World Health Organization (WHO) · Technical Documents

Preparation of the sixth general programme of work covering a specific period (1978-1983 inclusive)

December 31, 1975 World Health Organization

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WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT!a

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITlEE TWenty-sixth session Manila 1-6 September 1975 Provisional agenda item 17

WPR/RC26/11 31 July 1975 ORIGINAL: ENGLISH

PREPARATION OF THE SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1978-1983 INCLUSIVE) At its twenty-fifth session the Regional Committee considered the Regional Director's report on the review made of the Fifth General Programme of Work of WHO (1973 to 1977 inclusive) and the progress being made in implementing it, and adopted resolution wpR/Rc25.R4. One of the recommendations contained in resolution WPR/RC25.R4 was that: "consideration be given to General Programme of Work as an of the Fifth General Programme, six years to harmonize with the of the Organization". preparing the Sixth updated continuation covering a period of new biennial programme

At the request of the Cooni ttee the report and summary records of the discussion on the Fifth General Programme of Work at its twenty-fifth session were transmitted to the Director-General for consideration and inclusion in a document presented to the fifty-fifth session of the Executive Board which reviewed the Fifth General Programme of Work and created a working group, composed of nine of its members, to prepare a draft of the Sixth General Programme of Work to be considered by the Executive Board at its fifty-seventh session. The Regional Director now has pleasure in transmitting to the Regional Committee the following documentation: Annex 1 - A document (a) describing the procedure used in establishing the Sixth General Programme of Work; and (b) making a comparison between the Sixth General Programme of Work and the Fifth General Programme of Work.

WPR/RC26/ll pase 2 Annex 2 - A list of principal programme objectives of WHO with related detailed objectives. A tentative listing of the order of priority, ranging from A to C, suggested for the western Pacific Region has been indicated against each objective. In support of this list, Annex 4 gives the principal and detailed objectives that were originally proposed by the Western Pacific Regional Office, after consultations between WHO Representatives and governments, for inclusion in the Sixth General Programme of Work. Annex 3 - A draft of the proposed introductory part of the Sixth General Programme of Work. Annex 4 - The principal and detailed objectives that were proposed in March 1975 by the Western Pacific Regional Offioe, after oonsultations between WHO Representatives and governments, to a Secretariat Working Group oomposed of Direotors of Health Services of all the WHO Regions and Divisional Directors at WHO Headquarters, for inclusion in the Sixth General Programme of Work. After reviewing the above-mentioned documentation, and in particular Annexes 2 and 4, the Committee is invited to comment on the suggested prinoipal programme objectives and the tentative priority accorded to them for the Western Pacifio Region. The oomments on the tentative priorities reoeived from the six WHO RegiOns, together with the oontributions from Headquarters, will be amalgamated, taking into account the particular emphasis plaoed on the detailed objectives of eaoh Region. The amalgamated draft document will be sent from Headquarters to eaoh Region for review and comments in Ootober 1975. In the light of these oomments and those reoeived from the six regional oommittees, an amended dooument will be presented to the Executive Board Working Group in November 1975 for the formulation of a final draft to be submitted to the Executive Board at its fiftyseventh session in January 1976.

WPR/RC26/l1

ANNEX 1

SIXTH GENERAL PROGJWIt4E OF WORK COVERING A SPEC:r:FIC PERIOD (19.78 - 1983 INCWSlVE)

6GPW/SWG/9 4 July 1975

SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD 1978 - 1983 INCLUSI\~

The following outline describes briefly the procedure of establishing the Sixth General Programme,of Work Covering a Specific Period, as well as the principal and detailed programme objectives and comparisons with the Fifth General Programme of Work. information and should se~'e

This summary is chiefly intended for

for the information of the Regional pri~cipal

Committees whose comments on the

and detailed programme

objecti "es indicating regional priori ties will be of great importance for the final formulation of the Sixth General Programme of Work.

Procedures

Ar,ticle 28 (g) of the Consti tution of the World Heal th Organization requires its Executive Board "to submit to the World Health Assembly for consideration and appro'lal a general programme of work covering a specific period" . "'he World Heal th Assembly has thus far approved five gene'ral

programmes of work, respectively for the periods 1952-1956, 1957-1961, 1962-1966, 1967-i1n2 and 1973-1977 inclusive. These programmes were formulated by the Executive Board and approved by the Wo~ld Health

Assembly,

They were subsequently adapted to regional needs by the

Regional Committees.

At its fifty-fifth session, the Executive Board created a working group, composed of nine of its members, to prepare a draft of the Sixth General Programme of Work to be consideTed by the Board at its fiftyseventh session. At its fifty-fif~h

session the Board considered a

review of the Fifth General Programme of Work submitted to it by the Director-General, and decided to take into account the conclusions of this review, as well as its deliberations on the review, in formulating the Sixth General Programme of Work. 1

. .. / ..

lResolution EB 55.R25

(attaChed)

page 2 Likewise, the Board decided to take into account in its preparation of the Sixth General Programme of Work the oonclusions and recommendations of its organizational study on the interrelationships between the central technical services of WHO and programmes of direct assistance to Member States. 1

In addition, it decided to take into account the

r~ort

of the 2

Joint Inspection Unit on medium-term planning in the United Nations System, and the comments thereon of the Administrative Committee on Coordination.

A Secretariat Working Group composed. of Directors of Health Services of all the regions and Divisional Directors at headquarters'met in July 1974 to draw up the first draft material for the preparation of the Sixth General Programme of Work, the core of which consisted ofa list of programme objectives, criteria, approaches as well as directives to the WRs for consultations with governments. Programme proposals resulting from

-A

consultations with governments and headquarters' programmes based on these objectives were consolidated and presented for review to the Working Group set up by the Executive Board, together with the proposed procedure for follow up. This Group gave further directives to the Secretariat with

reference to the elaboration of the Sixth General Programme of Work.

second meeting of the Secretariat Working Group was convened at headquarters in June 1975, to review the form of presentation and in particular the principal and detailed obje~tives

which should also be reviewed by the comme~ts

Regional Committees to obtain their priorities.

and to identify regional I

The resulting version will be presented to the Executive Board

Working Group for the.formulationof a final draft to be submitted to the Executive Board at it's fifty-seventh session in January 1976.

. .. ,/ .. lResolution EB55. R26 ) 2

Resolution EB55.R66 )

attached

page

Comparison of

Sixth~neral

PrograDlllle of Work with the Fifth

The Sixth PrograDlllle is being prepared in closer consultation with Member States than the. Fifth.

The Fifth. ProgralllDle grouped its objectives under four principal headings namely, the strengthening of health services, the development of health manpower, disease prevention and control and the promotion of environmental health. The Sixth Programme will include two additional the promotion and development of

groups of programme objectives, namely:

biomedical and health services research and mechanisms for programme development and support.

In the Sixth. Progr4111D1e increasing emphasis will be laid on the relationship between health and socio-economic development, and on the inter-action of health, other social services and other sectors.

The Fifth programe presented a general description of ways of attaining its objectives with no attempt at distinguishing programmes and priorities at regional and headquarters' level. The Sixth PrograDlllle will present its

objectives in a much more detailed manner as well as more precise targets wherever possible. It will also describe in some detail the approaches to be

adopted for attaining these objectives and targets, and, in brcad terms, the activities to be pursued in conformity with each of these approaches. Output indicators will also be included wherever possible in order to permit the subsequent evaluation of the programme. All this material will

be presented in the form of regional and central variations on global themes.

An attempt will be made in the Sixth

P~ogramme

to relate the

Organization's medium-term programmes to long-term trends with respect to world health problems and WHO's eventual response to these problems.

Tte Sixth General Programme of Work will emphasize WHO's concern

for the development of programmes rather than unrelated projects.

consequence, whereas the Fifth Programme contained a limited number of criteria for project selection, the Sixth Programme will contain more detailed criteria for the selection of such programme areas.

page

Finally, the Sixth General Programme of Work will indicate how the programme, as a whole, should be evaluated by applying a new system as an -integral part of the programme planning and delivery at all Organizational levels based on sound programme information. This evaluation

system will be based, in large measure, on the organization' s Information System currently under development. The objectives, as well a9 a number of

targets and output indicators prepared for the Sixth General Programme of Work, will allow the subsequent comparison between planned attainments and the actual achievements.

Principal and detailed programme objectives

Annexed is the list of principal programme objectives with the related detailed objectives, deriving from the world health situation and the evolution and evaluation of WHO's programme (Annex 2).

Priorities

They are not synonymous with global priorities, but rather represent a functional classification of the Organization's main objectives.

with respect to these objectives will vary from country to country and from region to region.

Fifty-fifty Session

EB55.R25 28 January 1975

REVIEW OF FIFTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD: 1973-1977 INCLUSIVE

The Executive Board,

Having considered a review of the Fifth General Programme of Work Covering a Specific Period: 1973-1977 inclusive,. submi tted to it by the Director-General, 1. NOTES the review with appreciation and in particular the conclusions to be drawn in regard to the preparation of the Sixth General Programme of Work Covering a Specific Period; and 2. DECIDES to take these conclusions into a·ccount, as well as its deliberations on the review, in formulating the Sixth General Programme of Work.

Sixteenth meeting, 28 January 1975 EB55/SR/16

Fifty-fifth Session

EB55.R26 28 January 1975

ORGANIZATIONAL STUDY ON THE "INTERRELATIONSHIPS BETWEEN THE CENTRAL TECHNICAL SERVICES OF WHO AND PROGRAMMES OF DIRECT ASSISTANCE TO MEMBER STATES"

The Executive Board, Recalling resolution. WHA26.36 by which the Health Assembly requested the Executive Board to carry out an organizational study on the interrelationships between the central technical services of WHO and programmes of direct assistance to Member States, 1. THANKS the Working Group (Dr Chen Hai-feng, Dr S. P. Ehrlich, jr, Dr R. Lekie, Dr N. Ramzi, Professor Julie Sulianti Saroso, Dr C. N. D. Taylor and Professor J. Tigyi) which prepared the Organizational Study;

TRANSMITS its study to the Twenty-eighth World Health Assembly;

3. DRAWS the attention of the Assembly to its findings, conclusions and recommendations, and in particular to the necessity of an integrated approach to the development of the Organization's programmes, all programme activities at all levels being mutually supportive and parts of a whole; 4. INVITES the regional committees to take full account of the implications of the study for regional programmes; 5. DECIDES to take the conclusions and recommendations of the study into account in its preparation of the Sixth General Programme of Work covering a specific period; and 6. REQUESTS the Director-General to apply the conclusions and recommendations in the formulation and implementation of future programmes of the Organization.

Sixteenth meeting, 28 January 1975 EB5S/SR/16

Fifty-fifth Session

EB55.R66 31 January 1975

REPORT OF THE JOINT INSPECTION UNIT

The Executive Board, Having considereu the Joint Inspection Unit's report on "Medium-term Planning in the United Nations System" and the Director-General's report thereon,l _,1.

THANKS the Director-General for his report; THANKS the Inspector for his report; Co-ordination decided to and evaluation, and the well as to undertake, in basis in the first instance, study;

NOTES with satisfaction that the Administrative Committee on 3. pursue further its work for the improvement of programme planning formulation of medium-term plans for the United Nations system as full partnership with the countries concerned, on an experimental joint planning on rural development and an inter-sectoral country

4. DECIDES to take the report of the Inspector, and the comments thereon of the Administrative Committee on Co-ordination, into account in the preparation of the Sixth General Programme of Work covering a Specific Period; 5. REQUESTS the Director-General to transmit his report and this resolution to: (i) the Secretary-General of the United Nations for transmission to the Economic and Social Council through the Committee for Programme and Co-ordination; (ii )

the External Auditor of the World Health Organization: the Chairman of the Joint Inspection Unit.

and

Twenty-third meeting, 31 January 1975 EB55/SR/23

EB55/46 Add.2.

WPR;Rc26/11

ANNEX 2

SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1978 - 198J INCWSIVE)

List of Principal Program!! Objectives with the related aetailed obJeotlv•• (incorporating listing of tentative order of priority accorded for the Western Pacific Region)

, ,

.,. 6GPW/SWG/10 SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD 1978 - 1983 INCLUSIVE

List of Principal Programme Objectives with the related detailed objectives

PRIORITY ======== 1.

DEVELOPMENT OF HEALTH SERVICES To assist countries to further develop comprehensive health services both at the community and at the national level.

A A ~~

1.1

To assist countries to strengthen their capacity for planning and management of health services including institutions and manpower at all levels. To assist in the development of primary health care to under-served populations, with special attention given to high risk and vulnerable groups. To assist in the securing of a balance between preventive and curative health services and in the integration of promotive, preventive. curative "nd rehabilit"tive elements !IS appropri!lte to the needs ofe!lch country. To promote the development of public he!llth l!lbor!ltory services.

1.2

1.3

1.4

A B

1.5 1.6

To promote health educ!ltion "nd information for the public. To !lssist in the prevention of dis!lbility and the rehabilitation of the disabled. To promote and support policies and programmes for the care of the aged. To promote adequate logistic support to health programmes at all levels.

1.7

A B

1.8

To promote closer co-operation of health. services with social welfare and other services .and their integration, where appropriate.

.../"

" 3 July 1975

... page

PRIORIT':{ A 3. To promote the development of standard health technologies and their adaptation to various local needs 3.1

c A A A 4. 5.

To promote and support the international development of standardized and easily adaptable health technologies. To assist countries in developing simple, low-cost and effective technologies in specific areas.

3.2

To promote maternal and child health including family planning. To promote better nutrition of all individuals and thereby reduce the incidence of all forms of malnutrition. 5.1 To assist in developing multi-sectoral food and nutrition policies and programmes.

5.2

To assist in establishing a simple nutritional surveillance system and measures for the control of specific nutritional deficiencies.

To promote mental health including prevention of alcoholism and drug dependence and abuse. 6.1

c B

To assist countries in preventing and/or reducing mental morbidity and its consequences. To assist countries to develop strategies for intervention based on an increased awareness of the influence of social action on mental health. To assist countries to develop programmes for the prevention of alcoholism and drug dependence and abuse.

6.2

6.3

To promote a mor~ rational production, distribution and utilization of safe, effective and economical prophylactic, diagnostic and therapeutic substances.

7.1

To assist in developing and executing national drug policies and programmes based on such policies. To develop co-ordination at the international level of research for production and distribution of essential drugs. To establish and improve international requirements and standards for quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances.

7.2

7.3

. .. / ..

Page 3

· PRIORITY -=--~=-

A A

To improve methods and mechanisms of financing health services within a national context.

B.l

To provide information and to assist countries to devise and introduce improved methods of financing health promoting activities. To promote functional integration or closer collaboration of social security and/or health insurance schemes with health services in both public and private sectors. To assist countries to achieve a more equitable distribution of benefits from health services. To assist countries to base decisions concerning provision of health services on outcome and cost criteria.

8.2

8.S 8.4

DISEASE PREVENTION AND CONTROL To prevent and control cOIDWunicable diseases. To assist countries in the reduction of communicable dis~ase problems by immunization, surveillance, vector control and other suitable m~~sures.

c A

9.2

To assist countries to complete and consolidate tIle eradication of smallpox and set up a posteradication surveillance system. To strengthen assistance to countries in malaria control and its elimination where feasible. To assist the development of research of efficient and economical measures for prevention and control of communicable diseases.

9.3

9.4

10.

To prevent and control cancer, cardiovascular diseases, oral diseases and other non-communicable diseases of major public health importance 10.1 10.2 To assist cancer prevention and control. To assist in prevention and control of ischaemic heart disease, arterial hypertension, cerebrovascular disease, l~heumatic heart disease and other important car·diovascular di§ease5~

c B

Ie 3 To assist countries in the development of poliCies and programm<ls for oral health. 10,4

To assist countries in prevention and control of neurological diseases, diabetes mellitus, chronic nonspecific respiratory disease, chronic renal disease, chronic liver disease, rheumatoid arthritis !lnd allied conditions.

... / ..

Page 4 =::======

PRIORITY III. A A 11.

PROMOTION OF ENVIRONMENTAL HEALTH To promote and develop environmental health policies and programmes. 11.1 To assist in the planning and development of environmental he~lth policies and programmes associated with economic and area-wide development policies, pl~ns and projects. To promote manpower pl~nning, development ~nd management in the field of environmental health. To assist health authorities in ensuring that environmental programmes take proper account of he~lth aspects.

11.2

11.3

12.

To improve basic community s~nitation, particularly community water supply and disposal of w~stes 12.1 To promote and ~ssist in n~tional planning of services for the provision of community water supplies and for disposal of waste. To promote and assist in the est~blishment of continuing and system~tic surveillance of drinking water quality and wastes' disposal systems in accordance with public health criteria. To pro~nte the transfer of information and methods for community sanitation. To promote the h"~J.th

12.2

12.3

c B 13.

12.4

aspects of housing.

To promote recognition, evaluation and control of environmental conditions and hazards which may affect human health 13.1 To promote the development of programmes for the early detection ~nd control of pollution in the environment. To ev~lu~te the effects of environmental f~ctors on health, to promote and co-ordinate relev~nt research, and to foster the practical application of findings.

13.2

. .. / ..

Pa,. 5

PRIOR I'I'Y ::o~=:::.,,===:::

:':1

13.3

To promote the development of programmes to assure food safety and of information for their planning and implementation. To assist in preventing occupaticnal and work·-related diseases, and prot.ect and promote workers I health. To promote the development of policies and programmes and related information systems for accident prevention.

13.4

13.5

IV.

HEALTH MANPCMER DEVELOPMENT

14.

To promote the development of the types and numbers of health manpower needed to pr?vide health services that are adequate and appropriate to the needs of the largest possible segment of the population 14.1 To assist in the planning for and training of suffjcient manpower with the proper knowledge, skills and attitudes for the execution of national health plans and programmes. To promote the integration of health manpower planning, production and utiliz'ation within the context of natj.onal health plans .and socio-economic· development in eollaboration with the general eaucational syst"m. To promote optimal utilization and to reduce undesirable migration of trained manpower.

14 . 2

14.3

I,).

To promote the development of relevant basic and continuing educational processes (planning, curriculum, development,methodology and evaluation) for all categories of health personn.. l 15.1 'ro promote the development of national staff able to apply a systematic approach to educational processes. To promote the definition of learning objectives for relevant curricula, appropriate educational methods and valid evaluation systems for all wpes and levels of educational activities.

15.2

. . . f ..

Page 6 PRIORITY V. PROMOTION AND DEVELOPMENT OF BIOMEDICAL AND HEALTH SERVICES RESEARCH To promote and assist in the development and co-ordinaton of biomedical and health services research 16.1 To identify research priorities strengthen national research capabilities and promote co-ordination of research. To promote the application of existing and new scientific knowledge and research methods.

B B

16.

16.2

VI.

MECHANISMS FOR PROGRAMME DEVELOPMENT AND SUPPORT To promote wi thin the context of the overa 11 socio-economic development in Member States, systems for continuing planning, programming and management includinb financing and evaluation of health promoting activities 17.1 To provide assistance in the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policy. To promote the deveiopment and application of efficient managerial, information and evaluation systems for the planning and operation of health programmes.

17.

17.2

18.

To support social ,mri econo:nic;_pol Ie ies and programmes wi th heal th implic!' tions, such as rurll 1. ",nd. yrblln development. housing, e<luDa tion and @conomic development activities as appropriate

18.1

To help adjust s'ocio. ,economic development plans and activities in order to enhance health benefits and reduce heal. th h."z~n-c.s. To help introduce health components into regular social and econofflic ~ctivities and services and enhance their health effects.

18.2

. .. / ..

Page 7 =====~=:

19.

To increase UN and other international, multilateral and bilateral collaboration, in solving priority health problems or other socioeconomic problems with significant health implications 19.1 To increase the amount of external assistance available for health programmes, for the health component of development programmes, and for development programmes with identifiable effects on health. To provide an adequate and appropriate response to emergency situations.

19.2

WPR/RC26/11

ANNEX 3

A DRAFT OF TfE PROPCBED IN'lRODUCTORY PART OF THE SIXTH GENERAL PROG~ OF womc COVERING A SPIDIFlC PERIOD

(1978 - 1983 I~WSlVE)

DRAFI'

6GPW/SWG/7

SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD 1978 - 1983 INCLUSIVE

Contents

Introduction

The evolution of the world health situation and health challenges for 1978-1983

The evolution and

evalu~tion

of WHO's programmes

The role and functions of

during the period 1978-1983

Programme principles

, 42

Medium-term implications of long-term trends for WHO's programme

Principal programme objectives

Approaches

Programme criteria

10.

Detailed programme framework

11.

Evaluation

Annex

Geneva, 25 June 1975 Amended 3 July 1975

2. SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD

Introduction Article 28 (g) of the Constitution of the World Health Organization

requires its Executive Board "to submit to the World Health Assembly for consideration and approval a general programme of work covering a specific period" . The World Health Assembly has thus far approved five, general programmes of work, respectively for the periods 1952-1956, 1957-1961, 1962-1966, 1967-1972 and 1973-1977 inclusive. These programmes were formulated by the Executive Board, approved by the World Health Assembly and subsequently adapted to regional n"eds by the Rel(iumd Committees. At its fifty-fifth session, the Executive Board created a working

group, composed of' nine of its members, to prepare a draft of the Sixth General Programme of Work to be considered by the Board at its fifty-seventh session. At its fifty-fifth session the Board considered a review of the Fifth General Programme of Work submitted to it. by the Director-General, and decided to take into account the conclusions of this re~iew,

as well as its deliberations on 1

the review, in formulating the Sixth General Programme o'f Work.

Likewise,

the Board decided to take into account in its preparation of the Sixth General Programme of Work the conclusions and recommendations of its organizational study on the interrelationships between the central technical services of WHO 2 and programmes of direct assistance to Member States.

In addition it decided

to take into account the report of the Joint Inspection Unit on medium-term planning in the United Nations System, and the'comments thereon of the Adminis3 trative Committee on Coordination.

1 2 3

Resolution EB55.R25 Resolution EB55.R26 Resolution EB55.R66

3. In addition to the creation of the Executive Board Working Group mentioned above, considerable activity has taken place at all levels of the Organization to ensure the widest participation in the process of shaping the Sixth General Programme of Work. A Secretariat Working Group, composed of senior staff from

the regions and Headquarters, agreed on a preliminary list of programme objectives, based mainly on the Fifth General Programme of Work, which was later submitted to the Executive Board Working Group. Consultations took place with national

health authorities following the preparation of a briefing document for WHO representatives. Headquarters. Programme proposals were then prepared in the regions and at An explanatory document, including the proposed list of

programme objectives, was then presented to the Regional Committees for their review, following which further draft material was presented to the Executive Board Working Group, in accordance with whose directives the above mentioned activities took place. In addition, Member States and numerous experts

throughout the world in various health and related fields were consulted on long-term trends for WHO's programme. The specific period to be covered by the Sixth General Programme of Work was also considered by the Board at its fifty-fifth session. The question was At the same

raised of linking this period to the next developmental decade.

time, it was stressed that the period covered by the programme should, as far as possible. correspond with those adopted throughout the United Nations System, so that the Organization's activity specialized agencies. could be compared with that of the other

The adoption of the period 1978-1983 inclusive conforms

to the suggestion contained in the. report of the Joint Inspection Unit mentioned .above and will permit the implementation of the Sixth General Programme of Work to be divided into three biennial programme budgets.

The evolution of the world health situation and health challenges for 1978-1983

2.1

The evolution of the world health situation Since the World Health Organization was founded, profound changes have

taken place throughout the world.

Many new sovereign States have emerged and Newer inter-

on accession to independence have assumed new responsibilities.

national economic relationships have become established, unprecedented advances have been made in science and education has become the birthright of everincreasing proportions of the world population. During the same period, man's

environment has suffered more than ever before and the global ramifications are only gradually unfolding themselves. The psychological climate too has

rhanged, adding a further dynamic dimension to modern civilization. In this emergent framework of political, economic, social, cultural, scientific, technological and psychological systems, superimposed on the geophysical 'environment, health has to be brought about. Public health is implicated

in each of those systems, and, being a part of the total matrix, influences it by its own dynamics. In the past quarter of a century its armamentarium has been The new means available

enriched through intensive and extensive research.

include, among many others, chemical and immunological agents, genetical and biological techniques of disease vector control, new drugs, improved physical

methods and the by-products of nuclear fission for diagnosis and therapy, electronic monitoring apparatus, automated laboratory techniques, computers, and newer communications systems and analytical methods. Public health services have themselves evolved in answer to emerging problems, is evident. The pace has differed in different countries, but everywhere progress Developing countries have had to face the most difficult problems In order to counter those problems effectively they

with the least resourcej.

have had to use modern scientific methods and tools, for which their young health

servi·ce infrastructures were not always sufficiently developed.

In spite of

severe shortages of health manpower, a dearth of training facilities and inadequacy of available financial resources, vigorous application of public health measures has resulted in the saving of millions of lives, and sustenance and health care have had to be provided for additional populations. Population

dynamics and their influence on health are demanding increasing attention in many countries.

Health care has become more easily accessible for increasing numbers of people, and there has been a concomitant increase in expectancy of and demand for ever-higher standards of care as science and technology advance and as social progress is made. The profile of morbidity has changed. In a number

of countries, populations have emerged with a growing prevalence of chronic diseases and a higher proport~on

of elderly people, and the provision of

extensive and intensive care has led to the survival of many people who would previously have succumbed to their illness. necessity All this is highlighting the

of gauging conflicting priorities of community health needs and of As costs soar, it is

the immediate relief of individual suffering and pain.

becoming increasingly evident that socio-economic factors may limit the possible application of technological advances for all who require them, pointing to the necessity of seeking out new ways of making health care universally available. The economic and social advantages of industrialization and urbanization have been accompanied by factors ·detrimental to health, such as the introduction of harmful pollutants into the environment, the exponential increase in road accidents and the stress of city life. Increasing numbers of countries are including in their constitutions the principle of health as a fundamental human right, while a growing demand for health care and rapid population growth in some countries are placing severe strains on existing health facilities. Governments are becoming increasingly involved in

planning for economic and social development, and are creating general policy framewor~within

which health planning must become accommodated.

Man's health

has come to be regarded as,a prerequisite for optimal socio-economic development. Instead of being considered merely as a complex of solely medical measures, public health services are being recognized as an important component of socioeconomic systems, combining all tqe economic, social, political, preventive, therapeutic and other measures which human ~ociety,

in any country and at any

stage in its development, is using to protect and constantly improve the health of every individual and of society as a whole. In recent decades many health problems previously considered local in character have proved to have regional and global implications. Speedy and

massive international travel has converted certain seemingly national health problems into international health problems, and classical quarantine practices have given way to more positive measures of control through international collaboration in epidemiological surveillance. mental problems are reve~ling

National and regional environ-

themselves in reality as global problems, and

international collaborat.ion must again"form ,the keystone of their control. Thus, national, regional and global health systems are closely interwoven, and the modern world could not be envisaged without their reciprocity. However, experience has shown that the determining factor in the development of national health services is effective national effort. External aid can

only temporarily alleviate the consequences of disproportionately low allocations for health needs in national plans and budgets, and can never fully replace the shortage of local resources and manpower, or even significantly supplement them. As a component part of a country's socio-economic infrastructure, the health services must develop in keeping with the rates of its social, cultural and economic progress.

7. 2.2 The world health situation for assessing the world health situation in a positive The most that can be proffered

Adequate indicators

manner in quantified terms do not yet exist. at this stage are

rather general statements based on the analysts of the

most reliable available data emanating from the countries of the world concerning the demographic situation, mortality and morbidity. The following material is culled from the Fifth Report on the World Health Situation, 1969-1972 • 1

Demography The world population continues to increase, but the growth rate varies greatly from country to country and from region to region. The main causes

of this are well known: high birth rate, falls in infant mortality, increased life expectancy, and mitigation of the consequences of major natural disasters (famines, epidemics, floods, and earthquakes) by more effective relief measures and transport. The impact of population growth on the age structure of populations is revealed by an analysis of general mortality rates. In the least developed

countries the general mortality rate, where it is known, is still high (above 18-20 per thousand). In the developing countries where the health services can

reach a high proportion of the population the general mortality rate drops rapidly and may fall below five per thousand. In the developed countries it rises again

to about 10 per thousand because of the growing number of people over 65 - those who have reached or who exceed the average life expectancy. illustrated in graphs 1, 2 and 3. This situation is

Off. Rec. WId Hlth Org., 1975, No. 225

Graph 1 shows the distribution of the populations of the six WHO regions according to crude mortality rate. The distribution of the countries in the The histogram for the

African Region shows the existence of two subregions.

Americas is more homogeneous since it relates to a group of developed countries and countries that are less developed but have a young population. of South-East Asia are at a fairly comparable stage of development. The countries The histo-

gram for Europe tapers off at rather high mean values because of the large proportion of old people. The countries of the Eastern Mediterranean Region

have reached varying levels of development, which explains the heterogeneous nature of the graph. Finally, the histogram for the Western Pacific is influenced For the

by the rate for the vast population of the People's Republic of China. world as a whole three peaks are shown:

the first at 6-9 per thousand, corres-

ponding to countries with a young population and fairly developed health services, the second at 14-17 per thousand for many developing countries, and the third at 22-25.per thousand for countries where the health system does not yet serve a high proportion of the population. The developed countries are situated

between the first two peaks. Graph 2 also reveals three types of country according to life expectancy. The Region of the Americas and Europe have the highest life expectancy but in the Americas there is an earlier, secondary peak for the developing countries of Central and South America. The Eastern Mediterranean and Western Pacific however, the former has an earlier, secondary

Regions are similar to each other;

peak for its least developed countries, whereas the later, secondary peak in the Western Pacific Region corresponds to the most developed countries New Zealand and Japan. lowest life expectancy. Australia,

Africa alone constitutes a third category, with the For the world as a whole the distribution reflects the

classical difference between developed and developing countries.

9. The figures for South-East Asia should be interpreted with caution as they are based on a sample of only 27.5%. Graph 3 shows the percentage distribution of demographic growth rates in the WHO regions. The general rate for Africa is slightly lower than the rates

for the Americas and South-East Asia because the level of general mortality offsets the high birth rate. sub-continents. In the Americas, the two peaks distinguish the two

The pattern for the world as a whole again reflects the

difference between the developed and developing countries. The information that can be derived from these three graphs is limited because several WHO regions are heterogeneous with regard to levels of health and of economic development.

10.

GRAPH 1. PERCENTAGE DISTRIBUTION OF POPULATIONS BY CRUDE MORTALITY RATE. BY WHO REGION 1970 or years immediately preceding 100,-----------------------------------------------. 80 AFRICA 60 40 20 O~--~--~--~~--~-Percenlage of population to whi ch the cal culation applies 99.9 Total population (millions) 234.6

100.0

509.5

99.9 761.0

'" o c:

c. o c. o Q)

EUROPE

100.0

769.7

g> Q) ~

a..

EASTERN MEDITERRANEAN

90.7

284.7

99.8

1049.0

WOILD

99.2

3608.5

10 12 14 16 18 20 22 24 26 Crude mortal ity rate (per thousand population)

28 !-rHO

30 ·1111'11'

11.

GRAPH 2 PERCENTAGE DISTRIBUTION OF MEAN LIFE EXPECTANCY AT BIRTH. BY WHO REGION 1970 or years immediately preceding Percentage of population to whi ch the cal cui ation applies Total population (mi" ions)

99.5

234.6 .

72.1

509.5

27.5 0

721.0

c:::

co c-

'" ::J

99.6

769.7

'" '" c::: '" 2 e>-

98.6

284.7

92.3

1049.0

78.3

3608.5

65 Mean life expectancy Iyears)

75 WHO 40192

12.

GRAPH 3 PERCENTAGE DISTRIBUTION OF DEMOGRAPHIC GROWTH RATES BY WHO REGION 1970 Dr years immediately preceding Percentage of population to which the calculation applies Total population Imi II ions)

AFRICA

87.0

234.6

99.5

509.5

99.9 c 0

761.0

.. 8. 0 CIl

100.0

769.7

g' c CIl <..> CIl

a..

98.2

284.7

100.0

1049.0

98.9

3608.5

1.5

2.0

2.5

3.0

3.5

4.0 WHO ,fll

Demographi c growth rate I %j

'u •

13.

Mortality Mortality rates by cause of death are known precisely only in countries with well-organized registration services and where a high proportion of deaths are established by physicians capable of determining the causes in accordance with the international classification and filling in correctly the standard certificate recommended by WHO. Moreover, the list of causes

of death is sometimes shortened, several causes being grouped under the same heading. An attempt has therefore been made to present these data in a new way, so as to give an impression, not of the absolute number of deaths by causes of death, but of the classification by order of importance of causes of death that governments could draw up and use to guide their health action programme. Graph" has been prepared by the following method: deaths by cause notified

by governments for 1971

or 1972 have been added up for each WHO region (data a histogram

for Africa were not available) and ranked in order of importance;

was made for each main cause, the ranking of that cause in the region being indicated by its position on a scale marked from 1 to 20. For example, the

cardiovascular diseases are responsible for more deaths than any other cause in the Region of the Americas and in Europe; those regions are therefore However, these diseases

highest (ranking 1) in the "heart diseases" graph.

occupy only the second place in the Eastern Mediterranean and third place in South-East Asia and the Western Pacific Regions. Malignant neoplasms are not

the principal cause of death in any region but they take second place in the Americas and Europe. This graph also shows the universal nature of some causes These causes appear between

of death, such as obstetric and perinatal accidents.

the eighth and fourth positions, and are therefore of worldwide importance. The successful treatment of tuberculosis in Europe is shown by the fact that the disease has been relegated to thirteenth place, whereas it occupies fourth

14. place in South-East Asia. Influenza is regarded as a main cause of death in

only two regions, which brings out the importance of a more standard definition at the worldwide level. Finally, the shortcomings of notifications of causes

of death are illustrated by the fact that the diagnosis "symptoms and illdefined conditions" occupies first place in three regions. Europe sets a

good example by relegating this confession of imprecise diagnosis to seventh place. Communicable diseases, with the exception of tuberculosis and influenza, have not been taken into account as causes of death. The reason for this is

that the lists communicated by governments rarely mention the common infectious diseases as causes of death, since the underlying cause is not often given. Thus measles or whooping-cough rarely appear as causes of death, since the death of the infected child is most frequently attributed to the terminal bronchopneumonia.

L'i.

GRAPH RANKING OF DYSENTERY AND ENTERITIS (B3-4)

4 DIABETES (B 21)

CAUSES OF DEATH BY WHO REGION MALIGNANT NEOPLASMS I B 19)

2 4 6 8

TUBERCULOSIS IB5-6)

10 12 14 16 18 20 AVITAMINOSES MALNUTRITION (B 22) HEART DISEASES I B27' 29) CEREBROVASCULAR DISEASE (B 30) INFLUENZA I B 31)

.....,

t.:l

z 20

2 4 6 8 10 12 14 16 18 CIRRHOSIS OF THE LIVER (B37)

"" z < a::

PNEUMONIA (B 32)

BRONCHITIS (B 33)

NEPHRITIS (B38)

2 4 6 8 10 12 14 16 20 18

OBSTETRIC AND PERINATAL ACCIDENTS (B41-44)

SYMPTOMS AND IlloDEFINED CONDITIONS B 45)

ACCIDENTS (BE 47-48)

SUICIDE (BE 49)

2 4 6 8

10 12 14 16 18

20 A B C D E F ABCDEF ABC D E F A [3 C D E F WHO .Jf)lY,~

A=Africa B= Americas

C= South East Asia

D= Europe

E= Eastern Mediterranean

F= Western Pacific

16.

Morbi.ditv General morbidity statistics are either very incomplete or nonexistent in most countries, value, The morbidity statistics for hospital patients vary in

They are fairly satisfactory when the diagnosis is made on the

patient's discharge, less reliable when the diagnosis is made on admission; they ignore the private sector and reflect only morbidity that has led to admission to a public hospital bed, not general morbidity, Finally, the figures In countries

recorded depend to a great extent on the number of hospital beds,

where practically all requests for hospitalization are met, the statistics have a definite value and can be used to guide planning, On the other hand, where

the hospital bed potential is notoriously inadequate the criteria for admission are based more on the severity of the case than on the nature or curability of the disease, The data used here are derived from information supplied to WHO by governments and used for preparing the World Health Statistics Annual. On the basis

of these data, Graph 5 has been prepared by the same method as Graph 4, with the inclusion of the African Region, However, some changes have been made:

typhoid and paratyphoid fevers have been grouped together, as have bacillary and amoebic dysentry and enteritis. into consideration. The differences between countries in the lists of diseases subject to compulsory notification, combined with the fact that more than half the countries failed to reply to the questionnaire for this report, make it impracticable to base a picture of morbidity in the world as a whole on these replies. Nevertheless, the position occupied by each of the 21 diseases in the ranking list in order of importance by recton reflects the priority that national heal1h authorities in each recion might assign to those diseases in Smallpox and cholera have not been taken

17.

their programmes.

The graph shows the universal nature of some diseases, infectious hepatitis, and gonorrhoea,

such as tuberculosis, whooping-cough,

which occupy high position in all the regions. trachoma, trypanosomiasis,

Other diseases, such as typhus, and relapsing Finally, there are

schistosomiasis, rabies,

fever,

Gre notified or present in only a few regions.

diseases which, although present in all regions, do not have high priority anywhere; examples are diphtheria, leprosy, and poliomyelitis. Graph 5

brings out the anomalies in the notification of diseases that are clearly universal, such as meningococcal infections, influenza, and measles, none

of which has been reported from South-East Asia. The 21 communicable diseases and 16 leading causes of death selected for preparing Gmphs 4 and 5 are by no means representative of general morbidity. Moreover. there are many countries~

or areas of countries, where diseases that

do not appear in the above analysis take first priority.

Onchocerciasis,

which affects more than half the inhabitants of the African savannas, and filarial infections, which cause disabling oedemas among 30% of certain population groups in India, Sri Lanka, and Polynesia, represent the leading health hazard for those living in the affected areas and the health services that serve them. first priority for the

Although schistosomiasis appears in Graph 5,

its position does not reflect the hazard it presents for some popUlations living alongside canals and watercourses infested by the snail vectors. These comments were called for in order to stress the gaps in the available information.

lB.

GRAPH

5 TUBERCULOSIS

RANKING OF 21 NOTIFIED DISEASES BY WHO REGION TYPHOID AND PARATYPHOID FEVER

I A2·3)

I AS·l0)

LEPROSY I A 14)

DIPHTHERIA IA 16)

WHOOPING COUGH I A 16)

STREPTOCOCCAL SORE THROAT AND SCARlET FEVER

IAI71

MENINGOCOCCAL INFECTION I A 19)

2 4 6 8

POLIOMYELITIS I A 22)

INFECTIOUS HEPATITIS

I A 28)

TYPHUS IA 30)

A= Africa B = Americas

C" South· East Asia 0= Europe

;;; z «

E" TRYPANOSOMIASIS I A 32) RElAPSING FEVER SYPHILIS

Eastern Mediterranean

I A 33)

IA 35)

F" Western Pacific

,-".

-!-~

GONOCOCCAL INFECTIONS

SCHISTOSOMIASIS

I A 38)

I A 39)

TRACHOMA 1076·077)

ABCDEF

19.

2.3

Newer challenges Health and social development In recent years increased international attention has been devoted to

the establishment of a new international economic order.

In this context,

emphasis has been laid to an increasing degree on economic growth rather than on social development, making it more difficult than ever to give health development the recognition it deserves. It is becoming increasingly

important therefore to emphasize the contribution of health to social develop-

ment, of which economic development is only a .part.

The contribution of health

programmes to socio-economic development, and the integration of health planning with socio-economic planning, were dealt with at some length during the technical discussions on these matters at the Twenty-fifth World Health 1

Assembly in 1972 • Health planning processes It has become clear that for health development, as for all other endeavours for social development, it is necessary to evolve and to apply realistic yet flexible planning processes, commencing with the establishment of policies, and continuing with the translation of these policies into developmental strategies, with the formulation of operational programmes for the application of the strategies and with the proper management of these programmes to ensure that their objectives are attained. In this planning process, account has to

be taken of very many factors of an epidemiological, environmental, social, political, economic, scientific and technical nature, as well as the actual and potential availability of resources and the utilization of existing resources. Based on available data, health trends have to be analyzed. It

is important to integrate and organize properly the information and resources 1

Interrelationships between health programmes and socio-economic development. Public Health Papers N° 49. World Health Organization, Geneva, 1973.

20. with a view to reaching feasible health goals. For proper planning and opera-

tion of health programmes heavy reliance therefore has to be placed on health information in its broadest sense. The information has to be sufficiently

concise to be manageable, and sufficiently relevant and sensitive for evaluation that will lead to improved policy making and programme formulation and implementation.

Needs and resources The reduction of the gap between health needs and the resources available for satisfying them is an important challenge. While it would be unrealistic

to assume that resources for health development can be made easily available, much more could be achieved with existing resources if they were devoted to those health problems that deserve priority attention and if they were applied in such a manner as to yield maximal social benefit from the investment concerned. The promotion of health, however, involves much more than the development of health services and is dependent in large measure on other social and economic programmes, such as rural development, urban development, the proper distribution of wealth and food, general education and appropriate demographic policy. Comprehensive health service

The ultimate instrument for the delivery of health care is a comprehensive

......Ii..'

health service.

In the final analysis such a service can be conceived medical research and accumulation of medical

of as having three basic tasks:

and biological knowledge as the only possible basis for all complex measures aimed at protection and promotion of human health; comprehensive individual and

community measures of prevention of diseases, with special emphasis on the protection of the health of the new generations and on environmental health; and

provision to the entire population of timely diagnosis of diseases, when they occur, and of their adequate treatment and rehabilitation.

21.

In each society, various public and private resources may be used in different proportions and may be concentrated on solving different problems, but world experience has shown that there are a number of basic principles, as enunciated in resolution WHA23.61, observance of which can ensure optimal development of national health systems. These include the recognition of the

responsibility of society for the protection of the health of the population, the organization of rational' training of national health personnel at all levels, the development of the preventive approach both for the community and for the individual, the setting up of an appropriate system of preventive, curative and rehabilitative services, the extensive application of the results of progress in world medical research and public health practice, and the health education of the public. Few countries have reach~d

the stage at which they can feel satisfied The development of such

with the coverage and depth of their health service.

a service is a highly complex process for which full use has to be made of the methods mentioned above for planning, programme formulation and programme and service management. service r~quired

The complexity derives from the multiple facets of the

for health promotion and protection, disease prevention, from the need to take into

early detection, treatment and rehabilitation;

account different age and geographical distributions of people and their uneven educational and cultural backgrounds; from the difficulty of reaching a

balance between the needs of the individuai, the family, various types and sizes of communities and the ~ation

as 'a whole;

from the large number and

bewildering variety of social and technical disciplines required to create and operate health services; and from the huge financial investments and

organizational efforts required to develop a nation-wide network of health services.

22.

Primary health care

In many countries health services have been built up from the centre through institutions based on the pattern of more affluent societies, and have reached the periphery only in a most desultory and primitive way. This has led to the provision of expensive services for a privileged few rather than to a minimally a,dequate service for the people as a wholp. Other countries have attained a more equitable social distribution of their health services, and lessons have to be learned from them for adaptation and wider application~

Renewed attention is therefore being paid to primary

health care at the community level, particularly in rural areas of developing countries, and to the contribution of such health policies and programmes to rural development.

Adaptation of health technology Health technology continues to develop rapidly, giving rise to increasingly sophisticated diagnostic and therapeutic measures. As a result, the cost of

applying these measures is growing vertiginously, and a growing need is felt, even in the most affluent countries, for rationalizing tbese technologies and making them available at a reasonable cost. The reasonableness of cost depends

of course on the economic capacity of any given country, and this reemphasizes

the importance of adapting health technologies so that they can be applied in different social and economic contexts.

Financing health services Methods of financing health services also vary from country to country and, while reciprocal lessons can be learned, suitable adaptations have to be made to accommodate national patterns concerning such matters as fiscal allocations for health, social security systems, payments by individuals and the use of philanthropic agencies and volunteers.

23.

Pharmaceutical preparations The continual enlargement of the armamentarium of medicinal drugs, many of which are highly potent and may have harmful side effects, is creating ever increasing technical, financial and ethical problems for the health services. world. There is also a maldistribution of drug production throughout the

All these factors make it imperative to review national and inter-

national policies and programmes in this vast field. Health and social services If health development is closely linked with social development, it would seem reasonable to provide health care in close association with the provision of other social services. This approach has already been adopted in a number

of countries and these experiments deserve close examination for possible introduction by other countries after suitable adaptation. For example, the

provision of health care to children, pregnant women and mothers breast-feeding their infants would be futile without ensuring that at the same time they receive appropriate and adequate food. The provision of food is becoming an

increasingly international problem, and international health endeavours, if they are to be successful, must contribute to the concomitant development of food and nutrition policies. and programmes at all levels. Community participation In the midst of preoccupations with the establishment of health policies and the formulation of health programmes, sight can never be lost of the fact that health cannot be imposed; it can only be attained. For individuals and

communities to attain their desired level of health they have to be enlightened. However, there are too many instances of knowledge on health matters that has been made widely available to the public being unaccompanied by the necessary motivation to apply it. Fragmented approaches to individual health education

and mass information of the public on health matters having proved ineffective

24.

in so many countries, it appears mandatory to seek improved ways of gaining individual and public confidence and of encouraging greater community participation in the promotion of its own health. Disease control In no field more than in disease control is community participation an important element for success. This applies to such varied matters as immuni-

zation or mass vector control measures for communicable diseases control and individual life style for the control of certain cancers and cardiovascular diseases. It certainly holds true for the promotion of mental and dental

health, which are affected by so many factors within the individual and within the environment. It is evident that a two pronged attack is necessary for

disease control, namely through the incorporation of disease control measures into the general health services on the one hand and through the promotion of environmental health on the other. Environmental health The problems of the environment have been present since the beginning of history, and man's evolution has been shaped in large measure by his capacity to adapt to a changing environment. The apparent newness of the situation in

recent years stems both from the degree to which man himself has contributed to the increase in environmental hazards and from a growing world conscience concerning the environment. Recently, this conscience itself has not been left The old

unaffected by economic considerations in many parts of the world.

environmental hazards presented by poor community sanitation is still all too prevalent in many places, especially in developing countries, both in rural and urban areas. To these hazards have to be added, in almost all countries

of the world, environmental pollution by chemical and physical agents, as well as the all prevading vicissitudes of the social environment. All these

25.

environmental factors affect the health of communities and of working populations, whether through their contribution to the generation or spread of disease, their inducement of accidents, their adulteration of food or their adverse effects on mental ·heal tho It would be pretentious to assume that

heal th policies and prograllUDes alone could ensure a safe environment, but since a safe and propitious environment is essential for man's health, health aspects have to be given a prominent place in all considerations of the environment. This implies a closer interrelationship than ever before between all concerned with the cont·rol and improvement of the environment, whatever the basic discipline in which they have been trained. Biomedical research All policies and programmes, whether for the control of disease, for the development of community heal~h

services or for the promotion of environmental This is both the result of and the rationale A

health, are constantly evolving.

for the continual development of biomedical research 1n its widest sense.

proper balance has to be reached, however, between research and service, and between the development of new knowledge and the application of existing knowledge. To reach and maintain this balance, the social function of bioOnly by so doing, will

medical research must always be kept· in the forefront.

it be possible to rationalize the allocation of resources to biomedical research and the distribution of these resources to its various aspects. Health manpoWer development The most cru~ial

factor for the improvement of the world health situation

outlined in such broad terms above, is undoubtedly the development of health manpower that is properly attuned to the health-problems of the people and that is suitably trained to respond to health programme and service needs. Since these needs vary so greatly from country to country, any tendency towards stereotyped training patterns must be overcome. If the axiom is accepted that

26.

health manpower should respond to the pattern of need rather than create thp. pattern of demand, it become clear that education for the health professions must take into account not only the local health Situation, but alsn the local factors that have given rise to this situation as well as general educational, social, and economic factors. All this. implies a vast challenge, which has only

partially been taken up as y&t, for the education and training and subsequent optima~

use of professiodied auxiliary health personnel, and of other personnel

who can contribute directly or indirectly to the promotion of health. Long-term planning Health administrations are thus facing new dimenSions, necessitating the strengthening of their functions for planning and long-term development in addition to their executive powers. in a number of· countries elaborate health .. .

administrations have been developed in conforaity with these newer concepts. In certain countries long-tera forecasts, even until the end of the century, are being prepared. 3. twentiet~

The evolution and evaluation of WHO's programmes Programme developments WHO's programmes have bp.en·.continually adapted in an attempt to respond

3.1

to changing world health needs.

This evolution has been described in some

detail in the Executive Board organizational study on the interrelationships between the central technical services of WHO... and programmes of .direct assistance to Membe.r States. 1 ~ch

of. what follows is based on that study.

In the first· stage of its deve·lopment WHO, at that time highly centralize", based its programme on certain health priorities. These included malaria,

maternal and child health, tuberculOSiS, venereal diseases, nutrition and

Off. Rec. Wid Hlth Org.; 1975, No. 223, Annex 7

27.

envlronmentalsanltation.

This system of determining priorities was soon divers~

found to be unsuited to the widely

health needs of the countries of

the world, and was in due course replaced by a more flexible mechanism that was more responsive to the requests of Member States for help, and that made allowance for the particular. problems of each country. The progressively

strengthenin; regional organization fostered a better appreciation of the distinctiveness of national situations, thus enhancing the process of deter-

mining national and regional priorities within the context of global policies. These policies were established on the basis of the WHO Constitution, and on .~

decisions of the World Health Assembly and Executive Board, which, over the years, have been a determinant factor in giving direction to the whole programme of the Organization. Major policy decisiGns were the launching of the world-wide campaigns for the eradication of malaria in 1955 and for the eradication of smallpox in 1958. After brilliant initial gains, a nUmber of constraints hampered the progress of the time-limited malaria eradication programme, and the strategy was subsequently revised by the World Health Assembly permitting a return to less

ambitious control programmes as and where needed •. From 1958, the World Health Assembly gave active attention to the worldwide eradication of smallpox, making it one of the major objectives of the Organization. In 1967 this programme was intensified and coordinated efforts The attainment of small-

of an unprecedent nature began ona world-wide scale.

pox eradication is well within sight and this programme will no doubt be acclaimed in the future as a historical event in man's fight against disease. Once the disease has been eliminated it will be necessary to sustain adequate vigilance in order to maintain smallpox eradication throughout the world • I 1

Resolution WHA28.52

28. The character of country projects gradually developed fro•. single ',.servic9,s of limited scope to broader'projects. Action to meet local emergencies, of

which there are notable examples, became the exception,,' being replaced by programmes planned in advance for a number of years, ,by investigation of the natural histories of' colllllli.inicab1e', diseases with a vi_ to their IIOre rat,i9Dally planned control and by 'educationa1,programmes which could enab1. countries to develop their own health services~

These programmes for ,the education and,

training of health personnel developed, not only with the objective of increasing nuabers, bqt also with that 'of improving the content of the curricUla an4,of, adapting them more specifically to national needs. In recent years, the,bro~er

concept has em~rged of heal th manpower' development, 'including heal th manpowe,r planning and the efficient use of health personnel.

emphasis was laid on the organization of basic.hea1th serv~ces, This,was

designed ultimately to incorporatp. specific health progr...es.

fo1t'owed by a trowing realization of the importance of primary health care for the prollOtion of national health servi,ces, as .anifested, for example" by specific resolutions of the Executive Board and World Health Assemb1y1,2. Communicable diseases began to be viewed in the broader perspective of, cO-, ordination of their control. The concept of environmental sanitation gave Concern gr_ for the control of non-

way to that of environmental health.

communicable diseases, including mental disease, as they increased in importance as public health problems. The growing bOd! of scientific knowledge related bi~edica1

to health and disease reawakened interest and activity in the sciences.

Moreover, it, stimulated the Organization to develop its programme

of aSSistance tO,biomedical and public health practice research and to toster in some measure a positive approach to international co-ordination in medical research. 1 Resolution EB55.R16 2 Resolution WHA28.88

29.

The programme for the

pr~tion·

of· reaearoh has· been aaking· steady The Twenty-fifth World Health Assembly

progress since its inception in 1958.

"recognizing that the further success of WHO activities is to a considerable extent dependent on gains in biomedical research and the practical application 0:£ its results generally on behalf of the health of peoples of all countries". considered "·it necessary to ·intenstty WHO·aotivities in the field of biolledical research, particularly in ·regard to the developlll8l1t of its long-tel'll progl'_.s"1 •

The TW.aty-seventb World Health Ass.ably andorsed ·'the proposals submitted. for WHO activiti•• in bio.edical rese~rch

with particular att.ntion to: bi~ical

(a)

increased international cooperation and coordination of

research

activiti.s·and exchange of research infol'llation by WHO tbroulh medical research councilS and similar national bodies and·oth.r institutions. keeping public heal~h authorities infol'Ded as apprOpriate, and ,(b) proaotion and initiation .. .

of research in developing countries and the strengthening of research and. training centr.s in th.se countries, particularly With respect to disease pro~lells

of illportano.'to the ar.a such as.parasitic infections and other 2

endemic diseases".

The .1IIpl ....nt.tion of this r •.solution: is already gathering

mom.ntum and bas been. strengthened by more recent resolutions on long-term planning for tbe development and coordination of biomedical research particular of research in tropical diseases. 4 3

and in

The prompt application of a~ea

researcb findings bas been identified as an illportant 3.2 Meehani...s for prolr.... development

of concern.

WHO's progr.... is conceived and iIIplemented at ·a number of organizational ., levels, leading to a combination in varying proportions of direct assistance to individual countries, intercountry and regional activities, and interregional 1

Resolution WHA25.60

2 Resolution WHA27.6l 3 Resolution.WHA28.70 4 Resolution WHA28.7l

30.

and global activities.

These global activities include the establishment of biologic~l,

international standards, for example in_ relation to d;rugs and

sub-_

stances for prophylactic or _therapeutic use. - They also include the international statistical classification of diseases, injuries and causes of death as well as the international health regulations. These acti vi ties_, previously ¢onsidered importanc~

as exclusively normativ.e, are now recognized as being of direct health ~evelopment

at the country and regional levels.

The scientific and technical bases of the programme were built up through ..",

wide consultation, both formal and informal, with experts in individual fields from allover the world. The outcomes of the formal consultations have been

published in the WHO Technical Report Series which, although they may not represent the official views of the Organization, represent a rather unique sum of knowledge, the quality of much of which for health development programmes has been widely recognized and has Significantly guided the technical work of the Organization. This knowledge, in addition to-the policy guidance of the

Executive Board and the World Health Assembly--has led to the development by WHO ovei' the years of a doctrine in pubi"ic health which is continually evolving. The increasing importance of WHO's international coordinative role has been recognized. Programme coordination has also been intensified with the-

United Nations and with the other specialized agencies in the United Nations System, as well as with bilateral agencies. These developments have taken place

in view of the fact that international efforts for the promotion of health cannot be dissociated from economic and social develo~ent

as a whole, and WHO is bound Also the assistance

to cooperate with other agencies in this broader context.

provided by WHO is only one facet of the total external assistance received by its Member States in the field of health. A few examples of such coordination

"l-e the long standing activity of the Joint UNICEF/WHO Committee on Health Policy, WHO's involvement in the overall orientation of the United Nations-Development

31.

Programme and as executing agency to a number of specific projects within this Programme, the joint efforts of WHO. and the International Bank for Reconstruction and Development in pre-investment planning for basic sanitary services, and cooperation with the United Na10ns Fund for Population Activities and with United Nations Environment Programme as well as with regional economic commissions. A number of current trends can be discerned in programming and programme management aimed at improving the Organization's programme. Strong emphasis

has been laid on country health programming which is understood as the systematic assessment of a country's health problems and the context in which they exist, aimed at identifying areas susceptible to change. It is also an

attempt to ascertain the resources required to induce and sustain such changes in health problems and health services and to identify those which might be provided from sources external to the country, including those of WHO and of bilateral and other multilateral agencies and programmes. It is stressed

that country health programming is a national responsibility, WHO's role being to assist on request. Country health programming by itself, however, is not sufficient for WHO to determine its programmes over the medium-term in response to countries needs. Also, the general programmes of work of the Organization covering a specific period, have not been specific enough to determine the Organization's detailed programmes. It has therefore been necessary to introduce a process of medium-

term programming to cover the same period as the general programme of work. Medium-term programming for WHO by itself also cannot meet the programming needs of individual Member States. Only by moving on both fronts in a co-

ordinated manner can it be hoped to establish the required degree of consistency between country health programming and WHO's medium-term programming and to exploit to the full the complementary resources they offer.

32.

Successful programming, laudable in itself, has to be judged in the final analysis by the degree to which programmes are implemented and by the effect they have in improving thp health situation. Considerable efforts are now

being made to improve programme delivery and to evaluate the efficiency and effectiveness of programmes. In spite of the formidable problems of evaluating the effect of international health work, continuing effortg have been made by the Organization for the evaluation of its programmes. These efforts have resulted in the presentation

of valuable reports on selected subjects to the Executive Board and World Health Assembly, and in the inclusion of an evaluation element in reports on activities undertaken at all levels. Success has not been achieved, however, in providing

WHO with an instrument for assessing the value of its programme as a whole and its usefulness in solving country health problems. A renewed approach is now

being developed which would respond more fully to the conCern of the Organization's Member States and governing bodies for the systematic assessment of the delivery of the programme and of its ultimate impact on the health situations of the countries. In accordance with this approach, evaJuation is becoming an integral

part of programme planning and delivery at all levels, based on sound programme information. Intensive and extensive activities are taking place to develop a rational

information system for the OrgAnization.

This sytem is understood in the

broadest sense to imply an organization of human beings, methods and machines all interacting to select data and to transform these data into information by suitable recording, classification Rnd other means of processing. This system

includes information storage and retrieval and also the interpretation of the information. At this stage particular emphasis has been laid on the development

"f the system for the support of programme formulation, implementation and evaluation.

The s~·stem being d~,"eJ"ped is based on having information available

33. where it can best be used. Programme profiles are in the process of being The Organization's

established at country, regional and central levels. reporting system too is being completely restructured.

3.3

The general programmes of work The framework for the Organization's programme consists of the general

programmes of work covering a specific period.

The first four general pro-

grammes of work were formulated in very broad terms and could be interpreted in such a way as to permit any health activity to be undertaken by the Organization. The Fifth General Programme of Work is somewhat more explicit in

the guidance it offers, and facilitates the identification at country and regional levels of activities which are integral parts of composite country and regional programmes. The introduction of programme budgeting, the basic programrne~,

principle of which is programming by objectives and budgeting by

further facilitated the sela'ction 'of programmes that had greater relevance than hitherto to overall national, regional and world health needs. The Fifth General Programme of Work identified four principal programme obJectives and outlined how they were to be 'ltt'lined. These objectives consist

of the strengthening of health services, the development of health manpower, disease prevention and control and the promotion of environmental health. Despite its very general nature and the absence ot particular priorities, the Fifth General Programme has proved to be a useful guide for defining and programming the Organization'!I activities.. It has left gr'la t flex:! biU ty to Organi~atlon'~ countrie~

those executing tho programme, thus enabling them to adapt tho

activities to the particular reQuir ...ments of the regions and the

and

ai'so to certain developments which had not been foreseen or had been u,'derestimat~d.

With this proviso it has been faithfully implemented on the whole,

although within the framework many additional procedures have been adopted for formulating the Organization's detailed programmes, particularly with regard to the establishment of more specific objectives and priorities.

34. 4. The role and functions of WHO during the period 1978-1983 The Organization's role and functions are firmly rooted in its Consti tution. Different emphases have to be given to this rolp and thpse

functions at different periods in the Organization's history in respcnse to the world health situation at that time. Thus, during the period

1978-1983 inclusive, priority attention will be paid to the themes and approaches that follow. The Constitution states the objective of the Organization as fu llows: "The objective of the World Health Organization (hereinafter called the Organization) shall be the attainment by all peoples of the highest possible level of health". This is obviously a long-term objective. The

Organization's medium-term objectives are means for attaining this ultimate objective. It should be noted that WHO' 5 objective is to be attained "by all peoples"

and not by the various organs of the Organization.

These organs are listed

in Article 9 of the Constitution, which ,."tates that the work of the Orgo.nization shall be carried out by the World Health Assembly, the Executive Board and the Secretariat. There is no contradiction b,etween the work of the Organization

being carried out by its constitutional organs, and its objective being attainAd by all peoples. On the contrary, this clearly points to the constitutional

obligation of all WHO's organs to work towards the attainment by all peoples of the highest possible level of health. The functions of the Organization are also clearly stated in its Constitution. It should be noted that the first mentioned function is that of "the This

directing and co-ordinating authority on international health work", function is unequivocal;

whereas the provision of technical assistance is It is evident

conditional upon the request or the acceptance of governments.

from its Constitution that WHO is much more than just another international organization or funding agency. It clearly has a leadership role to play in

35.

international health, and yet, being international and not supranational, it ha~

no formal power to

1mpo~e

its policies on its Member States.

Herein

preci~ely leader~hip

lies its strength, on condition that it can maintain a dynamic role by consistent stimulation to thought and action in the fields

of health, by pioneering in relation to difficult health problems and by daring to innovate even in the face of conventional wisdom. Important functions of WHO are also based on many re~olutions

of the

World Health Assemblies and in particular on resolution WHA23.59 as follows: "(a) analysis and evaluation of information on the state of health of

the world population and on environmental health (the preservation and improvement of which are vital to the health and life of the present generation and of future generations) with a view to identifying general trends in the world health ~1tuation

and to p.volving a strategy in regard to the most promising

way~

of developing health services and medical science"; "(b) study of the methodology of the planning, organization and socio-

economic analysis of different health systems and services of different countries and the preparation of realistic recommendations on the be~t

ways in which they

might develop, taking into account the importance of the development and use of cost-effectiveness and cost-benefit analyses in the field of health"; "(c) preparation of international agreements, conventions and regulations

on the most important health problems, including questions of environmental health, the importan~and

implications of which go beyond individual countries

or groups of countries and have a direct bearing on the protection and promotion of health in all the countries of the world"; "(d) formulation of recommendations on the establishment of standards,

norms, uniform technical specifications and nomenclatures for chemical, physical, immunological and other substances, compounds and preparations used in international and national health programmes";

36.

"(e)

co-ordination of research on the most urgent and important problems

of biology, medicine and public health being carried on by national and international scientific institutions, with a view to making that research as effective as possible"; "(f) identification of the most rational and effective ways of helping

Member States to develop their own health systems and, first and foremost, to train national health personnel at all levels, provision of such assistance within the organizational and financial framework of the Organization and its Constitution, and participation in the co-ordination of such assistance from all sources". The pride of place given in the Constitution to WHO's co-ordinating role makes it essential to explain clearly what is meant by co-ordination. Co-

ordination implies, essentially, leadership aimed at bringing to bear the right solution on the right problem with the right amount and quality of resources at the right time and place. In selecting the right problems for WHO's involvement emphasis should naturally be given to the health problems of those peoples throughout the world who are at least capable of finding solutions of their own. In many developing

countries there is a dire lack of human, material and financial resources to cope with their burning health problems. Recent policy governing assistance to

developing countries which has been adopted by the World Health Assembly should therefore be applied with renewed vigour. 1

This does not mean that the problems Distinction between one type of

of more affluent societies can be ignored.

problem and another is not a manifestation of discrimination.

IPor example see Resolutions WHA 28.48, 28.75, 28.76, 28.78 and 28.79

37.

It is legitimate for the Organization to enter into critical dialogues with its Member States with a view to identifying the high priority health needs of their peoples. Such dialogues should help to minimize indiscriminate acquiescence in requests for assistance in relation to problems the solution of which could have only situation. Solutions to any health problem are not stereotypic. Appropriate solutions

a marginal

effect on improving the country health

to similar problems may vary widely according to local circumstances and cuI tures. There is a natural tendenc.y to apply to heal th problems in the

developing world solutions that have taken root in the industrialized countries. WHO's motto in this respect should be "Don't adopt-adapt". Whenever possible

attempts should be made to devise simple yet effective health technologies that can be applied by auxiliary health personnel for people who have no access to or no need for more sophisticated health services. Adaptation from one set of conditions to another is not a one-way process. There are outstanding examples in the Organization's history of health technologies which, having proved efficaceous and economical in developing countries, '--" I '

were later widely applied in developed countries. tory care for tuberculosis.

One such example is ambula-

The Organization is rich in expertise, being able It is the Organization's duty to

to draw on experts from allover the world.

make sure that the requisite expertise from whatever number and variety of disciplines required is brought to bear conjointly on health problems. The resources to be used should ~e

first and foremost those of the country

concerned, and the choice of solution for the problem concerned should therefore be largely determined by existing and potential national resuurces. This

emphasizes the paramount importance of training national health personnel in order to make countries largely self-reliant as quickly as possible for the implementation of health programmes. their health manpower. Even the highly developed countries cannot afford to waste This implies that skills have to be developed in accordance

38.

with tasks to be performed for the solution of health problems rather than solutions sought in accordance with eXisting skills. The economic use of

health manpower is even more important for less developed countries, and since it is most unlikely that they will have adequately trained professional health manpower in sufficient numbers within a reasonable period of time, solutions hitherto considered as unorthodox will have to be adopted. These solutions, such as the increasing training and use of auxiliary health personnel and traditional healers and midwives, may be unpopular with some policy makers but, if they are shown to be the most realistic, the Organization should attempt to convince the Member States concerned that the adoption of solutions of this nature would be in the best interest of their people and therefore politically wise in the long run, and in no way the expedient acceptance of an inferior solution. WHO's resources are meant to develop national resources, not to supplant' them. They should therefore be used at the national level,

primarily for collaborative analysis to promote the harnes1Sing of national resources and in particular for education and training. On the other hand,

for many years to come many governments will have to seek external aid, be it bilateral or multilateral. Such aid can make extremely valuable contributions Often capital investment in

to health development, but care has to be taken.

institutions, which was not followed up by the training of the requisite personnel or by adequate grants to cover current expenditure in subsequent years, has left an indifferent situation behind it, and in some instances it has had a det~mental

effect. WHO Should be increasingly involved in focussing

international attention on priority health problems and in assisting Member States to obtain and use external assistance that will help them solve problems. these

39.

The time horizon to be considered when formulating WHO's programme should be anticipatory rather than retrospective. Care must be taken not to continue

dealing with a problem that can now be dealt with by national health authorities or by other international organizations,even if the Organization played a pioneering role in providing the solution, As soon as solutions have been

found to current health problems the knowledge should be transferred as quickly as possible for application at national level. A constant watch has

to be kept for newly emerging health problems that will require WHO's attention, and attempts should be made to anticipate them and propose trial solutions. The prompt application of research findings should be promoted no less than further biomedical research. By properly adapting and applying the known

findings of biomedical and health practice research great improvements could be made in the health of peoples throughout the world. When planning health

programmes too, adequate attention must be paid to the future, taking into account the lengthy periods of time that must inevitably elapse between planning and implementation. It is easier to plan in relation to current

situations and even easier in relation to past situations, but both the necessity and the difficulty of planning in relation to future situations constitute precisely the kind of challenge that is meet for WHO's coordinating role.

As for the right place for WHO's activities, the primacy of activities within countries is unequivocal. In relation to activities conducted at any

other level, sight should never be lost of the supporting role of these activities for improving health situations within countries, whether directly or indirectly. The Organization's Member States are not only the main foci they also represent its highest constitutional authorities,

of its activities;

40.

It is the duty of all of

WHO'~

constitutional organs to impress on Member

States the importance of their active collaboration in maintaining a consistent approach to their individual priorities. The Organization can have no different A most important aspect of

set of priorities from those of its Member States.

the Organization's co-ordinating role is to ensure the complementarity of priority national health programmes and of the Organization's programme r~sulting from its general programmes of work and from the resolutions of the Executive Board and the World Health ASgembly. These measures should have the effect of

making country requests for WHO assistance consonant with their real needs, and of converting the Organization's programme into a rational response to their needs and requests. Technical assistance appears to have taken precedence over co-ordination in the evolution of the Organization's programme. It is now necessary to

moderate this trend, first by emphasizing programme rather than project, then by graduating from smaller to larger scale projects. This should be followed

by phasing out WHO's project implementation role along with the phasing in of the acceptance of national responsibility for current programme management as a successor to project implementation, and by the concomitant gathering of momentum of WHO's co-ordinating role. Among the reasons for emphasizing small projects in the past are that, being discretp. entities, they are more easily identifiable for international assistance, and are easier to formulate and manage than programmes. These

attributes have carried the disadvantage of leading to WHO assistance to countries being often provided through fragmented, unrelated efforts that are sometimes marginal to the solution of high priority health problems. In

recent years, in a number of countries, the systems analysis approach has led to a type of development project that emphasizes the production of an impact on

41.

the solution of priority health problems, instead of merely detailing the resources that are to be invested.

On the other hand, many programmes and

services, at national and other levels, appear to have no clear purpose in terms of their impact on solving clearly discernible health problems. is now mandatory to extend the analytical approach to programmes. At country level this trend should lead, in the first instance, to the definition of national health policies, and then to programmes aimed at solving the country's most important health problems through the formulation of strategies that, when implemented, are likely to have a significant impact on the solution of the health problems concerned. These might include major developThis demands It

ment projects where they are required and nationally acceptable. very careful programme formulation and very good management. and central levels, the systematic,analysis of p~grammes

At regional

should lead to

the formulation of programmes that have clearly 'defined, 'realistic purposes, whether for the support of individual national programmes or for the solution of priority regional or global health problems. This is where the Organization's technical assistance role and co-ordinating role must meet, programmes of technical assistance conforming to the prinCiples of co-ordination outlined above. The promotion of health is inextricably linked to the promotion of social and economic development in general. WHO has to become more prepared than

ever to work together with all the other organizations of the United Nations System which are ,concerned with social and economic development, as well as with other agencies of a bilateral or mUltilateral nature that wish to be involved in programmes of common concern. All this is a long-term process, but in the course of time, as the process advances, conflicts that have arisen as a result of the divergently attracting

42.

forces of technical assistance and co-ordtnatiori should progressively diminish until they finally disappear. countries. The speed of achievement cannot be forced on

Even if WHO succeeds in developiria its own rapid rate of progress

along the above lines, and although it is legitimate for i t to a ttempt to accelerate health development throughout its Member States, this acceleration will have to be adapted to a pace ~hat

countries can accept.

In view of the

long period of time that JllUst elapse

betwee~

the conception of any complex plan

and its ultimate realization, a start has to be made now, It is evident that, for the fulfilment of the above role, a great deal of innovation will be required. Innovation, however, does not necessarily It can also manifest itself as a new

imply the pursuit of new programmes. approach to existing programmes.

MOst imPortant of all, the role will have

to be properly understood and accepted by ali its constitutional organs and Member. States.

Programme principles. Taking into account the evolution of the health Situation and health

concepts in the world as described above, as well as the evolution and evaluation of WHO's own experience, the Sixth General Programme of Work Covering a Specific Period is intended to define major fields and directions for WHO programme activities in the period 1978-1983. These activities will

be a blend of country, inter-country, regional, inter-regional and world-wide programmes, which would derive both from the unique position and role of WHO in the development of world health as well as from its statutory, financial and other possibilities. Tho programmes of WHO should be oriented towards

defined goals and tasks during this period, and should include those major fields of activity which experience has shown to be most successful and productive.

43.

These programmes should be sufficiently flexible in order to integrate. global priorities with regional characteristics and individual country needs. They

should, finally, take into consideration all other possible international and national efforts and resources in the field of health. Therefore, the various programmes, activities, services and functions developed by the Organization within the Sixth General Programme of Work Covering a specific Period should be examined against the following criteria: (1) they should correspond to the majoriUnctions of the Organization

as defined by Article 2 of the Constitution and in particular by the Twentythird World Health Assembly in its resolution WHA23.59; (2) they should meed defined criteria in regard to quality of planning

and management as expressed in previous decisions of the Executive Board and the World Health Assembly, and as reflected in the growing experience of the Organization; and specifically in regard to the rationale for selecting

programme areas for WHO's involvement, programme approaches for attaining the objectives of these programme areas, the organizational level or levels for implementation of programme activities and the type of resource to be deployed. (3) they should concentrate on those problems or fields of activities

which have been identified as major objectives on a global or on a regional basis; (4) they should, to the extent possible, have quantified characteristics

and targets against which their progress could be assessed by the regional committees, the Executive Board and the Assembly.

44.

Medium-term implications of long-term trends for WHO's programme This will be prepared by Headquarters and presented later.

45. 7. Principal programme objectives The following are the principal objectives of the programme, grouped under 6 main headings. They have been arrived at as a logical consequence of the evolution of the world health situation and health challenges for 1978-1983, the evolution .and evaluation of WHO's programmes and the role and They are not synonymous

functions of WHO presented in chapters 2, 3 and 4.

with global priorities, but rather represent a functional classification of the organization's objectives. Priority programme areas and activities

with respect·to these objectives will vary from country to country and from region to region as well as centrally'. These regional and central variations

on global themes are exemplified in the details of the programme to be found in chapter 10.

Development of Heal th Services·

To assist countries to £urther develop comprehensive health services,

both at the community and at the national level. ·2. To promote closer cooperation of health services with social welfare

and other services and their integration, where appropriate. 3. To promote th~

development of standard health technologies and

their adaptation to various local needs. 4. 5. To promote maternal and child health including family planning. To promote better nutrition of all individuals and thereby reduce

the incidence of all forms of malnutrition. 6. To promote mental health including prevention of alcoholism and drug

dependence and abuse. 7. To promo~e

a more rational production, distribution and utilization

of safe, effective and economical prophylactic, diagnostic and therapeutic substances. ·8. To improve methods and mechanisms of financing health services

within a national context.

46.

II.

Disease Prevention and 'Control 9. 10. To prevent and control communicable diseases. To prevent and contr9l cancer, cardiovascular diseases,

oral diseases and other non-communicable diseases of major public hea'l th importance.

II!. Promotion of Environmental Health

11.

To promote and develop environmental health policies and

programmes. 12. To improve basic community sanitation, particularly community

water supply and disposal of wastes. 13. To promote recognition, evaluation and control of environmental

conditions and hazards which may affect human health.

IV.

Health Manpower Development

14.

To promote the development of the types and numbers of health

manpower needed to provide health services that are adequate and appropriate to the needs of the largest possible segment of the population. 15. To promote the development of relevant basic and continuing

educational processes (planning, curriculum development, methodology and evaluation) for all categories of health personnel.

Promotion and Development of Biomedical and Health Services Research

16.

To promote and assist in the development and coordination of

biomedical and health services research.

47.

VI. MechanismSfor Programme Development and Support

17.

To promote within the context of the overall socio-economic

development in Member States, systems for continuing planning, programming and management including financing and evaluation of health promoting activities. lB. To support social and economic policies and programmes with

health implications, such as rural and urban development, housing, education and economic development activities as appropriate. 19. To increase United Nations and other international, multilateral

and bilateral collaboration, in solving priority health problems or other socio-economic problems with significant health implications.

48.

Approaches

An approach is described in the "Glossary of Terms" in the Annex as a means,expressed in broad terms, for attaining an objective. There are various

means for attaining the same objective, and ideally each of them should be considered separately and in conjunction wi th others in order to arrive a.t what appears to be the best combination at the lowest cost. SOllie approaches

for attaining henlth objectives lie outside the health sector, for example, housing or development schemes which sweep away the eco~gical factors creating disease Situations. are available. Within the health sector very lIIany approaches

..-

WHO, in view of its international nature and limited resources

1s unable to apply all of them, but it is attempting to broaden its conceptual armamentarium and its technical and managerial repertoire for reaching its ends. The broad approaches used, or being Geveloped, by WHO include the provision of direct service to countries andthetra~ning

of national health personnel as

well as the creation of regional health institutions for training, research and development. International health coordinati~n

is of prilllordial importance.

The international exchange of information, the formulation of standards and the development, adaptation, application and transfer of lIIethods and techniques

related to health are all time honoured approaches applied by the Organization. Among other approaches that continue to be used by WHO are the development of health concepts, the promotion of international understanding of these concepts to provide policy makers with a wide choice for decision, participation in the formulation of international policies for health and social development, collaboration with other organizations and institutions for this purpose, collaboration in the formulation of national health and other social policies, collaboration in the formulation of national and international health legislat10n and the promotion of community participation. Studies and surveys,

49.

consultations with governments 'and health experts, as well as research and the application of its findings are all approaches widely employed for developing the Organization's programme. The following are a few illustrations of approaches that might be used at country level. One of the fundamental prerequisites for promoting health is the formulation of national health !)dlicies; WHO, mainly through its WRs, mi'ght be more active

in assisting countries to formulate these policies. Methodological support might have to be strengthened in relation to such matters as methods for projecting and forecasting health problems and needs and the introduction of country health planning and programming methods. If national health authorities encounter difficulties in conducting f

studt'es within' the heal thfield, these difficul ti,es are often accentuated manifold in relation to intersectoral stUdies involving economic and other social sectors. Pal"tioular attention might therefore be given by WHO to

providing assistance in'relation to such intersectoral studies.

The proposal of solutions for problems before these problems have been properly identified is a common phenomenon. For the correct identification

of problems situation analysis, epidemiological and statistical surveys, and pre-investment analysis might be used to greater advantage. Legislation is often required for the implementation of national health policies. Better~se

might be made of WHO publications on health legislation

by drawing the attention of ministries o'f health to legislation adopted in other'countries in relation to the questions concerned.

50.

Communi ty indifference is one of the grea test promotion.

s~m

bl ing blocks to health'

Fostering of community participation in the development and control

of health programmes is, therefore, often crucial for the successful implementation of these programmes. Popular information on health is essential for stimulating the public's interest in the promotion of its health and for leading to political interest in solving health problems. sensational. Such popular information is often inaccurate and

WHO might be more active in helping ministries of health to

provide accurate yet stimulating information on health to the mass information

It is a truism that national h~aith personnel are thl') key to the development and maintenance of a country's health programmes and services. The training

of national health personnel is therefore of paramount importance, but this training has to be conducted with a view to meeting the country's most pressing health manpower needs within the framework of its general manpower capacities. The provision of fellowships should therefore conform to a coherent plan for heal th manpower development. As countries own health ins.ti tutions develop,

additional emphasis might be laid on the provision of fellowships within the country.

The method of sending consultants to countries to solve specific problems for them has in most instances become outdated. Wherever possible, it should

be replaced by collaborative review with the national health administration or institution concerned.

51.

Requirements for technical support will no doubt evolve as the technological components of health programmes become more sophisticated. Technical support

might still be needed for such diverse activities as the introduction of laboratory techniques, quality control of drugs, environmental monitoring and the design of health facilities. Scientific support might grow in importance as countries' health research activities gather momentum. WHO might be able to help in such matters as the

setting up of medical research councils or by sending experienced research workers from other countries to work together for a year or two with local research workers until the latter gain sufficient experience and confidence. In view of the extended time lag between scientific and technological discoveries and their practical application, WHO might make special efforts to ensure that the knowledge of scientific and technological advances that is accumulating in the Organization becomes widely known at national level for possible application. At the same time, national health authorities and ins-

titutions might be more widely consulted in order to identify research require~.

Operational aSSistance, such as the provision of health personnel for a '-

defined period of time, as well as the provision of grants, for the development of institutions, for example, have become current practice and might have to be developed further in certain countries. The imPClrtanc.e_ of decentralized collaboration with other organizations and institutions is becoming increasingly recognized. Such local collaboration

should facilitate the channelling of the attention and resources of these organizations into ·priority health programmes at national level.

52.

Programme criteria One of the programme principles included in chapter 5 above states that

the Programme should meet defined criteria and specifies the types of criteria to be used. The criteria tha. follow are based on general logic, excluding

any technical conten., and thus, if suitably adapted, might be useful for application by countries, Regional Committees,. the Secretariat, the Executive Board and the World Health Assembly. They are intended for use first and

foremost for selecting programmes at the country level and for any type of heal th problem, so that re!;ional ,md Headquarters levels 'could respond to countries' requests using the same criteria. It is not intended that all Rather

of these criteria must be applicable, nor are they mutually exclusive. they represent the main types of criteria at decisions. (i) (a) Criteria for selection of programme areas for WHO involvement neces~ary

for arriving rationally

The problem with' which the programme area i~ concerned is clearly identified.

(b) The underlying problem is of major public health importance in terms of:-

incidence prevalencp. distributlon severity in terms of its related adverse socio-cultural and political implications. (c) The problem has a demonstrable potential for solution. (d) (e) The problem has major adverse economic implications. There is a strong rationale for WHO's involvement. The programme area is specifically mentioned in the Constitution, General Programme of Work, resolutions of the WKA, EB and Regional Committees, and/or governments have requested WHO's involvement.

53.

The prOblem requires international collaboration for its solution, WHO's involvement could have a significant impact in the promotion of world health. WHO's involvement will promote self-sustaining programme growth at national level. WHO has responsibilities as a specialized Agency of the UN System. WHO's non-involvement would have serious adverse repercussions,

(ii) Resource- criteria (a) (b) The programme area is appropriat'i' for funding from Regular Budget. The programme area may _be successfully developed and its activities maintained by Member States, after the- termination of WHO assistance. (c) The programae area-is likely to attract extra-budgetary funding whether .to countries or to WHO and from bilateral, multilateral, or non-governmental sources. (d) The capacity should exist or could be created if necessary for training . national or-in·ternational personnel for the programme area.

(iii)

Criteria for selection of appropriate approaches for attaining programme objectives

Once programme areas have been selected for WHO's involvement, it is , important to decide on the most appropriate approaches for attaining the objectives of each programme area. purpose: The approach! 1. Is destined ultimately to stimulate national health development, The following- criteria are intended for this

especially in developing countries. 2. Clearly identifies who is to benefit from activities to be conducted

in pursuit of the approach, and their contribution to these activities.

54. 3. Will lead to the development of broad national programmes rather

than to fragmented projects. 4. Is relevant to clearly identified actual or emerging health problems

within the programme area rather than to past or diminishing problems. 5. Is a suitable Regional Office response for supporting countries'

needs, or is a suitable Headquarters response to regional requirements for supporting countries' needs. 6. Includes, where appropriate, adaptation to various national contexts

of the technology involved. 7. Promotes the coordinated involvement of appropriate non-governmental

Organizations in the programme area. 8. Stimulates the use of WHO as a neutral platform for free expression

and genuine exchange of experience leading to the generation of information that can be put to practical use.

(iv)

Criteria for determining organizational level or levels for implementation of programme activities The following criteria are aimed at helping to determine at which organlza-

tional level or levels programme activities \;hould take place Country activities: 1. Should aim at solving problems of major public health importance in

the country concerned. 2. Should result from a rational process of identifying countries'

priority needs such as country health programming. Inter-country and other regional activi ti-es: 1. The pursuit of the activity as a collaborative effort of a number of

countries in the same region is likely to contribute significantly to attaining the programme objective.

55.

Similar

n~~d~ hav~ be~n

identified ina number of countries in the

same region following a rational process of programming. 3. Considerations of economy in the use of resources favour an inter-

country rather than a country activity. 4. Th~

inter-country

fram~work

us~ful

for pooling selected

re~ources,

e.g. for the provision of highly skilled advisory services to countries. 5. The activity encompasses regional planning, implementation and r~quir~d

evaluation or is 6.

for regional coordination. int~r

The activity involves guidance, monitoring and control of

country or country activities just being started in the region, or, when already established in the countries of the region it is further national activity in the programme area concerned at country level has been discontinued. 7. The activity is an essential regional component of an inter-regional int~nded

to stimulate

aft~r

WHO assistance

or global activity. Inter-regional and Headquarters activities: 1. The pursuit of the activity as a collaborative effort of a number th~

of regions is likely to contribute significantly to attaining objectives. 2.

programme

Similar requirements have been identified in a number of regions

following a rational process of programming. 3. Considerations of economy in the use of resources favour an inter-

regional rather than a regional activity. 4. The int~r-regional

framework is useful for pooling selected resources,

e.g. for the provision of very highly skilled advisory services to regions. 5. The activity encompasses global planning, management and evaluation.

56.

The activity is required for global health coordination and for

central coordination with other international agencies. 7. The activity consists of technical support to regions and/or between

regions and is intended to stimulate further regional activity in the programme area concerned.

57.

10.

Detailed programme framework This will be prepared by Headquarters and presented later.

58. 11.

Evaluation WHO is developing a new system of evaluation as an integral part of

programme planning and delivery at all organizational levels, based on soynd programme information. This system will be used for the e"aluation of the It is based in large measure on the OrgaR"ports asse~s

Sixth General Programme of Work.

nization's reporting system, which is beinjt compl"etely restructured. will now focus on progress made in implementing activities and on the

ment of the effect these activities are making on attaining the objectives of the programme area concerned. This system will be introduced for reporting

from WHO assisted projects in countries, from WHO representatives, from Regional Offices and from Headquarters programmes. The programme framework presented in chapter 10 contains details of the objectives, targets and output indicators of the Sixth General Programme. The basis of the evaluation of this Programme will be the subsequent comparison between planned attainments and actual achi?vements, For such comparison full

use will be made of the reporting system mentioned above, and the outputindicators are of particular importance for this purpose. In addition to periodic reporting it is intended to conduct specific evaluative reviews of WHO's programmes in countries in close collaboration with the national health authorities concerned. The evaluation of specific

programmes will also be conducted in Regional Committees, the Executive Board and World Health Assembly, particularly in the course of the review of the Organization's biennial programme budgets for the years 1978/1979, 1980/1981 and 1982/1983, which will be formulated within the framework of the Sixth General Programme. Finally, the progress of the Sixth General Programme as a

whole will be reviewed by the Executive Board at appropriate intervals and in particular before the Board embarks on the formulation of the Seventh General Programme of Work Covering a Specific Period.

ANNEX

GLOSSARY OF TERMS

OBJECTIVE

A desired aim or end, for example "the improvement of child health".

DETAILED

OBJ~TIVES

The

~reakdown

of an objective into subsidiary objectives:

For example,

for the objective "improvement of child health" some detailed objectives might be the reduction of perinatal mortality, the reduction of infant mortality, the improvement of child growth and development, the prevention of childhood infections and the 'prevention of accidents among children.

'TARGET An objective or detailed obj~ctives,

or group of detailed objectives

that have been made more specific in quantified terms and or in terms of time. For example, the reduction of the infant mortality rate to

thirty per thousand live births by 1980.

APPROACH

A means, expressed in broad terms, for attaining an objective:

For

example, surveys for assessing the infant mortality rate with a view to facilitating and monitoring the attainment of reduction in the infant mortality rate; or the public~tion

of popularized information on infant rate. Some approaches

care with a view to reducing the

infan~mortality

can be considered as intermediate objectives;

for example, the promotion

of community participation, the attainment of which will help to reduce infant mortality but requires a special effort in itself.

Annex,

p~ge

TYPE OF ACTIVITY

The practical interpretation of an approach in methodological and/or technical and/or logi$tical terms: For example, a repeated cluster

sample survey of a number of communities for assessing the infant mortality rate and for monitoring its reduction, or the formation of· a community mother club for promoting community participation in activities designed to reduce infant mortality.

OUTPUT INDICATOR

Variable for estimating the outcomes of programme or project activities. For example, the percentage of births attended by phYSicians, nurses, midwives or auxiliary nurse midwives as an indicator of the outcome of a programme for improving obstetric care. Ideally relevant base line

information should exist or be created at the beginning of the determined period in order to measure differences at the end of the period. However

the measurement of indicators requires an effort in itself and is often costly; dered. therefore the cost/benefit of , the measurement·has to be consiWherever possible at a reasonable cost, ways of arriving at the

indicators should form an integral part of the programme.

IMPACT INDICATOR

Variable for estimating the change in health or socia-economic situation brought about by the programme or project activities. For example, the

maternal and perinatal mortality rates as indicators of the effectiveness of a scheme for improving obstetric carecr the diminution of absenteeism rate as the consequence of a programme of occupational health.

Annex, page 3

A scheme of action for bringing about change in a specific period of time. This scheme should outline the objectives of the plan and the

approaches and types of activity required to attain these objectives.

PROGRAMME

An organized aggregate of services, activities and development projects

directed towards the attainment of defined objectives.

A programme

should ideally include the precise objectives, targets, methods, manpower, physical facilities, financial resources, time and their interrelationships required for the implementation of each service, activity and development project and for the aggregate of these services, activi-

ties and projects of which the programme is constituted, as well as output indicators for the evaluation of efficiency and effectiveness. For example,

programmes for maternal and child health, the promotion of mental health and cancer control.

10.

DEVELOPMENT PROJEX:T An aggregate of activities that have a definite time limitation and a pre-

determined amount of resources and that are directed towards the attainment of precisely defined quantified objectives. For exal1lple, the

d&velopment of a specific number of health centres, the construction of a sewage disposal plant or the building, equipping, staffing and commissioning of a hospital.

11.

COUNTRY HEALTH PROGRAMME

The totality of the health programl1les in a country. 1

The interpretation current in the UN System. In a number of countries the term "plan" means a precise definition of objectives to be attained, the determination of the resources to be deployed and the time taken for attaining them, and the allocation of responsibility for implementation.

Annex, page 4

12.

COUNTRY HEALTH PROGRAMMING

The systematic identification of priority health problems in a country, the specification of operational objectives for the solution of these problems and the formulation of programmes consisting of interrelated methods, activities, resources, time and organization required for the attainment of these objectives.

13 •

LONG TERM

Anything from ten to twenty years and above depending upon the nature of the plan.

14.

MEDIUM TERM

A period of time that coincides with the time frame of a WHO general programme of work, at present six years.

WPR/RC26/11

ANNEX 4

WHO REGIONAL OFFICE FOR THE WES'JERN PACIFIC DRAFT PROPCSALS FOR THE PRIR::IPAL AND DETAIIED OBJECTIVES OF Tl£SIXTH GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD (1978 - 198} INCLUSIVE)

(Submitted to Headquarters on 13 March 1975)

1. 1.1

PROGRAMME AREA A

STRENGTHENING OF HEALTH SERVICES

Programme I - Strengthening of health services Principal objectives (a) To assist in developing improved methods for the planning, programming and management of services serving the population, including the establishment or strengthening of suitable health information systems. To collaborate with the United Nations and its specialized agencies in joint programmes of assistance in connexion with social and economic development and in emergency/ disaster situations. To stimulate and assist in developing effective methods for financing health programmes and services from national and external sources, including the focussing of bilateral and multilateral aid on priority health problems. To help develop community health services for the delivery of health care to the widest possible segment of the population within the national socioeconomic framework. To assist in the prevention and rehabilitation of disabilities resulting from disease, accidents and other injuries. To promote and assist in the establishment or strengthening of health laboratory services to support medical services. Planning and management of health services

(b)

(c)

(d)

(e) (f)

1.1.1 Subprogramme:

Detailed objectives (a) To help establish, at national level, permanent machinery for national health planning and management, taking into account the needs for decentralization at regional and provincial level as well as the specific requirements of local areas. To assist in developing the capability of national staff in the systematic planning and management of health services. To promote and assist in the preparation and implementation of national health plans and/or country health programmes, including the proviSion of mechanisms for periodic evaluation and revision.

(b) (c)

- 2 -

(d) (e)

To help in developing methods for financing priority health programmes from national and external sources. To assist in establishing and developing a suitable

health information system that will meet the needs in planning and management at all levels of the health administration. 1.1.2 Subprogramme: Joint programmes of assistance with the United Nations and its specialized agencies Detailed objectives (a)

To collaborate in joint programmes with the United Nations and its specialized agencies in support of broad-ranged intercountry activities for social and economic development. To participate in United Nations and/or specialized agency efforts to assist countries in emergency/disaster situations. Organization and delivery of health care

(b)

1.1.3 Subprogramme:

Detailed objectives (a) To help develop organizational and functional collaboration between hospitals and community health services in support of improved delivery of health care to the population. To assist in the orientation/training of national staff having responsibilities in the organization and delivery of health care. To collaborate in studies to improve the productivity and standards of health care services. Medical rehabilitation

(b)

(c)

1.1.4 Subprogramme:

Detailed objectives (a) To promote the adoption of policies and programmes for the prevention and rehabilitation of physical disabilities resulting from disease, accidents and other injuries.

(b) (c) (d)

To help establish or strengthen specialized services and centres for medical rehabilitation purposes. To collaborate in concurrent activities for training of professional and auxiliary health manpower. To promote and assist in undertaking a nationwide programme of information and education on accident prevention and on the services available for medical rehabilitation.

- 3 (e) To assist in developing cooperative working relationships between specialized rehabilitation services and community health services, to ensure wider coverage of the population in need of assistance in rehabilitation. Health laboratory services

1.1.5

Subprogramme:

Detailed objectives (a) To help establish/strengthen central health laboratory services which will be responsible for providing technical guidance, planning programmes, adopting standards and serving as referral centres for health laboratory activities in the various countries. To help develop/strengthen intermediate and secondary level laboratory facilities in support of medical services. Maternal and child health including family planning

(b)

1.1.6 Subprogramme:

Detailed objectives (a) To help foster programmes for the health of the mother and the child, by systematically applying promotive, preventive, curative and restorative measures through the health and social services. To promote the integration of family planning in the maternal and child health component of the general health services. Nutrition

(b)

1.1.7

Subprogramme:

Detailed objectives (a) To promote the development of national food and nutrition policies through coordinated action by all related agencies. To collaborate in developing a method for nutrition surveillance with the use of simple indicators. To assist in determining priorities and alternative strategies for nutrition activities in the context of the existing health services. To assist in reducing the incidence of specific deficiencies through food fortification and other mass campaigns. To strengthen the training of nutrition personnel.

(b) (c)

(d) (e)

- 4 1.1.8 Subprogramme: Health education

Detailed objectives (a) To help promote positive attitudes on the part of individuals and the population as a whole towards personal and environmental hygiene and the roles they should play in improving the health standards of the community.

(b)

To promote the incorporation of health educational components in general and special health programmes, so as to ensure community understanding and support of the programmes.

(c)

To participate in training health staff in health education concepts and practices, thus enabling them to secure community understanding and support of their programmes. Development of health statistical services

1.1.8 Subprogramme:

Detailed objectives (a) To help strengthen health statistical services as an integral part of the information systems of national health administrations.

(b) (c) (d)

To assist in upgrading the recording and reporting systems of health services. To promote statistical services in support of national epidemiological surveillance. To participate in the orientation/training of staff engaged in the compilation of health statistics and medical records. HEALTH MANPOWER DEVELOPMENT

PROGRAMME AREA B

2.1

Programme I - Health manpower development Principal objective To assist in developing the required categories and quantities of health manpower needed to provide health services adapted to the population's needs.

2.1.1

Subprogramme:

Planning for health manpower development

Detailed objective To promote health manpower planning, as part of the health component of national socioeconomic development planning, and as an activity carried out in collaboration with the education sector.

- 5 2.2 Programme II - Education and training of health manpower Principal objective To assist in developing and conducting basic and post-basic training courses for different categories of health manpower. 2.2.1 Subprogramme: manpower Training and training methodologies for health

Detailed objectives (a) To assist in developing national policies for training health workers which can be adapted to service requirements in the field. To assist in the development and adaptation of curricula

(b) (c)

for the training of health workers. To collaborate in developing, organizing and carrying out special courses for training of teachers of the different categories of personnel in the health services. DISEASE PREVENTION AND CON'IROL

3. 3.1

PROGRAMME AREA C

Programme I - Communicable disease prevention and control Principal objective To assist in communicable disease surveillance, prevention and control, including vector control, and to assist in conducting related studies.

3.1.1

Subprogramme:

Epidemiological surveillance

Detailed objective To assist in strengthening the epidemiological surveillance of communicable diseases. 3.1.2 Subprogramme: Malaria control

Detailed objective To help in planning, implementing and evaluating national antimalaria programmes. 3.1.3 Subprogramme: Control of important parasitic diseases

Detailed objective To collaborate in stUdies on the epidemiological aspects of s.chistosomiasis, filariasis and other parasitic diseases and in formulating programmes for their control.

- 6 3.1.4 Subprogramme: Bacterial infections

Detailed objective To participate in epidemiological studies of common bacterial infections, especially plague, cholera and other enteric infections such as salmonellosis and Shigellosis, with a view to developing programmes for their control.

3.1.5 SUbprogramme:

Mycobacterial diseases (tuberculosis and leprosy)

Detailed objective To help in formulating and implementing tuberculosis and leprosy control programmes.

3.1.6 SUbprogramme: Virus diseases Detailed objective To promote the epidemiological surveillance of important virus infections and assist in implementing control measures with special reference to poliomyelitis and dengue haemorrhagic fever.

3.1.7 Subprogramme:

Venereal diseases and treponematoses

Detailed objective To help formulate and execute venereal disease control programmes and to maintain surveillance of treponematoses. 3.1.8 Subprogramme: Veterinary public health

Detailed objective To participate in the assessment of prevailing veterinary public health problems and help in formulating control programmes with special reference to rabies.

3.1.9

Subprogramme:

Vector biology and control

Detailed objectives (a) (b) (c) To collaborate in stUdies on the ecology of arthropod vectors of disease. To help develop procedures for surveillance and control of arthropod vectors. To promote the safe use of pesticides.

- 7 3.2 Programme II - Noncommunicable disease prevention and control Principal objectives (a) To collaborate in stUdies and the formulation of measures on the surveillance, prevention and control of cancer, cardiovascular diseases and other chronic diseases of major public health importance. To promote the development of dental health programmes. To promote studies and assist in programmes on the prevention and control of alcoholism and drug dependence and abuse. To promotp. and support the application of national and international standards on the quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances. Cancer

(b) (c)

Cd)

3.2.1

Subprogramme:

Detailed objective To promote and assist in the collection of information and the conduct of stUdies on the epidemiology of the more prevalent types of cancer in order to develop programmes of prevention and control.

3.2.2

Subprogramme:

Cardiovascular diseases

Detailed objective To promote the collection of information and the conduct of stUdies on the epidemiology of cardiovascular diseases and to assist in initiating or improving prevention and control measures. 3.2.3 Subprogramme: Other chronic noncommunicable diseases

Detailed objective To promote and collaborate in epidemiological studies on prevalent chronic diseases, including diabetes, and assist in initiating or improving,measures for their prevention and control. 3.2.4 Subprogramme: Dental health

Detailed objective To assist in establishing or strengthening national dental health programmes, with emphasis on the protection of vulnerable segments of the population.

- 8 3.2.5 SUbprogramme: Mental health

Detailed objectives (a) (b) To assist in developing mental health services as an integrated activity of the general health services.

To promote and assist in studies on the epidemiology of mental health in the social and cultural context of countries. Drug dependence and alcoholism

3.2.6 Subprogramme:

Detailed objectives (a) To collaborate in assessments and other studies to determine the magnitude and character of the drug dependence and alcoholism problem and the etiological factors responsible. To assist in the control and rehabilitation of victims of drug dependence and alcoholism. Biomedical aspects of radiation

(b)

3.2.7 Subprogramne:

Detailed objectives (a) (b) To assist in improving the use of radiation and radioisotopes in preventive and curative medicine. To assist in establishing radiation protection services in the medical use of ionizing radiation and strengthening existing ones. To assist in adopting the necessary measures to prevent or avoid the harmful effects of radiation.

(c)

3.2.8 Subprogramme:

Supervision and quality control of drugs

Detailed objectives (a) To assist national health administrations in developing policies and regulations for ensuring safety, quality and effectiveness in the manufacture, distribution and use of pharmaceuticals. To promote and support internationally-accepted practices for assessing the safety, quality and effectiveness of drugs, before and after their release for general use, including monitoring of their adverse effects.

(b)

- 9 -

4. 4.1

PROGRAMME AREA D

PROM~ON

OF ENVIRONMENTAL HEALTH

Programme I - Promotion of environmental health Principal objectives (a) To promote the development of environmental health policies in institutions, services and programmes.

(b) . To assist in the strengthening of basic sanitary measures in the community with particular regard to community water supplies and the disposal of wastes. (c) To help in the assessment and adaptation of measures against hazards involving the environment of working populations. To promote and assist in studies and programmes for food protection and safety. Provision of basic sanitary measures

(d) 4.1.1

Subprogramme;

Detailed objectives To assist in developing and strengthening basic sanitary facilities and services - particularly water supplies, excreta disposal facilities, sewerage and drainage systems, etc.

4.1.2

Subprogramme:

Pre-investment planning for basic sanitary services

Detailed objectives (a) (b) To assist in drawing up plans for urban and rural water supplies and waste disposal. To assist in formulating proposals to obtain financial support from national and external sources for the construction of specific sanitary schemes. Control of environmental pollution and hazards

4.1.3

Subprogramme:

Detailed objectives (a) (b) To collaborate in the assessment of environmental pollution and hazards in the community. To assist in the adoption of environmental standards and the formulation and execution of measures for surveillance of environmental pollution and hazards. To help in developing programmes to reduce or eliminate environmental pollution and hazards, including provision for the adoption of necessary regulations.

(c)

- 10 -

(d)

To collaborate in evaluating radioactive contamination of the environment. Health of the working population

4.1.4 SUbprogramme:

Detailed objectives To assist in formulating standards and programmes for reducing or eliminating environmental hazards; to provide facilities for health protection of the working population, and to train needed health staff. 4.1.5 Subprogramme: Establishment and strengthening of environmental health services and institutions Detailed objective

To assist in establishing and strengthening environmental health services and institutions. 4.1.6 Subprogramme: Food standards

Detailed objectives (a) (b) To assist in conducting stUdies for the identification and solution of specific problems of food hygiene. To assist in planning and implementing food hygiene programmes, including assistance in the formulation of standards and procedures for food hygiene practice.

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 1975

Source World Health Organization