WORLD HEALTH ORGANIZATION • REGIONAL OFFICE FORAFRICA
ORGANISATION MONDIALE DE LA sANIE ri BUREAU REGIONAL DE L'AFRIQUE
ORGANIZAÇÂO MUNDIAL DE SAUnE SEDE REGIONAL EM AFRICA
REGIONAL COMMITTEE FOR AFRICA Forty-eighth session Harare, Zimbabwe, 31 August - 4 September 1998
AFR/RC4817 26 June 1998 ORIGINAL: ENGLISH
Provisional àgenda item 8 REPORT OF THE PROG~SUBCOMMITTEE
CONTENTS Paragraphs
OPENING , , , .. . ... . ............ .. ..... . ..... .... .... ... ........ . ......... , .... 1-6 PROPOSED PROG~
BUDGET - 2000-2001 (document AFRlRC48/2) . ..... .. , ... 7-62
Overview . .. . . ... . , .. , . . .. ... ,., . . "" .. . . " , .. . " ". " . .. " " ...... , . .... 7-18 Governing Bodies ........... . ...... , .. . , . , .. , ..... , .... .. .. , . . . ... ... " ... 19-25 Health Policy and Management ....... . ...• . . . .. . ... . . . . .... . .. . . . . . .... . . .. . . 26-33 Health Services Development .. . , ., . ... . . , .. ... , . . . .. .. . , . . .. . ... ...... . . , ... 34-39 Health Promotion and Protection , ... . . . .... . . . . , ... .. , .. , . . , . . ... .. . .. .. . , ... 40-45 Integrated Disease Control ... ... .. " . . ' . " . . ' . .. .. , . . ,. "", . . , . . , ... , . . , . . , 46-56 Administrative Services, ... .. , . ...... . ....... .. ...... , . , .. . . . ......... . . . ... 57-62 FUNCTIONS OF WHO, ARTICLE 2 OF THE CONSTITUTION (document AFRlRC48/1 6) ... . ........ . ................................ . ......... 63-71 TERM OF OFFICE, QUALIFICATIONS AND SELECTION OF REGIONAL DIRECTORS (document AFRlRC48fI7) . .... .. ..... . , .. . .. , .. ... .... . .. . ...... , . . 72-79 INTEGRATED DISEASE SURVEILLANCE IN AFRICA: A REGIONAL STRATEGY, 1999-2003 (document AFRlRC48/8) . ' . ... . . , . . . . ..... , .. 80-94 ORAL HEALTH IN THE AFRICAN REGION: A REGIONAL STRATE GY (document AFRlRC48/9) . . . .. ..... ' . .. . . .. . , .. .. . .. . .. . , . ..... .. . . . , . . .. . . ' ... . 95-108 HUMAN RESOURCES FOR HEALTH IN THE AFRICAN REGION: A REGIONAL STRATEGY (document AFRlRC48/1O) ... .. ..... .... ........ "" .. 109-120 STRA TEGIC HEALTH RESEARCH PLAN FOR THE WHO AFRICAN REGION, 1999-2003 (document AFRlRC48/11) . . ......... , ... . , . ............ . . . . 121-138 ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITIEE (document AFRlRC48/7) .... . .... .. .. . .. , ..... . ............. . ................... 139 ASSIGNMENT OF RESPONSIBILITIES FOR THE PRESENTATION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE TO THE REGIONAL COMMITTEE .. ... .. . . . , . ... .... ... , . .. .. . ..•.. . ... .... . . . . . . . .. . .. . " .... .. . 140 CLOSURE OF THE MEETING .. ..... , ...... .... . , .. , .. ... .. , . .... . .... , .. , 141-148
'. AFRlRC48/7 page 1
OPENING
1.
The Programme Subcommittee met in Harare, Republic of Zimbabwe, 22-26 June 1998. The
bureau was constituted as follows:
Chainuan: Vice Chainnan: Rapporteurs:
Dr Casimir Ü1jioke (Nigeria) Dr Malick Niang (Senegal) Dr José da Costa Frota (Sao Tome & Principe) Dr Steven V. Shongwe (Swaziland)
2.
The list of participants is attached as Annex 1.
3,
The Regional Director, Dr Ebrahim M. Samba, we1comed members of the Programme
Subcommittee and reminded them of the importance attached to the work of the Subcommittee by the Regional Committee. It was recommended in the last session of the Regional Committee that the tenus ofreference of the Subcommittee should be reviewed and also that the Subcommittee should meet much earlier so that its recommendations can be made available on time for the consideration of the Regional Committee.
4.
The Chainuan of the Programme Subcommittee, Dr C. Ü1jioke, expressed his gratitude and that
ofhis country for being elected as Chairman. He reminded the Subcommittee of the need to ensure that the various issues to be discussed were done within the context of the African perspective.
5,
The provisional programme ofwork (Annex 2) was adopted as presented.
6.
The Programme Subcommittee adopted the following working hours: 8.30 a.m. to 12.30 p.m. and
2.00 p.m. to 5.00 p.m. both periods inclusive oftea breaks. The Agenda is attached as Annex 3.
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PROPOSED PROGRAMME BUDGET, 2000-2001 (document AFRIRC4812) OVERVIEW
7.
Mr K. Adikpeto of the Secretariat presented the overview of the proposed programme budget.
8.
He reminded the Subcommittee that it was the last programme budget of the period covered by the
Ninth General Programme ofWork (1996-2001) as well as the first programme budget of the 21st century.
9.
General guidelines from headquarters had been followed in preparing the budget. Two major
assumptions made were that before the budget's implementation, the Regional Office would have been re\ocated to Brazzaville and that the implementation of the policy on decentralization of regional functions would have advanced. Other considerations taken into account were zero budget growth rate and the prevailing exchange rate in 1998-1999. The priorities provided by the Executive Board had also been taken into consideration.
ID.
He added that the proposed programme budget document was in six sections - namely, introduction,
budgetary analysis, summary tables, country activities, regional programme analysis, and analytical tables.
II. The total budget was US $235 517 000 and the Subcommittee was invited to make necessary comments and recommendations.
12. The Regional Director reminded the meeting that the Director-General elec! would hold full consultations with the Regional Directors and Regional Committees before the proposed programme budget is revised to reflect her new orientations. Ifnecessary, the Programme Subcommittee's meeting might be convened in future to review the revised regional programme budget, particularly if substantial modifications would be made to the existing draft.
13.
He added that the Executive Board and the World Health Assembly had agreed to allocate more
regular budget to the African Region. The increase would be phased over at least three biennia.
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14. Dr A.M. d'Almeida, the Director of Programme Management, reminded the meeting that the parts of the proposed programme budget document dealing with country activities were usually not discussed by the Subcommittee. He suggested that each Divisional Director he allowed to present highlights of the appropriation section relevant to him or her before the meeting undertook a review and discussion on the section.
15. The Subcommittee wanted to know the average amount allocated to each country from the regular budget as well as how, when and by whom extrabudgetary funds were allocated hetween countries.
16.
The importance of releasing whatever money was withheld by headquarters to the regional and
country levels in a timely fashion so as to facilitate spending such funds hefore the deadline, was stressed.
17. The Regional Director informed the meeting that although allocation of the regular budget to countries, using sorne criteria that had been in place for many years, varied from country to country, it was on the average, about US $1.9 million per country.
18.
The amount from extrabudgetary sources could not he predetermined, although the Region had
experienced a significant increase in such funds over the last three years. The Regional Director concluded that one of the major problems with extrabudgetary funds was that certain programmes benefited from that source more than others. Usually the donors target the allocation of extrabudgetary funds to certain programmes.
GOVERNING BODIES
19.
Dr N. Nhiwatiwa of the Secretariat presented highlights of the section of the Programme Budget
relating to the work of the Goveming Bodies.
20.
She reminded the Subcommittee of recent reforms and budgetary reductions introduced by the
Executive Board and the World Health Assembly. These measures were aimed at improving the conduct and efficiency of meetings of the Goveming Bodies and included a reduction in the duration of meetings of the Regional Committee from lOto 6 days and a review ofthe terms of reference of the Programme Subcommittee.
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21.
Reductions in size, reader-friendliness and timely despatch of conference documents as we\1 as the
holding of conference-related workshops at country level were among other measures aimed at improving the quality of Regional Committee deliberations and the resulting decisions and resolutions.
22.
The Subcommittee was invited to examine this section in detail, make suggestions and provide
guidelines with particular regard to the work of the Regional Committee.
23.
The Subcommittee cautioned that inevitable delays in the travel of delegates to the Regional
Committee could adversely affect the quality of deliberations when the duration of the meeting was drastically reduced.
24.
Clarifications were sought by the Subcommittee on sorne of the indicators that had been defined,
particularly the qualitative ones.
25. The Secretariat assured the Subcommittee that action plans based on the proposed Programme Budget would provide quantitative indicators for a\1 targets.
BEAL TH POLICY AND MANAGEMENT 26. Dr A. M. d'Almeida of the Secretariat provided additional guidance on this aspect of the Proposed Programme Budget.
27. He reminded the Subcommittee that the major programmes under the appropriation section were: General programme development and management; Health, science and public policy; National health policies and programmes development and management; and Biomedical and health information and trends .
28. He requested the Subcommittee to carefully go through the strategie objectives, targets, expected results and monitoringlevaluation indicators for each major programme and make appropriate comments, suggestions and recommendations.
29. ln their discussions of this section of the proposed programme budget, members of the Subcommittee observed that there was need for WHO to ensure the a\1ocation of a reasonable proportion of the WHO budget to support activities at the sub-nationallevel, particularly the district level.
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30. Since sorne countries might have already developed sorne framework for forging a linkage between health development, poverty alleviation and socioeconomic development, the Subcommittee was of the opinion that any regional framework on this issue should take note of existing framework in sorne countries. Indeed, the objective of WHO should be to strengthen countries' framework, where they already èxisted, and assist countries without appropriate framework to develop one.
31 . The need for the Regional Office to respond promptly and positively to country requests for technical support, particularly in the area ofhealth policy and plan development, was stressed.
32. The Secretariat reminded the meeting that the targets indicated were those of WHO (at regional level) and not country targets.
33. On the issue of allocation of adequate resources for district level activities, the Secretariat reminded the meeting that the Regional Committee had in the past adopted a resolution !hat at least 50% of the WHO country budget be allocated to district level activities. The Subcommittee might want to bring that earlier decision to the notice of the Regional Committee for effective implementation.
HEALTH SERVICES DEVELOPMENT 34. Dr L. G. Sambo of the Secretariat presented this section of the proposed programme budget.
35. He reminded the Subcommittee that the programmes under the section aimed at providing support to eountries to develop their health systems based on primary health care, with a special focus on the district level.
36. He indicated that the major programmes covered by the section were: (i) organization and management of health systems based on primary health care; (ii) human resources for health; (iii) essential drugs; and (iv) quality of care and health technology. He also highlighted the major priorities, strategie objectives, targets, indieators of the programmes, and the allocated budget.
37. The Subcommittee stressed the importance of the various health services development programmes for the African Region. The Subcommittee also underscored the importance of sharing information and experienees, among others through the distribution of produced documents (e.g. the District Management Training Manual produced with support from NORAD) when ready and the organization of intercountry
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meetings as indicated in the proposed programme budget. In addition, the need to seriously address the issue ofbrain drain was raised.
38. The Regional Director confirmed that the Regional Office would continue to organize intercountry meetings, especially those that will strengthen the performance of the districts. The organization ofvisits to countries whose district health systems were performing weil by countries that were not performing as weil, was also referred to as an option that could be facilitated by WHO.
39. Dr Sambo reminded the Subcommittee that40 ofthe 46 countries of the Region participated in an intercountry meeting on the operationality of District Health Systems which was organized recently and that a follow-up meeting would be organized the following year. The issue of brain drain had been addressed in the regional strategy on human resources for health.
HEALTH PROMOTION AND PROTECTION
40. This section of the proposed programme budget was presented by Dr R. Tshabalala of the Secretariat.
41. She explained that the division consisted of the following four major programmes: reproductive family and community health and population issues; healthy behaviour and mental health; nutrition, food security and safety; and environmental health. The major priorities, strategie objectives, targets and indicators for each programme were also highlighted.
42. The Programme Subcommittee noted the importance of the various programmes and stressed the need for them to be given more attention.
43. Other issues raised, included the following: eountries in the Region should be assisted to develop national mental health policies;
reliable management information system (MIS) should be established in countries for the whole health system and not just for one programme;
AFRlRC4817 page 7
there was need to focus on the preparation of food for public consumption as wel1 as the environrnent in which they were sold;
health services at entry points into countries had been neglected in the Region and needed attention.
44. The Regional Director mentioned that the Director-General elect of WHO had identified reproductive health, mental health and non-communicable diseases among others, for special focus. He indicated that the Regional Office could provide technical and material support to countries for the regular provision of information relating to health issues in the newspapers and on radio and television.
A project to this effect was currently under discussion.
45 . The procedure of al10cating budget to both countries and the Regional Office was thoroughly explained.
INTEGRATED DISEASE CONTROL
46. Dr D. Barakamfitiye of the Secretariat presented this section of the proposed programme budget.
47.
He underscored the importance of communicable diseases (such as diarrhoeal diseases, malaria,
vaccine preventable diseases, HIV/AlDS, tuberculosis, epidemics) and non-communicable diseases in the Region. He mentioned the need for accelerating the implementation of disease control programmes to further reduce the burden of diseasçs, within the context ofhealth sector reform that was being carried out in many countries.
48.
During the discussions, the Subcommittee noted that several countries stil1 had a smal1 budget for
health at a time when the burden of communicable diseases remained high and non communicable diseases were increasing.
49 . The need to indicate the constraints facing the implementation of disease control programmes was underscored. It was also noted that the changes in the epidemiology of diseases required the
establishment of sound surveillance mechanisrns in the Region in order to orientate actions and facilitate monitoring the impact of the interventions.
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50. The Subcommittee further stressed the need for implementing aggressive interventions to reduce the morbidity and mortality due to malaria and other diseases such as measles, haemorragic fevers, meningitis and tuberculosis.
51 . Strengthening the control of malaria through the African Initiative for Malaria Control was noted. It was suggested that additional efforts and funds be made available.
52. Unlike the results achieved with National Inununization Days, the routine immunization coverage remained low in several countries and new antigens such as Hepatitis B vaccines were not being added to the EPI. The Subcommittee requested the Regional Office and countries to allocate specifie funds for district microplanning, social mobilization and refurbishing of the cold chain as weil as funds for operations so that increased routine coverage would be achieved.
53.
Countries and partners were requested to identify funds for the procurement of Hepatitis B
vaccines, so that the high prevalence of liver cancer could be reduced in the Region. 54. The Subcommittee underscored the high prevalence of non communicable diseases (mainly
coronary heart diseases and diabetes mellitus) in the Region and indicated that sorne countries had developed adequate information on the patterns of these diseases. 55. The Subcommittee requested that this section of the Programme Budget be modified to reflect the
high prevalence of non-communicable diseases. 56. On the proposed budget for the overall disease control programme, the Subcommittee recommended that the figures be increased given the magnitude of the problems and the required measures to be implemented.
ADMINISTRATIVE SERVICES 57. Mr K. Adikpeto of the Secretariat presented this section of the proposed programme budget. 58. He stated that the priority of the Division was to improve its effectiveness through the use of greater computerization, standardization and delegation of authority. He indicated that this had been initiated in Brazzaville but was interrupted by the forced relocation to Harare. He added that the relocation had created certain managerial difficulties which would soon be overcome.
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59. The Subcornrnittee suggested thal other strategies in addition 10 compulerization were necessary in order 10 improve personnel services as well as enhance efficiency in the operations of Ihe office.
60. Clarifications sought by the Subcornrnittee on the reduction in the budget for administrative services were provided.
61. The Subcornrnittee was assured that other strategies for enhancing the efficiency of administrative services were being explored.
62 . The Regional Director added that efforts were being made to reduce the administrative bureaucracy of WHO.
FUNCTIONS OF WHO, ARTICLE 2 OF THE CONSTITUTION (document AFRIRC48/16) 63. Dr A. M. d'Almeida of the Secretariat presented document AFRlRC48/16. 64. He reminded the meeting that as part of the WHO reform process, a Special Group was set up by the Executive Board to review the Constitution of the Organization. The Group considered WHO's mission and functions and the provisions of the Constitution that might need further examination with a view to possible revision. One of the issues on the Constitution that still had to be resolved related to Article 2 on the functions of WHO that would facilitate the achievement of the Organization's objective as stated in Article 1. 65 . The report of the Special Group was contained in document EB.IOI/7 of 14 November 1997. At the eighth meeting of the 101 st Session of the Board, it was decided that the Director-General should ensure that the revised text of Article 2 as contained in the report of Ihe Special Group was reviewed at allieveis of the Organization during Ihe course of 1998. A final text, reflecting the broad consultative process, was 10 be submitted 10 the Executive Board al its 103rd Session in January 1999.
66. He added that whilst the existing Article 2 listed 22 functions, the revised text had grouped the functions into five broad areas and elaborated on the activities that the Organization would need to carry out with respect to each broad function.
67. He concluded that the document, which was the revised text of Article 2 of the Constitution, was submitted 10 the Regional Cornrnittee for reyiew and comments which would be sent to the Director-
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General as the Region's input to the preparation of the final text of Article 2 to be presented to the 103rd Session of the Executive Board.
68. The Regional Director requested the Subcommittee ta examine the fimctions as defmed with a view to determining if given the prevailing conditions they met the needs of the Region, and to make recommendations to the Regional Committee on changes they would want to make. 69. The document was exhaustively discussed after further clarifications sought were made by the Secretariat. In addition ta minor editarial corrections, the following suggestions were made by members: On broad fimction 1
(c)
add "monitoring" after "implementing";
On broad fimction 2
(b) (c)
change "of disease treatments" to "on diseases, including their treatments"; delete "mental iIIness and substance abuse".
On broad fimction 3
(c)
change ....... food, biological, pharmaceutical and similar products" to ....... food, biological, pharmaceutical, chemical, and similar products".
On broad fimction 5 (d) add "and to communicable and non-communicable diseases" at the end.
70. Il was observed!hat although I(e) was very relevant for broad function l, it was equally important that WHO should work with, and promote cooperation between professional groups and nongovemmental organizations active in the field ofhealth at the nationallevel. 71. Finally, in order to accommodate any other fimction and activities that had not been covered under the proposed broad functions (1)-(5), il was suggested that a reformulation of the existing function (v) be added (i.e. "generally to take any ~ necessary action to attain the objective of the organization").
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TERM OF OFFICE, QUALIFICATIONS AND SELECTION OF REGIONAL DIRECTORS (document AFRlRC48/17) 72. Dr A. M. d'Almeida of the Secretariat presented document AFRIRC48117. 73. He reminded the Subcommittee!hat a special group of the Executive Board set up in 1996 to review the Constitution and regional arrangements of the World Health Organization proposed, among other things, that the term of office of the Director-General would be tive years, renewable once, but!hat the rule should not be applicable to the incumbent. 74. A special regional working group set up in 1997 to review the Constitution made recommendations as contained in document AFRlRC47/INF.DOC/1 which were not discussed during the Committee's forty-seventh session. The recommendations included criteria for selection, the selection process and the term of office of the Regional Director. 75. The forty-eighth session of the Regional Committee had been required to discuss the subject of the appointment of the Regional Director. The document had been developed by the Secretariat to guide the Committee in its deliberations on the subject. Il had drawn on the recommendations of the special group of the Executive Board, the new method of selecting the Director-General, the recommendations of the Regional Working Group of 1997, and document EUR/RC48112 from the European Region. 76. The Regional Committee was invited to decide upon the term of office, qualifications and process for selecting the Regional Director; constitute the tirst Regional Search Committee; and consider that what is being done is part of the process for the evaluation of candidates for nomination for the post of Regional Director at the forty-ninth session in September 1999. 77. The Regional Director further elaborated on the background of the document and underscored the importance of putting in place a transparent process for selecting the Regional Director. 78. Members of the Subcommittee sought clarifications on many parts of the document which was discussed paragraph by paragraph.
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79. The major comments and recommendations made on the document were as follows: (i) General comments
The numbering of the paragraphs should be done in such a way that: Paragraphs 7, 8, 9, 10, II and 12 be numbered 6.1, 6.2, 6.3, 6.4, 6.5 and 6.6 respectively; Paragraph 13 should become paragraph 7; Paragraph 14 to become 8; Paragraph 15 to become 9; Paragraphs 16, 17, 18, 19 and 20 should become paragraphs JO.1, 10.2, 10.3, 10.4 and 10.5 respectively; and Paragraph 21 should become paragraph Il.
(ii)
On the term of office After exhaustive discussion, the recommendation of the Secretariat on this item was supported by the Subcommittee.
(iii)
On quaIifications
6.1 - the second sentence should be rewritten as: "There must be demonstrated evidence ofhis or her personal involvement or an effective plan to operationaIize hislher commitment to WHO's mission". (iv) On principles ln (a), "nomination" should be changed to "designation";
ln (d), replace "should constitute the screening body" by "constitutes the screening body". On tennS ofreferençe of the Regional Search Committee (c) Change "conceming the candidates" to "conceming the work of the candidates".
(v)
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page 13
(vi)
On membersbin of the Regional Search Committee
Third sentence: Change .......... geographical and linguistic representation" to ...... geographical. gender and linguistic representation" ;
Last sentence: Reformulate to read "Any member of the Regional Search Committee coming from a country which presents a candidate for the post of Regional Director should not participate in the deliberation concerning that candidate".
(vii)
On the work of the Regjonal Search Commjttee
After exhaustive discussion. the recommendation of the Secretariat on this item was supported by the Subcommittee.
(viii) On decision expected from the Regional Committee
The Subcommittee supported the Secretariat 's proposaI.
INTEGRATED DISEASE SURVEILLANCE IN AFRICA: A REGIONAL STRATEGY, 1999-2003 (document AFRIRC48/8) 80. Dr D. Barakamfitiye of the Secretariat presented document AFRlRC48/8.
81. He pointed out that the weaknesses of the current national disease surveillance systems had led to the development of the regional strategy. He highlighted the basic features and guiding principles of the strategy and stressed the importance of information for taking appropriate decisions and actions.
82. He described the strategic framework inc1uding its major thrusts, such as the establishment of a list of priority diseases, involvement oflaboratory in confirmation of diseases. monitoring of drug resistance. surveillance data management and development of effective communication network.
83. The implementation framework at country, subregional and regionallevels was explained.
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84. He concluded by reiterating that surveillance remained a key element of effective disease control and prevention and that integrated as weil as coordinated actions were needed at ail levels to ensure success in implementing the proposed strategy.
85. The Subcommittee expressed their appreciation for the quality of the document presented and congratulated the Secretariat.
86. The document was exhaustively discussed and general comments were mainly related to the role of the districts which remained the key to the success of implementing the proposed strategy. The successful implementation of an integrated disease surveillance strategy was seen as one of the indicators of the performance of the district health system. 87. It was agreed that disease surveillance had a cost and efforts should be made to provide the required human and financial resources needed for its successful implementation at different levels. 88. While the Subcommittee appreciated the high priority given to the communicable diseases in the Region, it strongly expressed its concem on the increasing incidence of the non-communicable diseases, such as coronary heart diseases, diabetes mellitus and iodine deficiency. 89. The Programme Subcommittee consequently recommended to the Regional Director to assess the epidemiological situation of the non-communicable diseases and elaborate a regional strategy to be submitted to the Regional Committee at its 50th session in the year 2000. 90. It was suggested that two sets of standard case definitions be developed to facilitate case detection by the healthfacility and the community which could be the flfst source of information on disease outbreak. 91. The role of the laboratory in supporting the implementation of the integrated surveillance system was also stressed. There was a general consensus that a step by step implementation be adopted instead of going for a national scale from the beginning. 92. The Subcommittee suggested the harmonization of targets and strategic objectives as weil as the incorporation of sorne suggested amendments to the document. 93. In his concluding comments the Regional Director expressed optimism that funds would he available for the implementation of the strategy.
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94. The <!raft resolution AFRIRC481WP1R 1 was adopted for submission to the Regional Committee.
ORAL HEALTH IN THE AFRICAN REGION: A REGIONAL STRATEGY (document AFRIRC48/9) 95. Dr T. R. Tshabalala of the Secretariat presented the document. 96. She explained that one of the reasons why previous oral health strategies in the Region had not been sustainable was because past efforts had consisted of an unplanned, ad hoc and spasmodic evolution of curative oral health services which in most cases were poorly distributed and only reached affluent or urban communities. This had made it necessary to adopt a new approach of interpreting and responding to oral health problems that would lead to a fundamental improvement of community oral health in the Region. , 97. The aim of the new strategy was to assist countries to more systematically identify oral health priorities and plan viable programmes particularly at the district level with the involvement of relevant partners. 98. Based on the priority of oral health problems and needs, the five major programmatic areas identified, each with objectives were: development of national oral health strategies and implementation plans; integration of oral health in other programmes; delivery of effective and safe oral health services; regional approach to education and training for oral health; and development of effective oral health management information systems. 99. Country targets had been indicated and strategic orientations provided. Also provided were the implementation framework where the principal interventions and the major partners who could assist the process at country, intercountry and regionallevel were identified. Successful mobilization and efficient allocation and use ofresources and technology would be critical to the implementation of the strategy. 100. The strategy focused on the most severe oral health problems that people had to live with (e.g.
NOMA, oral cancer and oral consequences of HIV infection!AlDS). It also provided technical and managerial orientations that countries could use to streamline oral health services and deliver interventions that were affordable and in line with the oral health needs of the community. 101. Programme Subcommittee was invited to review the strategy and provide necessary orientation for the enhancement of oral health in Member States of the Region. 102. The Subcommittee congratulated the Secretariat for the document presented and wished that the strategy would be supported by the Regional Committee.
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103. It was noted that oral health had heen neglected in African countries and there was need for more advocacy including a deliberate increase in the budget allocated to the programme. 104. The need to focus on preventive oral health services was emphasized. lt was also stressed that oral health should be integrated into all primary health care programmes and training institutions. 105. Personnel should he trained to work at the district level and appropriate technology made available at this level. 106. lt was recommended that there should be mid-term targets for monitoring purposes. 107. The Secretariat thanked the Subcommittee for the valuable comments and indicated that the suggested arnendments would he incorporated into the document. 108. The draft resolution AFRIRC481WP1R4 was adopted for submission to the Regional Committee.
HUMAN RESOURCES FOR HEALTH IN THE AFRICAN REGION: A REGIONAL STRATEGY (document AFRlRC48/l0) 109. 110. Dr L. G. Sambo of the Secretariat presented document AFRlRC48/l0.
He noted that human resources could be considered as the most important resource for the
attainment of national health objectives. Unfortunately, health sector reforms had not always adequately considered issues related to the development of human resources for health. 111. users. 112. The proposed strategy had been aimed at improving national capacities for planning, training, Without a coordinated effort to reform medical practices and medical education as well as
better utilization ofhealth professionals, il would be difficult to improve quality ofhealth care and satisry
managing and supporting human resources. 113. The strategy had been developed as a result of a consultation with all Member States of the
Region in two meetings held in Ghana (1997) and Togo (1998). 114. The main thrusts of the strategy were : harmonizing the development of human resources for health with national health policies;
AFRIRC4817 page 17 strengthening institutional capac" ities; reorientation of the education and practices of health professionals; development of competent and well motivated health teams, at different levels ofhealth care; conducting research on human resources development as part of health systems research; and regulating professional practice for different categories ofhealth professionals. 115. He presented the main sections and invited members of the Programme Subcommittee to examine the proposed strategy and make recommendations for better utilization ofhuman resources for health in countries of the Region. 116. The Subcommittee expressed its appreciation on document AFRlRC48/l 0 and thanked the
Secretariat for the work done. 117. Il emerged from the general and specific comments made by members of the Subcommittee tha!: (i) although the issue of human resources was acknowledged as crucial to the success of the development and implementation of health policies and plans, seldom had it been inc1uded among policy priorities; (ii) the failure to consider human resources among policy priorities had created sorne problems which included: inequitable distribution of staff; the conservative attitudes of health schools; absence of coordination among the different partners; brain drain within and outside the continent; difficulty in recruiting graduates from health schools due to lack of material and financial resources. (iii) the problem in a number of countries was no longer the training of health personnel but their effective retention and use particularly in the public sector, due to inadequate budgetary resources. 118. Sorne editorial comments and other suggestions were made to improve the quality of the document. 119. The Secretariat gave sorne clarifications concerning the directory of training institutions being updated and on WHO fellowships. With regard to the latter, it was explained that 90% of WHO fellowships were made tenable within the Region.
AFRJRC4817 page 18
120. The draft resolution AFRIRC48!WP1R2 was adopted for submission to the Regional Committee. STRATEGIC HEALTH RESEARCH PLAN FOR THE WHO AFRICAN REGION, 1999-2003 (document AFRlRC48111) 121 . Dr L G Sambo of the Secretariat presented document AFRIRC48/11. 122. He recaJ1ed the need for decisions conceming health programmes and policies to be based on reliable information which should come from health research, among other sources. Ali countries in the Region should use research to promote knowledge, guide policies, strengthen health interventions and optimize the use of resources. 123. Research capacities in countries of the Region were still generally Iimited. Some specifie programmes (such as the Special Programme on Research and Training in Tropical Diseases, Special Programme of Research Development and Research Training in Human Reproduction) had played a crucial role in research capacity building. The funds allocated to research by national institutions remained low compared to financial support from abroad. 124. The strategie health research plan had been aimed at strengthening the institutional research capacities of Member States and at promoting the use of research results for the improvement of the management and quality ofhealth services. The basic principles of the strategie plan were!hat health research should be: comprehensive and multidisciplinary; address health problems and meet health needs; promote the development ofhuman resources; and be built into the overall development strategy. 125. Advocacy, national capacity building, strengthening of research support mechanisms and processes, regional networking, strengthening of the Regional Office and mobilization ofresources were the main thrusts of the proposed strategy. The implementation framework of the plan had set out the priority interventions for both the countries and the WHO Regional Office. Il identified the potential partners as weil as relevant support structures of WHO. The document also addressed monitoring and evaluation mechanisms and WHO's role in providing support to the countries. 126. The Subcommittee congratulated the Secretariat for preparing the document which addressed a major issue that influenced not only decision making in the health sector but also the provision of effective and efficient health services to the population. 127. Members of the Subcommittee used their experiences at country level to confrrm and also amplif)< many issues raised in the document. For example, they confirmed that the factors responsible for the inadequate attention to research as weil as for the Iimited use of research results in countries had both demand and supply aspects. The former included apathy to research on the part of decision-makers and
AFRlRC4817 page 19
inadequate communication between researchers and decision makers. execution of research proposais. disseminated.
The latter included non-
involvement of decision-makers in the identification of research issues as weil as in the development and In addition, many research results were badly packaged and
128. The need for demystification of research, greater advocacy with regard to the role of research in decision making, and intensified capacity building in research among health workers at ail levels was stressed. This would enhance the development of a research culture in the Region. 129. The regional strategy should dovetail into, as weil as support subregional research strategies, where they existed. 130. Countries in the Region shared many diseases as well as many health management problems; they also suffered from inadequate resources for research. There was, therefore, need to share research resources between countries and undertake multi-site, multidisciplinary and multi-country research projects. 131. In order to improve the management of the delivery ofhealth services, a balance should be struck between operational and basic research, taking into consideration the prevailing local realities. 132. The need for national ethics committee on research was stressed. Such a committee could among other things be charged with the responsibility of evaluating the funding and the conduct of research, particularly by the private sector. 133. Research priorities should reflect national health needs and, therefore, be country - rather than donor-driven. 134. Interagency collaboration and coordination on research issues should be promoted at national, subregional and regionallevels. 135. The need to bring policy makers and researchers together as weil as set up a network of researchers able to use appropriate strategies, was stressed. 136. The Subcommittee made sorne editorial comments and also provided sorne suggestions ta enhance the quality of the strategy document. 137. The Secretariat provided clarifications where requested and also stressed that greater efforts wou1d be geared at demystifying health research and promoting its awareness among decision makers.
AFRlRC48/7 page 20
138. The draft resolution AFRlRC481WP1R3 was adopted for submission to the Regional Committee.
ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE (document AFRIRC4817) 139 Afterreview, extensive discussions and amendments, the Programme Subcommittee adopted the
report as amended.
ASSIGNMENT OF RESPONSIBILITIES FOR THE PRESENTATION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE TO THE REGIONAL COMMITTEE 140. The Programme Subcommittee agreed to the assignment ofresponsibilities for the presentation of its report to the Regional Committee as indicated in the table below: (i) (ii) Opening ........................................................................................... - Dr C. Otjioke Proposed Programme Budget, 2000-2001 (document AFRlRC48/2) ................................................................. - Dr C. Otjioke (iii) Functions of WHO, Article 2 of the Constitution (document AFRlRC48/16) ............................................................... - Dr S. V. Shongwe (iv) Terms of office, qualifications and selection ofregional directors (document AFRlRC48/17) ............................................................... - Ms M. Mghatangwa (v) Integrated disease surveillance in the African Region: a regional strategy (document AFRlRC48/8) ................................................... - Mr M. Niang (vi) Oral health in the African Region: a regional strategy (document AFRlRC48/9) ................................................................. - Dr D. Alfari Dagara (vii) Ruman resources for health in the African Region: a regional strategy (document AFRlRC4811 0) ................................................ - Dr A. L. Manguele (viii) Strategic health research plan for the WHO African Region, 1999-2003 (document AFRlRC48/11) .......................................... - Dr Y. Pillay
AFRJRC4817 page 21 CLOSURE OF THE MEETING 141. The Regional Director thanked the members for the excellent work they had done and noted that they had enriched the documents and given adequate guidance to the Secretariat. 142. He seized the opportunity to express his gratitude on behalf of the Regional Office to the Ministers and the governments. particularly that of the Republic of Zimbabwe, for the support they had given since the Regional Office was dislocated from Brazzaville, Congo. 143. He also recounted the support that had been given by the WHO partners in the Region. He noted with satisfaction the support that had come from headquarters in Geneva. 144. He announced that an additional US $19 million had been allocated by the Organization to the African Region, particularly for supporting priority programmes at country level. The Secretariat would deliberate on how the additional funds would be shared and the proposed programme budget (2000-2001) would reflect the necessary changes. 145. He concluded that members should serve as advocates of the Regional Office in its efforts to enhance health development in the Region. 146. The Chairman thanked the members for their support and the clarity of their remarks, both of which had enabled the work to be completed so quickly. He also expressed bis appreciation to the Regional Director and his staff for their availability as well as for the good arrangements, including logistics, that had been made for the meeting. 147. He requested members to be ready to share the deliberations of the meeting with their Ministers when they retumed home in order to facilitate the work of the Regional Committee at the forthcoming sessIOn.
148. The Chairman declared the meeting c1osed.
AFRlRC4817
page 23
ANNEXiANNEXE/ANNEXO 1 LIST OF PARTICIPANTS LISTE DES PARTICIPANTS LISTA DOS PARTICIPANTES 1. Member states of the Programme Subcommittee Etats Membres du Sous Commité du Programme Estados-membros do Subcomité do Programme ERITREA* ERYTHREE Dr Ghimai Tesfasslassie Head, International Relations and Cooperation Unit, Ministry of Health
SENEGAL Dr Malick Niang Directeur de l'Hygiène de la Santé publique
SOUTH AFRICA AFRIQUE DU SUD AFRICA DO SUL Dr Yogan Pillay Department ofHealth
MOZAMBIQUE MOÇAMBIQUE Dr Alexandre Lourenço Jaime Mangue1e National Director of Health Ministry of Health
SEYCHELLES Dr Patrick Herminie Director-General, Primary Health Care
NAMIBIA NAMIBIE Ms Magdaleena Maggie Nghatanga Director for PHC and Nursing Services
SIEERA LEONE SERRALEOA
Dr Noah Conteh Deputy Director-General of Medical Services
NIGER NIGER Dr Daouda Alfari Dagara Inspecteur général de la Santé Ministère de la Santé publique
SWAZILAND SUAZILÂNDA Dr Steven V. Shongwe Deputy Director ofHealth Services
NIGERIA NIGÉRIA Dr Casimir ÜJjioke Director, Primary Health Care and Disease Control
2.
Members of tbe Executive Board Membres du Conseil Exécutif Membros do Conselbo Executivo
BURUNDI Dr J. M. Kariburyo Ministre de la Santé (Membre du Conseil Exécutif)
RWANDA* SAO TOME AND PRINCIPE SAO TOME ET PRINCIPE sAo TOMÉ E PRINCIPE Dr José da Costa Frota Director of Planning, Administration and Finance
CENTRAL AFRICAN REGPUBLIC REPUBLIQUE CENTRAFRICAINE REPUBLICA CENTRAFRICANA Dr Jean Limbabssa lnspecteur général de la Santé sic WR, Bangui
* Un.ble to .ttendIN'. participar
pas pu participerlN~o pôder
AFRIRC4817 page 24
ANNEX2 PROGRAMME OF WORK Day 1: Monday, 22 June 1998 ArrivaI of members Orientation of members Review of documents
Day 2: Tuesday, 23 June 1998 Session 1 9 a.m. - 9.10 a.m. 9.10 a.m. - 9.20 a.m . Agenda items 1, 2, 3 and 4 (Agenda item 1) Opening (Agenda item 2) Election of Chainnan, the Vice-Chainnan and Rapporteurs (Agenda Item 3) Adoption of the Agenda (Agenda item 4) Proposed Programme Budget 2000-2001 (document AFRlRC48/2) Tea break Agenda item 4 (cont'd.) Lunch break Agenda item 4 (cont'd.) Tea break Agenda item 4 (cont'd.)
9.20 a.m. - 9.30 a.m. 9.30 a.m. - 11 a.m .
11.00 a.m. - 11 .30 a.m. 11.30 a.m. - 12.30 p.m. 12.30 p.m. - 2 p.m. 2 p.m. - 4 p.m. 4 p.m. - 4.30 p.m. 4.30 p.m. - 5.30 p.m.
Day 3: Wednesday, 24 June 1998 Session 2 9. a.m. - Il a.m. Agenda items 5, 6 and 7 (Agenda item 5) Functions of WHO, Article 2 of the Constitution (document AFRlRC48116) Tea break (Agenda item 6) Tenn of office, qualifications and selection of Regional Director (document AFRlRC48/17) Lunch break
11 a.m. - 11 .30 a.m. 11 .30 a.m. - 12.30 p.m. -
12.30 p.m. - 2 p.m.
AFRlRC4817 page 25
Annex2 2 p.rn. - 4 p.rn. (Agenda item 7) Integrated disease surveillance in the African Region - a regional strategy (document AFRlRC48/8) Tea break Agenda item 7 (cont'd.)
4 p.rn. - 4.30 p.rn. 4.30 p.rn. - 5.30 p.rn.
Day 4: Thursday, 25 June 1998 Session 3 9 a.rn. - II a.rn. Agenda items 8, 9 and 10 (Agenda item 8) Oral health in the African Region - a regional strategy (document AFRlRC48/9) Tea break (Agenda item 9) Human resources for health in the African Region - a regional strategy (document AFRlRC48/1 0) Lunch break Agenda item 9 (cont'd.) (Agenda item 10) A strategie plan for health research in the African Region, 1999-2003 (document AFRlRC48/11) Tea break Agenda item 10 (cont'd.)
II a.rn. - 11 .30 a.rn. 11.30 a.rn. - 12.30 p.rn.
12.30 p.rn. - 2 p.rn. 2 p.rn. - 3 p.rn. 3 p.rn. - 4 p.rn.
4 p.rn. - 4.30 p.rn. 4.30 p.rn. - 5.30 p.rn.
Day 5: Friday, 26 June 1998 Session 4 3 p.rn. - 4 p.rn. 4 p.rn. - 4.30 p.rn . 4.30 p.rn. - 5 p.rn. Adoption of Report Assignrnent of responsibilities Closing session
AFRfRC4817
page 26 ANNEX3
AGENDA 1.
Opening of the session Election of the Chairman, the Vice-Chairman and Rapporteurs Adoption of the Agenda (document AFRlRC48118) Proposed Programme Budget 2000-2001 (document AFRlRC48/2) Functions of WHO, Article 2 of the Constitution (document AFRfRC48/16) Tenn of office, qualifications and selection of regional directors (document AFRlRC48117) Integrated disease surveillance in the African Region: a regional strategy (document AFRlRC48/8) Oral health in the African Region: a regional strategy (document AFRfRC48/9) Ruman resources for health in the African Region: a regional strategy (document AFRlRC4811 0) A strategie plan for research in the African Region 1999-2003 (document AFRlRC48111) Adoption of the Programme Subcommittee report (AFRlRC4817) Assigrunent ofresponsibilities for the presentation of the Programme Subcommittee report to the Regional Committee Closing of the session
2. 3. 4. 5. 6. 7. 8. 9. 10. Il. 12.
13.
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR AFRICA
ORGANISAllONMONDIALE DE LA SANTE BUREAU REGIONAL DE L'AFRIQUE
ORGANlZAÇÀO MUNDIAL DE SAiJDE SEDE REGIONAL EM ÂFRICA
REGIONAL COMMITTEE FOR AFRICA Forty-eighth session Harare. Zimbabwe. 31 August - 4 September 1998
AFR/RC48!WPIRI 6 July 1998 ORIGINAL: FRENCH
DRAFT RESOLUTION
INTEGRA TED EPIDEMlOLOGICAL SURVEILLANCE OF DISEASES: REGIONAL STRATEGY FOR COMMUNICABLE DISEASES
The Regional Committee,
Recalling World Health Assembly resolutions WHA22,47, WHA41.28 and WHA48.13 on the epidemiological surveillance of communicable diseases adopted by the World Health Assembly in 1969, 1988 and 1995 respectively;
Recalling also Regional Committee resolutions AFRIRC381R24 and AFRJRC431R7 relating to the evaluation and strengthening of national epidemiological surveillance systems, particularly to ensure early detection and effective control of epidemics;
Aware of the weakness of national epidemiological surveillance systems and the pressing need to have, at all times, appropriate information on disease trends and on the effectiveness, efficacy and impact of interventions of disease control programmes;
Acknowledging that the integrated approach applied to epidemiological surveillance was likely to enhance cost-effectiveness; and
Having reviewed the report of the Regional Director contained in document AFRIRC48/8 as weil as the report of the Programme Subcommittee relating thereto;
1.
APPROVES the regional strategy for integrated surveillance of diseases as presented in document
AFRJRC48/8;
AFRIRC481WP1R1 page 2
2.
CALLS UPON Member States:
(i)
to carry out, if not yet done, an exhaustive evaluation of their systems for epidemiological surveillance of diseases in order to identify their weaknesses and their needs in terms of human, financial and material resources, including means of communication;
(ii)
to evaluate the laboratory component of disease control programmes so as to provide il with the resources needed to contribute to epidemiological surveillance, and to the surveillance ofbacteria and parasite resistance to drugs;
(iii)
to take the necessary steps, inc1uding resource allocation, to implement the regional strategy for surveillance of diseases by giving special focus to the integrated approach;
(iv)
to effectively participate in intercountry cooperation activities in the spirit of subregional cooperation protocols adopted collectively through, inter alia. rapid notification of epidemics to WHO and neighbouring countries; and
(v)
to effectively use the available epidemiological data in taking decisions on priority setting and resource allocation.
3.
REQUESTS international partners concemed with the epidemiological surveillance of diseases
in Amca to provide support to the countries and the World Health Organization in the implementation of the present strategy; and 4. REQUESTS the Regional Director:
(i)
to provide support to Member States to enable them implement the present strategy;
(ii)
to pursue the effort to put in place technical teams in the epidemiological blocks in order to provide the countries with the technical support they need in the implementation of epidemic preparedness and rapid response to epidemics within the framework of subregional cooperation protocols and corresponding plans of action;
(iii)
to mobilize regular budget resources and extrabudgetary resources to support the implementation of the strategy at country, epidemiological block and regionallevels; and
(iv)
to report to the Regional Committee every other year on the implementation of the strategy.
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR AFRICA
ORGANISATION MONDIALE DE LA SANTE BUREAU REGIONAL DE L'AFRIQUE
ORGANlZAÇÂO MUNDIAL DE SAUDE SEDE REGIONAL EM AFluCA
REGIONAL COMMITTEE FOR AFRICA
AFR/RC48/WP/R2 6 July 1998
Forty-eillhth session Harare. Zimbabwe, 31 AUllust - 4 Se,ptember 1998
ORIGINAL: FRENCH
DRAFf RESOLUTION REGIONAL STRATEGY FOR THE DEVELOPMENT OF HUMAN RESOURCES FOR HEALTH The Regional Committee,
Having reviewed the Regional Director's report on the development ofhuman resources for health;
Recalling World Health Assembly resolutions WHA42.27, WHA47.9, WHA48.8 and WHA49. 1 and Regional Committee resolutions AFRlRC371R!3 and AFRIRC381R15 on the role ofhealth personnel in the implementation of national health development policies and plans;
Seeking to apply the spirit of the 1993 world conference and the 1995 regional conference on Medical Education;
Mindful of the need to make optimal use of the available human resources as part of the ongoing health sector reform in the countries of the African Region;
Recognizing the increasing burden of the problem of brain drain on the Member States;
Aware that health sector reform and reorientation of professional practice and training should be coordinated, pertinent and acceptable;
Recognizing the need for an integrated approach to the development ofhealth services and human resources for health;
Aware also!hat Ibis approach to the development ofhuman resources should be adapted to the needs and means of the countries and be based on active participation of the entire health personnel at allleveis of the health system just as for beneficiaries ofhealth care, the policy-makers and officiaIs of the private
. AFR/RC48fWPlR2 page 2
and public sectors, representatives of professional associations and teaching institutions, and aIl persons in charge of economic and social development; and
Considering WHO's special role in health matters, which can facilitate working relations between health authorities, professional associations and schools ofhealth in the African Region;
1.
ENDORSES the regional strategy for the development ofhuman resources for health contained in
document AFRJRC48/10;
2.
URGES Member States:
(i) to harmonize national health policy and the plan for the development of human resources for health;
(ii) to collaborate with aIl the institutional sectors of health development in the formulation and implementation of policies and plans for the development ofhuman resources for health in order to better meet the needs and improve the health status of the population;
(iii) to promote and support health systems research with a view to determining the standard health team for each of the various levels of the health care system, the optimal numerical strength, the mix and deployment of health personnel and the technologies and working conditions most likely to improve their performance in the provision of quality health care; and
(iv) to support efforts to improve education, training, utilization and regulation ofhealth professions; and
3.
REQUESTS the Regional Director:
(i) to encourage health authorities, professional associations and schools of health to study and establish, in a coordinated manner, new models of care and new working conditions that will enable health personnel to play their specifie roles in order to better meet the needs of beneficiaries of health care;
(ii) to support the development of guidelines and models that will enable the countries to strengthen their capacity to plan, train, utilize and regulate health professions;
AFRIRC481WP/2 page 3
(iii) to ensure continuity in the work of the regional multidiscipIinary advisorygroup on the development of human resources for health;
(iv) to reorganize and strengthen the unit responsible for Human Resources for Health programme in order to ensure easier coordination of regional and national efforts for optimal use of health personnel;
(v) to sensitize partners 10 and mobilize resources for the implementation ofthis strategy; and
(vi) to keep the Regional Committee informed of the progress made in the implementation ofthis resolution and to report to the Committee every other year.
WORLD HEALTH ORGANIZATION . , ORGANISATIONMONDIALEDEIASANI REGIONAL OFFICE FOR AFRICA BUREAU REGIONAL DE L'AFRIQUE
ORGANIZAÇAO MUNDIAL DE SMillE SEDE REGIONAL EM ÂFRICA
REGIONAL COMMITIEE FOR AFRICA Forty -ei IÙ1th session Harare. Zimbabwe. 31 August - 4 S!;l)tember 1998
AFRIRC48IWP1R 6 July 199
ORIGINAL: FRENCH
DRAFT RESOLUTION STRATEGIC HEALTH RESEARCH PLAN FOR THE WHO AFRICAN REGION The forty-eighth session of the Regional Committee for Africa;
Raving examined the Regional Director's report on health research in the Region;
Recalling World Realth Assembly resolutions WHA4.26 and WHA33 .25 relating to health research
Bearing in mind the importance accorded by the Regional Committee to health research policie
during the different sessions of the Technical Discussions, particularly during the 42nd (ref. Doc AFRJRC42fTD/ I) and the 47th (AFRJRC47fTD/ I) sessions; and
Considering that health research was one of the means for obtaining reliable infonnation to guide decision-making and improve the management and quality of the services of health systems:
1.
APPROVES the strategie health research plan for the African Region;
2.
REQUESTS the Member States:
(i) to detennine, together with ail parties concemed, priority research areas at the national level;
(ii) to draw up medium- and long-tenn research policies and strategies consistent with national health development policies;
(iii) 10 creale an enabling environment for researchers to function effectively;
AFRlRC481WP1R4 page 2
(H) systematically and meaningfully interpret oral health epidemiological information by describing oral disease prevalence, severity and age-wise distribution in the population;
(iii) give particular attention to the most severe oral problems that people have to live with (e.g. NOMA, oral cancer and oral manifestations ofHIV infection/AlDS);
(iv) develop appropriate and affordable programmes that match the oral health needs of the community;
Cv) integrate oral health activities in aH primary health care programmes;
(vi)
integrate training in essential oral health skills in the curricula ofhealth personnel and others who have the responsibility for oral health promotion;
(vii) strengtben health facilities with appropriate oral health technologies, methods, equipment and human resources;
(viii) undertake operational research on oral health priority problems and needs; and
(ix)
integrate oral health in national health management information systems; and
3.
REQUESTS the Regional Director ta:
(i)
provide technical support to the Member States for the development of national oral health strategies and implementation plans;
(ii)
provide support to aIl countries to enable them to strengthen or develop and implement cost-effective oral health care services, particularly at the district level;
(iii)
provide guidelines and technieal support that will facilitate the proper identification of oral health priority problems and appropriate eost-effective interventions;
(iv)
promote and support the development of suitable training programmes for effective delivery of oral health services;
·AFRJRC481WP1R4 page 3 (v) promote and support relevant research activities aimed at providing solutions to oral health problems; and
(vi)
report to the 50th session of the Regional Committee on the progress made in the implementation of the strategy.
-