for the prevention and rehabilitation of the disabled. In the context of health for all through a primary health care approach, the emphasis in the programme area is on community-based disability prevention and rehabilitation. Community surveys of disabled persons conducted in many countries of the Region point to a prevalence of 10 per cent. The causes of these disabilities include blindness, deafness, locomotor conditions, and mental disorders. Many of the disabilities are avoidable through appropriate strategies adopting known and often low-cost technologies. preventive

The recently-launched UNDP project IMPACT with UNDP, WHO and UNICEF paricipation aims at providing an impetus to the already existing initiative against avoidable disablement. The launching of this project in India in October 1983 would lead to the formulation of a plan for disability prevention and rehabilitation in India for inclusion in the Seventh Five-Year Plan. The programme will aim at creating an awareness in the community of the magnitude, causes and avoidable aspects of disablement and rehabilitative methods available. It would also provide information and support to activities for delivery of preventive and rehabilitative services. Proposed Programme Activities

WHO will support the formulatlon of national policies and preparation of plans of action for delivery of community--based rehabilitation in selected countries. Assistance will be given in the training of health personnel at all levels in the health care system to enable them to integrate the programme into primary health care. WHO will assist the development of one or more training/ demonstration centres for the provision of community-based rehabilitation in selected countries to serve as a model for replication in other parts of the same country or in a different country. The programme will promote and support epidemiological research in disability prevention and rehabilitation these activities, the programme will work along with such as nutrition, expanded programme on immunization, studies on operational methodologies. In all other programme areas leprosy, prevention of

blindness, mental health, etc., aspects of programme delivery. Budgetary Implications

both in technical as well as management

There is an increase of 87.2 per cent in the budgetary allocation, mainly due to three countries embarking on the formulation of national health policies/ plans of action for delivery of community-based rehabilitation services and the provision of a long-term expert in the Regional Office to support Member Countries in implementing the programme activities.

PROGRAMME Objective

4.13.0

DISEASE PREVENTION AND CONTROL

To collaborate with the Member Countries in the prevention and control of major communicable and non-communicable diseases. Proposed Programme Activities This programme consists of seventeen sub-programmes, namely, 4.13.1 Immunization, 4.13.2 - Disease Vector Control, 4.13.3 - Malaria, 4.13.4 Parasitic Diseases, 4.13.5 - Tropical Disease Research, 4.13.6 - Diarrhoea1 Tuberculosis, 4.13.9 Diseases, 4.13.7 - Acute Respiratory Infections, 4.13.8 - Leprosy, 4.13.10 Zoonoses, 4.13.11 - Sexually Transmitted Diseases, 4.13.12 - Smallpox Eradication Surveillance, 4.13.13 - Other Communicable Disease Prevention and Control Activities, 4.13.14 - Blindness, 4.13.15 Cancer, 4.13.16 - Cardiovascular Diseases, and 4.13.17 - Other Non-communicable Disease Prevention and Control Activities. Detailed activities that are proposed to be undertaken in 1986-1987 are indicated in the programme statements that follow.

PROGRAMME Objectives To:

4.13.1

IMMUNIZATION

- collaborate with the Member Countries in reducing morbidity, disability and mortality from diphtheria, pertussis, tetanus, tuberculosis, poliomyelitis, measles (and other diseases of public health importance, for which potent, safe and cost-effective vaccines become available) to a level where these diseases cease to be a major public health problem;

- promote country self-reliance in the delivery of immunization services within the context of comprehensive health services, and

- promote regional and, if feasible, country self-reliance vaccine quality control and vaccine production. Targets

in matters of

By 1986, all countries should have developed means for estimating the immunization coverage in children by the age of 12 months and the morbidity and mortality attributable to EPI target diseases included within the national programme. By 1988, all countries should have established morbidity and mortality reduction targets for the EPI target diseases included for the period 1990-1995 within the national programme. By 1990, immunization against the EPI target diseases should have been made available to all children and immunization against tetanus to all pregnant women or women of child-bearing age of this Region. Situation Analysis The EPI activities in SEAR were initiated in 1977 and by the end of 1981, the following were achieved:

Health workers, including national and middle-level managers, supervisors and vaccinators were trained in immunization activities, including surveillance of the target diseases and development of the cold chain to maintain the potency of the vaccines. The training was implemented initially through inter-regional and inter-country activities, and later through the organization of a large number of national training courses using standard training material that were sometimes translated into the national language and adapted to the local situation. Several epidemiological surveys were conducted in most of the countries to establish baseline data on some of the diseases preventable by immunization. Concurrently, the routine recording and reporting system of these diseases was much improved and is now a routine activity in almost all the countries of the Region. Several research projects on cold chain components, epidemiological studies, immunization strategies, and the cost of the programme, were completed or are currently in progress. In spite of these achievements, the national immunization programmes are still far behind the target of making immunization services against all the six EPI target diseases available to all children in the Region. By the end of 1982, it was estimated that the following average levels of coverages were reached for the countries of this Region (excluding DPR Korea): (1) Children less than 12 months of age:

(2)

One dose of Three doses Three doses One dose of

BCG of DPT of OPV (poliomyelitis) measles vaccine

22.4 24.9 9.5 0.6

per per per per

cent cent cent cent

Pregnant women: Two doses of tetanus toxoid

20.0 per cent

Therefore, intensive work is still required to improve the implementation of immunization activities in the countries of the Region. Proposed Programme Activities As the national immunization programmes in the Region mature and develop, the cnphasis will shift from support through inter-country activities to direct support at the country level in the directions of the EPI Five-Point Action Programme as adopted by the Thirty-fifth World Health Assembly in May 1982. In line with the Five-Point Action Programme, WHO will provide support to Member Countries to monitor performance of the EPI and keep abreast of the latest findings, provide information on immunization, examine EPI information systems and advise on relevant applied research. The Regional Office will provide technical cooperation to all the countries of the Region to develop sound immunization activities through dissemination of EPI-related documents, consultants, study tours, fellowships, grants, advice on supplies and equipment and regional staff duty travel. Support of training activities on all aspect$ of EPI management and implementation, epidemiological surveillance of the EPI diseases and quality control of EPI vaccines will be continued. Relevant training materials and guidelines will be provided to ensure adequate numbers of trained staff. Information on EPI and educational materials to promote acceptance of immunization will be disseminated to Member Countries of the Region to strengthen immunization as an integral component of health services. Efforts

will continue to attract extrabudgetary resources for the EPI to enable provision of adequate funds to the countries. Evaluation of national programmes will continue with support provided in organizing, implementing and analysing the results of periodic audits of the EPI to assess achievements in relation to established targets and to set operational priorities. Development of mechanisms and expertise to report, record and analyse information on EPI activities and the surveillance of the EPI target diseases will be fostered to enable evaluation of the programme outputs and impact. As part of this activity, guidelines and material for the EPI Information System Development will be provided to Member Countries of the Region and the regional information system developed further. Periodic immunization coverage surveys will continue to be promoted in the countries using WHO guidelines as well as epidemiologic surveys on the EPI target diseases. Countries will be assisted in developing and implementing applied research with a view to improving efficiency and effectiveness of immunization delivery with reference to training methodology, appropriate technology for the cold chain, local vaccine production, community participation and health education1 public information. Budgetary Implications There is an increase in the budgetary allocation for this programme which, after allowing for inflation, will enable the Member Countries to implement programme activities at the current high level. An attempt will also be made to mobilize extrabudgetary resources from donor agencies to supplement the activities.

PROGRAMME: Objective

4.13.2

DISEASE VECTOR CONTROL

To collaborate with Member Countries in reducing the spread andlor abundance of vectors, intermediate hosts and animal reservoirs responsible for the transmission of communicable diseases of major socio-economic importance.

Targets By 1989, to ensure that countries of the Region will have acquired means for self-reliant development, implementation and evaluation of vector and reservoir host control strategies. Situation Analysis Major vector-borne disease control. programmes in the countries of the South-East Asia Region will continue to depend mainly on vector control with pesticides. It is anticipated that integration of bio-environmental approach into chemical methods will increase but at a slow pace by 1986. Vector resistance to the safer and cheaper insecticides, refractory behaviour of vectors, increased cost of insecticides and opposition to the use of chemical pesticides by environmentalists are some of the major problems contributing to the breakdown in vector control. In view of the scarcity of well-trained entomologists and vector control specialists in each of the eight malarious countries in the Region, greater input in training and strengthening of training institutions is called for. Self-reliance through manpower development and training has been emphasized and pursued in recent years, and efforts will be continued in future years. Research on the development of technology by national institutions for integrated vector control and new cost-effective control methods suitable for application in different situations continues to be encouraged and assisted. Proposed Programme Activities In order to promote effective vector control programmes, WHO will participate in the planning, operation and evaluation of national anti-vector programmes involving periodic assessment of the needs, problems and constraints encountered in anti-vector programmes. Emphasis will be laid on Identifying priority intervention and management technology for improving national vector control programmes. In order to counteract vector resistance to insecticides, WHO will support government efforts to develop hio-environmental methods and pesticide management policies for rational use of pesticides in agriculture and public health. High priority will be given to promote integrated vector control. Community participation in simple source reduction/elimination of breeding places in relation to malaria, filariasis and dengue/DHF, in close liaison with public health information and health education will continue to be encouraged. WHO will continue the surveillance of vector resistance to insecticides. In order to develop cost-effective control methods, WHO will support national activities in research and investigations in vector biology and control with particular reference to field trials of alternative insecticides, of biological control agents, and of methods of environmental management. In order to promote national self-reliance in technical manpower in the field of vector control, WHO will support governments in establishing and strengthening training facilities in all aspects of vector biology and control so as to reduce the severe shortage of trained professional vector control specialists at country and community levels.

Budgetary Implications WHO'S increased input will be mainly in the form of technical services from the Regional Office (and for this purpose a long-term expert has been provided for). There will be no direct financial support except for two Member Countries.

PROGRAMME Objective

4.13.3

MALARIA

To collaborate with Member Countries in the prevention and control of malaria to enhance socio-economic development. Sub-objectives

prevent or substantially reduce mortality from malaria and progressively reduce malaria endemicity and transmission to a level that will not hinder socio-economic development of the countries at risk, and disease.

- prevent the re-establishment of malaria endemicity in areas now free of the Targets

- Malaria control activities will have extended to areas which are currently outside the purview of the anti-malaria programme to ensure, at least, the coverage of the population at risk in all priority areas of socio-economic importance.

- The annual parasite incidence (per 1 000 population) for malaria will be reduced to 0.1 in areas of low transmission and to 2 in areas of moderate transmission, while in areas of intense transmission the disease prevalence

will be reduced to around 7 per cent in priority areas (development project areas) and to around 18 per cent in non-priority areas. Situation Analysis On the basis of present trends, it is anticipated that, by 1986, the malaria situation in most countries of the Region will continue to improve but at a slower rate. The constraints now hampering malaria control programmes are likely to show only slight improvement. These constraints relate operationally to budget (rapidly rising costs, particularly if insecticides application are not being offset by increased funds), and efficiency (house coverage by spraying continues to fall); and technically to population migration of carriers into receptive areas and non-immunes into high risk areas, spread of multi-drug resistant falciparum malaria throughout the Region (replacing both drug-sensitive falciparum malaria and vivax malaria), ai~d situations where vectors are resistant to commonly used insecticides. Proposed Programme Activities In order to improve malaria control programmes, WHO will support national activities relating to stratification of malarious areas into ecologically, epidemiologically and operationally homogeneous areas, and will assist in developing, organizing and implementing appropriate anti-malaria measures. To reduce dependence on insecticides in these programmes, bio-environmental methods of vector control will be demonstrated. Studies on the impact of malaria control on socio-economic development will be promoted. Suppoit will be provided for external and internal reviews of programmes to assess the progress, identify constraints and recommend remedial measures. Methods for prediction, prevention and control of epidemics will continue to be designed. The development of health infrastructures able to undertake malaria surveillance, of guidelines for the integration of anti-malaria activities into the basic health services, and of intersectoral coordination committees at central, regional and local levels to implement malaria prevention and control work will form important parts of the WHO support programme. In order to promote training for anti-malaria programmes, WHO will identify training needs for several categories of personnel including primary health care workers, assess the adequacy of training facilities and courses in order to strengthen them, and collaborate in developing or revising curricula and manuals. National training courses as well as workshops for trainers and senior professional staff, and for individuals in other sectors who need orientation, will be supported. The establishment of research and training cells within national programmes will be promoted. Essential external training through fellowships for courses or study tours abroad, particularly within the Region where social and epidemiological conditions are similar, will be provided. Technical and operational problems will be identified, research protocols designed and results evaluated. The WHO regional programme and the UNDP/World BankfWHO Special Programme for Research and Training in Tropical Diseases will be closely coordinated so as to complement one another in supporting national activities. The studies will include in particular, work related to elucidating and circumventing Plasmodium falciparum resistance to drugs (including continued training of national personnel in the in vitro monitoring techniques, and trials of alternative medications particularly mefloquine in combination with sulfadoxine and pyrimethamine), and evaluation of vector resistance to insecticides (with trials of alternative methods of vector control, particularly those feasible for community participation). Impediments

to malaria control integration with primary health care systems (whether due to technical, personnel, or cost-effective constraints) will be investigated. Inter-country collaboration and coordination in all the above activities will be ensured by organizing of periodic border meetings of neighbouring countries, when the strategy, operations, research and training activities and mutual provision of supplies through TCDC may be determined. Budgetary Implications Continued emphasis is being placed on this programme by the Member Countries and the on-going activities will be continued during 1986-1987.

PROGRAMME Objective

4.13.4

PARASITIC DISEASES

To collaborate with the Member Countries in reducing the morbidity and mortality from parasitic diseases, and ensuring that these diseases will not hinder aocio-economic development of the areas where they are prevalent. Targets By 1989:

In respect of filariasis, to ensure that the affected countries will have research capabilities and programmes, and will have adopted such control measures as will be available. have adequate research capabilities and have adopted multidisciplinary approach for control through the primary health care system.

- In respect of intestinal helminthic infections, to ensure that countries

- In respect of leishmaniasis, dracontiasis and schistosomiasis, to ensure that the affected countries will have developed appropriate national control programmes, where feasible, through the primary health care system.

Situation Analysis Parasitic diseases are endemic in the countries of the region. Bancroftian and brugian filariasis are widespread and are the object of national control programmes, having varying degrees of effectiveness, particularly in urban areas. Local outbreaks of visceral leishmaniasis occur in India and Bangladesh in some areas where the vectors have proliferated following diminished house coverage with anti-malaria insecticide spraying. Dracontiasis is prevalent in some parts of India, particularly drier areas where water is contained in open tanks and ponds; however, the incidence of guineaworm is being markedly reduced by a national campaign. Schistosomiasis is focally present in some eastern parts of the region, particularly the Mekong basin and Central Sulawesi, but a more extensive threat is posed by migrations of infected people to places where potential snail hosts exist in ponds, streams and irrigation ditches. Intestinal helminths, an actual or potential pathogenic hazard especially for undernourished children in all the countries, are dealt with almost everywhere on an individual case-detection and treatment basis. Surveillance and mass treatment campaigns, coupled with sanitation inputs, are required particularly to reduce ascariasis and ankylostomiasis in children. Cysticercosis from pork tapeworm has been a major cause of epilepsy, notably in India, and Irian Jaya, Indonesia. Proposed Programme Activities WHO activities are aimed at promoting and strengthening national parasitic disease control programmes. Particular stress is laid on forecasting, preventing and controlling those showing epidemic potential, notably leishmaniasis. WHO will provide technical cooperation through advisory services, and collaborate in group educational activities and national trainins programmes. Research capabilities will be strengthened. Activities in respect of intestinal helminthic infection will include promoting and strengthening research capabilities, in assessing the magnitude of the problem and its socio-economic impact, as well as in planning, evaluation, and support of national interventions, with particular reference to communityoriented methodologies essential for HFA. The surveillance and control programmes of each country will be promoted particularly where intersectoral activities are involved and where linkages are required with EH (especially in respect of intestinal helminthiasis), with VBC (for mosquito vectors of filariasis, sandfly (phlebotomine) vectors of leishmaniasis, and snail vectors of schistosomiasis), and with PHC (for control and treatment at the community level, particularly of intestinal helminthiasis). Inter-country collaboration and coordination in these activities will be promoted by organizing workshops and meetings between neighbouring countries, when the strategy, operations, research and training activities stressing TCDC may be determined. Budgetary Implications Hitherto, country and WHO support for these programmes has, to some extent, been contained in general sanitation or other budgets, and this will no doubt persist due to the inter-disciplinary and intersectoral nature of the diseases, particularly intestinal helminthiasis.

PROGRAMME Objectives

4.13.5

TROPICAL DISEASE

RESEARCH

To develop new and improved tools for the treatment, prevention and control of tropical diseases; and to promote self-reliance in biomedical and health research in countries in which these diseases are endemic, in compliance with the policies and strategies of the Special Programme for Research and Training in Tropical Diseases (TDR). Sub-objectives

To promote and coordinate scientists and institutions of Member Countries for goal-oriented research leading to the development of new and improved tools for the control of major tropical diseases prevalent in South-East Asia, and To train scientists and strengthen institutions with a view to ir~creasing the research capabilities of the endemic countries.

Situation Analysis This programme is concerned with goal-oriented research development in six diseases - malaria, leprosy, filariasis, schistosomiasis, leishmar~iasis and trypanosomiasis, of which malaria, leprosy, filariasis and leishmaniasis are of major concern to the South-East Asia Region. The programme is operated through well-established mechanisms. Apart from the Scientific Working Groups, which support research promotion and developnent in specific disease areas identified as priority to the programme, the Research Strengthening Group promotes institutional strengthening activities and manpower development in endemic developing countries. Through the Research and Development efforts of TDR, improved and new tools have been, and are being, developed. Some of these are at a stage suitable for field and testing application. These include biological control agents for vector-borne diseases, new anti-malarial drugs and anti-leprosy vaccine. In SEA Region, since the inception of the TDR Programme, the countries with

endemic tropical diseases have participated actively in the planning, implementation and evaluation of the programme. These countries are Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. Efforts for further participation by the countries of the Region in the programme are being made by stimulating and promoting national research organizations, institutions and scientists through national, inter-country and regional meetings and by comunications on TDR mailing list, site visits, etc. At the country level, with the increasing awareness of the aims and objectives of the programme, further collaboration with TDR is being promoted in strengthening their national coordinating mechanisms according to their procedures and policies. Regarding research projects, the major contributions made by the SEA countries to the programme are in the field of chemotherapy of malaria and leprosy. Increasing participation is expected in all other components of the programme and in particular, in applied field research including socio-economic aspects. The research capability strengthening activities, which are important and relevant to the countries of the Region, have recently been increasing both in the training of scientists and in the strengthening of institutions. Most of the major focal institutions dealing with research and training in the tropical diseases are now receiving TDR grants in accordance with strategic plans developed by the Research Strengthening Group. Proposed Programme Activities Update inventories of ongoing and planned research in tropical diseases and relate these to the strategic plans of respective Scientific Working Groups (SWGs) with emphasis on the promotion of research in relatively neglected areas. Develop an inventory of institutions that are currently undertaking, or have the potential to undertake, research and training activities on tropical dlseases with special reference to the strategic plan of the Research Capability Strengthening Group (RSG). Develop through an inter-country workshop guidelines/mechanisms for the promotion of operational/field research including socio-economic research with special reference to testing new and improved tools for their application in the health care programme. Collaborate and provide necessary assistance and guidance in formulating proposals for strengthening researchlinstitutions. Disseminate research information with Programme with WHO headquarters. special reference to the Special

Collaborate and participate in the overall strategy of the WHO Regional Research Promotion and Development Programme. Budgetary Implications The activities under this programme area in the Member Countries are supported by WHO Headquarter's Special Programme on TDR through extrabudgetary resources.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 1ncreaset (Decrease)

Other Sources 1984-1985 1986-1987

us Inter-Country

168 400

PROGRAMME Objectives

4.13.6

DIARRHOEAL DISEASES

To collaborate with Member Countries in:

- preventing and reducing mortality from acute diarrhoeal diseases, and

reducing morbidity and associated ill-effects in infants and young children.

Targets By 1989:

- To achieve a decline in mortality rates and an improved status of nutrition among children under 5 years of age.

- To provide more than 25 per cent of acute diarrhoea cases access to oral rehydration therapy and information related to child care practices within the primary health care context. Situation Analysis Diarrhoea1 diseases are recognized in all countries as a serious health problem. About 250 million episodes occur every year in the children population in the South-East Asia Region, this population being the main target. From the national data, it is clear that in most countries diarrhoeal diseases are the leading causes of children's morbidity and mortality. Among the diarrhoeal diseases, cholera continues to be a cause of concern despite the fact that it accounts for less than 10 per cent of all acute diarrhoeas and seldom affects infants. Recent research in diarrhoeal diseases has made available new knowledge in the diagnosis, treatment and prevention techniques. This knowledge includes new diagnostic techniques such as ELISA (enzyme linked immuno sorbent assay) technique for the detection of rotavirus and Biken test for the detection of heat labile enterotoxin producing E.Coli, new treatment methods such as oral rehydration therapy (ORT) and new preventive methods such as home-made rehydration solution. The ELISA test has been used successfully for the detection of human rotaviruses. The methods are more sensitive than electronmicroscopy. The ELISA test can be used under field conditions to examine a

large number of stool specimens. In the Biken test, specific anti-toxin reacts with toxin liberated by actively growing organisms on a special medium and produces a line of precipitation at the sites where they meet in the optimal proportion. Proposed Programme Activities Countries will be assisted in the implementation of the basic strategies of their national diarrhoea1 diseases control programmes through the provision of consultant services; support to training health manpower by national and inter-country workshops/courses; strengthening PHC services; developing epidemiological surveillance system; improving food and hygiene education; strengthening clinical management including laboratory services; collaboration with UNICEF in ORS production and supply and creating awareness in the population for the values of ORS in diarrhoeas; developing a workable logistics system within the existing structure of PHC; identifying specific data and indices for programme evaluation and implementation; support to operational research, etc. Budgetary Implications There is a sharp increase in the allocation of resources for this programme area, mainly owing to the growing interest shown by Member Countries in the programme as evidenced by Bangladesh, Mongolia and Nepal initiating activities for implementation with WHO support. Funds from extrabudgetary sources will also be mobilized to supplement the programme activities.

PROGRAMME Objectives

4.13.7

ACUTE RESPIXATORY INFECTIONS

To collaborate with Member Countries in reducing the morbidity and mortality from acute respiratory infections (ARI) in children population aged less than 5 years, and older age groups.

Targets By 1986, to assess the magnitude of ARI problem in the Member Countries, and by 1989, to establish, in most countries, national control programmes on ARI integrated with basic health servicesIPHC, and develop adequate infrastructure to ensure flow of relevant data on ARI. Situation Analysis The problem of morbiditylmortality due to ARI has been clearly identified; however, each of the crucial aspects of ARI, namely diagnosis, treatment and prevention is complex and still controversial. As such, the main effort of this programme will be directed towards the reduction of mortality and morbidity specifically among infants and young children, in response to the following two facets:

- available epidemiological knowledge and effective, specific preventive measures; and

- scope for the reduction of mortality from ARI through PHC. Several countries of the Region have expressed the need for forrilulating workable programmes for service-cum-research components of ARI, and, subsequently, to develop mechanisms adaptahle to PHC for implementation of control activities. Proposed Programme Activities The magnitude of ARI problem in Member Countries will be assessed by co,.ducting epidemiological surveys, where necessary, and national ARI control programmes and mechanisms for flow of information on ARI will be developed1 strengthened; risk factors that influence the occurrence and clinical management of the disease will be identified; scientific information on ARI will be disseminated; country and inter-country educational actjvities on various aspects of ARI control will be stimulated, and the development of educational material useful for the management of the disease, including conduct of studies on the progress of the programme in PHC services, especially on operational aspects, will be supported. Within the operational research and services components, the following have been identified by the Technical Working Group on ARI, March i983, and the Inter-country Consultative Meeting held in the Regional Office in July 1983 as priority activities for regional and country implementation:

- setting up of national focal points to coordinate ARI activities and act as guiding body while implementing basic ARI strategies through the primary health care infrastructure;

- adapting existing and available ARI management strategies so that their application at various levels of national health delivery systems would be feasible and efficient;

- designing and testing alternative and improved management procedures that will constitute part of the ARI services programmes;

initiating PHC staff training in ARI based on local language curricula and preparation of similar health education material for the mothers;

- implementing community-based studies on mortality/morbidity to describe the magnitude of the ARI problem for planning current and future ARI control/ preventive activities, especially with regard to the most vulnerable age groups (children 0-5 years of age and age-group above 45 years of age);

- conducting operational research according to country needs, in support of the services component of ARI activities (clinical studies on different approaches to ARI management, pathogenetic studies, socio-behavioural investigations relevant to programme delivery, etc.);

- developing multicentre studies of regional/national interest based on standard protocols, and

- identifying collaborating and training centres for ARI and transferring technology within TCDC concept. Budgetary Implications Four Member Countries of the Region have shown their interest in formulating workable programmes for service-cum-research components of ARI, which has resulted in a substantial increase in the allocation of funds for this programme area.

PROGRAMME Objective

4.13.8

TUBERCULOSIS

To collaborate with Member Countries in the prevention and control of tuberculosis till it is no more a major health problem in most countries of the Region.

Targets By 1989:

- Most countries will have integrated tuberculosis control programmes into their health systems based on PHC.

At least 90 per cent of eligible age-groups in the population will be immunized with BCG vaccination and such coverage maintained in all countries. Most countries will have sufficient number of trained workers for the control of tuberculosis.

- All country programmes on tuberculosis will have been evaluated. Situation Analysis Tuberculosis continues to remain a major public health problem even though national programmes for the control and prevention of tuberculosis have been in operation for nearly two decades in the Region. In order to make sustained efforts to control tuberculosis, affected countries are paying greater attention to implement a control strategy which includes treatment of all bacteriologically confirmed cases, and integration of the programme activities into the general health services, as far as possible. In some countries, tuberculosis and leprosy control activities were combined into a programme of mycobacterial disease control. WHO collaborated with national programmes by providing advisory technical support, training support and 'research support to a tuberculosis chemotherapy centre. WHO and UNICEF have provided BCG vaccine and are supporting its production to achieve regional self-sufficiency. The present status of the programme is such that immunization by BCG vaccine has been incorporated into national programmes on expanded immunization while control measures, namely, case-detection and treatment are gradually being integrated into the general health services. This strategy will be further implemented during the period of the Seventh General Programme of Work (1984-1989). Proposed Programme Activities

In order to assist the countries in tuberculosis control, technical collaboration will be undertaken by WHO in the planning and organization of integrated tuberculosis control programmes and resource analysis for implementation. Further activities will include: surveys on the status of integration of tuberculosis control programme into general health services; involving community participation in tuberculosis prevention and control activities including BCG vaccination, case-detection and treatment; organization of national and international courses for training health workers in the epidemiology and control of tuberculosis; dissemination of valid scientific and technological information; support for expansion and development of facilities for standardized bacteriological examination of sputum for intensifying case-detection activities; support for achieving self-reliance in BCG vaccine production; strengthening national research institutions and supporting national studies on operational, technical and epidemiological problems related to tuberculosis prevention and control; evaluating and reformulating tuberculosis control programmes and support analysis of resource availability and use, and identification of resource needs and gaps and mobilization of additional internal and external resources. Budgetary Implications There is an increase of 119 per cent in the allocation of funds from the Regular Budget, as Bangladesh, India and Nepal have increased their country

allocation in order to strengthen their respective national programmes while Bhutan and Maldives have taken steps to implement the programme activities with support from the Regular Budget during this biennium. 4.13.8 7

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Country

620 100

1 358 500

738 400

119.1

1 077 9 0 0

PROGRAMME Objectives

4.13.9

LEPROSY

To collaborate with Member Countries in reducing progressively the prevalence rate of leprosy by interrupting the transmission of infection and preventing the occurrence of sequelae of the disease. Targets By 1989, all countries in the Region with endemic leprosy will have national managerial capability for planning, implementing and evaluating leprosy control, implemented within the primary health care system, and 90 per cent of multi-bacillary cases of leprosy will be brought under effective treatment. Situation Analysis Leprosy is a subject of increased research effort, especially under the TDR as well as national control programmes. The Regional Office is coordinating with nine Member Countries in strengthening their national leprosy control servlces. Significant increase in the registration of new cases has been achieved in Burma, India and Indonesia. More than 8 0 per cent of registered patients received treatment. However, only 47 per cent received it regularly. The need for improvement of case-holding and operational efficiency of the treatment delivery system and defaulter retrieval and health education is well recognized. The low proportion of the institutionalized patients (5.2 per cent) indicates that Member Countries have adopted the strategy based on ambulatory treatment. Integration of leprosy with PHC is an accepted policy throughout the Region and is implemented in Bangladesh, Burma, Indonesia, Sri Lanka and Thailand. Survey results from Indonesia have revealed the magnitude of the problem with prevalence rates as high as 15.3 per thousand. Multi-drug regimen studies have been promoted to make better use of the existing drugs and decrease the risk of relapses. Nine out of ten Member Countries participated in the training for the development of technical and managerial expertise. In four countries, research studies are

being conducted and the Organization is assisting in the evaluation of control activities in several countries. A significant decline in incidence has been noted in Thailand, Burma and parts of India; however, these gains are obscured by the emergence of cases resistant to Dapsone, and relapses. In order to overcome this problem, multi-drug regimens are being recommended for the treatment of leprosy for which voluntary agencies, such as SIDA, SASAKAWA and the Damien Foundation are providing support. In order to propagate the uses of multi-drug therapy, there have been national and inter-country meetings. Research Projects

A number of research projects on the immunology of leprosy (IMMLEP) and ld Special Programme therapy of leprosy (THELEP) under the ~ ~ ~ P / w o r ~ank/~kIO for Research and Training in Tropical Diseases are currently in progress and being promoted in the countries of the Region. In order to reduce the prevalence rate of leprosy and prevent occurrence of sequelae of the disease and to provide effective treatment to the leprosy population, collaboration will be undertaken with the countries in the analysis of their current situation and formulation of national leprosy programmes suggesting improved methods of case-detection, early treatment with effective chemotherapy, promoting case-holding and contact-tracing through programme management and training. For this purpose, assistance will he provided in the assessment of the social attitude towards leprosy and the promotion of intensive health education to general social support and community participation. In addition, country and inter-country workshops will be organized to design strategieslapproaches for leprosy control, and clinical, laboratory and rehabilitation services will be assisted. Research on leprosy will be encouraged and field trials with multi-drug regimens to ascertain optimum drug combinations, dosage and duration of treatment and to delay or prevent the emergence of dapsone resistance in multi-bacillary patients and activities on any other relevant aspect of leprosy will be supported. Budgetary Implications The large increase of 155 per cent in the Regular Budget resources for activities under this programme area is necessitated by increased allocations made by Burma and India to strengthen their national programmes. Mobilization of extrabudgetary resources will also be resorted to in order to provide additional support to these programme activities. 4.13.9

PROGWE

4.13.10

ZOONOSES

Objective To promote and collaborate in the development of strategies and programmes for the control of zoonoses and food-borne diseases. Targets

BY 1989, to achieve:

- recognition of major zoonotic and food-borne diseases through surveillance programmes;

- initiation and strengthening of control programmes; - minimization of health risks due to animals in urban areas and in large intensive animal production units, and

- identification of research priorities in zoonoses and food-borne diseases. Situation Analysis Rabies is a serious problem in most countries of the Region. Brucellosis is prevalent in those countries where the basic economy is agriculture and livestock breeding. More zoonotic and food-borne diseases would be identified as the epidemiological surveillance mechanism and health laboratory facilities develop. While it is a concern that is shared by at least two Ministries Health and Agriculture - many Member Countries are yet to develop strategies for the prevention and control of zoonotic diseases, and properly assess the magnitude of the disease problem. Proposed Programme Activities This programme will be implemented by promoting the establishment of national zoonoses and food-borne diseases committee; supporting planning and development of surveillance activities at national, state/provincial levels; formulating and implementing control programme strategies including assistance in the national plans for manpower requirement, and training in VPH through the organization of national and inter-country educational activities, stepping up support to national research in VPH, and development of regional zoonoses centres. Budgetary Implications The modest increase in the allocation of resources for this programme is owing to the increasing interest of Member Countries as evidenced by India and Sri Lanka increasing their allocation for strengthening their respective national programmes, and Indonesia and Nepal initiating action to formulate control programme strategies with WHO collaboration.

PROGRAMME Objective

4.13.11

SEXUALLY TRANSMITTED DISEASES

To collaborate with the Member Countries in developing and strengthening national capability in the prevention and control of sexually-transmitted diseases. Targets

- At least four countries in the Region will have assessed the magnitude of the STD problem, particularly of PPNG resistance.

- Most of the countries will have established facilities for diagnosis and contact-tracing.

Most of the countries will have STD control programmes integrated into PHC.

Situation Analysis Sexually-Transmitted Diseases (STD) are becoming an increasingly complex public health problem in the South-East Asia Region, with serious consequences for individuals and the community as a whole. The rising trend in STDs should be viewed against the rapid environmental changes affecting the tradition-bound societies. The magnitude and dimensions of the problem are not yet exactly ascertained due to inadequacies of the reporting and recording system. Besides, the main problems are the increase of antibiotic resistance, scarcity of physicians, self-medication by patients, difficulties in case-finding, poor community participation and motivation and limited health education. The control of STDs should be considered by the Member Countries as a multidisciplinary and integrated approach within the framework of existing health services structure.

Proposed Programme Activities The activities will include assistance in establishing adequate health infrastructure; conducting epidemiological surveys; promoting development of services at all levels to improve service delivery to the community; developing or strengthening information systems on STD for the smooth flow of information and feedback; strengthening operational management and integration of STD control into PHC; creating a mechanism for adequate source detection, investigation and treatment of cases and strengthening laboratory services, including logistics and equipment and drugs, involving health-related sectors in the programme. Collaborate with the nationals in the development of health manpower by organizing educational activities, (country and inter-country) and award of fellowships. Support health education of the public (vulnerable age groups), specially in schools, by teaching, providing technical literature and audio-visual aids. Budgetary Implications There is a slight decrease in the resources allocated for this programme area as compared to the previous biennium. Due to the importance of this programme in the Member Countries of the Region, extrabudgetary resources will have to be tapped to support the activities.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us S Country 150 200

128 000

(22 200)

(14.8)

PROGRAMME Objectives

4.13.12

SMALLPOX ERADICATION SURVEILLANCE

To collaborate with the governments in maintaining continued surveillance of smallpox. Situation Analysis Following eradication of smallpox from the globe in 1978, WHO is maintaining an effective system to coordinate with the Member States in the investigation of suspect smallpox cases in the Member Countries. Reports about suspect cases are investigated promptly by the national authorities and when needed specimens are collected for testing in WHO collaborating centres.

Proposed Programme Activities Necessary supplies will be provided to field projects and support through local cost subsidies/grants will be provided for national EPI mid-level management courses.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Country

77 900

PROGRAMME Objectives

4.13.13

OTHER COMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

To collaborate with Member Countries in improving national capabilities in communicable diseases surveillance, prevention and control programmes with international coordination, where necessary, with special reference to the arthropod-borne viral and rickettsia1 diseases, as well as virus diseases transmitted by other routes, specifically: (a) Dengue F ~ v ~ ~ / D H F / D s S

- to continue development of passive and active surveillance/control activities integrated surveillance system; with the national communicable disease

- to continue and complete prospective epidemiological studies in Thailand, Sri Lanka, Indonesia and Burma and transfer operational results to the national surveill.ance system on DHF, and

- to continue research on the development of dengue virus vaccine, using available and emerging technologies. (b) Acute Viral Hepatitis (and Liver Diseases)

- to incorporate surveillance of the diseases into the existing communicable diseases surveillance system in Member Countries where it has been recognized as a major health problem;

to continue epidemiological and etiological research in this area specifically to find out the magnitude of Non-A/Non-B acute hepatitis (NA NB) infections by identifying the causative agent and their epidemiological pattern;

- to continue efficacy studies of hepatitis B vaccine in high risk population groups, and

- to strengthen national research capabilities in the field of rapid diagnostic reagents and human immunogloholin production. (c) Japanese Encephalitis (JE)

- to strengthen the existing passive surveillance system areas where JE is endemic;

- to initiate operational research in support of improving diagnostic and management strategies, and

- to initiate well-designed test trials of JE vaccine. Targets By 1986, all countries in the Region will have developed epidemiological surveillance/services integrated at all levels of health service systems and sensitive to the detection of known or emerging communicable diseases of public health importance. By 1989, countries in the Region will have undertaken relevant research in the epidemiology and control of emerging communicable diseases, particularly the arthropod-borne and other viral and rickettsia1 diseases of the Region's concern. Situation Analysis Dengue haemorrhagic fever, previously reported in a few cities, seems to have Burma, Indonesia and spread to the countryside too in three countries Thailand. There has been evidence of circulation of dengue virus in Bangladesh, India, Maldives and Sri Lanka though DHF as such has not so far been reported except five cases in Sri Lanka in 1984, indicating further potential for the spread of the disease.

Acute Viral Hepatitis: NA NB hepatitis of viral and non-viral origin emerged as a major health problem in most countries of South East Asia. The A-like type is predominant, although B-like NA NB cases were also detected sporadically. The high case fatality rates among pregnant women cause concern and need urgent in-depth assessment. Viral B hepatitis, due to its chronicity and long-term sequelae leading to primary hepatacellular carcinoma, is the second priority public health problem among viral hepatitis. The hepatitis vaccine B trial, now in progress in Burma, will render valuable results towards the appropriate selection of preventive strategies in high risk groups of infection, specifically after dosage and vaccination schedules have been investigated with regard to overall costefficiency of this strategy. Prevention of hepatitis A needs improvement of environment and personal hygiene. Although the number of cases is still high, the fatalities are very low and no chronicity is observed. A suitable vaccine now under development is the only effective measure to contain hepatitis A infection and disease in our Region.

Japanese Encephalitis: Outbreaks are reported regularly from several countries of South-East Asia. Rapid diagnostic techniques are not yet available and casefinding and management strategies that are applied to acute cases are symptombased. Passive surveillance on JE exists in some countries. However improvement is still needed, especially intensified vigilance on vector and in endemic areas. The situation, therefore, demands that full collaboration with the public health laboratory services be established. In this context, the public health laboratory service itself requires strengthening and further expansion to the peripheral areas. These measures are essential to make epidemiological surveillance of known and emerging communicable diseases stronger and to promptly respond to epidemic or sporadic outbreaks of DHF, Japanese encephalitis and endemic/sporadic acute hepatitis. Proposed Programme Activities WHO will support:

- Development and improvement of the existing epidemiological surveillance system with regard to DHF and viral hepatitis, rendering them an efficient tool in initiating early control activities in both epidemic and endemic situations. Besides passive surveillance, efforts to initiate an active one (sentinel surveillance and special surveys) will be supported;

- Development of special surveillance approach for Japanese encephalitis needs;

- Strengthening of regional diagnostic capabilities for

D H F , acute viral hepatitis and JE through the promotion of regional-national programmes for the indigenous production of reagents;

- Developing concise training curricula for case-finding, management and control of outbreaks of DHF, viral hepatitis and JE and incorporating them into the existing national health workers' training schemes;

DHF research in main priority areas (epidemiology of D H F I D S S in silent and

endemic areas, dengue vaccine development, clinical management where indicated, and immunopathological research), and

studies

- Expansion of viral hepatitis research, Hepatitis B virus trials and epidemiological studies, which will include NA NB research and feasibility studies on reagents, human immunoglobolin and hepatitis B vaccine production. Budgetary Implications There is a decline in the allocation of resources for this programme area as support for ongoing activities will be mobilized from extrabudgetary resources.

PROGRAMME Objectives

4.13.14

BLINDIESS

To collaborate with the Member Countries of the Region in the provision of essential eye care to the total population and the control of the major causes of avoidable blindness. Targets By 1989:

- All countries will have formulated andlor further refined their national plans for the prevention and control of blindness.

- All countries will have established and strengthened facilities for the training of all levels of health and allied personnel in community-oriented health care.

- Most countries will have undertaken, through regional collaboration research in the area of eye health services delivery and common causes of blindness. Situation Analysis A large percentage of blindness and visual impairment is avoidable, i.e., curable or preventable. It is estimated that there exist 12 million blind persons and a further 60 million visually impaired persons in the Region. Apart from the human suffering and impaired quality of life that results from this disability, the economic consequences both in terms of loss of working hours and the cost of rehabilitation of those disabled is phenomenal. Blindness is therefore a major public health problem, particularly in the context of the low cost technology generally available to prevent or treat avoidable blindness. A firm national commitment exists in all countries to include prevention of blindness in the overall national health plans. Many of the countries have

formulated national programmes which are in different phases of implementation. The basic approach has been the integration of eye care as part of primary health care. Such an approach has led to the development of facilities for the delivery of primary eye care at the peripheral and referral facilities at intermediate and tertiary levels. Programme implementation has also included the training of personnel at all levels, management of outreach services for delivery of eye care and eye health promotion. In view of the multi-factoral causes of blinding diseases, a multi-disciplinary approach in prevention has been promoted and supported. Proposed Programme Activities With a view to enhancing the delivery of essential eye care in the Member Countries, WHO will support the training of specialist and non-specialist medical staff, nursing and other health personnel in the principles and practice of community-oriented ophthalmology. This would include fellowships, both regional and extra-regioal, and workshops - both national and regional and the supply of educational audio-visual material. In addition, direct support would be provided through supplies and equipment for the delivery of eye care at the peripheral level and through outreach services, and at intermediate and tertiary centres through referral services.

WHO will promote and provide guidance and assistance for research projects aimed at improving the delivery of eye care and methodologies for the prevention and management of the common eye conditions. Support will also be provided for the monitoring and evaluation of programme implementation through the setting up of suitable data bases, information systems, and defining indicators for evaluation of the efficiency and effectiveness of programme delivery. Budgetary Implications Burma, India, Indonesia, Nepal and Sri Lanka have made enhanced provisions for the programme in keeping with the national commitment. In these and other member countries, the programme will be supported through contributions from the Voluntary Fund for Health Promotion.

PROGRAMME Objective

4.13.15

CANCER

To collaborate with Member Countries in reducing morbidity and mortality due to cancer. Targets By 1989:

- To have widely promoted such life styles and behaviour which are conducive to the reduction of cancer incidents.

- To have halted further deterioration of the cancer problems in the Region and reduced the incidence of the commonest cancers. Situation Analysis In a number of countries of the South-East Asia Region, cancer is emerging as one of the causes of the significant morbidity and mortality. Oropharyngeal cancer is widely prevalent in Bangladesh, India and Sri Lanka. Cancer of the cervix uteri is a common form of cancer in several countries of the Region. Primary cancer of the liver is also an important cause of mortality. The socio-economic conditions in most countries of the Region make it imperative that the detection of cancer be carried out at a very early stage of the disease. For this purpose, a pilot project was initiated in Sri Lanka in which trained primary health workers proved capable of detecting pre-cancer and cancer of the oral cavity. These results need to be reproduced in other parts of the country as well as in other countries of the Region, to tackle the problem of oral cancer more effectively. It is also recognized that the chewing of tobacco is a major cause of oral cancer. This also calls for health education efforts to change the behaviour of the people. Proposed Programme Activities National policies and programmes for cancer control will be formulated in at least five countries of the Region. Cancer health education, early detection, diagnosis and treatment, including rehabilitation, will be promoted through the primary health care system with adequate referral support. An information system for health professionals and public health administrators will be established through hospital-based and population-based registries in five countries of the Region. Surveillance and monitoring of environmental carcinogens will be established in a few selected countries. Efforts will be made to promote collaborative research, such as epidemiological studies in public health intervention. Primary health care workers will be trained in the detection and referral of cases of the commoner cancer. In the selected five countries of the Region, investigations will be carried out into the possibilities of control of chronic liver diseases, and intervention in one or two selected countries in the prevention of liver cancer. National, regional and international coordination will be fostered for training and research in cancer control. A regional strategy will be developed for the prevention and control of two commonest cancers of the Region, oropharyngeal and cervical cancer.

Budgetary Implications The allocation of funds is maintained at the 1984-1985 level and the marginal increase registered is due to India utilizing WHO collaboration to strengthen its programme activities.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources 1984-1985 1986-1987

us Country

us $

529 800

581 500

51 700

9.7 I

PROGRAMME Objective

4.13.16

CARDIOVASCULAR DISEASES

To collaborate with Member Countries in reducing morbidity and mortality due to major cardiovascular diseases and in adopting measures for their primary prevention. Targets

- By 1987, identification of risk groups and education on prevention. - By 1989, adoption of public health intervention measures as an integral part of primary health care.

- By 1989, to implement, in at least two countries, programmes based on improved methods and strategies for preventing cardiovascular diseases and to select priorities for intervention. Situation Analysis Cardiovascular diseases are emerging as a public health problem of importance in several countries of the Region. Economic and social changes are bringing about changes in life style, age distribution patterns, life expectancy and, consequently, new public health priorities. Such trends have been recognized in several countries of the Region, e.g., in Sri Lanka and in the urban population of India and Thailand. Hypertension is ubiquitous, and prevalence rates of around 150 per thousand exist in both developed and developing countries. Its main complications cerebral stroke and heart failure - are worldwide problems, especially in older age groups. It is a risk factor for ischaemic heart disease. Rheumatic

fever, though readily preventable, is still showing prevalent rates of 2 to 5 per thousand in under-privileged children. With the exception of some cardiomyopathies, measures exist for the prevention and control of common cardiovascular diseases. Control of cardiovascular diseases in the community may be regarded as a paradigm of comprehensive chronic disease control, and the primary prevention of cardiovascular diseases is aimed at remote, but nonetheless very concrete and attainable goals. National programmes for the control of rheumatic fever need to be developed on the basis of available experience in this field. Also there is scope for implementing a programme on 'smoking and health' for preventing cardiovascular diseases. In 1983, national seminars on smoking and health were held in Sri Lanka, Bangladesh, Thailand and in 1984, a national seminar was held in Bangladesh and an inter-country seminar in Nepal. Proposed Programme Activities A regional programme on the prevention and control of rheumatic fever and rheumatic heart diseases will be established and promoted in at least three countries of the Region. Surveys will be carried out to identify risk factors and the population at risk of cardiovascular diseases. National medium-term programmes will be formulated for the promotion of the status of cardiovascular health and prevention of cardiovascular diseases in four countries of the Region. A programme of public education on smoking and its adverse effects on health will be instituted in six countries of the Region. An educational programme on the value of adequate physical exercise in the prevention of cardiovascular diseases will he instituted in at least six countries of the Region. A training programme for health and allied personnel in the prevention and control of cardiovascular diseases will be mounted in the majority of the countries of the Region. Facilities for the management of cardiovascular diseases, including rehabilitation, will be strengthened or established as an integral part of the existing health care system in most of the countries in the Region. Research on the primary prevention of cardiovascular diseases will be promoted. Inter-country collaboration and consultation on strategies for the prevention of cardiovascular diseases will be promoted and a regional programme for the prevention and control of cardiovascular diseases, especially for the prevention and control of rheumatic fever and rheumatic heart diseases, will be mounted. Budgetary Implications There is slight decrease in the resources for this programme area as a whole. However, some countries have made enhanced provision to strengthen their ongoing programme activities.

Approved Budget 1984-1985

, Regular Budget Proposed Budget 1986-1987 Increase1 (Decrease) Other Sources 1984-1985 1986-1987

Country

790 600

709 000

(81 600)

(10.3)

. PROGRAMME Objective To collaborate with the Member Countries in reducing the socio-economic burden caused by non-communicable diseases of major public health importance such as diabetes mellitus, chronic respiratory diseases and rheumatic diseases. Targets 4.13.17 OTHER NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

- At least in four countries of the Region surveys to determine the magnitude of the problem of diabetes mellitus will have been completed.

- At least in two countries of the Region, surveys to define the magnitude of the problem of chronic respiratory diseases will have been completed.

- In some countries of the Region, the surveillance of priority noncommunicable diseases as part of general disease surveillance will have been established.

- In most countries of the Region, community-oriented measures for the control of diabetes mellitus will have been established and the burden of available socio-economic loss reduced. Situation Analysis Apart from cancer, cardiovascular diseases, hypertension and rheumatic fever, other non-communicable diseases of metabolic and degenerative origin are emerging as public health concerns in the Region. Diabetes mellitus is one such disease which affects a large number of people including children. Mortality due to diabetes mellitus, chronic rheumatic conditions, and chronic respiratory diseases gives very small indication of the human suffering and the aggregate socio-economic burden that these diseases account for. A WHO Collaborating Centre for Research, Training, Prevention and Control of Diabetes Mellitus has been set up in Bangladesh. Notable progress has been made in the study of the epidemiology and clinical management of diabetes mellitus. A longitudinal action research study at one

institute in the Region, has produced useful experience and knowledge relevant to comprehensive control programme, related research and training in respect of diabetes mellitus. A collaborative study on chronic liver diseases including liver cancer was carried out under the auspices of the Regional Advisory Committee on Medical Research. Information in regard to the prevalence of viral hepatitis and liver cancer in the countries of the Region was also gathered through this study. It is hoped that in the not too distant future, preventive measures against primary liver cancer may become known. Experts from the Region have participated in global meetings on diabetes, hereditary diseases including thalassemia, at WHO headquarters. Proposed Programme Activities A regional strategy will be developed for the implementation of a communityoriented comprehensive programme for the prevention and control of noncommunicable diseases as an integral part of primary health care in at least three countries of the Region. Community-oriented comprehensive programmes for the prevention and control of non-communicable diseases of public health importance will be formulated. A plan of action will be developed for the prevention and control of selected diseases, such as diabetes. Epidemiological studies and surveys to define the magnitude of the problem and other noncommunicable diseases will be carried out in four countries of the Region. Information on the morbidity and mortality in selected non-communicable diseases will be collected in several countries of the Region to assess the epidemiological situation and trends. Health services research on integration of activities for the prevention and control of non-communicable diseases in primary health care will be promoted. Budgetary Implications The 40.9% increase registered in the funds allocated for this programme area is mainly due to DPRK and Mongolia making use of Regular Budget for supporting their programme activities, while India and Sri Lanka have reduced their provision.

PROGRAMME Objective

5.14.0

HEALTH INFORMATION SUPPORT

To ensure the availability to Member Countries of valid scientific, technical, managerial and other information relating to health, in printed and other forms, whether originating within the Organization or outside it, particularly in relation to the attainment of the target of health for all by the year 2000. Targets Health Literature Services: By 1988, a functioning mechanism will have been established in all countries of the Region and in the WHO South-East Regional Office, for collecting and disseminating valid and relevant health information and literature to all categories of users. Publications and Documents: The translation of WHO publications in regional languages will have been promoted. The dissemination of WHO publications throughout the Region will have been expanded. Situation Analysis Health Literature Services National health science libraries have now been linked into functional HeLLIS networks in seven of the eleven countries of the Region, viz., Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand, each with an identified focal point library and they in turn, are linked to a focal point located in the Regional Office. Progressive strengthening of the technical capabilities of national health science library staff has taken place with a series of national and regional training workshops. Sharing of resources is now taking place between the libraries, especially with reference to procurement of reprints and photocopies of journal articles while the MEDLAR search facility made available by the Karolinska Library and Information Center is being increasingly used. Collaboration between national Health Services Research and HeLLIS focal points has been established for the collection and indexing of "fugitive literature" as an essential support of national HSR efforts, while exchange of information between these national focal points is being promoted by exchange of national and regional HeLLIS and HSR Newsletters. Abstracts from national health science and related periodicals have been collected, annotated and indexed for publication of Volume I1 of the Index Medicus for South-East Asia. Volume I has since been widely distributed within the Region and its sale to other libraries and institutes concerned is progressing satisfactorily. The achievement of HFA goals envisages the increasing and active involvement of non-health professionals in health-related matters. This defines the need for libraries and information centres of the future to encourage and cater to the information requirements of totally new categories of users. lne rapid growth of communication technology will soon begin to pose new problems relating to the cost and effectiveness of the traditional technologies now utilized in libraries of the Region. These developments call for a clearer definition of national information policies. Their translation into plans that are more future-oriented will lay greater emphasis on the training and retraining of librarians in new skills, establishment of broader information bases and wider deployment of information facilities to meet the needs of the new category of users.

Publications and Documents: The Regional Office is now publishing a large range of texts in three series. These series are tailored to meet the needs of Member Countries both as regards health and biomedical information for promoting PHC at the grassroots level. The findings of groups of experts convened by the Regional Office to provide the latest scientific and technical advice on health on biomedical subjects are now being published in the SEARO Technical Publications series. The recent quantum leap in in-house printing and word processing technology has enabled the Regional Office to produce publications informally and inexpensively. In consequence, reports and other documents are also being brought out more rapidly and efficiently. WHO'S translation subsidy scheme is being promoted through briefings of consultants and by communication with Member Countries through the WPCR offices. Committees or working groups have been established within the Ministries of Health of three countries in the Region to identify WHO texts suitable for translation under the subsidy scheme. Spontaneous requests for translation are also being received and approved. WHO and SEARO publications are being distributed free and sold throughout the Region from the Regional Office. The possibility of decentralizing the sales distribution network from the Regional Office to the countries is being studied. Proposed Activities for 1986-1987 Health Literature Services: Support will be provided for national and regional activities concerned with the strengthening of the regional and national Health Literature and Library Services Network with special emphasis on training health science librarians in areas which foster network activities. This would include support provided for the publication of further updated volumes of the Index Medicus of South-East Asia and assistance provided for the classification and indexing of information generated at the national level, which is of significance in supporting national health services research efforts. Publications and Documents: Publications and documents in support of WHO programmes in Member Countries will be produced with emphasis on texts covering the development of health infrastructures and the related managerial process, health systems research and the delivery of primary health care with the support of the rest of the health system. An increasing proportion of the published texts will be devoted to information on health systems based on primary health care and their development and social control through community involvement and intersectoral action, including descriptions of innovative and successful examples that are to be found in the countries of the Region. All countries will be kept aware of WHO'S subsidy support for translation of publications into national and local languages. Better and cheaper dissemination of health and biomedical information in the countries will be attained by further improving the in-house printing technology of the Regional Office and developing improved distribution mechanisms in the countries. Budgetary Implications The slight decrease is due to reduced provisions made under the inter-country programme and by Indonesia while Nepal is maintaining its allocation at the 1984-1985 level. Sri Lanka will be initiating activities under this programme during 1886-1987.

P R O G W Objective

5.15.0

SUPPORT SERVICES

To provide effective and efficient administrative support services at all organizational levels in support of the delivery of the WHO regional collaborative programme. Plan of Action for 1984-1989 and Activities for 1986-1987 This programme will evolve and utilize policies and practices which take into account the overall long-term and medium-term requirements of the Organization's health programme as well as statutory requirements such as those enunciated by the World Health Assembly, Executive Board, Regional Committee, Financial Rules and Regulations, and Staff Rules and Regulations. It will also provide the full range of administrative, constitutional and legal interpretation; personnel services; general services; supply services; budgetary and financial services necessary for timely health programme delivery and staff support and ensure appropriate liaison between the administrative support services and health programme management.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

z 7.4

4 356 000 4 679 700 323 700

162 000

178 500

PROGRAMME

5.15.1

PERSONNEL

This programme ~rovides the full range of personnel services appropriate to the implementation of the WHO Regional collaborative programme and to WHO staff in the Region, within the context of the Staff Regulations, Staff Rules, and appropriate guidelines. These services include: recruitment and classification, staff relations, contract administration and staff development and training.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

364 600

381 900

17 300

4.7

PROGRAMME

5.15.2

GENERAL ADMINISTRATION AND SERVICES

This programme provides for administrative support to the Regional Director in all policy, legal and constitutional matters, as well as for the full range of general services required for the operation of the Regional Office; for the physical support of the staff working in this office and for the conduct of meetings held there. The estimates include requirements for (a) office of the Director Support Programme, and (b) building/maintenance; utilities, acquisition, operation and repair of office furniture, office equipment and transport; communications; expendable office supplies, and staff of the General Administrative Services Ilnit.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase/ (Decrease) Other Sources 1984-1985 1986-1987

us Regional

a 9.1

3 110 800 3 395 200 284 400

35 000

38 500

PROGRAMME

5.15.3

BUDGET AND FINANCE

This programme provides budgetary and financial services in the planning, preparation and implementation of the regional collaborative programme, as well as financial services to WHO staff. It includes preparation of the programme budget document, budget implementation monitoring, control and accounting of expenditures, maintenance of bank accounts, claims settlement, etc., and ensuring that transactions are In accordance with the Financial Rules and Regulations of the Organization.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

z 2.0

623 900

636 300

12 400

127 000

140 000

PROGRAMME

5.15.4

EQUIPMENT AND SUPPLIES FOR MEMBER STATES

This programme provides for the procurement, delivery, inventory and disposal of supplies and equipment necessary for the implementation of the regional programme.

Regular Budget Approved Budget 1984-1985 Proposed Budget 1986-1987 Increase1 (Decrease)

Other Sources 1984-1985 1986-1987

us Regional

256 700

266 300

9600

3.7

Annex 1

REGIONAL O F F I C E

- BUDGET PROPOSALS

Number of Posts REGIONAL OFFICE

Budget 1984-1985 Proposals

F U

N 19841985 1 9 " 1987 1986-1987

1.2.0 WHO'S General Programme Deveopment and Management 1.2.1 Executive Management Regional Director Administrativeofficer Secretary Secretary Clerk-stenographer UG P2 ND8 ND7 ND7 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 156 95 29 25 25 800 800 600 000 000 172 102 28 24 24

400 500 800 800 800

332 200 36 200

Duty Travel

353 300 47 000

368 400 1.2.3 General Programme Development Director, programme management Programme directors Chief, health manpower development Chief, planning and coordination Technical officer (health for all) Planning officer Special assistant Administrative assistant Assistants Assistant Assistant Clerk-stenographer D2 Dl P6 P6 P5 P5 NDX ND8 ND8 ND8 ND7 ND6 1/24 2/48 1/24 1/24 1/24 1/24 1/24 1/24 3/72 1/24 1/24 1/24 1/24 2/48 1/24 1/24 1/24 1/24 1/24 1/24 3/72 1/24 1/24 1/24 133 400 266 800 133 400 133 400 133 400 133 400 40 100 29 600 88 800 25 000 25 000 20 700

400 300

R B

140 300 280 600 140 300 140 300 140 140 39 28 86 28 24 20 300 300 200 800 400 800 800 800

.. Number of Posts REGIONAL OFFICE Approved Budget 1984-1985 Proposals

F U N D

19841985

19861987

1986-1987

Clerk-stenographer Clerk-typists

ND6 ND5

1/24 2/48

20 700 34 200

1 217 900 74 500 1 292 400

1 267 700 97 600 1 365 300 RB

20 800 36 000

Duty Travel

2.6.0 Public Information and Education for Health Information officer Assistant P2 ND6 1/24 1/24 1/24 1/24 95 800 25 000 120 800 9 100 27 300 157 200 5.14.0 Health Information Support Editor Reports assistant Special assistant Library assistant Assistant Technical information assistant Clerk-stenographer Clerk-stenographer Clerk Stores clerk P4 NDX NDX NDX ND7 ND6 ND6 ND5 ND6 ND5 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 133 40 40 40 25 20 20 17 20 17 400 100 100 100 000 700 700 100 700 100 140 39 39 39 24 20 20 18 20 18 300 200 200 200 800 800 800 000 800 000

102 500 20 800 123 300 11 800 34 100 169 200 RB

-Duty Travel Public information material

Number of Posts REGIONAL OFFICE

Approved Budget 1984-1985

Proposals

1985

1987

1986-1987

F U N D

Clerk-typist

ND4

1/24

13 800 388 800 17 500 406 300

11 Library books

15 600 396 700 21 900 418 600 15 600 24 800

- -

Clerk-typist Sales assistant

ND4 ND7

1/24 1/24

38 800

13 800 25 000

40 400 AS

5.15.0 Support Services 5.15.1 Personnel Personnel officer Administrative assistants Senior assistants Clinical nurse Clerks Clerk-stenographer P4 ND8 ND7 ND6 ND5 ND5 1/24 2/48 4/96 1/24 2/48 1/24

1/24 2/48 4/96 1/24 2/48 1/24

133 400 59 100 20 34 17 200 000 700 200 100

140 300 57 99 20 36 18 600 200 800 000 000

11 364 600

371 900 10 000

Staff training

364 600

381 900

Number of Posts

Approved Budget 1984-1985

Proposals

REGIONAL OFFICE 1985 1987 1986-1987

F U N D S

5.15.2 General Administration and Services Director, support 1/24 Dl programme 1/24 Administration and finance officer P5 1/24 1/24 Administrative services officer P4 1/24 1/24 Special assistant NDX 1/24 1/24 Airconditioning operator NDX 1/24 1/24 Administrative ND8 assistants 2/48 2/48 Supervisor, typing/ printing NDX 1/24 1/24 Travel assistant ND7 1/24 1/24 ND7 Clerk 1/24 1/24 Administrative assistant ND8 1/24 1/24 Assistant airconditioning operator ND6 1/24 1/24 Machine operator ND6 1/24 1/24 Assistant ND6 1/24 1/24 Clerk-stenographer ND5 1/24 1/24 Clerk-stenographer ND5 1/24 1/24 Mail clerk ND5 1/24 1/24 Registry clerk ND5 1/24 1/24 Machine operator ND5 1/24 1/24 ND5 Clerk-typists 5/120 5/120 Telephone operator ND4 1/24 1/24 Receptionist ND5 1/24 1/24 Clerk-typists ND4 4/96 4/96 Clerical assistants ND4 4/96 4/96 Driver ND4 1/24 1/24 Drivers ND3 61144 61144 ND4 Clerical assistants 2/48 2/48 Mechanical assistant ND4 1/24 1/24 Janitor messengers ND3 111264 111264 ND2 Daftries 3/72 3/72 Janitor messengers ND2 61144 61144 Janitor messengers NDl 15/360 15/360 Clearing supexvisor ND4 1/24 1/24 Janitor messenger ND1 3/72 3/72

133 400 133 400 133 400 40 100 40 100 59 200 29 25 25 25 600 000 000 000

140 300 140 300 140 300 39 200 39 200 57 600 39 24 24 28 200 800 800 800

20 700 20 700 20 700 17 100 17 100 17 100 17 100 17 100 85 500 13 800 13 800 55 200 55 200 13 800 70 800 27 600 13 800 129 800 30 000 60 000 126 000 13 800 25 200 1 526 100

20 800 20 800 20 800 18 000 18 000 18 000 18 000 18 000 90 000 15 600 18 000 62 400 62 400 15 600 82 200 31 200 15 600 150 700 36 000 72 000 156 000 15 600 31 200 1 681 400

Number of Posts REGIONAL OFFICE 1985 1987

Approved Budget 1984-1985

Proposals 1986-1987

N D

Temporary assistance General operating expenses Supplies and material Acquisition of furniture and equipment

105 700 830 600 505 100 130 000 3 097 500

137 400 874 000 525 0 0 0 160 000 3 377 800 17 400 3 395 200 38 500 -

Duty travel

13 300 3 110 800

R B AS

General operating expenses 5.15.3 Budget and Finance Budget and finance officer Special assistants Administrative assistants Cashier Assistants Assistants Clerical assistants Clerk-typists P4 NDX ND8 ND8 ND7 ND6 ND5 ND4 1/24 2/48 3/72 1/24 3/72 61144 3/72 3/72 22 Assistant BFO Budget assistant P2 ND7 1/24 1/24 1/24 2/48 3/72 1/24 3/72 6/144 4/96 2/48 22 1/24 1/24

35 000 -

133 400 80 200 88 29 75 124 51 41 800 600 000 200 300 400

140 300 78 400 86 28 74 124 72 31 400 8 0 0 400 800 000 200

- 623 900 95 800 25 0 0 0 120 800 6 200 127 000 636 300 102 500 0 0 24 8 127 300 12 700 140 000 AS

- 2 Duty travel

- -

Number of Posts

Approved Budget 1984-1985

Proposals

REGIONAL OFFICE 1985 1987 1986-1987

F U N D

5.15.4 Equipment and Supplies for Member States Supply officer Administrative assistant Supply assistant Assistant Clerical assistant Clerk-stenographer Clerk-typist P4 ND8 ND7 ND6 ND5 ND5 ND4 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 1/24 133 29 25 20 17 17 13 400 600 000 700 100 100 800 140 28 24 20 18 18 15 300 800 800 800 000 000 600 RB

7 -

7 256 700 266 300

Total

---163

- REGIONAL OFFICE

----

163

6 781 100 --------6 580 300 200 800

-- -------

7 252 000

Of which: Regular Budget Other Sources

159 4

7 033 100 218 900

Annex 2

COUNTRY PROGRAMMES

COUNTRY STATEMENTS AND BUDGET PROPOSALS

Bangladesh

2. 3.

Bhutan Burma Democratic People's Republic of Korea India

5. 6.

Indonesia Maldives

7. 8. 9.

Mongolia Nepal

10.

Sri Lanka

11.

Thailand

SUMMARY OF DIRECT TECHNICAL COOPERATION WITH, AND SERVICES TO, GOVERNMENTS

Regular Budget Approved Budget 1984-1985 Bangladesh Bhutan Burma Democratic People's Republic of Korea India Indonesia Maldives Mongolia Nepal S r i 1,anka

Other Sources Approved Budget 1984-1985 4 521 200 860 800 5 174 200 39 400 9 234 600 3 320 100 142 600 430 SO0 3 753 300 1 678 700 303 400 6 508 800 ------- ---

Proposals 1986-1987

6 348 000

7 555 400 843 300 4 849 700 1 548 500 11 623 700 8 292 000 892 500 1 711 100 5 302 500 3 812 000 4 465 300 11 794 100 62 690 100 ------------- ---- +

244 400 196 900 2 407 300

642 000 4 123 000 1 327 400 9 920 000 7 113 000 770 500 1 491 100 4 492 000 3 264 000 3 824 000

3 557 000 757 200 1 400

688 200 817 200

Thailand Inter-Country Total

11 351 300

1 471 900

-- --------

54 666 300

35 967 900

----------- -- ---- -

10 141 500

BANGLADESH NATIONAL HEALTH SITUATION During September 1983, the Planning Commission (Ministry of Finance and Planning) of the Government of the People's Republic of Bangladesh published two important papers, namely, "Thoughts about Perspective Plan" and "Thoughts on the Third Five-Year Plan 1985-90". The second paper mentions in paragraph 15 that Bangladesh has achieved significant progress in primary health care and has been successful in eliminating some scourges. Life expectancy is now around 48 years and infant mortality is estimated to be around 135 per thousand. In both areas, substantial improvements have yet to be brought about. Mother and child health care should continue to receive high priority in primary health care in order to make family planning a success. The physical infrastructure in each Union should be completed during the Third Five-Year Plan and the capacity for training of all field level officers of primary health care should also be enhanced. Secondly, supply of safe drinking water in rural areas should be a major goal for the Third Five-Year Plan. Programmes on health and nutrition, and village sanitation will also be emphasized. The first paper mentions in paragraph 23 that "in spite of substantial effort of the past, the health status of people is still far from being satisfactory for the simple reason that the curative programme has been generally overemphasized. If primary health service has to be ensured to all, the emphasis should shift from curative to promotive and preventive services. These should contain (i) supply of safe drinking water, (ii) village sanitation, (iii) health education at the family level, (iv) control of communicable diseases, (v) improvement of paramedical services, (vi) strengthening of the vertical referral system throughout the country, and lastly, (vii) improving the hygienic environment at the community level. The community responsibility in health care should be the key to health for all by 2000 AD." The above statements reflect the health status of the country as of 1983 and the thrust the Government wishes to have in the health sector during the Third Five-Year Plan, which covers the period from July 1985 to June 1990. Communicable diseases like malaria, diarrhoea1 diseases, tuberculosis, leprosy, intestinal helminthiasis, and diseases preventable by vaccines, together with malnutrition, still remain the major causes of morbidity and mortality in Bangladesh. Health services have yet to reach the villages in an effective manner. Shortage of drugs and medical supplies, poor maintenance of medical equipment, shortages and deficiency in the health manpower area (specially nurses) in terms of quantity and quality, administrative and organizational constraints involving health and population wings of the Ministry of Health, are the main determinants of inadequate and ineffective health care delivery system in the country. On the other hand, it should be noted that the Government has rationalized its policy regarding the production and deployment of health manpower during the last two years. The country's overall administrative infrastructure is being streamlined with decentralization to the periphery, whereby a thana would become the main focus of national development. As of mid-1983, around 260 thanas out of 360 rural thanas in the country have been upgraded to become "uppa zillas". An uppa zilla or new tt~ana shall have the means to generate some revenue, and administer and manage other resources within the thana to foster developmental efforts which invariably will include family planning and primary health care.

The 18-point programme of the Chief Martial Law Administrator was announced, and the programme is now being operationalized. Among others, the highlights of the programme are: village-oriented development, reorganization of the administration and the judiciary, decentralization and austerity, establishment of the role of women in the society through participation in the national development, provision of medical care facilities to the people, and population control. These steps would lead to a situation wherein the community would take initiatives in health and family planning activities in the context of total development in their locality. All the activities, planned and implemented in the uppa zillas, which would address food production, literacy, health, family planning, etc., will converge to a socio-economic uplift. This, in turn, would lead to reduction of infant mortality, control of population growth, adequate food supply and better nutrition, and longer life expectancy. The important epidemiological features of almost all the common diseases in Bangladesh are known. Administrative, managerial and organizational weaknesses can be identified as major constraints in the application of scientific and technical know-how in solving disease problems. Furthermore, failure to mobilize the people to take active part in solving their own health problems, coupled with grossly inadequate logistics support, complicate the situation. WIlO COLLABORATIVE HEALTH PROGRAMME 1986-1987 WHO'S technical cooperation in 1986-1987 will be mainly in the expansion of its current programme in 1984-1985. Special emphasis will be laid on the mobilization of external resources from bilateral and multilateral agencies so that WHO'S resources could be spread out in a number of programmes with the attendant catalytic effects. In its endeavour, consideration will be given to the need for the development of national capabilities on the operational, organizational and managerial apsects of health services with specific technical inputs. The main thrust of the collaborative programme will be in the fields of strengthening of health services, training of health manpower, development of health infrastructure in support of primary health care, community water supply and sanitation, control of various communicable diseases and strengthening of the managerial process for national health development. Health Situation and Trend Assessment WHO will support the development of the health information system, including health statistics and epidemiological surveillance activities, with particular reference to the utilization of health information in the assessment of the health situation and trends extrapolation. The lay reporting system will be further developed in the context of primary health care as an adjunct to overall health information generation. This will include the development of electronic data processing facilities. A suitable health survey-cum-service delivery and thana health complex will be developed and tested. Managerial Process for National Health Development Support will be given to the formulation, implementation, monitoring and evaluation of the health programmes from both technical and financial aspects. The programme will also promote better coordination within the Ministry of Health and Population Control, and with other ministries and non-governmental bodies in matters of health.

Health Systems Research WHO will support a suitable institution to promote health services and operational research, and application of the results in primary health care. Organization of Health Systems Based on Primary Health Care Support will be provided to national activities for the strengthening of health infrastructure at uppazilla and union levels, expansion of primary health care, and various aspects of health planning and management, both for the enhancement of health planning capability in general, and planning and management directed to health services/systems development based on primary health care. Health Manpower WHO cooperation in this field will cover the training of different categories of health manpower. Specifically, support will be provided to health manpower planning as part of overall health planning, training of nursing personnel, mid-level and peripheral level health workers and dental personnel. Support will be given to the development of teachers in various institutions, with particular emphasis on basic science and clinical subjects. Public Information and Education for Health Development of health education curricula, training courses and health education material will continue to be supported. Efforts will be made to consolidate the infrastructure so far developed and to promote technical effectiveness of the programme at thana, union and village levels. Research Promotion and Development WHO cooperation will provide necessary support to the Bangladesh Medical Research Council in the development of research methodology and motivation of potential research workers. Nutrition Support will be provided to assess the magnitude of nutritional disorders and for the promotion of delivery of nutritional component of the PHC package. Accident Prevention WHO will support the Government in carrying out a survey to assees the magnitude of the problem of accidents. Maternal and Child Health, including Family Planning In order to bring down perinatal and maternal mortality, efforts will be made to strengthen the MCH component of primary health care, with special emphasis on mothers during pregnancy and delivery, and care of postnatal mothers and children. Workers' Health Support will be provided for the development of a workers' health programme, focusing attention on areas where industry has been established or is being developed. Support will also be given for the formulation of national action

programme for effective safety measures for industrial workers, training of occupational health workers and development of informative material for workers and their families. Prevention and Treatment of Mental and Neurological Disorders WHO will continue to extend cooperation to national activities for the prevention and control of mental health and neurological disorders. Training of health workers in slmple cllnical management of mental disorders will be undertaken.

Community Water Supply and Sanitation Continuing support will be provided to ongoing activities in the field of community water supply and sanitation being undertaken by the Department of Public Health Engineering under the Ministry of Local Government and Rural Development. Food Safety The Institute of Public Health will initiate measures on food safety and necessary support will be provided under this programme. Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care WHO will continue to collaborate with the national authorities for the development of public health laboratory network, and for the repair and maintenance of electro-medical equipment. Essential Drugs and Vaccines Support will be given for the production of pharmaceuticals, training of stores managers and pharmacists, and development of the storage and distribution system. Drug and Vaccine Quality, Safety and Efficacy Support will be given for ensuring the quality, safety and efficacy of essent-ial drugs and vaccines. Rehabilitation Support will be extended for the training of nationals in the formulation of a policy and plan of action for disability prevention and rehabilitation services and for the preparation of a national manual for the disabled. Immunization Activities for the expansion of the coverage of EPI and for the training of personnel will be supported. Malaria WHO collaboration will be geared to extend continuing support to the ongoing malaria control programme, and for undertaking surveillance and control of other vector-borne diseases of public health importance.

Diarrhoea1 Diseases The Government is proposing to launch a new project in the field of diarrhoea1 diseases. WHO collaboration will support the operational coverage of diarrhoea control activities. The existing National Oral Rehydration Project will constitute an integral part of this programme. Tuberculosis Continuing support will be provided by the Organization to the ongoing tuberculosis control activities, including active case-finding operations. Leprosy The ongoing leprosy control activities will be provided with the necessary support, including the conduct of training courses. Blindness The ongoing activities for the prevention of blindness such as conducting workshops, training of health and allied personnel in a community-oriented ophthalmology and strengthening of eye care will be supported. Cancer WHO will support the national activities for the development of the cancer prevention and control programme. Cardiovascular Diseases

A national programme for the prevention and control of cardiovascular diseases will be developed and necessary activities initiated. Other Noncommunicable Disease Prevention and Control Activites Support will be given to the Bangladesh Institute of Research on Diabetes, Endocrinology and Metabolic Disorders, focusing on community-based diabetes prevention and control. Budgetary Implications The 1986-1987 budget shows an increase in the allocation of resources to the strengthening of the health infrastructure. Resources have also been allocated to programmes such as nutrition, accident prevention, maternal and child health, workers' health, mental health and food safety, which were not included for WHO collaboration under the 1984-1985 biennium. This has been done through marginal reduction of allocations to other programme areas.

Approved Budget BANGLADESH 1984-1985

Proposals 1986-1987

N D

417 000 72 700

680 000 113 400

0 0 1 076 0 32 800 1 601 100 2 046 500 10 100

0 0 1 057 8

RB VD

2 115 500 244 400

RB DP vA

2.6.0 Public Information and Education for Health 3.7.0 Research Promotion and Development 3 . 8 . 0 General Health Protection and Promotion 3.8.1 Nutrition

202 600 6 200

151 100

RB VD

75 600

37800 177 000

RB DP

3.8.2 Oral Health 3.8.3 Accident Prevention

350 000 37800

Approved Budget BANGLADESH 1984-1985

Proposals

F U

1986-1987

N D

3 . 9 . 0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 479 300 3.9.3 Workers' Health 3.10.0 Protection and Promotion of Mental Health 3.10.1 Psychosocial Factors in the Promotion of Health and Human Development 3.10.3 Prevention and Treatment of Mental and Neurological Disorders 3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 3.11.4 Food Safety 3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 567 500 604 400 37 800 RB RB 37 800

113 400

RB VD RB

200 000

75 600

330 600 997 000

188 200

RB LS

Approved Budget BANGL.DE SH 1984-1985

Proposals

F U N D

1986-1987

3.12.2 Essential Drugs and Vaccines 3.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.3 Malaria 4.13.6 Diarrhoea1 Diseases 4.13.8 Tuberculosis 4.13.9 Leprosy 4.13.13 Other Communicable Disease Prevention and Control Activities 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular Diseases

250 000

302 200

75 600 SO 000 37 800

250 000 400 700 354 500

377 800 604 400 226 700

RB VI RB RB RB

70 000 70 000

75 600 75 600

14 400 130 000 100 000 80 000 166 000 75 600

VL RB

VB 75 600 75 600 RB RB

r Approved Budget BANGLADESH 1984-1985 1986-1987 Proposals

F U N D

4.13.17 Other Noncommunicable Disease Prevention and Control Activities Total: BANGLADESH

70 000

75 600 7 799 800

10 869 200 ==========

--------

Of which: Regular Budget Other Sources

6 348 000 4 521 200

7 555 400 244 400

BHUTAN NATIONAL HEALTH SITUATION Commitment to primary health care (PHC)-based health services has been the core of the Royal Government's health policy which seeks the attainment by all people of the highest level of health that can be achieved by providing modern health services. A master plan for achieving health for all by the year 2000 (HFA/2000) has been prepared by the Government. In consideration of the predominantly rural population, the health development strategies in all the socio-economic development plans including the current one, laid emphasis on the development of health services in the rural areas so as to make equitable distribution of health facilities throughout the country and reduce the existing urban-rural imbalance. The past four Five-Year Plans have successfully laid the foundation of a health care delivery system. The ongoing health development efforts of the Fifth Plan (1981-1987) are mainly directed towards the strengthening of the health infrastructure and expansion of population coverage with essential health care. A number of serious problems, obstacles and constraints are hindering the development of health services in the country. Difficult terrain and scattered population are limiting factors in the expansion of health care coverage. Communication and transportation are extremely difficult. The country lacks resources necessary for the expansion and strengthening of its health infrastructure and for disease control programme on conventional lines. The allocation for the health sector constitutes about 4.3 per cent of the national budget. Infant mortality rate is estimated at 147 per 1 000 live births and life expectancy at birth is low. In spite of the efforts made so far, the effective access to minimum health care remains eluslve to large sections of the population, especially those living in remote village units. The majority of the deliveries are conducted at home; perinatal maternal mortality is high, and nutritional deficlency diseases, especially goitre, cretinism, anaemia, protein deficiency malnutrition, and xerophthalmia are quite common. Only 6 per cent of the rural population have reasonable access to safe drinking water compared to the national target of 100 per cent coverage by the year 2000. So far, fifty basic health units, each estimated to serve about 4 000-6 000 population, have been established. Forty dispensaries are providing limited ambulatory care. Besides, there are 19 hospitals at the district level, including three referral hospitals with varying number of beds. Even two districts together do not have a hospital yet. There is a serious shortage of all types of manpower, resulting in heavy dependence at present on non-national medical and health workers. The Government's efforts to increase the number of basic health units and expand facilities in district and referral hospitals are constrained by the shortage of paramedical and medical staff. The output of paramedicals from the Thimphu Health School is such that dependence on foreign nationals will continue for several years. There is a need to strengthen and expand diagnostic services to support public health and disease control programmes. Scarce resources, and inadequate logistics and distribution systems are responsible for the shortage of drugs and supplies. The immunization programme of the .country needs transport, cold chain, logistics and managerial support. The leading health problems are diarrhoeal diseases, acute respiratory infections, malaria, tuberculosis, leprosy and goitre. The major causes of morbidity are diarrhoeal diseases, worm

infestation, tuberculosis, scabies, goitre and xerophthalmia. Problems of dental caries, cancer, psychiatric disorders and sexually-transmitted diseases are increasing. Recognizing that vertical programme approaches are not the appropriate solution, integration of health care delivery is carried out through the general health services. WHO COLLABORATIVE HEALTH P R O G R W 1986-1987 The development of the infrastructure with WHO collaboration and support will be the main feature of the national health programmes in 1986-1987. Health Situation and Trend Assessment The development and strengthening of the health information system including epidemiological surveillance of important communicable diseases with a view to increasing the national capability for the assessment of the health situation and trends will be another important area for WHO'S support. Managerial Process for National Health Development In order to deal with the health problems outlined above, WHO will collaborate with the Department of Health Services to promote an integrated managerial process for national health development including support for reviewing national strategies, programme formulation, implementation, monitoring and evaluation at the country level. WHO will provide support for management training through collaboration in specific activities like detailed situation analysis of health services, establishment of a health project management system, and assessment of priority programmes. Intersectoral coordination will be promoted in order to achieve maximum participation of the relevant sectors in the implementation of national strategies for health for all. It is proposed that WHO'S support to the national health programmes makes adequate provision for equipment and supplies with a view to improving the quality of existing health services and adding new facilities, all in support of primary health care, and thus helping in relaxation of acute financial strain. Organization of Health Systems based on Primary Health Care Health care coverage of the remote rural areas is planned to be attained by the extension of services of basic health units (BHUs) through the establishment of outreach support and training of volunteer health workers. Sixteen new basic health units will be established in 1986-1987 bringing the total to 80. These BHUs provide integrated health care including McH/FP, nutrition, immunization, and disease prevention and control. WHO'S technical support to planning, management, monitoring and evaluation of the coverage and quality of services will be needed. WHO will further collaborate with other UN Agencies in the development and strengthening of the basic health infrastructure so as to achieve substantial coverage of the population with reasonable access to health care facilities. Areas for further attention include establishment, expansion, and strengthening of service facilities at supportive and referral levels, i.e., district and referral hospitals. The promotion and development of facilities will serve as an important tool in the surveillance, prevention and control of communicable diseases which are important causes of morbidity and mortality in the country.

WHO'S technical cooperation will aim at the promotion of managerial capability for planning, implementation and monitoring the development of appropriate methods and technologies at all levels, and material support through supplies and equipment. Health Manpower In 1986-1987, WHO will support the training of nationals, both paramedicals and professionals, through the provision of fellowships and organization of intra-country courses in different programme areas, including training of community-based volunteer health workers. Support will also be provided in manpower planning and utilization. The UNDP-funded project BHU PTR 001 on the development of manpower, which is currently being executed by the WHO, will continue up to 1986. The capability of the health training institutions will be reinforced through the provision of supplies and education materials. Public Information and Education for Health Public information and education for health has been receiving the serious attention of the Government with a view to securing support of the population in carrying out health plans and programme, and for stimulating and encouraging the community in the development of PHC. WHO collaboration will continue through the provision of training, health education materials, supplies and technical guidance. Nutrition The nucleus of the 'Nutrition Cell', now based in the Department of Health Services, will be shifted to the Planning Commission with a view to generating effective coordination among relevant sectors. UNDP, WHO and UNICEF will collaborate with the Government in formulating national policies and strategies for the development and promotion of nutrition and prevention of deficiency diseases in the country. WHO'S technical cooperation will aim at the promotion of coordination among relevant sectors, support to UNICEF and other UN Agencies, and the promotion of nutritional education. Oral Health 5 1 1 1 0

support will be directed to the strengthening of the oral health programme and promoting the prevention of oral and dental diseases as well as the training of manpower in oral health.

Maternal and Child Health, including Family Planning MCN care is provided through clinics in the hospitals and BHUs. WHO will provide technical cooperation in strengthening maternal and child health care as an important component of the basic units and wi1.1 collaborate with other CN Agencies, particulary UNICEF, UNFPA and WFP in this field. Provision of training and supplies, monitoring of growth of children, and organization of surveys on maternal and infant mortality are other areas where WHO'S support will be needed. Prevention and Treatment of Mental and Neurological Disorders WHO will support epidemiological studies, training of health workers, provision of equipment and supplies, and the development of managerial process for planning and operation of a mental health programme.

Community Water Supply and Sanitation The Government has accorded high priority to the acceleration of rural water supply and sanitation programme. UNICEF is supporting Government efforts in the establishment of 1 031 water supply schemes during the Fifth Plan period which will provide 30 per cent population coverage. WHO will collaborate with other UN Agencies in providing technical guidance to the national working group and in the implementation of the Decade Plan. WHO will also promote activities on the health education component of safe drinkb g water supply and basic sanitary measures. WHO collaboration in the periodic review of the Decade Plan policies and strategies, and guidance in appropriate technology, monitoring and evaluation of decade activities will be provided as and when required. Clinical, Laboratory and Radiological Technology for Health Systems based on Prlmary llealth Care

WHO support will be extended for the strengthening and expansion of diagnostic services at district hospitals to ensure proper diagnostic and surveillance procedures in support of public health and disease control programmes. Essential Drugs and Vaccines WHO support for basic health services, tuberculosis control programme and STD will include provision for the supply of essential drugs. Immunization WHO'S technical support will be directed towards strengthening the surveillance system of EPI target diseases, and the development of appropriate methodologies for monitoring and evaluation of the programme. Additional supply of vaccines and cold chain equipment might be required if the country has to meet its Decade target. WHO will further collaborate with other UN Agencies, particularly UNICEF, in the training of nationals in the operation and maintenance of EPI equipment and the cold chain system. Other Diseases In the field of disease prevention and control, besides the EPI programme, the Royal Government of Bhutan identified four disease problems, viz., diarrhoea1 diseases, tuberculosis, cancer and sexually-transmitted diseases, for possible WHO collaboration in 1986-1987. Diarrhoeal Diseases Diarrhoeal diseases are considered as a priority problem because these are important causes of morbidity and mortality, particularly among children. The Government's efforts to control this problem through attacks on all contributing factors will continue to be supported by WHO in the form of training of nationals, supply of ORS and health education materials, development of the logistics system, and monitoring and evaluation of control measures. Necessary resources are likely to be obtained from voluntary funds. Tuberculosis WHO'S involvement in the control of tuberculosis, which is a major health problem, will include the strengthening of the surveillance system, training of microscopists and basic health workers, and supply of drugs.

Sexually Transmitted Diseases Returns from hospitals and basic health units show that the incidence of sexually-transmitted diseases is increasing. The Government intends to tackle the problem before it becomes alarming. WHO's support will include the provision for surveys in order to ascertain the extent of the problem, strengthening of the surveillance system and contact-tracing, training of nationals in the early diagnosis and treatment and in prevention and control measures, expansion of diagnostic facilities and supply of drugs and health educational materials. Budgetary Implications The 1986-1987 budget shows an increased provision of the Regular Budget, reflecting WHO's greater participation in the national integrated health development programme described above.

Approved Budget BHUTAN 1984-1985

Proposals

F U N

1986-1987

210 000

642 000 100 000

248 300

RB VA

2.5.0 Health Manpower 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral Health 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and Treatment of Mental and Neurological Disorders

378 200

174 200

5 000 70 000

DP R B

322 400

23 000

Approved Budget BHUTAN 1984-1985

ProposaIs

F U

1986-1987

N D

3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 55 200 20 000 22 700 RB DP

3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.8 Tuberculosis 4.13.11 sexually-Transmitted Diseases 27000 20 000 30 000

175 000

RB RB

Total: BHUTAN Of which: Regular Budget Other Sources

1 502 800 =========

1 040 200 =========

642 000 860 800

843 300 196 900

BURMA NATIONAL HEALTH SITUATION The Burmese Constitution guarantees the provision of medical care by the State as a fundamental right of every citizen. The 20-year national development plan, launched in 1974-75, aimed at realizing this objective and the policy laid down in the plan emphasizes: (i) the importance of preventive measures, (ii) the need for narrowing the gap in the availability of health services between urban and rural areas, (iii) the raising of the health standards of the working people, and (iv) the provision of efficient treatment for all diseases. The people's Health Plan (now recognized as the People's Health Programme) was launched in 1978 with the objective of reducing crude mortality and infant mortality rates. The plan details have been developed. The third CHP to develop the third phase of the People's Health Programme covering the period 1986-1990 is due to start in mid-1984. The strategies adopted will be directed to the realization of the goals of HFA 2000, using primary health care as an essential approach. The infant mortality rate is 48.6 and maternal mortality 1 per 1 000, the crude birth rate 18.5 and crude death rate 9.2, whilst life expectancy for males is 59.3 years and for females 64 years. Of the total population estimated at 34.69 million, over 84 per cent live in the rural areas and have access to basic health services, except in the remote hilly areas. The phased implementation of PHC now covers 207 of the total 314 townships. By the end of the current plan period (1986), all 314 townships will be served by voluntary health workers (VHWs). Besides WHO, UNICEF and USAID are the main collaborators in the PHC programme. The incidence of diarrhoeal diseases in parts of the dry zone area of Upper Burma has declined. The reduction in morbidity is accompanied by a reduction in mortality due to the availability of ORS with VHWs. In those areas where the management of the water supply is faulty and the cost of drinking water is still relatively high, people use surface water collections as water sources during the monsoon season. As a result, reduction of diarrhoea1 diseases during this season has not been possible. There has been a definite improvement in the control of goitre with the introduction of the iodized-oil injection programme, which is fully supported by UNICEF. The incidence of malaria has increased, particularly Falciparum infections. Pockets of chloroquine-resistant infection have increased and fansiderresistant cases have occurred with increased incidence on the Burma-Thailand border. The immunization of expectant mothers with tetanus toxoid has resulted in a reduction of cases of tetanus neonatorum, whilst improved obstetric hygiene and improved training of auxiliary midwives and traditional birth attendants (lethes) has resulted in a reduction of post-partum infections and maternal deaths. Nutrition monitoring and school feeding programmes have been intensified but there is need for improved management, particularly in the primary schools supplementary feeding programme.

More emphasis is being laid on the health of workers, including agricultural workers. The control of toxic pesticides has been intensified and a toxicology laboratory has been established as part of the occupational health project. The campaign against drug abuse has been intensified with s nationride educational programme using every possible publicity medium. In 1982, a Drug Dependence Hospital was opened at Thayetmyo, and a Rehabilitation Centre st Wettigan. Community involvement in health and health-related projects has been enhanced as the benefits of the PHC programme, improved water supply and better sanitation become more and more obvious. Political and community leaders have become directly involved in implementing and monitoring the People's Health Programme at all levels. PHP implementation committees have been formed in various townships and village tracts, and township medical officers are required to prepare a plan of action on which monitoring and the achievements of plan targets are based. Station hospitals, sub-centres, aid posts for VHWs and hospital wards have been built through public donations and labour. Although the impact of the health programme is becoming apparent, there are problems which require attention to ensure more rapid health development. The rate of expansion of the health services is slowed down by the limited resources available; only 2 . 2 per cent of the national capital expenditure budget is allocated to health in the 1983-84 fiscal year. Most of these funds are spent on the construction of hospitals and hospital support services. Burma is fortunate in that rural health centres, MCH centres, sub-centres, health posts and even station hospitals are often constructed out of community funds and private donations. This community contribution is a major factor in the expansion of health services. However, the efficient running of the services to serve the needs of the population is faced with the constraint that only 2.76 per cent of the total national recurrent expenditure budget is spent on health. Most of these funds cover staff salaries so that the rate of expansion of the health infrastructure is not matched with a commensurate increase in the employment of adequate numbers of trained staff. There is an insufficient supply of basic drugs in hospitals and other health institutions. The Burma Pharmaceutical Industry manufactures most of the essential drugs for use in the health services. The local production of basic drugs is also insufficient to supply the required number of drug packages for CHWs. The EPI still depends, to a large extent on the provision of vaccines by UNICEF, with limited quantities being produced locally. The logistics system for the timely distribution of drugs and medicaments to health units still requires attention. The strict control on foreign currency expenditure limits the importation of drugs and medicament. The PHC programme has attracted enhanced support from USAID and as a result, the number of V W s trained has increased considerably. Flowever, the distribution of kits has not kept pace with training programmes. Although communications throughout the country are relatively good, the health services transportation system is poorly developed and several township medical officers are unable to provide the supervisory services necessary. The rural water supply programme has continued to expand with more safe water sources being provided. However, the cost of water to the consumer is high and safe sources are not used during the monsoon season when open water collections provide free water.

The allocation of external support to the health sector is relatively small as priority is given to the income-generating sectors. The country's commitment to PHC has attracted aid from USAID but most of the external resources are still directed to the building of hospitals and the provision of sophisticated equipment that is difficult to maintain. Due to lack of spare parts, various items of medical equipment are unutilieed. Emphasis is laid on the integrated development of health services and manpower, improvement of management skills at all levels, strengthening of the existing infrastructure, further improvement of the health information system, improved logistics support and enhancement of research activities to improve the effectiveness and efficacy of delivery of health services. WHO COLLABORATIVE HEALTH PROGRAMME 1986-87 The national health programme will continue to direct its efforts to the implementation of the plan of action for HFA 2000 and will develop its activities towards the attainment of HFA goals. WHO'S collaborative programme will continue its support to the development of various systems, with special emphasis on health management and trend assessment, primary health care, promotion of environmental health and disease control. Health Situation and Trend Assessment WHO will provide support for the monitoring and evaluation of the Third People's Health Programme, local training of statistical and medical records technicians of StatelDivisLonal and township levels; training abroad in demography and biostatistics and medical records service. Technical collaboration will be provided on sampling methods and in the training of nationals in these skills. Assistance will be channelled towards the improvement of existing epidemiological surveillance activities for early diagnosis, reporting and notification of communicable diseases aimed at early recognition and timely treatment, prevention and control. of diseases by appropriate measures with a view to reducing morbidity and mortality of the target diseases. Managerial Processes for National Health Development The national planning and programme development activities will be supported through the WHO Programme Coordinator and Representative's Office while the training of nationals in management skills and programme evaluation and the further strengthening of the national health management system will continue through the provision of consultants in health planning and evaluation. Emphasis will continue to be laid on supporting training programmes in the management and administration at all levels, especially at the township level. In order to strengthen the Planning and Training Unit of the Ministry of Health, support will be given by WHO in providing management and planning training programmes for fellows to study abroad. Attention and support will be given to improve the management of training institutions of various categories of health staff. Support will be given to improve the pl.anning and designing of research activities, including health services research. Cooperation and coordination with other UN Agencies, bilateral, multilateral and other agencies will be strengthened, especially in areas of primary health care and nutrition where joint programmes are under implementation.

Organization of Health System based on Primary Health Care WHO'S activities will relate specifically to supporting the training of VIWs and ten-household health workers (THUS) and their trainers, training in PHC management, production of manuals and teaching materials, supporting evaluation workshops at all levels and providing consultants to the programme. In this support, WHO will be joined by UNICEF and USAID who will concentrate their support on local training cost subsidies and the provision of kits for v n h ' s . WHO support will also be given to improve the referral system and the management of hospital services at all levels, including training to improve ward management and the orientation of specialists to PHC. Support to improve the quality of hospital records will continue and training in these areas will be supported. The logistics system will be supported by WHO to improve the timely distribution of drugs and other supplies. Training abroad will also be supported to strengthen the supply logistics systems. The Central Medical Stores Depot will continue to receive WHO collaboration in training personnel in the maintenance and repair of electro-mechanical equipment. Health Manpower The basic health personnel training and paramedical training institutions will receive support in improving the quality of the trainers through local training at the Education Technology Units and through the fellowship programme. Support will be given to continuing education programmes for paramedical personnel and to medical personnel institutions. On-the-job training to promote an effective system of delivery of PHC in the community will be supported. WHO will support the strengthening and upgrading of the basic medical sciences departments through fellowships, consultancy and equipment for the laboratories. Support will also be extended to the upgrading of knowledge and skills of the senior staff of teaching institutions through fellowships to similar institutions in neighbouring countries. WHO will provide support to improve the library facilities and teaching aids and materials to all categories of training institutions. Special emphasis will be laid on the strengthening of the nursing education programme, through consultancy services, workshops in nursing administration, and fellowships in nursing management, nursing education, post-graduate nursing, and the role of nurses in the context of PHC. Studies on manpower development and utilization will be supported. Public Information and Education for Health The country has embarked on a national programme focusing on a package including environmental hygiene, personal hygiene and food hygiene. At the same time, the network of health education units has been extended to each Statet~ivisionlevel. WHO will continue to support the strengthening of these units as well as the Central Health Education Bureau through fellowships for Diploma in Health Education in the neighbouring countries. A health education specialist in training will be provided as a consultant to review the training curricula and conduct training courses in the country. Other supcort will include grants for a study on community behaviour, assistance to workshops and seminars and the strengthening of the library at central and state/division units together with equipment for the development of health education

materials. Support will also be provided to related studies in nutrition practices, community involvement in health development and to the development of health education materials on specific topics. Research Promotion and Development WHO will extend support in health research activities that will help achieve national health aims. Support will be provided mainly through responsible national research coordinating organizations, mechanisms and focal points. Major emphasis will be laid on applied research and research which repidly adapt and apply new and emerging knowledge to the solution of the country's health problems but with due regard to balanced development of problemoriented basic research necessary for HFA 2000. Support will include promotion of research, research manpower development, research training, research management training and dissemination of research information and health impact study on drilling tube-wells in the dry zone of Burma. Nutrition WHO'S support will be directed mainly to nutrition orientation of township medical officers and township health officers and the training of doctors, public health nurses, lady health visitors and midwives as trainers in nutrition for VHWs, THHWs and TBAs. WHO will also provide a consultant to advise on economic activities in relation to nutrition. Trainers in nutrition and one person to take a certificate course in nutrition will be provided through fellowships. Educational materials, training aids and support supplies will also be provided. Maternal and Child Health, including Family Planning WHO support will be directed mainly to supporting in-service training of doctors, lady health visitors, nurses, midwives and teachers as well as training abroad in MCH. The training of trainers of lethes (traditional birth attendants) will also be supported and equipment provided in support of training programmes and services. Workers' Health There is increased awareness of the need to pay special attention to the health of both industrial and agricultural workers, especially those exposed to occupational hazards. WHO'S support will be directed to studies to obtain baseline data regarding occupational hazards and diseases, surveillance of the working environment to determine safety limits for various substances used in different industries and work places, and for the early detection of workrelated diseases. Support will also be given to local training programmes in occupational health and training abroad. The newly set up occupational health laboratory will also receive support. Community Water Supply and Sanitation WHO will continue to give support to IDWSSD programme in the planning and management of water supplies and sanitation activities. Efforts will be made to stimulate intersectoral collaboration and joint planning, monitoring and evaluation of the programme as well as to review the decade strategies. WHO support will focus more on sanitation as the water supply component has made sufficient progress towards achieving the Decade targets. Workshops on the latrine construction programme combined with health education of the

community on the proper utilization of latrines as well as the development of manuals and booklets on water and sanitation will receive support. The rehabilitation of existing water resources to make them sanitary and fit to be used as safe drinking water sources will be intensified. Environmental Health in Rural and Urban Development and Housing WHO'S support will be for the development of a long-term plan and grants to conduct studies as a follow-up of a national workshop, training courses for urban voluntary health workers and community leaders. Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care The strengthening of laboratory services will be supported by WHO as well as through an ADB loan for upgrading the laboratories at township and station hospitals and other support system. WHO will support the training of laboratory staff including those involved in special disease control programmes such as plague and cholera, training in laboratory organization and management, refresher training of pathologists and technicians, and training in specialized fields through the fellowships programme. Drug and Vaccine Quality, Safety and Efficacy WHO will continue to support the BPI in the production of DPT vaccine and in improving the quality of the products in conformity with WHO standards and biological standardization, in the production and control of pertussis vaccine and in stable management. Consultancy services will be provided for training in the production and quality control of vaccines and sera. Traditional Medicine The main activities in this programme area to be carried out through UNDP support will include: (1) the training of voluntary community health workers, midwives, artificial limb-making technicians; (2) research and production of artificial limbs and their components, and (3) the establishment of rehabilitation services in rural communities. Rehabilitation The activities during 1986-1987 will include strengthening the existing capabilities for (1) drug standardization in physico-chemical works; ( 2 ) drug standardization in pharmacognosy, and (3) drug efficacy evaluation work. Technical collaboration will be provided in pharmacological screening and toxicology of traditional drugs and to review overall research activities. Training of nationals will be supported in methodology of analytical chemistry, in crude drug museum technology and related fields. Immunization WHO'S support will be directed to the training of township medical officers in the management of the EPI programme as it continues its phased expansion and the training of basic health workers in the delivery of immunization services. It will also support the maintenance of the cold chain, monitoring the implementation and evaluation of EPI through WHO consultants. The cold chain

will be developed as much as possible within the limitation imposed by the availability of electricity supply. WHO will continue to facilitate the oral poliomyelitis immunization programme in urban areas with vaccine provided by the "Save the Children Fund", U.K. Disease Vector Control The vector borne disease control programme is the largest single programme in operation and includes the control of spread of malaria, dengue haemorrhagic fever, Japanese encephalitis and filariasis. WHO'S support will be directed mainly to improving the management of the programme, training of various categories of health workers, holding of the Annual Conference on VBDC and similar meetings held at the StatejDivision level. Technical and operational problems will be identified, remedial measures developed, and vector surveillance mechanisms of the vector-borne disease covered by the programme reviewed. Tubrculosis The national tuberculosis control programme will receive WHO support which will be directed mainly to the refresher training of nurses and LHVs. With the aim of improving the management of the programme, fellowships will be awarded to senior staff to visit neighbouring countries and observe successful operational and managerial techniques. Leprosy WHO'S main support will be directed to the strengthening of the infrastructure of the programme with laboratory equipment, transport and management training. Training abroad in the study of public health administration, dermopathology, clinical dermatology and leprosy will be supported, and medical officers and leprosy inspectors sent to neighbouring countries to observe leprosy control operations. Local training of leprosy operational staff will be supported and consultants in epidemiology and clinical work provided. Support will be given through grants to studies in chemotherapy trials on pauci-bacillary leprosy in accordance with the recommendation of THELEP and studies on operational problems. Blindness WHO'S support will be directed to the local training of township medical officers and basic health staff in the promotion of the blindness prevention programme, the training abroad of professionals in preventive ophthalmology and observation tours to countries of the Region by paramedical workers in the programme. Grants will be provided for the production of a manual on blindness prevention and for the production of mass educational materials. A short-term consultant will be provided to advise on the programme as well as equipment to strengthen the infrastructure. The programme will be fully integrated into the PHC programme and supported by mobile opthalmic units. Cancer Cancer control activities have been initiated focusing attention on early diagnosis and treatment, arousing public awareness, formation of a Cancer Advisory Committee, strengthening of existing cancer registries and the formulation and implementation of a cancer control plan. Ongoing activities

will be supported and the cancer prevention programme, including health education, will be integrated into PHC activities. WHO will support the training of the radiotherapist and the strengthening of the radiotherapy unit with equipment spare parts. Cardiovascular Diseases The objective of the programme is to promote the cardiovascular health of the population through education and to reduce cardiovascular morbidity and mortality through the organization of facilities for early diagnosis, effective management and rehabilitation of cardiac patients. WHO will continue to support ongoing activities, particularly local training programmes for doctors and basic health staff on preventive cardiology and ICCU training of team for State and Division level hospitals. Training abroad of cardiologists, chest physicians and a team to study CVD and stroke rehabilitation will be supported. Most of the preventive programme activities will be integrated into the PHC programme. Grants will be provided for a stroke survey in the Rangoon City area and for the printing of educational materials on C W , stroke and smoking hazards. Budgetary Implications The programme proposal lays emphasis on the development of integrated health services and manpower in addition to strengthening of existing health infrastructure. Programme areas, such as, Nutrition, Workers' Health, Leprosy and Tuberculosis have been allocated resources for initiating new activities. Health Situation and Trend Assessment will receive an increase of 68% over 1984-1985 biennial budget whereas Managerial Process for National Health Development will register a 28% decrease. The increase of 174% for the current biennium for Health Manpower Development indicates the high priority being given to this area; Reseach Promotion and Development will be allocated a 10% increase in the budget. Both these programmes will be widely supported by extra-budgetary resources. Nutrition has been allocated US dollars 203 000 in 1986-1987 which will be fipent on improving nutrition monitoring, training of VHWs and other categories of health workers. Maternal and Child Health is expected to receive increased assistance from UNICEF, US AID and possibly from UNFPA. The allocation to this area is 31 per cent less than the 1984-1985 ceiling. Community Water Supply and Sanitation registers a 15% increase, which will be directed towards training in sanitation activities of health staff from the central to the village level. The Disease Prevention and Control Programme area registers an overall increase of 5 per cent in the 1986-1987 biennium.

Approved Budget BURMA 1984-1985

Proposals

F N D

1986-1987

552 100

398 300

922 600

986 300

145 000 1 129 200

397 200 1 309 200

RB DP

2.6.0 Public Information and Education for Health

100 000 206 000

100 000 682 000

RB DP

3.7.0 Research Promotion and Development

143 300 12 100

156 900

RB VG

3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning

203 000

394 000

271 000

Budget BURMA 1984-1985

Proposals

F U

N 1986-1987

3.9.3 Workers' Health 134 200 3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and Control of Alcohol and Drug Abuse 3.11.0 Promotion of Environmental Health 7.11.1 Community Water Supply and Sanitation 3.11.2 Environmental Health in Rural and Urban Development and Housing 3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.2 Essential Drugs and Vaccines 1.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.4 Traditional Medicine 3.12.5 Rehabilitation 220 600 479 600

50 000

RB DP

153 800

252 900 27 300

RB DP

50 000

50 200

182 600 53 900

208 100

146 300 82 600 359 200 252 900

155 000 331 8 0 0 57 000

RB DP DP DP

Approved Budget BURMA 1984-1985

Proposals 1986-1987

F U N D

4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.2 Disease Vector Control 4.13.8 Tuberculosis 4.13.9 Leprosy 25 500 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular Diseases 75 000 50 000 125 000 108 400 50 000 192 500 52 500 500 685 300 2 338 600 52 400 RB VI

613 300

RB VD RB RB VL

20 000 207 000

RB RB RB

Total: BURMA Of which: Regular Budget Other Sources

9 297 200 =========

7 257 000 ========a

4 123 000 5 174 200

4 849 700 2 407 300

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA NATIONAL HEALTH SITUATION The health status of the people has been improving significantly during recent decades as reflected by the low infant mortality, longer life span of the people, and availability of health and medical care services throughout the country. The health care delivery system is based on the "Juche" idea which places man in the centre of all thinking and makes everything serve him in public health services. As such, the country aims at realizing the desire of the people to live a long, healthy and happy life. All the people including workers and peasants are enjoying the benefits of universal free medical care which envisages effective prophylactic measures as well, regardless of sex, age, residence, occupation, etc. The health care delivery system is well-organized, covering the entire country based on the primary health care approach. The "section doctor" system has been functioning smoothly and it is now being consolidated in urban and the rural areas. The traditional Korean medicine and modern medicine are optimally combined to ensure maximum benefit to the people. Self-sufficiency in the production of pharmaceutical products and medical instruments has already been achieved. Health of the mothers and children receives a high priority. Care of the mothers during pregnancy and at the time of delivery has attained 100 per cent coverage by the health services in both urban and rural areas. In the context of the socialist system, nursing care and education for children are provided in order to bring up all the pre-school children with sound mind and body through the State-run nurseries and kindergartens. Most of the communicable diseases which are common in the developing countries have been eradicated, or their problems minimized. As the population is ageing due to increasing life-expectancy, a number of degenerative and chronic diseases peculiar to old age, are emerging as health problems. Thus, the subjects of gerontology, rehabilitation and medical research as relevant to those problems become important in order to face the health needs of the present and the future. The health services are being modernised. Research in celllgenetic engineering is being developed along with the use of other advanced techniques to provide better health care to the people. Training of health workers in those advanced techniques and providing them with equipment and information on modern scientific research have become important. Support in the area of advanced surgical techniques such as cardio-thoracic surgery and transportation of internal organs along with supporting disciplines will also be required. MAIN DIRECTIONS OF WHO SUPPORT During the period of the Sixth General Programme of Work (1978-1983), WHO'S technical cooperation with DPRK was mainly in three areas: prevention and control of cardiovascular diseases, cancer and biomedical research. Under the Seventh General Programme of work (1984-1989), technical cooperation widens its scope to address itself to the prevention and control of emerging health problems and changing needs. This was reflected in the programme proposals for 1984-1985, and WHO'S further technical cooperation for the biennium 1986-1987 would continue on these trends.

Epidemiological surveillance of emerging health problems and operational research for effective delivery of health care with PHC approach, will be supported through the provision of literature, selected supplies and equipment. Development of health manpower in specialized areas for the prevention and control of emerging health problems of national importance, learning of English language by health professionals for better international cooperation in health technology will continue to receive emphasis. Training of health workers in order to function optimally at the PHC level and for the provision of effective referral services through medical colleges and polyclinics would he strengthened. Production of essential drugs and vaccines including their quality control, safety and efficacy would receive priority considerations. Research towards further development of traditional medicine would be emphasized in the health care delivery system through scientific investigation of indigenous drugs and methods of application for the promotion of health, and prevention and control of diseases. Diagnostic laboratory and radiological facilities including protection from radiation hazards would be further developed to render the health services more effective in the diagnosis and management of diseases. Under communicable diseases, prevention and control of acute respiratory infections would be undertaken through health education and appropriate intervention, integrated with general education and primary health care. Control of rheumatic fever and rheumatic heart disease amongst school children will continue to receive priority consideration. Non-communicable diseases like allergy and other immunological arthritis, diabetes, gout, cardiovascular diseases and cancer will public health problems for years to come. Research studies on the and control of these will be strengthened as an integral part systems development, based on the PHC approach. disorders, remain as prevention of health

As the population structure in DPR Korea is changing due to the increasing life-span and improving socio-economic status, scientific foundation would now be laid as a preparation to look after the health and welfare of the elderly people. Biomedical research, mental health, prevention and control of degenerative non-communicable diseases and rehabilitation will be the components for technical cooperation. Environmental health situation would be monitored and the hazards controlled with a view to maintaining a healthy environment for the working people. Provision of safe water, control of industrial pollution and promotion of hygiene at the work sites are areas which deserve attention. During the 1986-1987 biennium, WHO technical cooperation will further strengthen the organization of health services based on the primary health care approach, epidemiological surveillance and monitoring of the emerging health problems through development of operational research, health information system development (for health situation and trend assessment), training of manpower, sharing of experience with other countries through meetings and seminars, and monitoring of the progress and evaluation of the health programmes keeping in mind the objectives of HFA/2000.

WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 Health Situation and Trend Assessment WHO will support the development and strengthening of an information system and statistical sub-system for individual programmes within Health Information System Development, establishment of the central health information service with intermediate and peripheral level linkages, for monitoring and evaluating the health programmes in support of PHC; intersectoral cooperation in the development of a national system for registration of vital statistics; strengthening of information generation on morbidity and mortality patterns; strengthening of electronic data processing facilities leading to better analysis of health information and projection of future health needs; collection and analysis of information on PHC activities and appropriate health technology, and dissemination of the same to all health workers. Managerial Process for National Health Development Support will be provided for a study on the impact of public health law enforcement on the functioning of the health system; generation of innovative approaches and appropriate health technology in the delivery of primary health care; workshops for community health leaders at brigade, country and provincial levels to promote the organization of PHC activities in their own community; development of strategies on the concept, dynamics, methods and modalities of community participation in PHC in the context of community development efforts; promotion and extension of health education and information as an integral part of general education to the public as related to primary health care; promotion of survey and research methodology as a means to determine specific health needs and evaluate health programmes; utilization of information and experience gained in the area of PHC for further planning and implementation of health services, with special reference to oral health, accident prevention and management, maternal and child health, community water supply and sanitation. Health Systems Research Operational research towards the optimal use of health resources and application of research findings in the training of health workers and health services research to evolve an integrated approach in the control of noncommunicable diseases within PHC activities will be supported. Health Manpower WHO collaborative programme will support the training of medical doctors and health workers in English language; supply of health literature and learning material for health workers; development of learning material for various levels of health workers focusing on health needs such as prevention and control of cancer, cardiovascular diseases and psychosocial disorders; training of health workers in specific areas, such as cancer, heart disease, mental health, occupational health, and gerontology, in line with priority health care needs of the country. Research Promotion and Development WHO will support activities for the review of the national health research policy, priorities and mechanism for the coordination, management and promotion of research activities; training of professionals in research methodology, use of modern equipment and scientific study of traditional medicine; supply of information and literature on health research; development

of research proposals; strengthening of institutions engaged in biomedical research in the context of PHC and HFA/2000. Nutrition

WHO support will aim at promoting national policies and strategies for the strengthening of the nutrition programme. Oral Health Training of oral health workers in various sub-specialities of oral health and dissemination of information to the public on oral health will be supported. Maternal and Child Health, including Family Planning

A study on the demographic pattern to project the future trends and a study on the causal factors of infant mortality and coverage of MCH services will be undertaken. Workers' Health

WHO collaborative programme will assist in the monitoring of health hazards in the working environment and the training of medical officers to look after the health of workers. Health of the Elderly

A study of the health problems of the elderly will be carried out for developing a long-term action plan for comprehensive health care. Training of health workers in geriatric care, gerontology and study of the ageing process will also be supported.

Psychosocial Factors in the Promotion of Health and Human Development Training of health workers in such areas as psychic development of pre-school children and psychiatric patterns among the elderly people will be undertaken. Community Water Supply and Sanitation

WHO support will be extended to the provision of safe water and sanitation facilities and for promoting IDWSSD programme activities. Control of Environmental Health Hazards

WHO will collaborate with the Government in the monitoring of the environmental health situation and in the control of environmental hazards with a view to maintaining a healthy environment for the working people.

Support will be provided for the development of clinical, laboratory and radiological technology in the referral laboratories at various levels of health services, including the quality control of diagnostic methods and development of a network of radiological diagnostic services and also to support advanced clinical practice and prevention of radiation hazards.

Drug and Vaccine Quality, Safety and Efficacy

WHO will support efforts for the strengthening of facilities for the production, control of quality, safety and efficacy of drugs and vaccines. Traditional Medicine A survey of herbs and plants of medicinal value will be carried out as also a scientific enquiry into the efficacy of traditional medicine and methods of treatment for selected diseases. Both these activities will be supported. Immunization Immunization against prevailing diseases will be emphasized. Testing of locally-produced vaccines such as polio vaccine will be undertaken. Cancer The implementation status of the action plan for the prevention and control of cancer in the context of national health plan will be monitored. Training in oncology and other aspects of cancer control, and of primary health care workers in cancer health education for early detection will be undertaken. Dissemination of health education and information to the public with emphasis on prevention and early detection, through the PHC approach will be promoted as also research in the prevention of cancer and development of chemotherapy. Cardlovascular Diseases WHO will support the training of personnel in the prevention and control of cardiovascular diseases as also research related to the promotion of cardiovascular health, prevention and control of cardiovascular diseases. Other Non-Communicable Disease Prevention and Control Activities Development of the community-oriented action plan for the prevention and control of non-communicable diseases of national importance such as diabetes, arthritis, deafness, allergy, etc. will be supported. Epidemiological studies on non-communicable diseases to monitor the changing pattern, including the collection of information on morbidity and mortality trends will be undertaken. Training of surgical teams to enable them to perform surgical transplantation of internal organs will be supported. Budgetary Implications The increasing importance given to the prevention and control of emerging health problems is reflected in the allocation of funds to important programme areas under Health System Development, Laboratory and Radiological Technology, Maternal and Child Health, Mental Health, Promotion of Environmental Health, Traditional Medicine, Expanded Programme on Immunization etc.

Budget DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA 1984-1985

Proposals

F U

N 1986-1987 D

2.3.0 Health System Development 2.3.1 Health Situation and Trend Assessment 2.3.2 Managerial Process for National Health Development 2.3.3 Health Systems Research 2.4.0 Organization of Health Systems based on Primary Health Care 2.5.0 Health Manpower 3.7.0 Research Promotion and Development 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral Health 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 50 000 50 000 RB RB 164 700 50 000

50 0 0 0 50 000

RB RB

99 800

64 900

100 000

299 400

40 000

100 000

* ' p r o v e d Budget DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA 1984-1985

Proposals

F U

N 1986-1987 D

3.9.3 Workers' Health 3 . 9 . 4 Health of the Elderly 3.10.0 Protection and Promotion of Mental Health 3.10.1 Psychosocial Factors in the Promotion of Health and Human Development 3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 3.11.2 Environmental Health in Rural and Urban Development and Housing 3.11.3 Control of Erlvironmental Health Hazards 3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.4 Traditional Medicine

50 000 94 500

RB RB

50 000

39 400 50 000

DP RB

100 000

50 000 50 000

INDIA NATIONAL HEALTH SITUATION 1986 will usher in the Seventh Five-Year Plan (1986-1991), with additional thrust and resources directed to the further implementation of the 20-Point Programme for Total Socio-Economic Development, which embraces the broad spectrum of health, social welfare, education, works and housing, and other sectors. Within this socio-economic intersectoral development, priorities in health relate to the promotion of family planning on a voluntary basis as a people's movement; acceleration of programmes of welfare for women and children, and nutrition programmes for pregnant women, nursing mothers and children, especially in tribal, hill and underserved areas; substantial augmentation of universal primary health care facilities, and control of leprosy, tuberculosis and blindness, provision of drinking water and basic sanitation to all problem villages. In early 1983, the Statement on National Health Policy laid down guidelines for further action on the preventive, promotive, public health and curative aspects of health care, with accelerated expansion of comprehensive primary health care services to reach the population, particularly in the rural areas. Decentralization of the health care delivery system was also to be pursued with the maximum community and individual self-reliance and participation. The formulated National Population Policy has the long-term goals of reducing the birth rate from the current level of 33 per thousand to 21 per thousand by the year 2000, with a corresponding reduction of the death rate from 14 per thousand to 9 per thousand. The National Medical and Health Education Policy was formulated to cater for the current phenomenal growth of the health services and to bring about the required reform of undergraduate and postgraduate curricula and training, with balanced growth and placement of medical, paramedical and other health personnel, and inter-relationship between the allopathic and Indian systems of medicine and homoeopathy. The Revised Minimum Needs Programme will continue to invest in human resource development across various sectors, and to be the main instrument for the development of the rural health care delivery system and achievements of national health targets within a time-bound framework. Within the overall ambits of the above-mentioned policies, the health strategy approaches will continue to be directed to; (a) a multi-pronged population policy; (b) to keep shifting from the development of city-based curative services and super-specialities to a comprehensive primary health care system; (c) to extend the coverage of primary health centres, each to serve a population of 30 000, and sub-centres, each to serve 5 000 population; (d) basic specialities would be provided at community health centres at the block level for a population of about 100 000 with a 30-bedded hospital attached and a system of referral of cases from community health centres to district hospitals/medical college hospitals; (e) various programmes under social welfare, education, works and housing (water and basic sanitation), agriculture, family welfare, maternal and child health, school health, area development and integrated child development schemes, nutrition, control of being communicable diseases, blindness and other disablement prevention implemented by different departments/agencies - would be properly coordinated for optimal results; (f) intensification of the training and education of all levels of medical and paramedical manpower for orientation towards primary

health care; and (g) involvement of the community and family unit in the participation, supervision and management of their health programmes. In addition to the above thrusts, the Seventh Five-Year Plan (1986-1991) will give increasing attention to the gradual implementation of the recentlyformulated national plans for cancer, cardiovascular diseases, mental health and disablement prevention and rehabilitation.

WHO COLLABORATIVE PROGRAMME 1986-1987 The Government has formalized the mechanism for a joint Ministry of Health and Family ~elfare/WHO programme planning, implementation and monitoring of the inter-related activities. From 1983 onwards, this coordination mechanism has identified key priority programme areas for WHO support, with direct relevance to the Sixth Five-Year Health Plan of the country and in consonance with the WHO Seventh General Programme of Work, covering the period 1984-1989. The main directions of WHO collaboration and support in 1986-1987 will continue to be on health system infrastructure development; implementation and monitoring of priority programmes/interventions of national importance, and operational research and action programmes to improve the functioning of primary health care within the existing total health system and resources. Health Situation and Trend Assessment Support will be provided to improve the Integrated Health Information and Management System at central, State and district levels, to strengthen institutional facilities in vital and health statistics, and medical record service. Support will be provided to task or field-oriented training in epidemiology for various levels of functionaries concerned with both epidemiological surveillance and the required laboratory competence. Assistance will be provided to update or introduce informatic technology in order to secure improved management and evaluation of national intervention programmes for prompter action at Central and State levels, Managerial Process for National Health Development In support of the Managerial Process for Health Development, three types of activities will receive attention: improvement of planning and management, primarily at the district level; build-up of a network of management institutes and of training activities in planning and management, and preparation of case studies of problem situations currently facing the health services, particularly at the district level. Mechanisms developed for the joint Ministry of Health and Family Welfare/WHO programme planning, implementation and monitoring of the WHO collaborative programme will continue to be strengthened, and in the process, special support given to the International Health Division. In addition, the Government will continue to support, in collaboration with WHO, TCDC activities between countries of the South-East Asia Region and India, initially in the priority areas of health manpower development, expanded programme on immunization, and control of diarrhoea1 diseases. Organization of Health Systems based on Primary Health Care It will he directed towards strengthening the required organizations and effective operation of the health system at the most peripheral level (from village level to primary health centre); identifying terms and issues of

health in urban slums with a view to working out an improved health system for primary health care; involving voluntary organizations in the strengthening of primary health care in the areas outlined above, and reviewing the functions of the district level hospitals with a view to developing their role in community health care in the context of the above. Health Manpower Support will continue to be given to the strengthening of health manpower planning, development and assessment cells at Central and State levels; the build-up of a network of centres of medical educational technology; research for surveys, experimental projects in medical colleges/district hospitals, management areas, etc., in the field of health manpower planning and development; development of regional centres for continuing education; development of specialized nursing courses, and the further build-up of national medical library and documentation centres. Public Information and Education for Health Health Education Bureaux in the various States and Union Territories will be supported to ensure effective integration of health education components, development of appropriate curricula, learning resource material and support to faculty for health training institutions. Research Promotion and Development WHO will continue its catalytic support to the ICMR and its research institutions. Other major institutions under the Ministry of Health and engaged in health services research work will be assisted. Activities on research methodology, research capability build-up, exchange of information on research results, and task-related research programmes relevant to primary health care will also be undertaken. Nutrition Activities will be directed to the strengthening of Central and State Nutrition Divisions and institutions in their implementation and monitoring of the national nutrition and food policy as part of primary health care; to strengthen the goitre control programme, and to promote further research in the field of breastfeeding and weaning practices, nutritional anaemia and blindness; and in developing nutrition education and training at various levels. Accident Prevention To increase national awareness on rising accident morbidity and mortality trends which are preventable, support will be given to the formulation of a plan of action for the prevention and control of accidents in urban and rural areas. A study of ambulance services' performance and requirements in an urban setting will be conducted; assistance will be given to the preparation of suitable educational material and training curricula for the general public and health workers respectively. Maternal and Child Health, Including Family Planning Technical and methodological activities will be directed to the application of the risk approach suited to maternal and child health and family planning; also to the specific problems of infant nutrition, low-birth weight, diarrhoea, acute respiratory diseases and immunizable diseases. Training and development

of appropriate curricula for maternal and child health-related personnel wlll be continued. Workers' Health To control occupational health hazards, protect and promote the health of the working populations, special attention will be given to underserved sectors such as agriculture, small-scale industry and construction. Support will be given to the strengthening of institutions concerned with occupational health and to the training of various types of occupational health manpower. Monitoring of specific hazards (e.g., pesticides/fertilizers in agriculture) will be supported. Prevention and Treatment of Mental and Neurological Disorders Assistance will focus on integrated mental health care delivery through the PHC infrastructure and with an appropriate two-way referral system. Attention will also be given to the field of child mental health and psychological development as part of the National Mental Health Programme and the activities of the ICMR. Community Water Supply and Sanitation Activities will be directed to supporting the implementation of the strategy and evaluation of the national plan for IDWSS Decade. Control of Environmental Health Hazards WHO will support activities related to the recognition and control of environmental hazards and conditions which affect public health. Food Safety In support of the policy, strategy and technologies adopted by the Government, WHO will continue to collaborate in the strengthening of national institutions engaged in securing the safety of food with a view to reducing food-borne whatever the cause and food losses, and improving nutritional morbidity and hygienic quality.

Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health* Support will be given for activities to upgrade standards for clinical, diagnostic and treatment methods. The promotion of integrated clinical, poblic health laboratory and radiological technology within the national health services will be supported. Essential Drugs and Vaccines

WHO will support the production of essential drugs, particularly for use in the PHC programme; and vaccines for the prevention of diseases, in particular the EPI target diseases and rabies control. Training of pharmacologists, microbiologists, clinicians and health managers will be pursued. Drug and Vaccine Quality, Safety and Efficacy

WHO will collaborate in the consolidation of the national drug policy,

including the selection of essential drugs and vaccines, appropriate legislation, drug supply and management, and quality control. Traditional Medicine To develop the traditional system of medicine in conjunction with the modern system and to enhance research efforts and training facilities in it, particular attention will be given to the utilization of traditional practitioners in the delivery of preventive and promotive health care. Development of country-specific training materials and phased training programmes will be a key approach. Rehabilitation WHO will continue its collaboration and support to the National Action Plan for the Prevention of Disablement and Rehabilitation (i.e., IMPACT INDIA) from blindness, hearing and speech disabilities, physical handicaps, accident prevention and mental handicap and developmental disabilities, and to intensify action both at the primary health care level in terms of prevention and control and at the secondary level of curative interventions. Immunization Support will be provided in the expansion of EPI activities through surveillance, training of managers, evaluation and monitoring, and close collaboration with UNICEF on the improvement of the cold chain. Malaria The main thrust of support will be in the modified Plan of Operations of NMEP, and also for the containment of P.falciparum, periodical assessment of the situation and monitoring of the drug and insecticide resistance. Parasitic Diseases

WHO will support the eradication of guineaworm disease, and the prevention and control of other parasitic diseases. Diarrhoea1 Diseases Support will focus on the National Plan of Action to control diarrhoea1 diseases as an integral part of primary health care, the production and use of oral rehydration salt in the prevention of mortality and morbidity from diarrhoeas as well as training of the health workers in order to accelerate the programme. Acute Respiratory Infections The main thrust will be on better case management of pneumonia in children at the primary health care level and on supporting a network of institutions in the country for collaborative research in this critical area. Tuberculosis

WHO support will be given to further develop an integrated tuberculosis control programme, through the strengthening of the Central Directorate, the network of District TB Centres, the National Tuberculosis Institute, Bangalore and the Tuberculosis Research Centre, Madras.

Leprosy WHO will support the planning and organizing of the control programme through training, multi-drug regimen trials and delivery of the programme activities integrated with primary health care, in an increasing number of hyper-endemic districts. Zoonoses Prevention and control of rabies and other zoonoses will be supported to enhance the surveillance activities, diagnostic facilities and research. Sexually-Transmitted Diseases Technical cooperation will be provided in the surveillance of sexuallytransmitted diseases, collection of information on the magnitude of the problem, health education of the public and training of health workers. Other Communicable Disease Prevention and Control Activities The Organization will focus on evolving epidemiologically-based and monitored control strategies for the priority bacterial and viral diseases, supported by rapid, simplified diagnostic techniques, as appropriate to all levels, and particularly at district and primary health centre levels. WHO will support the national plans for viral hepatitis and Japanese encephalitis, particularly in surveillance and research. Blindness Appropriate technologies for the prevention and treatment of blindness due to major causes will be implemented further at national and community levels. A nation-wide scheme for the training of ophthalmic assistants will be assisted. The elaboration of training aids and learning material in eye care, along with the promotion of low-cost spectacles production, will be supported. Research through a network of collaborating centres will be encouraged. Cancer WHO will participate in epidemiological studies and assessment of the existing technologies for diagnosis, treatment, prevention and rehabilitation, training and research activities in the national programme of cancer. Cardiovascular Diseases WHO will support the development of cardiovascular diseases control programme, in the areas of identification of the risk factors, and in the prevention and control of rheumatic fever, rheumatic heart disease and streptococcal infections. Other Non-communicable Disease Prevention and Control Activities WHO support will be given to areas of research and training of health workers along with support to collaborating institutes for liver, renal and respiratory diseases.

Budgetary Implications Proposed Programme Budget reflects the changed emphasis that the Government is placing on the different programme areas, priority in health being given to areas such as maternal and child health including family planning, nutrition, control of leprosy, tuberculosis, blindness, provision of drinking water supply and basic sanitation. This is in line with the thrust given to the implementation of the twenty-point programme for total socio-economic development. There is a marked decrease in the allocation of resources to some programme areas such as Organization of Health Systems based on Primary Health Care and Health Manpower. However, activities relating to these areas will be undertaken through the medium of other programme areas or through extrabudgetary resources. Programme areas of Workers' Health and Food Safety witness activities which will be initiated during the coming biennium. Some programme areas register considerable increase over the allocations for the current biennium, viz., Managerial Process for National Health Development 7 4 % , Nutrition 132%, Maternal and Child Health including Family Planning 132%, Clinical Laboratory and Radiological Technology 364%, Traditional Medicine 3 6 4 % , Immunization 364%, Tuberculosis 161%, Leprosy 210% and Blindness 81%. Commencing 1986, when the Seventh Five-Year Plan of the countrywill be implemented, increasing attention will be given to implementation of national plans for Cancer, Cardiovascular Diseases, Mental Health and Disability Prevention and Rehabilitation.

Approved Budget INDIA 1984-1985

Proposals

1986-1987

U N D

2.3.0 Health System Development 2.3.1 Health Situation and Trend Assessment 2.3.2 Managerial Process for National Health Development 2.4.0 Organization of Health Systems based on Primary Health Care 2.5.0 Health Manpower 2.6.0 Public Information and Education for Health 172 200 3.7.0 Research Promotion and Development 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral Health 3.8.3 Accident Prevention 1 0 0 200

601 000

581 200

1 002 000

1 743 600

1 302 000

581 200

2 607 000

581 200

58 100

RB VD

100 200

116 200

232 500

50 100 50 100 58 100

Approved Budget INDIA 1984-1985

ProposaIs

F U

N 1986-1987

3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 3.9.3 Workers' Health 3.9.4 Health of the Elderly 3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and Treatment of Mental and Neurological Disorders 3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 3.11.2 Environmental Health in Rural and Urban Development and Housing 3.11.3 Control of Environmental Health Hazards 3.11.4 Food Safety 100 200 290 600 50 100

500 800

1 162 400 58 100

RB RB

150 300

116 200

100 200 290 600 58 100

RB RB RB

Approved Budget INDIA 1984-1985

Proposals

F U

1986-1987

N D

3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.2 Essential Drugs and Vaccines 3.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.4 Traditional Medicine 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.3 Malaria 4.13.4 Parasitic Diseases 4.13.6 Diarrhoea1 Diseases 4.13.7 Acute Respiratory Infections 50 000 4.13.8 Tuberculosis 400 600 2 900 1 075 000 i

50 100 50 100

232 500 87 200

RB RB

100 200 100 200 100 200

174 400 464 900

RB RB RB

58 100

100 200 300 600 6 548 500 250 500 150 300

465 000 348 700 3 557 000 29 100 116 200 116 200

RB VM

RB RB

RB VD

1 046 100

RB VG VD

Approved Budget INDIA 1984-1985

Proposals 1986-1987

F U

N D

4.13.9 Leprosy 4.13.10 Zoonoses 4.13.11 Sexually-Transmitted Diseases 4.13.12 Smallpox Eradication Surveillance 4.13.13 Other Communicable Disease Prevention and Control Activities 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular Diseases 4.13.17 Other Noncommunicable Disease Prevention and Control Activities

300 400 1 308 100 50 100 100 200 77 900

929 900

RB VL RB RB VS

58100 58 100

200 400 450 700 150 300 150 300

116 200 813 700 232 500 232 500

RB RB RB

200 400

116 200

Total: INDIA Of which: Regular Budget Other Sources

----------

19 154 600 9 920 000 9 234 600

15 180 700 ========a=

11 623 700 3 557 000

INDONESIA NATIONAL HEALTH SITUATION The Government of Indonesia has adopted a national policy and strategy for Health for All by the Year 2000, designed to meet the basic health needs of the population. One of the most outstanding achievements of the Third Five-Year Development Plan (REPELITA 111, 1979-80 1983-84) is the formulation of the National Health System (SKN). The SKN reflects the efforts of the Indonesian people to strengthen their ability to achieve an optimal state of health as a realization of general welfare and as meant in the Preamble of the 1945 Constitution. It consists of three parts, i.e., Basic Policies for the National Health System, Long-term Development Plan in the Field of Health and Basic Structure of the national health system.

The Basic Policies for the National Health System stipulate the direction, goals and conceptual bases of health development as a comprehensive, integrated and well-coordinated part of the overall national development. The Long-term Development Plan in the field of health is intended to serve as a guideline for all parties concerned with health development: government agencies as well as the public, including private bodies and individuals, in working out their policy and steps concerning long and medium-term development in the field of health. The Basic Structure of the National Health System provides guidelines for the organization of the health system to enable concerted health efforts to achieve the stated goals efficiently and effectively. The national goals are grouped in three broad categories: (1) Goals about the overall socio-economic development, which imply equitable access to health, wealth and education, social justice and democratic participation in all decisions concerning the community, with special regard to decisions in the field of health development. Political commitment at the highest level to endorse and support development policies with special regard to national health development is a priority goal. Goals about the health status of the population as expressed by life expectancy at birth, morbidity and mortality patterns, infant and child mortality rate, nutritional status, etc.

(2)

(3) Goals about the continuous flow of health efforts and services directed to the well-being of the population, such as (a) coverage of MCH and immunization, (b) provision of potable water, (c) percentage of national gross product (NGP) devoted to the health sector, ratio of doctors/nurses to the population, etc. The responsibility for achieving these goals lies both within and outside the Ministry of Health. The first group of goals, which bear a very high value for the Ministry of Health and which, to a great extent, will determine the impact of the health sector, will require a sustained commitment from outside the Ministry of Health. The other goals, which will require commitment and a leading role of the health sector, must be pursued in collaboration with other sectors through an integrated, multisectoral approach. Therefore, for the first type of goals, qualitative criteria to measure the relative degree of

achievement have been set. For the other two, quantitative targets have been set in the Long-term Health Development Plan as an expression of the National Health System goals. The Basic Principles of the National Health System which guide the health development efforts during Repelita IV are the following: (1) All citizens have the right to attain an optimal level of health in order to be able to work and live properly, according to human dignity.

(2) The Government and the community are responsible for maintaining and raising the level of health status of the community. (3) Execution of the health effort is directed by the Government and carried out harmoniously in cooperation between the Government and the community, and is mainly implemented through promotive and preventive activities.

(4) Each form of health effort has to follow humanitarian principles based upon belief in God with emphasis on the national interest - the community at large - and not merely the interest of groups or individuals. (5) An attitude and atmosphere of kinship and mutual help, and all available resources should be directed, as far as possible, for the benefit of development in the field of health. In conformity with the principles of justice and equity, the achievement of development has to be enjoyed equally by all the people. All citizens have the same position and rights under the law and are obliged to fully honour and obey all the regulations in the field of health. National health development should be based on self-reliance, capability, strength and national identity.

(6)

(7)

(8)

The targets of Repelita IV represent the first step in the achievement of the targets of the Long-term Health Development Plan. The health situation in Indonesia, with a population of more than 158 million in 1983, and an annual population growth of 2.3 per cent, is improving. The improved health status of the people over the two decades is reflected in the declining crude death rates and morbidity rates of certain diseases and in an increased life expectancy at birth. The crude death rate has declined from 19.4 in the seventies to 12.5 per 1000 population in the eighties. The infant mortality rare has declined from 140 in the sixties to 98 in 1.980. The maternal mortality rate is also decreasing. There is a favourable trend of decreasing birth rate from 43 in the sixties to 35.9 in the eighties due to a successful family planning programme. The morbidity and mortality rates are high. The major causes are preventable communicable diseases, malnutrition, poor environmental conditions and personal hygiene. The Government has given top priority to health development since Repelita I. During Repelita 111, emphasis was laid on increasing production of all categories of manpower especially those required for manning the health services infrastructure. Of a total 108 000 health workers employed by the Ministry of Health, 63 per cent are assigned to local government and approximately 64 200 are medical or paramedical personnel. There are currently 15 400 doctors and 37 600 health nurses. The government has also given top priority to the strengthening of health services infrastructure, especially in rural areas. The number of

health centres has increased from 1 637 in 1970 to 5 353 in 1983 and the number of sub-health centres has increased from 8 386 in 1980 to 13 636 in 1983. Also, the number of hospital beds has increased from 126 272 in 1982 to 133 538 in 1983. During Repelita 111, the Ministry of Health budget increased significantly to a total of Rupiah 1 107 billion as compared to Rp.272.3 billion in Repelita I1 and Rp.52.4 billion in Repelita I; thus the Ministry of Health budget in Repelita I11 was more than four times that during Repelita 11. The health budget as a proportion of the national budget is relatively small (1.9 - 2.2 per cent). WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 The collaboration between the Government of lndonesia and the World Health Organization is based on the process of a total integrated national health development. A protocol for programme collaboration has been concluded between the Government of Indonesia and WHO. It supports the total health development in Indonesia, based on national objectives for the national health developinent (Panca Karsa Husada). A multi-sectoral approach to achieve these goals is envisaged and actuated at the central level down to the village community level with particular emphasis on the priorities of the national programme in conjunction with direct support to planning and implementation efforts in selected geographic areas. The policies, strategies and principles to achieve HFA by the Year 2000 in Indonesia have been integrated into the National Health System (SKN). Within the spirit of the Government of IndonesiajWH0 Protocol of Collaboration, the 1984-1985 collaborative programme was based on the Broad Outline of State Policy for Repelita IV (GBHN), the policies and principles of the SKN, its long-term development programmes, Repelita IV formulation exercise in which WHO has participated as a partner and which is in line with global and regional strategies for HFA and the WHO Seventh General Programme of Work, its global and regional medium-term programmes (which have been operationalized for Indonesia) and guidelines ensuring the use of WHO resources at the country level. Accordingly, proposals for the biennium 1986-1987 have been formulated as guided by the above national/WHO policies and are in continuation of the collaborative programmes during the present biennium of 1984-1985. This collaborative programme would ensure the achievement of the national goals, objectives and targets for Repelita IV. Health Situation and Trend Assessment The objective of this programme is to develop the health information system in order to provide accurate, timely and adequate information to all units at different levels of the Ministry of Health, to support efficient management, and to enable the community to develop self-sufficiency in the health field. WHO will support the Bureau of Planning and all units at central, provincial, regency and health centre levels in the development of a health information system, training courses at all levels, development of a monitoring and evaluation system, strengthening of epidemiological surveillance and training in epidemiology, strengthening of the hospital and laboratory information sub-systems, the health centre information sub-system, and GEAs. Managerial Process for National Health Development The objective of this programme is to strengthen the management of national

and WHO programmes to ensure maximum impact for more efficient and effective health development. Support will be provided for improving the coordinated mechanisms, ensuring the best utilization of WHO resources and attracting extra-budgetary resources. Health Systems Research WHO will support the Centre of Health Services Research in strengthening its research capabilities and promoting HSR relating to health care delivery and the development of managerial process for health i.nstitutions. Health Legislation Support will be given for continuing the activities initiated during 1984-1985, and for reviewing the existing laws and regulations, identifying problems in their implementation and updating them, including the basic health laws enacted In 1960. Organization of Health Systems based on Primary Health Care WHO support will be directed towards organizing and expanding health centre services, promotion of community participation in the health activities to achieve optimal health status of the population, improve coverage, effectiveness and efficiency of the health centre programme including service delivery management and development. Health centre and primary health care infrastructure will also be strengthened. Assistance will also be provided for the preparation of training materials, designing, evaluation of the health care delivery system, training in health planning and public health and hospital administration, and workshops on management and logistics.

Health Manpower Health manpower development during Repelita IV deals with education and training of health workers with the objective of providing qualified health manpower in sufficient number and categories, and health manpower management with the objective of creatingfestablishing effective and efficient management. WHO will support the organizational development of the Centre for Education and Training, strengthening of the structures and the functional framework in the provinces; development of the nursing manpower educational system, development of a higher education programme to strengthen nursing leadership, strengthening of the capabilities of the nursing teachers at all levels; expansion and further development of the public health education system by the development and revision of currlcula, and strengthening of the new faculties of public health; monitoring and evaluation of the implementation of the community-oriented curricula of all the medical schools, upgrading of the expertise and functional patterns of the teacher-training centres; assessment and strengthening of the training of other paramedical manpower by reorientation of the curricula towards PHC needs. Public Information and Education for Health The primary objective of this programme is to increase the capability of the community to help themselves in maintaining their health through healthy living and participation in health efforts. WHO'S support will be directed towards the training of staff, development of health educational services, organization of workshops on health educational methodology and communication skills.

Research Promotion and Development The aim of the programme is to promote national capabilities in health research and development, and scientific knowledge and skills required for providing support to health development. WHO collaboration will be directed toward strengthening research capabilities of the National Research Centre, Health Ecology Research Centre, Biomedical Research Centre, Non-communicable Disease Research Centre, and Drug Research Centre. Nutrition Support will be given to the further development of nutrition surveillance activities, strengthening of rural hospital and labour force institutions in the field of nutrition, provision of relevant information on food and nutritional surveillance, proper planning and management of food supplies, and training of staff at central and provincial levels. Oral Health WHO will collaborate with the Government in strengthening the oral health programme and promoting the prevention of oral and dental diseases. Workshops on surveys of oral health will be promoted, as also training of personnel in dental health and water fluoridation. Accident Prevention Support will be given to assess the magnitude of problems associated with accidents. Maternal and Child Health, including Family Planning WHO will support the strengthening of the delivery of integrated family health package (MCH, FP, Nutrition, DDC and EPI), enhancement of technical and managerial aspects, GEAs, preparation of training materials, training in the fields of school health and family planning, and workshops to review the MCH programme at different levels. WHO inputs will be provided to strengthen the implementation of the integrated family health package in selected provinces with emphasis on the community level. Workers' Health The objective of this programme is to develop the comprehensive workers' health programme in a phased manner. WHO'S support will be directed tovards the strengthening of primary and referral health services to cover the underserved labour force engaged in agriculture, construction, and cottage industries; training activities will also be promoted. Health of the Elderly WHO support will be provided for training in the field of health problems affecting the aged, formulation of national policies and plans of action to implement the approaches to the care of the elderly. Prevention and Treatment of Mental and Neurological Disorders Support will be given to training activities, rehabilitation of mental patients, recording and reporting system in mental health institutions, and promotion of operational research.

Community Water Supply and Sanitation The activities undertaken by the Ministries of Health, Public Works, Interior, Population and Environment, to increase the coverage of rural and urban populations with clean water supply, basic sanitation, sanitary housing and environment, solid waste management, environmental quality monitoring and surveillance and control will be supported by the WHO collaborative programme. Assistance will also be provided for the development of an institute for quality control of environmental health. Control of Environmental Health Hazards WHO will support the training of national8 concerned with the control of environmental health hazards including chemical safety, pesticides, insecticides and industrial base. Food Safety WHO will support the strengthening of the programme for food safety with special reference to training courses for food inspectors, strengthening of food control laboratories, training of central and provincial staff in food inspection, food analysis and analysis of hazardous materials.

WHO will support the strengthening of virology in regional laboratories and the production of laboratory reagents, in-service training in laboratory management and quality control and laboratory utilization studies at peripheral and mid-level laboratories, especially at the health centre level. Essential Drugs and Vaccines Support will be given to the activities designed to strengthen the supply and management of a national network for the production and distribution of drugs, including training of staff and organization of group educational activities. Drug and Vaccine wality, Safety and Efficacy WHO will support Government's efforts in improving the quality, safety and efficacy of drugs and vaccines, and the training of staff in quality control, promotion of drug utilization studies and strengthening of the drug information system. Traditional Medicine Support will be provided for training in traditional medicine, conduct of GEAs and research on medicinal plants. Rehabilitation Support will be given to manpower training for the formulation of a policy and plan of action for disability prevention and rehabilitation, and preparation of a training manual for the disabled. Immunization

WHO will support all aspects of the managerial process for EPI within the

integrated family health package, cold chain development and training of EPI personnel, organization of workshops at health centre and village levels, evaluation of cold chain performance, and special epidemiological surveys on target diseases to measure the impact of EPI. Disease Vector Control WHO will support the national disease vector control programmes in identifying priority activities for improving the vector control component of disease control, identifying and developing entomological and operational methods, and developing a vector surveillance mechanism, as well as a system for detecting and monitoring vector resistance to pesticides. It will also support the national training programmes and the strengthening of research capabilities in disease vector control through the provision of fellowships, supplies and equipment to research institutions. Malaria In collaborating with the Government in the national malaria control programme, WHO will support malaria control assessment exercises, monitoring of falciparum chloroquine resistance as well as anopheline resistance to insecticides, assessing field malaria operations including logistics of insecticides, anti-malarial drugs, organizing training courses for malaria operations at different levels, preparation of educational materials and training and operational manuals, malariometric and entomological surveys. Emphasis will he laid on expanding malaria control in the outer islands. Parasitic Diseases WHO will support the implementation of parasitic diseases control activities and the training of national health personnel. Diarrhoea1 Diseases Support will be provided for studying the feasibility of the production of ORS in outer islands and for the training of personnel. Strengthening of DDC and its expansion within the integrated family health package will be emphasized. Acute Respiratory Infections . Through epidemiological surveys, WHO will support the Government in assessing the magnitude of the problem of acutc respiratory infections, and in the development of training and health education materials. A national programme within the integrated family health package will start in a phased manner during Repelita IV. Tuberculosl s WHO will support the implementation of the plan of action for tuberculosis control with the focus on case-finding, case-holding and investigation of contacts, and training of staff in tuberculosis control.

Leprosy Support will be given for the training of leprosy control personnel at central and provincial levels.

Zoonoses WHO will support the activities for assessing the magnitude of the rabies problem and in formulating necessary control measures. Sexually-Transmitted Diseases Support will be given for the training of central and provincial staff in sexually-transmitted diseases and the yaws programme through study tours to observe sexually-transmitted diseases control activities and laboratory methods for the diagnosis and follow-up of cases. Blindness WHO will support the training of health and allied personnel in communityoriented eye health care. Cancer Support will be given for training manpower in the development of a national strategy for the prevention and control of cancer and promotion of cancer health education, early detection, diagnosis and treatment including rehabilitation through the primary health care system with adequate referral support. Cardiovascular Diseases Support will be given for training manpower in the strengthening of surveillance activities and in identifying the risk factors and the population at risk, as well as for the training of health and allied personnel in the prevention and control of cardiovascular diseases. Health Information Support Support will be given for training in the fields of information sciences, use of storage and retrieval of medical health information, and the strengthening of national libraries through the provision of books and periodicals. Budgetary Implications The programme budget proposals support the process of total health development in the country based on the national objectives for national health development. In the majority of the programme areas, the activities being undertaken during the current biennium will be continued during 1986-1987. However, some programme areas are given increasing importance. These areas are Health Legislation which registers an increase of 174%, Maternal and Child Health including Family Planning 105% and Community Water Supply and Sanitation 80%. Certain other programme areas such as Workers' Health, Health of the Elderly, Control of Environmental Health Hazards, Rehabilitation, Parasitic Diseases, Acute Respiratory Infections, Zoonoses, Blindness, Cancer and Cardiovascular Diseases are allocated inputs from the WHO regular budget in contrast to the current biennium's activities. These resources are expected to provide a catalytic impact.

Approved Budget INDONESIA 1984-1985

Proposals

1986-1987

N D S

3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.2 Essential Drugs and Vaccines 3.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.4 Traditional Medicine 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.2 Disease Vector Control 427 500 4.13.3 Malaria 4.13.4 Parasitic Diseases 4.13.6 Diarrhoea1 Diseases 4.13.7 Acute Respiratory Infections 4.13.8 Tuberculosis 30 100 497 700 317 200 38 000 27 400 27 000 50 000 J

109 400 182 900

91 000 200 100

61 200 244 000 46 300

69 200 45 600 8 400

RB DP RB RB

268 900

321 200 203 300

RB RB

VG RB RB RB

RB RB J

62 800

Approved Budget INDONESIA 1984-1985

Proposals N 1986-1987

F U

4.13.9 Leprosy 4.13.10 Zoonoses 4.13.11 Sexually-Transmitted Diseases 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular Diseases 5.14.0 Health Information Support

70 700 188 400

31 500

RB VL RB

27 000

50 000

39 900 27000 8 400

RB RB

8 400

65 300

56 900

Total: INDONESIA Of which: Regular Budget Other Sources

-------- -----------

10 433 100

9 049 200 =========

7 113 000 3 320 100

8 292 000 757 200

MALDIVES NATIONAL HEALTH SITUATION Through a country health programming (CHP) exercise carried out in 1980 with active WHO support and collaboration, the Government of Maldives adopted its national health policy and strategy for HFA by the year 2000. These strategies are in the process of continued monitoring and evaluation. In early 1982, a workshop was held to review the progress of implementation of the strategies. Later, the strategies were slightly modified. Recently, in order to facilitate monitoring and evaluation on a continued basis, an approach of repeated sample survey has been agreed to in principle. The first of its type will be held in December this year. The country's overall rate of progress is remarkably fast. In the health sector, the achievement is satisfactory in general and in some areas the target has already been achieved. As such, the Ministry of Planning and Development (MPD) of the Government has already undertaken to reset targets in consultation with the Ministry of Health and other concerned ministries with the aim of launching a Five-Year Socio-economic Plan basing health-sector plan as a model. Maldives is a small country with only 160 000 population (53 per cent male and 47 per cent female), but is spread over a vast ocean area of 90 000 sq. kms. under a virtually sea-locked condition. The country's main constraints are lack of adequate manpower, high drop-out rates of trained manpower, and transport. The country has no mineral resources. Its economy is reared mainly by fishing, shipping and a newly emerging tourism sector. These sectors have shown promising economic viability. During the period 1978-81, 13 per cent increase in GPD was achieved while 8 per cent - 9 per cent increase has been estimated for the period 1982-85. The GPD for the year 1981 was estimated at US$ 384 0 0 00 0 0 . About 1.4 per cent of GPD and about b per cent 9 per cent of national budget is spent on health sector.

The country has one 86-bed general hospital at the capital city Male. One regional hospital with 12 beds is functioning in a rural atoll capital while three more will be established according to the plan. In addition, there are two MCH centres and four clinics, one each for TB, leprosy, malaria and filaria situated in Male and 21 health centres in the 19 rural atolls. Manpower availability to run the hospital, clinics and the health centres is very limited and therefore emphasis is laid o f i health manpower development through training both in and outside the country. The leading health problems of the country are diarrhoea, malaria, TB, fevers, worms, etc. The other problems for which government programmes are available from earlier dates are filaria, leprosy and EPI diseases. Of these, malaria is virtually under control. The coverage for immunization against EPI diseases is good. In fact, diarrhoea1 and other water-borne diseases are the main threat to the people's health. Although diarrhoea management and control efforts have been developed very satisfactorily, total control will depend on the availability of safe drinking water and hygienic disposal of excreta on a national basis. This has now become a challenge for Maldives. The challenge is well taken by the Government which is trying to launch ambitious schemes through bilateral, EEC, WHO, UNICEF and other funds. WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 WHO collaborative activities during the 1986-1987 biennium are proposed to be

carried out in the programme areas of organization of health system based on primary health care, health manpower, community water supply and sanitation, malaria, immunization, TB, and leprosy. Organization of Health Systems based on Primary Health Care The Government is proposing to strengthen management of the health services, especially programme formulation, implementation, monitoring and evaluation at the country level, and promote the coordination of resources for the development of health programmes at the country level as an intrinsic part of organization of health systems based on PHC. It will also expand the delivery system, and implement a programme of primary health care through the development of the basic health services network, national health information system and updating and implementing the manpower development plan.

WHO will support national activities for planning, programming and management of national health programmes, promotion of coordination between national health programmes and collaboration with other national sectors and international agencies including those of UN. Training of national staff, development of specialized services, strengthening of national capabilities in some disease control or preventive activities and promotion of service delivery will also be undertaken. Health Manpower In the area of Health Manpower, WHO will support national activities aimed at improving HMD capacity through teachers' training, field-based training activities, higher training of doctors, development of specialities in the Central Hospital, etc. Connuunity Water Supply and Sanitation WHO support will consist of technical collaboration for realizing the national objectives in respect of provision of safe drinking water with particular emphasis on rural water supply and provision of safe excreta disposal system.

WHO will support national activities to expand the coverage of the immunization programme with a view to reducing mortality and morbidity from EPI diseases. Malaria Malaria is expected to be fully under control by the end of 1985 and as such the objective during the 1986-1987 biennium would be to maintain status quo as well as prevention of reintroduction. WHO will support national efforts at strengthening their capabilities to continue programme activities in the right direction. Tuberculosis

WHO support will be given to national activities for reduction in the incidence of tuberculosis. Leprosy WHO support will be focused on case-detection and treatment.

In the field of disease prevention and control, national activities will focus in the areas of TB, leprosy and EPI. Operational expenses and drugs will be met through voluntary donors, particularly Damien Foundation. It is hoped that voluntary contributions will continue, but to intensify control measures to achieve the objectives as laid down in the country health programme, there will be greater involvement of WHO in the programme activities which will be focusing on case detection and treatment, and immunization of the vulnerable segment of the population. Budget Implications For the 1986-1987 biennium, the total country budget has been increased by 16 per cent from US$ 770 500 in 1984-1985 to US$ 892 500 in 1986-1987. This increase has been reflected by additional services provided under each programme. Although the primary health care (PHC) programme has decreased its allocation from US dollars 486 400 to 450 000, the health manpower development (HMD) programme has been further strengthened. The allocation for Water Supply and Sanitation Programme has been increased from US dollars 157 800 to US dollars 180 000 as water-borne diseases due to continuing inadequate sanitation remain the major area of concern. While the allocation for the Malaria Programme has been decreased from US dollars 126 300 to 80 000, EPI, Tuberculosis and Leprosy programmes have been allocated US dollars 20 000, 19 000 and 19 000 respectively.

MONGOLIA NATIONAL HEALTH SITUATION As part of the overall national socio-economic development plan, the concept of health for all is being pursued by the Mongolian People's Republic. The protection and improvement of people's health is one of the basic goals of the Government and is endorsed by the Constitution of the Mongolian People's Republic. The Government's policy is aimed at effecting a permanent improvement of the living and working conditions of the Mongolian people. The Eighth Five-Year Plan covering the period 1.986-1990 is geared to the solution of major socio-economic problems. During the past few decades, the health of the population of Mongolia has improved considerably. The crude mortality rate has been reduced by 2.2 times and infant mortality has gone down by eight times. The net population growth is 30 per 1 0 0 0 people. In 1983, the number of physicians increased by 10.2 per cent in comparison with 1980, and the number of mid-level medical personnel by 8 per cent. At present, 23 physicians take care of each 10 000 of population. There are 109 hospital beds available for the same number of people. In 1984, another 700 new hospital beds will be established. New specialities have been established in many hospitals and out-patient departments. The material and technical basis of the medical irlstitutions has been improved through the delivery of necessary supplies and equipment. Special attention has been paid to the development of out-patient care which was particularly strengthened in rural areas. Great efforts have been made to improve the paediatric services which is very important since about 46 per cent of the total population are children up to the age of 16 years. There are 460 paediatricians in the country. Thanks to the implementation of immunization programmes, the incidence of infectious diseases has been reduced. For example, in 1982, about 114 800 children have been immunized against tuberculosis, about 180 000 against poliomyelitis, 80 000 with DPT vaccine and 63 000 against measles. In 1984, the budgetary allocation for education, health services, culture and arts, sciences and sports will increase by 3.8 per cent. On an average, about 10 per cent of the State budget is allocated to health. Respiratory, digestive, neurological and cardiovascular diseases are the main cause for the prevalent morbidity. Efforts are under way to cope with these diseases. The National Influenza Centre of the State Institute of Hygiene, Epidemiology and Microbiology has been strengthened as also the Central Bacteriological Laboratory. The capacity for diagnosis of viral, diarrhoea1 diseases is being developed at the Institute of Hygiene, Epidemiology and Microbiology. Research activities to study the epidemiology of hepatitis are being undertaken. The Huvsgul aimak project aimed at the improvement of health care delivery for identifying new organizational forms, particularly in rural areas, is being implemented as part of the primary health care programme. The main problems in the field of health that confront the Government relate to the improvement of maternal and child health care, infectious diseases control, particularly control of hepatitis, typhoid and other viral and enteric diseases, mobilization of the population and mass organizations for the improvement of environmental health, enhancement of the knowledge on hygiene and health problems, reorganization of the rural medical institutions and services, strengthening of the material and technical basis of the health

care delivery system, particularly in rural areas, and providing medical institutions with necessary equipment and drugs. WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 Health Situation and Trend Assessment The programme aims at strengthening the national capabilities for assessing the general health situation and trends and improving the utilization of health information data by the decision-makers for planning and management. WHO will support the establishment of the computer-based information system, training of health managers in the analysis and utilization of statistical data, training of health information specialists in designing health system research studies, analysis techniques and research methodologies for the evaluation of health programmes, improving the standard of medical records by training personnel and strengthening of statistical units technically, and introduction of new methods of "dispensarization" (systematic surveillance of selected population groups). Managerial Process for National Health Development A National Intersectoral Coordinating Council for HFA has been established and is responsible for assessing the results achieved and to decide on further national activities related to health. WHO will support Government's efforts for further development of health planning and management, monitoring and evaluation of health programmes related to the implementation of the national strategy for HFA 2000. The programme will also promote intersectoral approach, and facilitate implementation of the Plan of Co-operation between the Government and WHO, and formulation of broad and detailed programming and project formulation. Support will also be provided for the evaluation of the quality of the planning and management process, country-specific short courses and seminars, developing problem and task-oriented health management training programmes, and strengthening the qualitative and quantitative forecasting of health manpower requirements. Organization of Health Systems based on Primary Health Care The programme aims at promoting further development of a comprehensive and effective model PHC delivery system in the Huvsgul aimak and promoting applied health services research at the primary level as a basis for finding appropriate and effective solutions for the organization of health services, particularly in rural areas. Support will be given for organizing and surveying the work of health services in the somons, conducting seminars for physicians and other health personnel on the planning and management of PHC, seminars for health administrators of other aimaks with the aim of acquainting them with the advanced experience of the Huvsgul aimak and to use these results in their own aimaks, conducting a national conference on the results of the Huvsgul aimak., preparing managerial guidelines for aimak health administrators, strengthening the radio-communication network connecting different levels in rural areas in order to ensure the flow of information and functioning of the referral system, and evaluation of the programme. Health Manpower Assistance will he provided in the further strengthening of the National Centre for the training of health science professional teachers, implementation of the undergraduate training programme in the Medical Institute, improvement of the continuing education system for different categories of

health workers, monitoring and utilization of the WHO fellowship programme to enhance the national capacity to meet the goals of the national strategy for Health for All, further development of national research capabilities, and training in research management and research methodology. Maternal and Child Health, including Family Planning For Mongolia, with a population growth rate of 27.5 per 1 000 (1980), a well functioning system of maternal and child health care is very important. The policy of the Government is aimed at a further growth of the population. These efforts are sponsored by appropriate social measures facilitating the life of the mothers and sustaining women's role in the community. There is a widespread network of medical institutions taking care of mothers and their children. In order to achieve further progress, WHO support will be provided particularly for training, strengthening specialized services, developing research activities and improving the material basis for selected areas. Community Water Supply and Sanitation In Mongolia, activities directed to water supply and sanitation problems are planned and carried out in line with the national IDWSSD plan. Considerable progress has been achieved in constructing water supply systems in towns and industrial areas. As in the past, there are still problems with regard to low-cost water supply systems in rural areas which are effective and easy to maintain. There is also a lack of suitable new designs for sewerage systems. WHO will support the training of manpower for improving the quality of water surveillance, introduction of new and appropriate technologies, particularly for small-scale water supply systems in rural areas, introduction of new technologies of harmless waste disposal, improvement of the equipment of some control laboratories, financial support for some design works, establishment of three water quality control laboratories in Darkhan, Sukhbaatar and Choibalsan, and establishment of a central control laboratory for studying water pollution and impact of water factor on health at the State Institute of Hygiene, Epidemiology and Microbiology. Drug and Vaccine Quality, Safety and Efficacy Support will be provided for improvement of the organization of blood donation and transfusion services including medical care of haemophilia patients, establishment of cytopheresis (production of thrombocyte, erythrocyte and leucocyte preparations), training of physicians of different specialities in problems of haemotherapy, training of staff of the Institute of Biopreparations and Blood Transfusion in problems of cytopheresis, and HLA typifying. Traditional Medicine The Government of Mongolia pays great attention to the further development of the Institute of Folk Medicine and to the development of traditional medicine as a whole. The national policy of folk medicine aims at introducing its experience and methods into the every-day practice of medical institutions. WHO will support the strengthening of research work in the Institute of Folk Medicine, particularly, carrying out scientific enquiries into the efficacy of folk medicine in selected diseases for which other remedies are not effective, inclusion of the problems of folk medicine in the curricula of the Medical Institute, and preparing manuals and guidelines for broad use in folk medicine.

Immunization The objective of the programme is to ensure the full coverage of all eligible child population by the EPI. WHO will support national seminars and courses/ workshops for physicians and mid-level health workers on problems of epidemiological and immunological surveillance, establishment of a system for surveillance, ensuring a high quality of the vaccinations through immunological supervision, formulation of selected proposals for research activities, further improvement of the cold chain system in rural areas, and preparation of guidelines and evolving other health educational activities regarding immunization problems. Diarrhoea1 Diseases The prevention and control of diarrhoeal diseases are one of the serious public health problems, especially in the field of child health protection. Diarrhoeal diseases make up 4 0 per cent of all patients hospitalized in paediatric clinics; among them, children of the 0-4 years age group constitute 95 per cent. A national programme on CDD has been established and partially implemented. During 1986-1987, WHO will support the implementation of the revised National CDD Programme, improvement of the production and supply of ORS, introduction of weekly registration and information of diarrhoeal diseases in all aimak centres and cities, improvement of the laboratory diagnosis of diarrhoeal diseases, and the strengthening of effective health education measures. Other Communicable Disease Prevention and Control Activities The high rate of viral diseases, particularly viral hepatitis, is a serious public health problem. 80 per cent cf the infectious morbidity is due to viral infections. Acute Respiratory Infections (ARI) are another problem especially in children's morbidity and mortality. 16.3 per cent of all out-patient consultations are due to ARI, about 70 per cent of which are registered in the age group upto 5 years. WHO has contributed to improving epidemiological control and laboratory diagnosis services.

WHO will support the strengthening of the rapid laboratory diagnostic services of viral infections, especially viral hepatitis B, production of appropriate viral diagnostic reagents, improvement of the registration and information system for influenza and ARI, and improvement of diagnosis and anti-epidemic measures for salmonelloses. Other Non-communicable Disease Prevention and Control Activities

WHO will support the project for C W control and strengthening of the surveillance system for CVD with the aim of early detection and early treatment of hypertension, especially in risk groups, further study of the epidemiology of cancer diseases, functioning of the integrated non-communicable disease control programme in an experimental area of Ulan Bator; review of the current educational programmes in the Stomatological Faculty of the State Medical Institute, Ulan Bator; seminars and workshops on organizational problems of dental care In urban and rural areas, and organization of a system of continuous education of dentists in special stomatological problems. Budgetary Implications The allocation of resources for the programme areas conforms to the priority accorded by the Government for emerging health problems.

Approved Budget MONGOLIA 1984-1985

Proposals

F U N

1986-1987

2.3.0 Health System Development 2.3.1 Health Situation and Trend Assessment 2.3.2 Managerial Process for National Health Development 2.4.0 Organization of Health Systems based on Primary Health Care 2.5.0 Health Manpower 3.8.0 General Health Protection and Promotion 3.8.2 Oral Health 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 99 800 193 600 170 000 RB

199 600

305 000

229 600

200 000

199 600

120 000

189 600 0 0 430 8

161 100

RB FP

3.11.0 Promotion of Environmental Health 3.11.1 Cornunity Water Supply and Sanitation 3.11.3 Control of Environmental Health Hazards 59 900 49 900 100 0 0 0

RB RB

NEPAL NATIONAL HEALTH SITUATION The long-term objective of the health sector is to expand the health services curative, preventive, promotive and rehabilitative - in the entire country, taking into consideration the regional balance and social justice, by providing to the maximum number of people at least the essential health services, to increase their life expectancy and to improve the quality of life, to combat malnutrition, to prevent communicable diseases through the expanded programme on immunization and provision of safe drinking water and basic sanitation facilities, to provide family planning and maternal and child health services, to promote the Ayurveda system of medicine, and to develop the required health manpower with a view to achieving national self-reliance and self-sufficiency.

To achieve the overall socio-economic development of the country, including the health sector objectives, His Majesty the King is providing dynamic leadership through the National Development Council, while the National Planning Commission, under the chairmanship of the Prime Minister, is coordinating the planning, implementation and evaluation of the various sectors of His Majesty's Government. The Government is fully committed to the global social goal of Health for All by the Year 2000, and has adopted primary health care as the key approach. As 96 per cent of the population lives in rural areas, the primary health care package is being delivered at the village level through health posts. The health posts are health institutions at the periphery providing both static and mobile basic health services, supported technically and administratively by the district health offices and district hospitals. At present, there are 744 health posts in the country (population: 15.368 million), out of which around 200 health posts are delivering integrated community health services. The Integrated Community Health Services Development Project is entrusted with the task of integration of community health services. This project is at the moment in operation in 23 districts, and is poised for expansion into eight more districts in the near future. To promote active community participation, the Government has also introduced the "community health leaders" scheme in 13 districts (to be expanded to other districts). The infant mortality rate is high (156 per 1 000 live births). The annual population growth rate is 2.66 per cent (1971-1981), which affects the socioeconomic development of the country. The FP/MCH Project under the Ministry of Health is providing family planning and MCH services in 52 districts in the country. The Government has also initiated the delivery of primary health care package through the FPIMCH Project in some selected districts. Malnutrition remains one of the most serious health ~roblerns in Nepal. The nutritional surveillance and treatment of malnutrition, promotion of breastfeeding and weaning foods, and prevention of goitre and cretinism are some of the main activities that are being carried out. The strengthening of the Nutrition Section of the Department of Health Services, and intersectoral coordination and collaboration with other related ministries and departments are also receiving priority attention. The Government is trying its best to prevent, control and contain the communicable diseases that are prevailing within the country. The epidemiological surveillance system for ten communicable diseases in 23 districts is being further intensified. Surveillance and control of Japanese encephalitis in the Terai districts are being continued. Rabies control activities, particularly

registration and vaccination of pet dogs and destruction of stray dogs, were start:ed in the Kathmandu Valley from July 1983. Medical records assistants are being given in-service training on a regular basis. The lay reporting system has been initiated in two districts. The overall malaria situation remained unchanged, although there was an increase in the number of microscopically diagnosed cases of malaria due to an increase of imported cases and further improvement in ABER. It was estimated that 0.5 per cent of the population is suffering from infectious type of pulmonary tuberculosis. The TB control programme continued to face difficulties in ensuring timely and adequate supplies of anti-tuberculosis drugs owing to procurement and distribution problems. The national Leprosy Control Project is coordinating the activities of both extrrnal and internal agencies working in the country. The multi-drug therapy (MJJT) reginen has been introduced in 28 districts. Facilities for the mouse foot-pad inoculation technique were developed in Anandban Hospital. The national programme is still faced with a number of problems such as inadequate trained manpower, inadequate supply of drugs and logistic problens, and still high defaulter rate in receiving medical treatment. The Expanded Programme on Immunization is currently in operation in 46 districts. The primary objective of this programme is to reduce morbidity and mor~alitydue to EP1 diseases among the children of 0-12 months of age, and to protect the newborns from tetanus by giving TT to expectant mothers. The Prevention of Blindness Programme in Nepal was started in August 1980, with a nation-wide survey on the epidemiology of blindness in the country. Out of an estimated 117 620 blinds, cataract accounts for two-thirds, or about 78 605 cases. The sequelae of cataract account for another 6 195 cases. Following the survey, the national programme was formulated and is being implemenled. The main emphasis of the programme is on active community involvement and the utilization of existing basic health staff. The incidence of filth-borne and water-borne diseases is high in Nepal. llysrntrry, gastroenteritis, hook-worm and round-worm infestations are common, and these conditLons are directly related to a very low level of safe water supply coverage and extremely poor sanitation. At present, only 11 per cent of the total population (83 per cent in urban and 6.6 per cent in rural areas) are covered with water supply. As regards manpower development, except village health workers, who are trained by the Ministry of IIealth (ICHSDP project), all other categories of liealth workers are trained by the Institute of Medicine, Tribhuvan University. 'There are two extension programmes (Auxiliary Health Workers and Auxiliary Nurse Midwives), six certificate level programmes (Health Assistants, Ayurveda Assistants, Elurses, Pharmacy Assistants, Health Laboratory Technicians, and Radiography Assistants), and four post-basic programmes (MBBS degree course, Post-basic Midwifery, Post-basic Community Nursing and Post-basic Adult Nursing). Despite the progress made by the Institute of Medicine, the manpower requirements of the health programmes in the country are still much greater than the number and types that could be produced by the Institute. In fact, inadequate trained health manpower is one of the major constraints the country is current3.y facing.

WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 Health Situation and Trend Assessment WHO will continue to provide technical support to the Epidemiology and Statistics Division, Department of Health Services, to carry out epidemiological surveillance of communicable diseases, extend the use of the International Classification of Diseases, and improve the standard of medical records by conducting in-service training courses for medical records assistants. WHO will also suppori- the further development of the national health information system (NHIS) and national staff development in NHIS subject areas in close collaboration with the Health Planning Unit and the Integrated Community Health Services Development Project. Managerial Process for National Health Development Continued support will be provided for the implementation of national HFA strategies, management of health programmes, and optimal utilization of WHO'S resources at the country level, the joint programming and joint review of national health programmes and WHO collaborative programmes, regional cooperation and TCDC with Member Countries in the field of health and population, and mobilization of external resources and their coordination. Through the Health Planning Unit, Ministry of Health, hXO will also provide technical support for the further strengthening of the Health Planning Unit as the focal point for Managerial Process for National Health Development (MPNHD), national staff development in MPNHD subject areas through national and regional training, periodic review of national health plans, the establishment and functioning of national health management mechanisms, and district level health planning and management. Organization of Health Systems based on Primary H e a l ~ hCare WHO will continue to provide technical support to the Integrated Community Health Services Development Project in the further development of integrated community health services and the community health leaders scheme, with emphasis on the strengthening of the district organizational set-up, going down to the village level. WHO will also assist the FP/MCH Project and other national social services organizations, such as Health Services Coordination Committee, in the identification, planning, and implementation of alternative or complementary approaches to primary health care. WHO will support activities aimed at achieving community participation in primary health care, in the development of appropriate technology for PHC, and in the procurement/production and distribution of essential drugs. Health Manpower WHO will support activities carried out by the Department of Health Services in cooperation with the Institute of Medicine, Tribhuvan University, for health manpower planning, strengthening of the managerial process of HMD (supervision and perso~nel management), health manpower research, and the development of an appropriate information system for manpower planning. WHO will also continue to support activities in this area carried out by the Institute of Medicine, Tribhuvan University, in cooperation with the

Department of Health Services, including staff development through teacher training workshops and the development of an Education Support Unit, curriculum review and development of community physicians, nursing, middle level and auxiliary health workers, production of health learning materials, review and planning of workshops to improve the self-reliance and performance of the Institute, continuing education for health workers, and post-graduate medical education, TCDC activities in HMD, including alternate approaches to fellowship programming. Through the Nursing Administration Division, Department of Health Services, WHO will continue to support the development of nursing services and nursing manpower, the strengthening of nursing administration and management, and the training and utilization of traditional birth attendants (TBAs). Public Information and Education for Health WHO will continue its technical support to the Health Education Section, Department of Health Services, particularly in the production of health education materials, and promotion of behavioural science research.

Research Promotion and Development WHO will collaborate closely with the Nepal Medical Research Committee in the promotion of research programmes on national priorities. Emphasis will be laid on the development of national capabilities and skills in research methodologies, strengthening of the research coordination mechanism at the country level, and development of mechanisms for TCDC with Member Countries. Nutrition WHO will continue its support to activities relating to the promotion of breast-feeding, introduction of complementary weaning foods at the proper time, nutritional surveillance for early detection and appropriate care of the malnourished, measures for the control of anaemias, vitamin A deficiency and goitre, training of health personnel in nutrition, nutritional education of the public, and inter-sectoral coordination and collaboratfon for "non-dietary factors". Maternal and Child Health, including Family Planning

WHO will continue to support the FP/MCH Project in carrying out MCH activities in the country, with emphasis on the expansion of MCH/FP services as a part of primary health care, health manpower development for MCH/FP services, curriculum review and development in MCHIFP education programmes, development of appropriate teachingleducation materials, development of service manuals and guidelines in MCHIFP for health personnel, and planning, monitoring and evaluation of MCH~FPprogramme. Prevention and Treatment of Mental and Neurological Disorders WHO will support the Government in the delivery of community mental health services in the context of primary health care. Emphasis will be laid on the early detection and referral of mental and neurological cases,and health education and social action in the prevention of alcohol and drug abuse. Conmunity Water Supply and Sanitation WHO will continue its technical support to the water and sanitation agencies

of HMG, viz., Department of Water Supply and Sewerage (DWSS), Rural Water Supply Department of the Ministry of Panchayat and Local Development (MPLD), and the Environmental Sanitation Section (ESS) of the Department of Health Services. Activities will be geared to the promotion of the Water and Sanitation Decade Plan, National Institutional Development (support for programme management and information systems; socio-behavioural studies; community education and participation; intersectoral collaboration; and for drinking water surveillance programmes including source protection), development of human resources (supporting community-oriented education and training, strengthening manpower development institutions, and training workers of all levels), and information exchange. Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care WHO will continue its technical support for manpower development for health laboratory services, development of elementary laboratory services which could be made available at the health post level, further development of district laboratories and central health laboratory, establishment of an efficient referral system, and quality control of the laboratory services. Traditional Medicine WHO will provide technical support for the promotion of Ayurvedic medicine in the country. Emphasis will be laid on the training of Ayurvedic medicine practitioners, promotion of cultivation, harvesting, processing and preservation of medicinal plants and herbs, modernization of vaidya khana, small-scale local production of Ayurvedic medicine at district and village levels, utilization of traditional practitioners in primary health care and research activities on the efficacy of traditional medicines. Rehabilitation WHO will provide technical support in the prevention of disabilities, and medical rehabilitation of the disabled. Immunization WHO will continue its technical support to the Expanded Immunization Programme. Emphasis will be laid on national training courses, logistics and cold chain, epidemiological surveillance, development of EPI information system, operational research, immunization coverage surveys and programme auditing, and promotion of community participation in EPI activities. Malaria WHO will continue its technical support in all aspects of programme management, viz., spraying operations, epidemiological surveillance, entomological studies, training, field research, community participation and health education. Emphasis will be laid on inter-departmental coordination between NMEO and various departments of HMG. WHO will also support the annual Internal and External Assessments, and border coordination activities between Nepal and India. Diarrhoeal Diseases WHO will provide technical support to the National Diarrhoea1 Diseases Control Programme so that it could be implemented effectively with extra-budgetary resources.

Acute Respiratory Infections WHO will support activities in the prevention and control of acute respiratory infections, with emphasis on the vulnerable group of infants and young children, within the framework of primary health care. Tuberculosis WHO will continue i t technical support with emphasis on intensified passive case-finding and treatment, measures to reduce defaulter rate in receiving medical treatment, active collaboration with the Integrated Community Health Services Development Project for the utilization of basic health staff in integrated districts, procurement and distribution of anti-tubercular drugs, community participation in TB control activities, operations research studies, and periodic evaluation of the programme. Leprosy WHO will support the national leprosy programme in case detection, especially early detection and treatment with effective chemotherapy, expansion of the multi-drug therapy regimen in the country, promotion of case holding and contact-tracing through the development of effective programme management and training, further development of laboratory diagnosis and immunotherapy, and rehabilitative programmes for the disabled persons due to leprosy, including reconstructive surgery and community involvement in leprosy control activities and the social rehabilitation of non-infective leprosy patients. Zoonoses WHO will continue its support to the Zoonotic Diseases Control Section of the Epidemiology and Statistics Division, Department of Health Services, in surveillance, prevention and control of zoonoses and related food-borne diseases, including food hygiene, meat hygiene, and sanitation of restaurants and hotels. Other Conmunicable Disease Prevention and Control Activities Through the Epidemiology and Statistics Division, Department of Health Services, WHO will support surveillance and control of Japanese encephalitis and rabies control activities. Blindness WHO has been implementing the Prevention of Blindness Programme in Nepal with funds from voluntary contributions made by donor governments and social organizations, since 1980. The programme aims at the prevention of blindness and treatment of the curable blind. WHO will support activities directed to the c~eningand running of eye centres, organization of eye camps, training of ophthalmic assistants and basic health staff in primary eye care, and the procurement of instruments and ointments. Health Information Support WHO will continue to support HeLLIS, and the HeLLIS network in the country and its linkage with the regional network.

Budgetary Implications The proposed programme budget is so formulated as to continue the on-going activities in the different programme areas during the 1986-1987 biennium. Emphasis is being given to the control and prevention of communicable diseases, maintenance of epidemiological surveillance system and training of different categories of health workers. The area of Managerial Process for National Wealth Development is given over 100% increased allocation in the current biennium. Health Manpower gets more than 50% of what was budgeted for during 1984-1985. Traditional Medicine, Rehabilitation, Diarrhoea1 Diseases, Acute Respiratory Infections, Zoonoses and some Noncommunicable Diseases are allocated resources for initiating new activities. Certain programme areas such as Organization of Health Systems based on Primary Health Care, Nutrition, Clinical, Laboratory and Radiological Technology register a decrease in the regular budget allocation as compared to the on-going biennium. However, the activities envisaged under these programme areas will be carried out through support from extra-budgetary resources.

SRI LANKA NATIONAL HEALTH SITUATION The Government of Sri Lanka has adopted a national policy and strategy for Health for All by the Year 2000, designed to meet the basic minimum needs of all the people. As a result of policy and programme reviews organized on an intersectoral basis by the Ministry of Health, adjustments are continuously being made in the national plans for development in line with the national strategy for health for all. Health development in the country is faced with a number of serious problems, obstacles and constraints. For climatic and geographical reasons, the country has limited natural resources and limited opportunities for developing them. Since the population of 15 million people represents the country's greatest potential resource, as emphasized in the Government policy statement, it is necessary to fully involve the people in their own health development. The literacy rate is 90.5 per cent for men and 82.4 per cent for women. With a GNP , Lanka lacks the resources necessary to continue per capita of only ~ ~ $ 2 6 5Sri extension of general health and hospital services as well as disease control programmes on conventional lines. Expenditure on health is less than $3 per head, and variably distributed among different population groups and geographical areas. Economic development is proceeding at a vigorous pace but has not started yielding significant resources so as to be able to significantly increase health budgets in the foreseeable future. The country is, therefore, reliant on external support, of which a relatively small share is currently devoted to health. Health situation and trend assessment studies, carried out by the Government with the technical support of WHO and other agencies, such as US AID, reveal an infant mortality rate of about 37 per 1 000 compared with a national target of 24 per 1000 live births, and a life expectancy of 64.2 years for males and 67.0 for females for which, however, no national targets were set. A large percentage of the population of this predominantly rural country has access to essential health care though considerable variations appear to exist. The nutritional status of children is not adequately known, but better epidemiological understanding of the situation will emerge from the extension of integrated health services based on primary health care. The extent to which the basic health problems of this country are related to malnutrition, inadequate housing, environmental pollution, inadequate access to safe drinking water and excreta disposal, and communicable diseases are demonstrated by the following eight leading causes of morbidity and mortality, and by the fact that these causes have shown little change over the past decade: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) Respiratory diseases; Accidents and suicides; Diarrhoea1 diseases; Diseases of infancy and immaturity; Anaemia and malnutrition; Malignancy; Other infections, and Tuberculosis.

Recently, the incidence of malaria rose sharply but was, however, brought under control, through a series of measures.

A largt Infrastructure development project was developed for the strengthening of the -xisting health institutions and construction of new health centres so

as to ameliorate many of the problems in the existing health systems. Training programmes are under way, but there is a serious shortage of all types of health manpower properly trained and socially attuned to provide primary and first referral health services. Studies show that only about 35 per cent of the required manpower exists, and that existing patterns still tend to be somewhat skewed in the direction of high cost curative technology, which is not in line with the requirements of the new strategic approach. There is a need for better back-up services, including peripheral laboratories providing appropriate technical services. Shortage of essential drugs and supplies is a notable deficiency due to scarce resources, inadequate logistics and distribution systems. The immunization programme has developed considerably during the last few years, but needs managerial and cold chain support. With such a pattern of morbidity, any further improvements to the health status of the people can be brought about only through a systematic evaluation of the ongoing programmes, and the designing of technical interventions of proven efficacy based on the approach of selectivity and oriented towards specific target groups. In this context, the further development of health services research as an instrument of change has to be promoted and developed. Inter alia, these inputs are likely to direct further attention of the national authorities to the resource allocation patterns and issues thereof, which at presen: are meeting with resistance from some policy levels though agreed to in principle. In addition, the development of appropriate referral 6ystems and strengthening of first line referral institutions such as district hospitals is of paramount importance.

WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 The main thrust of the WHO collaborative programme during 1986-1987 in Sri Lanka will be to support the national efforts in the development of the health system infrastructure, particularly the strengthening of managerial proces e; for health development, organization of health systems based on primary he:Lth care and the related health manpower development. The WHO collaborative programme for 1986-1987 is an extension of the 1984-1985 programme and further development of the same within the framework of the MTP 1984-1989. Health Situation and Trend Assessment During 1986-1987, support will be extended to further strengthen the information support to national health management, including the monitoring and evaluation of the national health programmes and projects. The activities would encompass strengthening the managerial processes and the information units at district levels and levels below by in-service training in analysis and interpretation of data; establishment of improved systems of information for specialized campaigns and their integration with management at district level; establishment of medical record-keeping at institutions; strengthening of capabilities at national and district levels in conduct of surveys to collect information on identified priority areas where routine information is not available, and strengthening the capacity of the National Health Information Centre through manpower development, data processing methods and further development of data base. UNDP support for National Health Information System (NHIS) is envisaged to provide for the establishment of the National Health Information Centre and implementation of the improvements to the NHIS countrywide. WHO support would complement the development of the NHIS largely in the fields of manpower development and in-service training.

Managerial Process for National Health Development WHO will support the promotion of National Health Development Policies and Programmes towards the goal of HFA/2000, promotional activities of the National Health Development Council and promotion of TCDC, promotion of PHC strategy and its implementation, development of health projects, their implementation and evaluation, monitoring the implementation of the WHO collaborative programme, and mobilization of external resources for priority health programmes. In the field of planning and management, the focus will be on improving managerial processes at intermediate levels of the health system, besides institutionalization of the processes and procedures with emphasis on the strengthening of the district level planning and management systems and procedures. The major activities which will be supported are: establishment of national and district level health planning cycles with expertise, supplies and finances; redesigning and strengthening of management support systems such as logistics, supplies, personnel, information, etc.; regular periodical evaluation of PHC; investigation of health system and organizational problems through studies; in-service training of supervisory staff at different levels, and training of national and district level staff (senior and middle level officers) in MPNHD areas. Health Systems Research Health systems research has become an essential input to health development. The focus of the 1986-1987 collaborative programme will be towards developing increased capacity in health systems research; supporting various institutions/ centres in undertaking studies on national priority problems in the context of regional research priorities, and in the area of training of staff and financing of research studies. Organization of Health Systems based on Primary Health Care WHO will support the promotion of dissemination of information on primary health care; involvement of non-governmental organizations in PHC at local levels; establishment of in-service training and continuing education programmes for all categories of PHC workers; in-depth evaluation of the PHC mobilization of resources for the infrastructure development project(s); projects already developed or likely to be developed during 1984-1985 in support of PHC; strengthening of the Electro-medical Engineering Division through staff training for facilitation of decentralization of its services in support of PHC, and strengthening of medico-legal aspects and the forensic medicine laboratory, through staff training, equipment and supplies. In view of the availability of niajor anticipated resources from bilateral and other multilateral agencies, WHO financial collaboration towards the activities specified above would be for organizing seminars/workshops, study tours for senior officers and for monitoring evaluation teams, through making available expert advisory services. Health Manpower The national concern has been towards the strengthening of standards cf qualifying examinations, strengthening of infrastructural facilities such as library, equipment, educational materi.lls, etc. Wbtle efforts to strengthen the same were initiated during 1982-1983 and will continue into 1984-1985, the 1986-1987 biennium is envisaged to be the consolidation phase. Paramedical

education at NIHS, Kalutara, has been receiving substantial support from UNDP and further resource support is anticipated from USAID and other bilateral agencies. While major efforts have gone on for its strengthening, it will continue into 1984-1985 and 1986-1987, and will witness efforts to consolidate the gains already made. Development of other para-professional staff such as medical laboratory technicians, nursing personnel, pharmacists, ophthalmic auxiliaries, etc., is envisaged to continue during 1986-1987. Further, it is considered necessary that the entire dynamics of manpower development within the Ministry of Health be strengthened by establishing a manpower data base and by reinforcing the intersectoral and intra-sectoral linkages concerned with manpower development. During 1986-1987, a streamlined s y s t e ~for health manpower development in totality will be established. Keeping this in view, during 1986-1987, WHO will support developmental needs of undergraduate medical education, with emphasis on the Department of Community Healtb the Department of pre-clinical and para-clinical disciplines; enhancing of the standards of post-graduate medical education; consolidation efforts in NIHS, Kalutara, through evaluation/assessment of the Institute and providing direction to its further development; education and training of other para-professional personnel, and development and establishment of mechanisms for continuous monitoring of the manpower situation through the strengthening of infrastructural facilities for health manpower management, including the training of staff of planning units at national and divisional levels in manpower planning and management. Public Information and Education for Health Massive initiatives have been made to develop capabilities for, and programmes in, public information and education for health. A project proposal in information, education and communication in PHC towards supporting local level programmesjactivities through Health Education Bureaux for mobilization of external resources was formulated. One limitation of the earlier efforts was that they lacked focus and attempted to cover large ground within a short time. There has been no evaluation of the past efforts not only to assess the impact of programmes but also to formulate future directions for strengthening. The 1986-1987 collaborative programme will, therefore, be directed towards supporting the evaluation of ongoing programmes of public information and education for health; development of manpower required for strengthening field units; in-service training of staff at all levels so that every worker becomes an effective health educator; production of educational materials for mass media, and production of audio-visual materials for health education and materials for mass media, and school bealth education. Research Promotion and Development Th2 objectives of the collaborative programme in this area are: (a) to promote a comprehensive health research policy, (b) to strengthen organizational framework for management of research; ( c ) to strengthen institutional capabilities; (d) to promote the establishment of inter-institutional network of technical collaboration for research development and utilization of results, and (e) to develop the infrastructure for biomedical research at the Medical Research Institute. WHO will support the further development of research management capacities and the strengthening of infrastructural facilities through manpower development, equipment, essential reagents, etc.

Nutrition The Food and Nutrition Policy Planning Division (F&NPPD), in coordination with a number of agencies, initiated major efforts during 1982-1983, towards strengthening the nutrition programme. The 1984-:985 collaborative programme is designed to support: a national programme to combat iron-deficic~lcy malnutrition, in collaboration with IJNICEF; other programmes oriented towards the control of diseases that diminish/drain nutritional status, namely, diarrhoea1 diseases, water and sanitation, EPI, and assessment of the magnitude of the goirre problem. WHO country collaboration programme during 1986-1987 will support the programme of iron-deficiency malnutrition; formulation, monitoring and evaluation of rhe goitre control programme; development of manpower with emphasis on nutritional education and its promotion; designing for, and implementation of, monitoring and evaluation, and review and updating of programme strategies. Oral Health The Oral Health Programme is designed to provide dental services to the population as an integral part of primary health care. However, the programme suffers from want of epidemiological situation with regard to oral health, namely, prevailing problems of oral health, their magnitude, geographical distribution, vulnerable groups, etc. An oral health survey was undertaken during 1983 to provide such an information support to the programme. On the basis of data gathered from the national oral survey, the prevalence and extent of the various oral diseases in the country and regional variations will he determined. With the continuing in-service training programme and manpower development, the need for strengthening the service component in the ever-expanding school dental health programme will he felt. Hence, the major thrust of WHO collaboration during 1986-1987 would be directed towards: provision of the school dental clinics with essential equipment to provide a satisfactory service to school children under the primary health care concept; intensification of the school dental health education programme with special emphasis on the primary health care approach, and designing and operation of monitoring and evaluation systems for school and dental health programmes. Accident Prevention The available epidemiological information in Sri Lanka indicates that accidents and suicides constitute a major problem. There has heen no concerted effort to prevent the same and there exists no organised programme directed towards this problem. The WHO collaboration during 1986-1987 will be focused on supporting promotional efforts through intensive information, education and communication strategies and training thereof, besides other activities as determined and identified during programme formulation. Maternal and Child Health, including Family Planning While the service provision indicators of Family Health Programme are quite high, the family planning coverage is satisfactory though not upto levels that would maintain an acceptable rate of growth of the population. It is proposed to undertake an in-depth evaluation of the programm? during 1984-1985, supplemented by specific studies in areas where managerial information is much needed, so as to support the designing of 'selective interventions' that would enhance programme impact.

WHO support to the programme during 1986-1987 would be directed towards improving its efficiency and effectiveness, with special emphasis on the education and training of PHC workers; development of educational and training materials, and monitoring and evaluation of selected components of the programme as well as the total programme. Workers' Health Agriculture continues to be the occupation of a major proportion of workers in Sri Lanka. Recent years, however, have witnessed a significant growth in construction industry and, consequently, an increase in the number of cnnatruction workers. While pesticide toxicity and blue asbestos exposure were known to be the major problems among agriculture workers, accidents due to inadequate machine safety measures are on the increase among construction workers. Ilowever, neither reliable data on workers' health nor organized programmes directed towards the same, exist. WFIO collaborative programme will support surveillance of work sites for safety mpasures and occupational diseases, and training of PHC workers in occupational health. I'revention and Treatment of Mental and Neurological Disorders An organized programme of community-based mental health has been designed and is currently being implemented. While early detection of mental health problems, institutional care of acutely ill, and training thereof, are progressing quite satisfactorily, the rehabilitation of the mentally ill in the community with community resources has been slow and would get extended into 1986-1987. The development of mental health indicators and monitoring systems thereof are being currently designed. A system for the mocitorfng of child mental health is also being designed with UNICEF collaboration. WHO collaboration in this programme during 1986-1987 would, therefore, be in the training of PHC staff in the early detection, intervention and monitoring of mental health problems; promoting and supporting involvement of local bodies in rehabilitation of the mentally ill in communities with community resources, dnd promoting social action in the area of alcoholism and drug abuse. CommunitzWater Supply and Sanitation T h e N'jtional Decade Plan adopted by the Government in 1980 is being implemented hy the Natior!al Water Supply and Drainage Board with guidance from the National

Co-ordinating Committee. A review of the experience of decade activities has rrsolted in a shift in the Government priorities and strategies which will now Idy emphasis on operation and maintenance, and on socially-relevant and financially-viable programmes. h'HO will support Decade activities through assistance in the improvement of the Planning and Coordinating Unit, the management information system, and the monitoring and evaluation system; workshops on Decade activities and review of priorities and strategies from time to time; hydrogeological and geophysical investigations on annual programmes; data bank on ground water information at the W S & D Board and also on-the-job training to geologists and engineer officers of the Board in ground water prospection and development techniques; the W S & D Board Training Centre on its activities in the water and sanitation sector programmes; manpower development through institutional support to the NWS&D Board and technical support to undergraduate and postgraduate training programmes at the engineering universities and to other agencies actively associated wit11 the programme, and research study programmes on the environmental health aspects of water supply and sanitation.

Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care The current emphasis of the programme is on the training of laboratory technicians who are in short supply, but essentially required for the effective functioning of the decentralized peripheral laboratory units as well as strengthening quality control through the training of paramedical personnel working in pathology laboratories. In addition, with the training of laboratory personnel in quality control, the laboratories are required to be supplied with necessary sera and media. There is also a need for inter-laboratory collaboration for effective quality control. Another area whici~ needs to be promoted is radiological protection measures. WHO will support activities for the strengthening and expansion of facilities for the training of laboratory technicians; continued in-service training and strengthening of laboratory's physical facilities for quality control; promotion of inter-laboratory collaboration for quality control and development of mechanism for such collaboration, and promotion and introduction of radiological protection measures. Essential Drugs and Vaccines Major developments have taken place in the field of essential drugs. A drug policy has been formulated, essential drugs have been identified and a project has been developed for producing these drugs locally. WHO has provided technical support in the formulation of a production plan and the training of nationals in packing, tabletting and capsulating techniques. During 1984185, WHO collaboration will primarily be directed towards the mobilization of external resources for the local production of essential drugs, increasing the management efficiency in the production and distribution of drugs and the formulation of a programme for the control of drug abuse. A drug quality laboratory is expected to be established during 1984-85 with the financial support of NORAD. Though this project provides for quality assurance of drugs, it is envisaged that WHO support will be required for the training of technicians during 1986-87. In view of the above, WHO collaboration during 1986-87 is envisaged primarily in the following areas:

- Assessment of the utilization of drugs and further refinement of the list of essential drugs in the light of the findings of the proposed utilization survey;

Monitoring and evaluation of drug policy management and support to the solution of any technical problems in these areas; control measures;

- Dissemination of information on drugs and implementation of drug abuse

Research in drugs, and of those of the sterile fluids project.

- Training of technicians in quality assurance, procedures and processes and

Traditional Medicine WHO, with UNDP support, will assist in the training of traditional practitioners in the preventive, promotive and family health aspects of primary health care, development of medicinal plant resources, improvement of manufacture of traditional drugs and strengthening of the Bandaranayake Memorial Ayurvedic Research Institute, Nawinna. Rehabilitation In the wake of IYDP, a long-term national programme has been developed for: (I) public awareness of the problems of the disabled, (2) rehabilitation of the disabled in the communities through the expansion of the integrated education system, vocational training, etc., (3) mass-media campaign for the prevention of disablements, (4) expansion of the existing services for the disabled, and (5) community education for creating a positive attitude towards the disabled. During the 1984-85 biennium, WHO will collaborate in national efforts at the rehabilitation of the disabled and support information and education activities, training of middle level and peripheral level workers in the use of the WHO Manual on Community-Based Rehabilitation and in strengthening the Rehabilitation Hospital, Ragama, as the focal point for training activities on rehabilitation. By the end of 1985, it is expected that the programme will have started in selected areas. During 1986-87, WHO will support information and education activities aimed at promoting public awareness of the problem, further expansion of training of middle level and peripheral level workers in the use of the WMO Manual on Community Based Rehabilitation, and expansion of training facilities at the Rehabilitation Hospital, Ragama. Immunization During 1986-87, WHO support will continue to be focused on the further improvement of the management capability through the training of middle level and peripheral level workers in EPI management, evaluation of the different components of the national programme, and EPI-related operational research for further improvement of the programme. Disease Vector Control Till now the Anti-Malaria Campaign has been the major programme in the field of vector control. There is also a national Anti-Filariasis Programme which received support in the past through a UNDP-supported and WHO-executed project. However, an integrated vector control programme is yet to be developed. While individual programmes will remain in operation, WHO, during 1986/87, will collaborate in the promotion and formulation of an integrated and coordinated programme of vector control. An allocation of ~ S $ 1 5000 is proposed for this purpose. Malaria The Intensive Malaria Control Programme carried out during the period 1977-1982 resulted in a significant reduction in the incidence of Malaria in the country.

There are no major technical problems encountered at the moment in the operation of the malaria control programme. The problem plaguing the operational efficiency of the programme is primarily one of management. Continued WHO support to the improvement of operational efficiency of the programme is considered essential not only for stimulating national actions for programme efficiency but also for sustaining the confidence and interest of the donors. During 1986-87, WHO support is envisaged for stimulating operational efficiency of the malaria control programme through a mix of epidemiological and management skills, support to the efforts of the Ministry of Health for active involvemeot of the general service in the malaria control programme and in-service training required for this purpose, evaluation of the programe, and development of training facilities for malaria epidemiology and medical entomology based on the feasibility assessment being undertaken during 1984/85. Diarrhoeal Diseases The National CDD Programme is being implemented with WHO assistance through the special programme of Diarrhoeal Diseases Prevention and Control. The programme envisages a phased coverage of the country and primarily concentrates on training of programme managers and field workers in the management and distribution of oralites, development of handbooks on the use of oralites, education of parents, and preparation of a training manual on the prevention of diarrhoeal diseases. During 1986-87, it is envisaged that the programme will be further extended to bring the whole country under its coverage. WHO collaboration during 1986187 will support the training of middle level management personnel in the management of diarrhoeal diseases, strengthening of supervisory capabilities for improved management of the programme, and evaluation and operational research. Acute Respiratory Infections

A project has been developed for the epidemiological investigation of the problem. During the 1984-85 biennium, WHO'S collaboration will be directed towards the development of a research project in the area of MOH provinces. The project is expected to start in 1984 and will be continued for a period of two years. During 1986-87, depending on the findings of the research project, the main thrust of the programme would be towards its further extension to other areas. WHO will support the training of necessary manpower, information and education activities, and programme assessment. Zoonoses The major emphasis under this programme is on the control of rabies. An accelerated rabies control programme has been in operation for the last three years. The programme is currently being financed mostly with national resources with limited technical support from WHO. During 1984185, WHO collaboration will primarily focus on the mobilization of external resources, epidemiological studies to assess transmission of rabies in the dog population, training of local government bodies personnel and production of educational materials.

During the 1986-87 biennium. WHO will support the strengthening of the operational efficiency of the programme, promotion of a multisectoral approach to the problem through active participation of the relevant departments and agencies, evaluation of various programme inputs such as the health education programme, laboratory services, training programmes, etc., and the training of health workers and personnel of other involved agencies. Blindness During 1984185, WHO collaboration will primarily focus on conducting an epidemiological survey of the blindness situation and the disease pattern, continued support to, and assessment of, the cataract operation programme and training of health workers in preventive eye work. It is expected that by the end of 1985, the national programme for the prevention of blindness will be modified based on the directions that are likely to emerge from the proposed survey and assessment of the cataract operation programme, and the minimum number of trained auxiliaries and health workers required to make a start of the decentralized services will be in the field. During 1986-87, WHO will support the peripheral units to provide first aid to prevent deterioration of the problem, establishment of a proper referral system, continued training of health workers in preventive eye care, evaluation of the utilization and performance of the ophthalmic auxiliaries, and support to a feasibility study for the production of glasses locally. Cancer The primary focus of the national programme is on the prevention and control of tobacco-related cancers with special emphasis on oral cancer. The cancer control programme has progressed satisfactorily. After the encouraging results of the pilot project in Kandy to study the feasibility of using PHC workers for the detection of early lesions of oral cancer and prompt referrals, the programme has been introduced in two other areas, i.e. Galle and Jaffna, to study its applicability in other areas. During 1986-87, programme coverage will continue to be extended to new areas and in this context, WHO collaboration will be towards: further training of radiotherapists, physicists and PHC workers; strengthening and expansion of the cancer registry which has already been set up; information and education programme for the prevention and control of cancer; and strengthening management aspects of the programme through technical support. Cardiovascular Diseases The focus in this area is on developing and implementing an intensive programme for the prevention and control of CVD as a part of primary health care, using peripheral health infrastructure as well as community resources. During 1984-85, WHO will continue support to the ongoing pilot study of community control of CVD. During 1986-87, WHO will support activities for the development of trained manpower through specialized training of doctors, training of peripheral health workers and other health personnel involved in the programme with emphasis on epidemiological surveillance and community control, developing and implementing an appropriate information and education programme, setting up a referral system, and equipping the peripheral units for providing first aid type services in respect OF CVD.

Health Information Support The HeLLIS network was est<-blished in Sri Lanka in 1980, and since then, it has been in operation with a significant progress in promoting resources sharing within the national network of libraries, particularly those of the universities. During the 1986-87 biennium, WHO collaboration w ~ l lcontinue with the major focus on strengthening management and operational capability of the network, further strengthening inter-library linkages, provision of critical logistic support, and development of trained manpower. Budgetary Implications The proposed programme budget is geared tu providing support to the national efforts for development of Health System Infrastructure, in particular the Primary Health Care and Managerial Process for National Health Developmen:, Health Manpower Development. By and large, the hxdgetary allocation folLows the same pattern as for the current biennium, attesting to the continued emphasis that is being placed on the on-going activities. However, there are a few programme areas which register marginal increases, a notable exception being the programme area of Managerial Process for National Health Development which is allocated 66% more than the 1984-1985 allocation. New activities will be undertaken in the fields of Noncommunicable Diseases especially Cancer and Cardiovascular Diseases, the latter two programme areas getting an allocation of $65 000 and $50 000 respectively.

SRI LANK.

2.3.1 Health Situation and Trend Assessment 2.3.2 Managerial Process for National Health Development 2.3.3 Health Systems Research

Org~nizacion of Health Systems bnscd on Primary Ilealth Care

2.5.0 Health Manpower

2.6.0 Public Information and Education for Health

3.7.0 Research Promotion and Development 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral Health

3.8.3 Accident Prevention

Approved Budget SRI LANKA 1984-1985

Proposals

F U

1986-1987

N D

3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning

39 800 165 700 2 200

60 000 5 900

RB FP AS

3.9.3 workers' Health 3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and Treatment of Mental and Neurological Disorders 3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation

79 600

50 000

89 600

80 000

403 000 250 700 8 300 24 900

470 000 124 300

RB DP

FT RB

3.11.4 Food Safety 3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.2 Essential Drugs and Vaccines

29 900

50 000 100 000

RB RB

Approved Budget SRI LANKA 1984-1985

Proposals 1986-1987

F U

N D

3.12.3 Drug and Vaccine Quality, Safety and Efficacy 3.12.4 Traditional Medicine 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.2 Disease Vector Control 4.13.3 Malaria 4.13.6 Diarrhoea1 Diseases 4.13.7 Acute Respiratory Infections

49 800 49 800 525 000

450 0 0 0 20 000

39 800

40 000 15 000

RB RB RB

398 000 39 800

467 000 30 000 30 000

58 000 4.13.10 Zoonoses 4.13.13 Other Communicable Disease Prevention and Control Activities 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular Diseases 39 800 50 000

RB VD RB

39 800 19 900 20 000 65000 50 000

RB RB

*Pproved Budget SRI LANKA 1984-1985

Proposals

1986-1987

F U N D

4.13.17 Other Noncommunicable Disease Prevention and Control Activities 5.14.0 Health Information Support

39 800

20 000

Total: SRI LANKA Of which: Regular Budget Other Sources

---------

4 942 700 3 264 000 1 678 700

4 629 200 =========

3 812 000 817 200

THAILAND NATIONAL HEALTH SITUATION The Fifth Five-Year National Economic and Social Development Plan aims at a more balanced growth between the economic sector and the social sector. Efforts have been made to allocate more resources to the underprivileged areas through the Poverty-stricken Area Development Project and Rural Job Creation Project under the administration of the National Committee for Rural Development. It can be said that during this medium-term plan, systematic planning and implementation of integrated and decentralized rural development emphasizing the role and capabilities of the community in self-management has been the main focus and key strategy for health and overall social and economic development of the country. A basic minimum needs framework (BMN) is being tested as a key tool for village action and coordinated government support in the four areas of health, agencies, education and international or local government. At the level of the Ministry of Public Health, steps have been taken to reorient the existing health care system in such a way that it could better serve the initiation and wider implementation of primary health care activities. The year 1984 has been announced as "National Primary Health Care Year" during which 5 000 self-supported model PHC villages will be developed. With the use of potential trainers from model villages employing the village training and development strategy, with intimate guidance from special supervisory/trainlng teams, and with other related development strategies, further advancement of self-managed PHC villages in basic PHC components of BMN as relevant to the local needs will be operationalized with the ultimate target of approximately 56 000 villages by the year 2000. As for infrastructural development, the Ministry has speeded up expansion of necessary facilities at the level of district and below. These facilities will provide training and logistics support for future development of primary health care. Likewise, reorientation of health manpower development activities has been focusing on PHC approach and basic minimum needs of communities. Organization of collaborative mechanisms to support effective operation of primary health care and to improve management capability as required for the successful decentralization of authority will continue to be developed. Job descriptions of health personnel posted at peripheral and intermediate levels are being modified in conjunction with appropriate pre-service and in-service training. Technical committees were appointed to review the integration of training, services, research and development of technology for disease prevention and control. A network linkage was established for the smooth-running of these development activities by assigning focal points with secretariats.

It is projected that by 1985 the population of Thailand will be close to 54 million with an annual rate of increase of roughly 1.5 per cent. Infant mortality rate will be around 4 0 per I 0 0 0 live births or less. DPT, polio and BCG vaccinations will cover 80 per cent of infants under one year of age. Seventy per cent of pregnant mothers will receive two doses of tetanus toxoid. Full coverage of VHV's and VHC's in all of the 56 000 villages will be achieved with progressive support in terms of continuing education and supervision. Five essential programme areas of PHC, namely MCHIFP, nutrition, essential drugs, immunization, water supply and sanitation will be continuously promoted until the system of self-managed PHC villages can be effectively responsible for them.

It is also envisaged that the campaign initiated in 1984 and onward will decrease the intensity of problems in the area of MCH/FP, nutrition, water supply and sanitation, essential drugs and immunization. As a consequence, major health problems in the 1986-1987 biennium may begin to shift from malnutrition, lack of water supply and sanitation, and inadequate supply of essential drugs, to a set of more complex problems like control of locally endemic diseases, mental health, drug addiction, accidents, dental health, and non-communicable diseases. This shift in major problems may call for readjustment and readaptation of more relevant and innovative information and education for health. Mid-Term Plan Adjustment In follow-up of the implementation of the Fifth Five-Year National Health Development Plan, a consultative meeting was jointly arranged by NESDB and the Ministry of Public Health in July 1983. In view of the country budget situation and the necessity to foster effective implementation of preventive and promotive services through PHC approaches, a committee responsible for mid-term plan adjustment was appointed. Programme areas were divided into three categories: high priority, low priority and maintenance of operation. Among the high priority areas were EPI and prevention of endemic diseases, health education, drug production, procurement and distribution, health manpower development and expansion of PHC self-managed villages. Areas of low priority were the expansion of large municipal and provincial hospitals, and construction of new district hospitals. The areas which were to be maintained included MCHIFP, nutrition, curative services, programme for non-communicable diseases, and food and drug control. Following the principles established by NESDB and MOPH, efforts are being made to strengthen preventive and promotive services and slow down infrastructural development at tertiary and secondary levels. Main Thrust of Sixth Five-Year Plan Towards the end of the Fifth Five-Year National Health Development Plan in 1986, it is expected that the number of self-managed PHC villages will be increased and will gradually reach the peak of support requirement. In this connection, it is imperative for the Ministry to continue strengthening community organization pertaining to management, technical services and financing to achieve BMNIHFA. Thus, as a main thrust of the Sixth Five-Year Plan there will be a concomitant emphasis on the expansion of PHC activities, increased capabilities of support services, and reorientation of infrastructure and personnel. A community health insurance system initiated in 1984 will have to be expanded with corresponding increase in efficiency and effectiveness of the referral system at all levels of health service infrastructure from the primary level up to the tertiary level. Multi-sectoral coordination and cooperation in an effort to achieve BMNIHFA will further be ~tren~thened. WHO COLLABORATIVE HEALTH PROGRAMME 1986-1987 An experiment in decentralized management of WHO country programme called Programme Budgeting Exercise (PBE) began in Thailand in 1982. Under the PBE, the Government has assumed the responsibility for decision-making for the best use of WHO resources to effectively support national health development, thus laying the groundwork for the establishment of the new managerial framework for the use of WHO resources in support of Member Countries. Work was done in operating special managerial mechanisms and processes for programme planning and implementation. Modifications were made in 1983 based on experience gained

and fully employed in the development of the 1986-1987 PB utilizing, as agreed upon, the flexibility and decentralized decision-raaking in programming and reprogramming with detailed planning as close as possible to implementation for relevant support to actual government and WHO priorities. The role of WHO in this new relationship with the Government continues to focus on WHO'S promotional, catalytic and technical coordinating and collaborative functions through training, research and development activities. The salient and expanding feature of WHO programme development is the use of national talent having major project responsibility. This represents an increasing mode of international services while direct financial participation is steadily expanding in its support to locally planned and managed developmental activities with the required degrees of innovation and flexibility. The entire programme is designed toward building up further national self-reliance. Managerial Process for National Health Development This programme will support the government priority of improving the effectiveness and efficiency of the total health management system, with emphasis on health administrators' capabilities focusing on the district level and below, in responding to the problems and priorities of the country in national development including the goal of HFA, through the national policy of more effective resource utilization and decentralized management strategy. Areas of WHO collaboration include policy formulation and analysis, programme planning and implementation management, monitoring and evaluation, and concurrent development of the national health information system, including application of computer technology. In the 1986-1987 biennium, WHO will complement the government policy and strategies through extended technical cooperation, training an& research in support of the governmental managerial efforts. WHO will continue to use and maximize its own resources through the decentralized management mechanism. This programme will offer support to the activities undertaken by the RTGIWHO Executive Committee assisted by the Office of the WHO Programe Coordinator. There is a need for inter-sectoral action within a more integrated and decentralized approach in order to promote the self-reliance of communities, i.e., rural development to achieve HFA. WHO will support the MOPH in its leading and coordinating role in HFA action in close coordination with the National Rural Development Programme and Basic Minimum Needs Strategy (BMN). Beyond the government's BMN approach, this progrmme should contribute to the progressive promotion and development of the involvement of private enterprise in the areas of social welfare, including feasible and relevant social security systems, with the aim of developing a more socially responsible private sector. WHO support will also be aimed at strengthening the social development and HFA network in the country and in TCDC development in the same area. WHO has collaborated in this programme under the aegis of the NESDB, with financial support from the Netherlands Government and the Director-General's development fund since 1980. Organization of Health Systems based on Primary Health Care As stated in the national health development situation description, integrated and decentralized rural development emphasizing the roles and capabilities of the communities in self-management towards self-reliance has become even more clearly the first priority and key strategy for health and overall socioeconomic development. Therefore, as in the 1984-1985 bienniul;, this core programme is the top priority for the Government and WHO receiving 35 per cent

of the overall budget in direct support of comunity/village self-managed activities covering the components of the national PHC programme. In the 1984-1985 biennium, a "National PHC Campaign" strategy is being launched to stimulate and support community self-managed activities. The first stage targets 5 000 villages to become model PHC villages. Out of these, primary training and development villages will be developed to extend to other villages in the PHC self-managed programme. In the 1986-1987 biennium and complementing the government efforts, WHO will support village focused activities in the promotion, training, organization, research, community mobilization and village-to-village transfer of PHC technical, managerial and financial knowledge and skills. Special attention will be given to health system reorientation and development. Emphasis is also focused on the need for a sound and relevant infrastructure to support comunity-based PHC development and to provide effective linkage and entrance to the health system for all the population. The government priorities emphasize the reorganization of the health facilities and manpower infrastructure, improvement of the quality of basic health services promotive, preventive and curative - with special attention to cost effectiveness of medical care, referral system development, essential drugs, logistics and supply system, and health systems research. The WHO inputs will be supportive of the government strategies and objectives, particularly through health systems research applicable to the above areas. Both the Ministry of Public Health and universities will be cooperating in this approach. In addition, it is also deemed necessary that WHO should extend its support to the designing of suitable models for the development of health care systems based on PHC in the rapidly growing urban and industrial communities.

Health Manpower Improving the quality and relevance of health manpower and developing a system for health services and manpower development is a high government priority covering many areas of need, particularly in view of the expansion of the primary health care system. Three main areas of GovernmentfWHO collaborative action can be envisaged in the health service system, with special emphasis at the peripheral level. There is a need to assess the performance of front line workers and the efficiency of development teams so that development of continuing education and other maintenance and performance improvement methods for district, tambon, and village health manpower can be effectively pursued. In both preservice and in-service training, there will be continuing need for support to the development and revision of curricula. Ample opportunities will be provided for experimental teaching and learning in the area of community health development through the initiation of supervisoryftraining teams in provinces. Appropriate types and levels of support will be provided for continuing development and strengthening the roles of universities in support of HFA. For example, educators or trainers will participate in performance assessment activities and assist in the design of appropriate job descriptions for critical categories of personnel. Personnel management will be an important area of intervention. In 1986-1987, it is expected that WHO technical and financial support will be relevant to the areas of intervention as proposed by the Ministry of Public

Health through the introduction of innovative approaches covering also the promotion of right understanding among health personnel. Public Information and Education for Health The Government has identified as a top priority the need for raising the level of awareness and right understanding of the national leadership at all levels, particularly, of the community itself concerning PHC and HFA. The need to develop political ideology and action in support of HFAIPHC is fully recognized. So is the need to develop consumer protection in all the fields of medicine and public health. Concerted action is intended in the high priority areas of development of primary health care in schools so as to try and transform any child in future to a primary health care agent instrumental for community development. Clearly, the multiple multi-directional action with high level village concentration is intended to bring about modification in the community-based behaviour. WHO will assist innovative activities and approaches both to increase understanding and awareness and effective behaviour modifications of health personnel in technical and service positions, and the community members. Professional approaches to modern communication techniques with the use of media will be explored. Potentially effective information, education and communication agents will be chosen from skilful villagers to assist in the work of supervisoryttralning teams in some specified areas or population groups. This is an essential component of the "village training and development centres" strategy. Research Promotion and Development Appropriate development of PHC requires the elaboration of right technologies in various areas of health development, including the promotion of relevant traditional systems of medicine. The Government has decided to accord primary attention to the prevention and control of both communicable and noncommunicable diseases, laboratory technology, including the production and control of drugs and vaccines. Also, of particular importance are water supply and sanitation, nutrition, MCH/FP, CDC, essential drugs, mental health and other technic1 areas of PHC being applied at the village/community level for their own action and management. In the efficient generation and transfer of adequate technologies, emphasis should be laid on adequate information and communication system in all directions, top down, bottom up and most importantly, horizontally, i.e., among villages and communities themselves. It is intended to support research and investigations from the simplest applied research based on village-based technologies and needs to sophisticated research as may be required with expanding collaboration among the various institutions involved, i.e., Ministry of Public Health, universities, research and training facilities at various levels. Budgetary Implications The budgetary implication of the above broad programming is resource allocation to a priority central programme (village community based development programme) with corresponding allocations to four coordinated and supportive programmes in accordance with their expected impact on village/ community development. Continuation of the 1984-1985 Programme Budget can be seen with a smooth evolution towards concentration on the most relevant programmes. In the implementation of the 1986-1987 Programme Budget WHO will give full attention to supporting the national policy of strengthening decentralization and leadership at the operational level for coordinated action.

Approved Budget THAILAND 1984-1985

Proposals 1986-1987

F U N D

2.3.0 Health System Development 2.3.1 Health Situation and Trend Assessment 2.3.2 Managerial Process for National Health Development 2.3.3 Health Systems Research 2.4.0 Organization of Health Systems based on Primary Health Care 2.5.0 Health Manpower 2.6.0 Public Information and Education for Health 3.7.0 Research Promotion and Development 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and Control of Alcohol and Drug Abuse 363 200 RB

837 300 30 400 99 500

1 027 100

VD RB

1 554 200

2 232 600

236 800 6 0 0 0

446 500

RB FP

53 800

223 300

129 400

535 800

124 100

66 700

Approved Budget THAILAND 1984-1985

Proposals 1986-1987

F U

N D

3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 76 500 76 200

RB DP

107 500 18 900

RB RB

57 700

Total: THAILAND Of which: Regular Budget Other Sources

4 127 400 =====-===

4 465 300 =========

3 824 000 303 400

4 465 300

Annex 3

INTER-COUNTRY

PROGRAMMES

- BUDGET

PROPOSALS

Approved Budget INTER-COUNTRY 1984-1985

Proposals

1986-1987

F U N D

3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 224 400 48 900 4 600 59 500 171 100

RB VD VG RB

3.8.2 Oral Health 3.9.0 Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and Child Health, including Family Planning 3.9.2 Human Reproduction Research 3.9.4 Health of the Elderly

509 800 786 200 37 000 30 000

346 300 1 000 000

RB FP VH AS

30 000

4 000

3.10.0 Protection and Promotion of Mental Health 3.10.1 Psychosocial Factors in the Promotion of Health and Human Development 3.10.3 Prevention and Treatment of Mental and Neurological Disorders

157 300

171 100

84 500

Approved Budget INTER-COUNTRY 1984-1985

Proposals 1986-1987

N D

3.11.0 Promotion of Environmental Health 3.11.1 Community Water Supply and Sanitation 963 12 274 39 300 200 000 100 951 200 109 500

RB VW

DP VD

3.11.3 Control of Environmental Health Hazards 3.11.4 Food Safety 3.12.0 Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care 3.12.2 Essential Drugs and Vaccines 3.12.4 Traditional Medicine 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.2 Disease Vector Control

74 600 25 300

35 000 20 0 0 0

RB RE

193 100 62 700 90 0 0 0 189 000 148 800

377 800

RB FB

30 000

RB DP DP

170 300

336 000 389 200

354 900

RB VI RB

160 300

Approved Budget INTER-COUNTRY 1984-1985

Proposals 1986-1987

F U N D

4.13.3 Malaria 4.13.4 Parasitic Diseases 4.13.5 Tropical Disease Research 4.13.6 Diarrhoea1 Diseases 4.13.7 Acute Respiratory Infections 4.13.9 Leprosy 4.13.10 Zoonoses 4.13.13 Other Communicable Disease Prevention and Control Activities 4.13.14 Blindness

976 300 94 000

730 400 188 000

RB DP RB FA VC

168 400 1 955 500 15 000 299 000 691 500 26 400 31 000 100 51 000 30 161 139 96 100 300 000 900 200 000 20 000 129 400

RB FB ST VL RB VD

RB RB DP ST VB AS RB RB

4.13.17 Other Noncommunicable Disease Prevention and Control Activities 5.14.0 Health Informtion Support Total: INTER-COUNTRY Of which: Regular Budget Other Sources

219 700 87 700 17 860 100 ==========

201 100 50 000 13 266 000

--------

11 351 300 6 508 800

11 794 100 1 471 900

Annex 4

A B B R E V I A T I O N S

Abbreviations used in this document include the following: CIDA DANIDA HeLLIS

Canadian International Development Agency Danish International Development Agency Regional Health Literatt~re, Library and Committee Health for All by the Year 2000 International Atomic Energy Agency International Bank for Reconstruction and Development Primary Health Care Royal Thai Government Swedish International Development Authority Technical Cooperation among Developing Countries United Nations Development Programme United Nations Environment Programme United Nations Fund for Drug Abuse Control United Nations Fund for Population Activities United Nations Children's Fund United Nations Industrial Development Organization United States Agency for International Development World Health Organization Information Services

HFA IAEA IBRD PHC RTG SIDA TCDC UNDP UNEP UNFDAC UNFPA UNICEF UNIDO US AID WHO

Following are the abbreviations for the source of funds: AS DL DM DP

Special Account for Servicing Costs Standard Letter of Agreement between Executing Agencies United Nations Development Programme United Nations Development Programme Figures United Nations Environment Programme Trust Fund for the Special Programme for Research and Training in Tropical Diseases

Special Measures Indicative Planning

EP FA

Associate experts other than UNDP United Nations Fund for Drug Abuse Control United Nations Fund for Population Activities Trust Funds United Nations Sundry Trust and Voluntary Funds WllO Regular Budget Revolving Sales Fund Sasakawa Health Trust Fund United Nations Children's Fund

Voluntary Fund for Health Promotion (VFHP): VA

Voluntary Fund for Health Promotion - Special Account for Assistance to the Least Developed among Developing Countries Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (Prevention of Blindness) Voluntary Fund for Health Promotion - Special Account for Diarrhoea1 Diseases including Cholera Voluntary Fund for Health Promotion Special Account for Miscellaneous Designated Contributions (Other) Voluntary Fund for Health Promotion - Special Account for Medical Research (Specified) - Other than Human Reproduction Voluntary Fund for Health Promotion - Special Account for Medical Research (Specified) - Human Reproduction Voluntary Fund for Health Promotion - Special Account for the Expanded Programme on Immunization Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (DANIDA) Voluntary Fund for Health Promotion the Leprosy Programme Voluntary Fund for Health Promotion Voluntary Fund for Health Promotion Disasters and Natural Catastrophes

VI VK VL

Special Account for

VM VN

Malaria Special Account Special Account for

Voluntary Fund for Health Promotion the Mental Health Programme Voluntary Fund for Health Promotion Smallpox Eradication Voluntary Fund for Health Promotion Communtty Water Supply

Special Account for

Key facts

Organisation World Health Organization (WHO)

Source World Health Organization