WORLD HEALTH ORGANIZATION • REGIONAL OFFICE FOR AFRICA
ORGANISATIONMONDIALEDElASANfE BUREAU REGIONAL DE L'AFRIQUE
ORGANIZAÇÂO MUNDIAL DE SAÛDE SEDE REGIONAL AFRICANA
REGIONAL COMMITIEE FOR AFRICA Forty-ninth session Windhoek. Namibia. 30 August - 3 September 1999 Prayi sional a~enda item 9 REPORT OF THE PROGRAMMESUBCOMMITTEE CONTENTS
AFRfRC49/6 18 June 1999 ORIGINAL: ENGLISH
Paragraphs
OPENING OF THE MEETING ................ .. .......... .. ................ . ... 1-7 HEALTH SECTOR REFORM IN THE WHO AFRICAN REGION: STATUS OF IMPLEMENTATION AND PERSPECTIVES (document AFRlRC4917) ................. 8-23 REGIONAL HEALTH-FOR-ALL POLICY FOR THE 21ST CENTURY (document AFRlRC49(a) and (b» ... .. .......... . . ... ......................... . ... 24-41 REGIONAL STRATE GY FOR MENTAL HEALTH (document AFRlRC49/9) .......... 42-60 INTEGRATED MANAGEMENT OF CIllLDHOOD ILLNESS (!MCl): STRATEGIC PLAN FOR 2000-2005 (documentAFRlRC49/1O) ... .. . .... .. .... .. ..... 61-74 ESSENTIAL DRUGS IN THE WHO AFRICAN REGION: SITUATION AND TREND ANALYSIS (document AFRlRC49/11) ............ .. .. .. ....................... .. . 75-90 HEALTH TECHNOLOGY POLICY IN THE AFRlCAN REGION (document AFRJRC49/12) ...... . . . . . . .......................... . ....... . " " ... 91-106 REVIEW OF THE IMPLEMENTATION OF THE BAMAKO INITIATIVE (document AFRlRC491l3) . .......................... . . .. ...................... 107-120 ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE (document AFRlRC49/6) .... . ...................... . . ... ...................... .... 121 ASSIGNMENT OF RESPONSffiILITIES OF THE PRESENTATION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE TO THE REGIONAL COMMITTEE .. ... . 122 CI,OSURE OF THE MEETING ......................... .. ..... . ............. 123-126
ANNE-XES Page 1.
2. 3. 4. 5. 6. 7. 8.
List of participants ...... . ... . .. ... ......... . . ..... ...... . .. ..... ........... . . . 14 Programme ofwork ......................... , .. ......... . ..... .. , . .. . , ....... . 15 Provisional agenda . . . , .. , . , . , .. . .. , . . . , , . ... , .. . ... . .. .. , .. .. , , . . . .. .. ... , .. , . 17 Health sector refonn in the WHO African Region: status of implementation and perspectives 19 Regional strategy for mental health ............. , . . . .. , . . . . ..... , .. . , ............. 21 Integrated management of childhood iIIness (!MCl): strategie plan for 2000-2005 ...... .. . 25 Essential drugs in the WHO African Region: situation and trend analysis .. . . .... , , ...... 27 Review of the implementation of the Bamako Initiative ........ , .... . . . . .. , . . .. .. ... . 31
AFRJRC49/6 page 1 OPENING OF MEETING 1. The Programme Subcommittee met in Harare, Republic of Zimbabwe, from 14 to 18 June, 1999. The bureau was constituted as follows: Chairman: Vice-Chairman: Rapporteurs: Dr Malick Niang (Senegal) Dr Hassan A. Altas (Tanzania) Dr Gilberto José da Costa Frota (Sao Tome & Principe) Dr Paul Sikosana (Zimbabwe)
2.
The list of participants is attached as Annex 1.
3. The Regional Director, Dr Ebrahim M. Samba, we1comed participants and used the occasion to express his gratitude to the Gavernment and people of the Republic of Zimbabwe for aH they had done ta make members of staff of the WHO Regional Office comfortable. He added !hat in spite of ail the efforts made, the office was still on a refugee status and, consequently, things had nat been perfect. 4. He reminded members of the revised terms of reference of the Programme Subcommittee and stressed that the comments and recammendations of the Subcommittee would serve as a basis for discussing the technical documents during the Regional Committee meeting. 5. Dr M. Niang expressed his gratitude and that ofhis country for being elected as Chairman of the Programme Subcommittee and thanked the Regional Director for his words afwelcame. He added that the Programme Subcommittee wauld rely on the competence of the Secretariat to facilitate its deliberations. He congratulated the Regional Director and his staff for the work they had done in spite of the difficulties associated with the temporary relocatian of the Regional Office from Brazzaville. 6. The provisional programme of work (Annex 2) was adopted as presented.
7. The Programme Subcommittee alsa adopted the following warking hours: 8.30 a.fi to 12.30 p.m. and 2.00 p.m. ta 5.30 p.m., bath periods inclusive of tea breaks. The Agenda is attached as Annex 3. HEALTH SECTOR REFORM IN THE AFRICAN REGION: STATUS OF IMPLEMENTATION AND PERSPECTIVES (document AFRJRC4917) 8. Dr L. G. Samba of the Secretariat introduced this document.
9. He recalled !hat after twa decades of significant sociaeconomic growth and development in most independent African countries, the 1980s ushered in a period ofworld ecanomic recession that negatively impacted on the econamies ofmost cauntries of the WHO African Region. They began experiencing declining and even negative ecanamic growth rates. This changing saciaecanamic enviranment called for various forms of economic reforms sorne of which had unfavourable consequences on the health sector. The health care delivery systems of many countries were so weakened that they were incapable of coping with the increasing health challenges as weil as meeting the needs of the growing population which had became better infarmed about their right to quality health care. 10. He observed that the aforementioned developments called for health seetor reform which is a process of change designed to improve the deteriarating health situation. Ali cauntries in the Region had embarked on one farm of health sector reform or anather, but the scape of refarm varied from country to country.
AFRlRC49/6 page 2
Il . The document which had been prepared by the Regional Director 10 bring 10 the attention of the Regional Committee the status of implementation ofhealth sector refonns in countries of the Region and future perspectives, bad been divided into 6 sections: introduction (paragraphs 1-6); context of health seclor refonn in the Region (paragraphs 7-13); content ofhealth secter ongoing refonn (paragraphs 14-18); status of implementation ofhealth sectoT refonn (paragraphs 19-35); future challenges and perspectives (paragraphs 36 ta 49); and conclusion (paragraphs 50 to 56). 12. He indicated tbat the Regional Committee was expected ta review the progress report and: (i) comment on the operational definition ofhealth sector refonn provided; the way the refonn process had been characterized; the framework proposed for linking health seetor refonn ta health status improvement; the major les sons leamt from the review of country experiences; the key suc cess factors observed; and the future challenges and perspectives enumerated; (ii) provide appropriate guidance and orientation ta the Regional Office to enable it effectively support Member States in their refonn efforts.
13. The participants praised the Secretariat for the relevance, timeliness, good quality and c1arity of the document. 14. While agreeing that there was no blueprint for health sector refonn, they underscored the need to use those prineiples enumerated in the document as a guide to health seetor refonn in aU eountries of the Region. They also expressed the need for specifie results ta sustain consensus building throughout the health sector reform process. 15. The Subcommittee supported: the operational detmition ofhealth sector reform provided; the way health seetor reform had been eharaeterized; the framework provided in the document linking health sector reform to health status improvement; the enumerated major lessons leamt as well as the key suceess factors highlighted; and the future challenges and perspectives enumerated. 16. Il was noted that health seetor refonn would need to focus on HIV/AIDS, tuberculosis and malaria whieh represent a great proportion of the burden of disease in the Region. While the adoption of seetorwide approaches (SWAPs) ta health sector reform was we1comed, the problem of giving adequate attention ta priority health programmes sorne of whieh have successfully been implemenled as vertical programmes wilhin the context of SWAPs was noted. 17. The Subcommittee also noted that sueeessful health seetor reforms had been eonstrained by factors beyond the control of the Ministry ofHealth. These included lack of good govemance and opposition to refonns from individuals and/or interest groups outside the Ministry ofHealth. 18. While reallocation ofresources in favour ofprimary health care is important as part ofthe reform agenda, the need ta ensure tha! secondary and tertiary care would not be negleeted was emphasized. In addition, greater resource allocation ta district health services should take cognizance of the absorptive capacity at that level. 19. The Subcommittee cautioned that while decentralization was an important aspect ofhealth sector refonn, particularly with regard ta the organization and management ofhealth services, decentralization should not be seen as a panaeea ta ail health sector problems.
AFRJRC49/6 page 3
20. It was noted that donors had olten undertaken interventions without really considering local health realities and priorities. The Subcommittee stressed the need for WHO to assist countries to lay down common strategies that could be adopted to ensure that donors buy into national health policies and development plans. 21. The Secretariat took note of some specifie comments made for the purpose of improving the document. 22. The Regional Director, Dr Ebrahim M. Samba, thanked the participants for their useful comments and suggestions. He added that the experiences of eountries of the Region in the area of health seetor reform as they had been presented at the inter country meetings organized with the World Bank, will be summarized and disseminated later. He stressed the need for govemments to assume a leadership role al every stage of the reform process. 23. The Subcommittee prepared a draft resolution to be submitted to the Regional Committee for review and adoption (Annex 4).
REGIONAL llEALTH-FOR-ALL POLICY FOR THE 21 ST CENTURY (documents AFRJRC49/8(a) and (b)) 24. Dr L. G. Sambo of the Secretariat introduced the document. 25. He indicated that the document was in two parts - namely, a 3-page summary and a 37-page main part. The latter was divided inlo six sections: section 1 dealt with background; section 2 presented an overview ofhealth development in the Region; section 3 contained future scenarios; section 4 contained a vision for heaIth development in Africa; section 5 addressed fundamental questions and strategie plans; and section 6 contained health agenda 2020. 26. He added that the poliey was formulated in stages over many years and that ils formulation started al country level followed by sorne consultations. 27. The policy was based on a review of the past, an analysis ofthe present and a systematie exploration of the future, and reflected both the aspirations of the people to a better health status and the vision inspired by the preferred scenario expected to lead to 'Dignity and health'. 28. The vision ofhealth development in the decades ahead, as defined in the document, encompassed different possible scenarios which were assumptions based on factors of uncertainty that could influence health development. Two of these factors, namely poverty and the availability of essential health care, were crucial. Poverty directly impacted on the health status of the populations and on health determinants. It also affected access to social services. Govemance and the attitudes as welI as motivation of the various actors were factors affecting the availability of essenlial health care. 29. The preferred scenario was based on positive assumptions regarding trends in poverty and in the availability of essential health care. The scenario, dubbed "Dignity and health", reflected a cohesive policy of human development and efficiency in health development. The implication of that scenario was that, by the year 2020, the populations would he freed from poverty and exclusion, health care would effectively be provided especially to the most disadvantaged segments of the population, diseases related to poverty and ignorance would finally be minimized and Africa would face the future with dignity. 30. As a health policy framework, the document addressed the issue of actions to be undertaken. Health Agenda 2020 for Africa was a list of strategie options, translated into objectives, areas of action, actors involved, factors of suecess and expected results. The strategie options resulted from choices of the ways and means of realizing the vision within the set time frame. These choices were answers to questions related to how that vision should be realized.
AFRlRC49/6 page 4
31. Health Agenda 2020 would be translated into reality through action programmes and specifie interventions in the health sector and, inevitably, in other sectors ofhuman development. 32. Because the successful implementation of any policy depended largely on the degree ofinvolvement of and consensus among the different actors, special consideration had been given to the role and responsibility of actors, including govemments and the World HeaIth Organization, and especially individuals, communities and the civil society in general.
33. The proposed health development policy was based on the Heaith-for-Ail policy as adopted at the World Health Assembly (WHA51) in 1998 and on its values and principles. Health Agenda 2020 reflected the priorities and targets that had been set for action in order to foster global heaIth development. 34. He concluded by requesting the Subcornmittee to make comments and suggestions with regard to the relevance, structure, content and length of the document as weil as the process that should be followed in finalizing the document. 35. The Regional Director, Dr Ebrahim M. Samba, observed that unlike the other documents that were before the Subcornmittee which either reported on the CUITent status of the implementation of sorne programmes or initiatives or had medium-term perspective, the policy document was futuristic and visionary. It would be a referenee document to guide health development in the Region for at least the next twenty years. He stressed that the document was a fust draft and that the Secretariat would he ready ta go back to the drawing board if necessary. He then requested the Subcommittee to pro vide appropriate guidance. 36. The Subcommittee congratulated the Secretariat for the efforts that had gone into preparing the detailed document that addressed a very relevant subject. Il was agreed that the document had comprehensively reviewed the process of health development in the Region and, on the basis of the review, tried to chart the best course for health development in the next twenty years. However, the Cornmittee noted !hat the document was too long as a policy document and that it was fairly complex to understand. Incoherence was al 50 noted as a problem of the document in the present form. 37. Since sorne factors that would affect health development in the future were beyond the control of the Ministry of Health and also given that the health development scenario selected would need inputs beyond what Ministry of Health could provide, the development of the policy document would need further and wider consultation at national and regional levels. This would involve other sectors and partners contributing to health. lndeed, the consultations should be multisectoral, multidisciplinary and multiagency. 38 In order ta make the document more comprehensible, there would he need to: develop a glossary for sorne concepts that had been used; put sorne parts of the document as annexes; and simplify the presentation 80 that non-technical people could understand il. 39. In further review of the document, it was observed that the following should a180 be taken into consideration: not to make the vision too ambitious; the role that traditional medicine would play in the next century; the impact of population growth on sustainable development; further analysis of demographic and epidemiological data; and the strategies of other sectorsJagencies !hat contribute to poverty reduction and elimination of ignorance.
AFRlRC49/6 page 5 40. After extensive discussions, the Subcommittee agreed on the following with regard to the way forward: Structure and content A shorter and user-friendly 4-part policy document comprising the following was proposed: (i) preamble; (ii) situation analysis bringing out the strengths, weaknesses, opportunities and threats (SWOT); (iii) a vision with clear goals, targets and objectives built on the result of (iil as well as the scenario for attaining the vision; and (iv) health agenda 2020. The proeess
(i) second draft to be prepared by incorporating the comments and suggestions of the Subcommittee; (ii) presenting the second draft to RC49 for further review and orientation; (iii) third draft ID be prepared by incorporating the comments and orientations of RC49; (iv) holding a consensus building meeting which is multisectoral, multidisciplinary and multiagency; (v) fourth draft to be prepared by incorporating comments and suggestions of the consensus building meeting but keeping the key orientations of the Regional Committee; (vi) review of the fourth draft by the Programme Subcommittee in June 2000 and its submission ta RC50 for consideration and adoption. This pracess had been followed to a large extent by at least one other WHO Region in developing a similar regional document. 41. The Secretariat expressed their gratitude for the valuable comments, suggestions and future orientation provided by the Subcommittee and assured members that the revised document would be sent ID the cauntries by the end of July 1999, to allow adequate time for its country leveJ review before RC49. REGIONAL STRATEGY FOR MENTAL HEALTH (document AFRlRC49/9)
42. Dr M. Belhocine of the Secretariat introduced the document. 43 . He stated that mental health was an essential and integral part of health as staled in the definition of health in the Constitution of the World Health Organization. Just as health was not merely the absence of disease, mental health was not simply the absence of mental disorder or ilIness, but also included a positive state of mental well-being. 44. He noted that the use and abuse ofpsychoactive substances (alcohol, tobacco and other drugs) were becoming an increasing public health concern in the Region. Many African countries were used as transit eountries for illicit dmgs which then found their way into a dmg culture in the countries, adding to the existing indigenous problems associated with cannabis consumption. Tobacco demand was threatened
AFRlRC49/6 page 6
in many countries in the North, creating growing pressure to increase sales in the developing world where consumption was rising dramatically and children were starting to smoke at very young ages. 45. Many countries in the Region were engulfed in civil strife which has a negative impact on the mental well-being of the affected populations. HIV infection has added considerably to the psychosocial prohlems already being experienced in many countries, requiring support and counselling for those affected and care for their surviving family members, especially children. 46. He reminded the Committee that the contribution of mental health as an essential component of individual and community health had been stressed in different resolutions adopted by the World Health Assembly (WHA), the Regional Committee (Re), the United Nations General Assembly and the United Nations Drug Control Programme (UNDCP). However, previous approaches to mental health in the Afiican Region had failed to recognize priority areas and develop appropriate strategies to address them. Il was for this reason that the strategy document had been prepared. 47. He highlighted the contents of the document as follows: paragraphs 1 to 5 underlined the need to revise the existing strategies and develop a comprehensive strategie framework for mental health and the prevention and control of substance abuse; paragraphs 6 to 13 contained the global picture conceming the magnitude of the problem, the factors determining a status of poor mental health in the African Region and the available resources with which to deal with issues pertaining to mental health and the prevention and control of substance abuse; paragraphs 14 to 16 presented the aim, objectives, vision and gui ding princip les for the implementation of the strategy; paragraphs 19 to 26 contained priority interventions; and paragraphs 27 to 34 provided details of the implementation framework. 48. The regional strategy for mental health and the prevention and control of substance abuse for the period 2000-2010 was being submitted as a tool for assisting Member States and other relevant partners to identify priorities, and deve10p and implement programmes at various levels of the health system, with particular emphasis on what could be done at district and community levels. 49. The Programme Subcommittee was invited to review the document, and give necessary orientations for its improvement and adoption for implementation. 50. The Programme Subcommittee welcomed the document and stressed the need for increased awareness of mental health problems and for a change of attitude in order to reduee the stigmatization of and discrimination against patients with mental disorders. 51. The Subcommittee noted that mental health would continue to be a major problem because of increasing drug addiction, the prevalence of civil strifes and wars, deteriorating eeonomie and social conditions, domestic violence against women and children, and rising unemployment particularly among young educated people. 52. Capacity building would be imponant in order to effectively address this growing health problem. This would involve, among other things, the introduction of mental health modules in the training curriculum for general health staff as weil as the training of specialists, especially women, in mental health. 53. Il was noted that existing I~gislations on the management of mentally ill patients \Vere old and draconian and would need to be revised. 54. Il was observed that in view of the importance of the programme, the document should be more aggressive in order to convince govemments and other relevant partners of the urgent need to take appropriate action.
AFRlRC49/6 page 7 55. The need to take neeessary steps to curb domestie violence against women and children and to provide eounselling and rehabilitation, particularly for drug addiets, were identified as important additional interventions. 56. The Programme Subeommittee recognized the important role that traditional healers and praetitioners had been playing in the management of mentally iII patients and recommended that due cognizanee be taken ofthis in the implementation of the strategy. 57. Taxes on commodities that constitute health risks such as tobacco and alcohol should be eannarked for finaneing general health services, including mental health. 58. The Subcommittee further made sorne specifie eomments and suggestions to improve the document. 59. The Regional Director thanked the Subcommittee members for their useful comments and agreed that mental health had hitherto not been given the priority it deserved. He noted that with the breakdown of farnily support systems, increase in poverty, etc. mental jJ] health had become a serious publie health problem that required mueh more attention. 60. The Subcommittee prepared a draft resolution to be submitted to the Regional Committee for review and adoption (Annex 5). INTEGRATED MANAGEMENT OF CHILDHOOD ru~NESS (IMCI): STRATEGIe PLAN FOR 2000-2005 (document AFRlRC49/l 0) 61. Dr A. Kabore of the Secretariat introdueed the document. 62. He reminded the Subcommittee that approximately 11 million ehildren under five years of age die annually of common preventable conditions such as acute respira tory infections, diarrhoea, malaria, measles and malnutrition, and !hat projections based on the global burden of disease analysis completed in 1996 indicated that these conditions would continue to be major contributors to morbidity and mortality up to the year 2020 unless more significant efforts were made to control them. 63. He added that the WHO Regional Office for Afriea had, sinee 1995, intensified its support to Member States by adopting the Integrated Management of Childhood IIIness (IMCI) strategy for the reduction of morbidity and mortality in this vulnerable group and that as of December 1998, the strategy was being implemented in 22 countries of the Region. 64. He noted that in spite of the potential gains of IMCI, a number of constraints such as limited human and financial resources and weaknesses of health systems existed at the regional, national and district levels and required attention in order to accelerate implementation. 65 . The document provided justification for the implementation of IMCI. It gave a elear situation analysis of the current status of IMCI implementation in countries and described the Regional IMCI strategie plan for 2000-2005. It also outlined the plan's guiding principles, objectives, expected outcomes and priority interventions that could be implemented and monitored at national, district and community levels. The implementation framework of the strategy clarified the role ofMember States, WHO and cotlaborating partners. Critical factors for success had also been identified. 66. The Regional IMCI strategie plan for 2000-2005 was presented to the Regional Committee for review and adoption in order to aceelerate the implementation of the IMCI strategy in the Region. 67. The Programme Subcommittee eongratulated the Secretariat for developing the strategie plan for !MCI. Il noted that IMCI was an important strategy, and not a programme, for dealing with common diseases among children in an integrated manner. The Subeommittee underscored the need ta incorporate IMCI as one of the important strategies for implementing health sector refonn in the Region.
AFRlRC49/6
page 8
68 . The Subcommittee also noted Ihat the implementation of the IMCI could be hampered by the fact Ihat il was a resource·intensive strategy. 69. The need to institutionalize !MCI in arder ta make it sustainable was stressed. One way of achieving this was to introduce !MCI as part of the basic curriculum for training health workers. 70. Successfu] implementation of IMCI would require: national consensus building on the usefulness of the !MCI strategy; policy changes particularly with regard to vertical programmes and drugs; provision of adequate support to districts; and effective use of information, education and communication measures to reach the communities whose involvement in the implementation of the !MCI strategy in a phased and non·disruptive manner was very important. 71. The Programme Subcommittee noted that the experiences of the 22 countries already implementing the strategy were being used (0 guide the extension of implementation 10 other countries in the Region. 72. After seeking clarifications from the Secretariat on sorne issues, the Subcommittee made various cornments and suggestions for improving the document. These included the need to stress the importance for countries to define indicators for monitoring the implementation of the strategy at district and community levels. 73. The Programme Subcommittee observed that the period of five years provided for the implementation of the !MCr strategic plan was different from the periods provided for other strategies (ten years) and for the HFA poliey (twenty years) and wondered whether there was a need for harmonization. In response to this observation, the Secretariat explained that the HF A policy was a long· tenn vision ofhealth development in the Region, whilst the !MCr strategie plan was a medium·terrn plan for aceelerating the implementation of the !MCr strategy. The Secretariat added tbat other strategies currently being defined for a ten·year implementation period would require a three to five·year mediumterm plan for their implernentation. 74. The Subcornmittee prepared a draft resolution to he subrnitted to the Regional Cornmittee for review and adoption (Annex 6). ESSENTIAL DRUGS IN THE WHO AFRICAN REGION: SITUATION AND TREND ANAI.YSIS (document AFRlRC491l1)
75. Dr B. K. Nguyen of the Secretariat introduced the document. 76. He recalled that the publication of the first WHO Model Essential Drugs List in 1977 marked the launch of the Organization's advocacy for the 'essential drugs' concept. The establishment of the Action Programme on Essential Drugs (DAP) in 1981 aceelerated the development and implementation of national drug polieies. By 1999, 33 Member States in the African Region had national drug policies and over 40 had national essential drug lists. He added that although the Regional Committee had passed a number of resolutions on essential drugs, no previous report of overall progress of work had been presented. The document had therefore been prepared to inform Member States of the aehievements made and ofWHO's work in the past 10·15 years. 77. Paragraphs 1· 3 contained a statement on WHO's mission in the area of essential drugs; paragraphs 4 to 7 provided the global and regional eeonomie, sociopolitical, demographic and disease environment influeneing the development and implementation of national essential drug polieies; paragraphs 8 to 27 contained analyses of trends in and achievements of sorne components of national drug policies; paragraphs 28 tn 34 described sorne challenges to be met and the framework for action; and paragraphs 35 to 38 outlined sorne future perspectives and the role of WHO.
AFRlRC49/6 page 9 78. The Committee was invited to take note of the slow but steady progress in national drug policy development and implementation, and the serious challenges the Region was faeing in providing essential drugs despite previous strategies developed and efforts made by Member States to address these challenges. The Committee was also invited to review the components of the Intensified Essential Drugs Programme for the African Region and provide guidance on ways and means of supporting the collaborative implementation of the programme and raising funds for its implementation. 79. The Regional Director stressed the importance of essential drugs in national health care delivery systems, particularly at the district level. He added that it was for this reason !hat a WHO regional meeting was organized in Cape Verde in 1998 to look at the various aspects of the local production of essential drugs, including the identification of areas of collaboration between countries. He therefore , called on the Committee to pro vide guidance on this important subject. 80. The Subcommittee noted the various dimensions of the drug issue that are of great coneem. These included the limited availability of, and lack of regular access to, quality essential drugs, inappropriate drug use, and lack of standards, regulations and relevant legislation. 81 . They noted that bulk purchasing involving many countries has the potential of reducing the cost of drugs and thereby enhancing their affordability. 82. The Subcommittee noted the impact of international !rade agreements on the local manufacture of drugs and the implications ofWHA resolution on the revised drug strategy. Countries would need to consider the implications of these agreements very seriously and al! parties concemed (ministries of heaIth, !rade, commerce and industry) should be involved in the protection of public health interests. 83. The Subcommittee suggested that health professionals should collaborate with traditional healers in order to enhance the use of medicinal products of proven efficacy and innocuity. On this issue, the Subcommittee was reminded that WHO was deve!oping a strategy on the role oftraditional medicine in health care delivery. 84. It was noted that the undertaking of scientific studies and clinical trials wou!d make it possible to assess the efficacy and safety ofherbal formulations. 85 . The Subcommittee stressed the need to ensure the availability of essential drugs at allleveis of the health system in order to enhance the effective implementation of priority programmes (e.g. malaria, tuberculosis and HIV/AIDS) and strategies (e.g. !MCl). 86. The Subcommittee advised that essentia! drug lists for the various levels of the health system be periodically revised to take cognizance of emerging and re-emerging diseases, resistance to existing drugs and new developments in the drug industry. 87. The Subcommittee expressed special coneem about the high proportion of imported drugs that are fake or iIIicit. It was suggested that WHO should make coordinated efforts with relevant partners to address the issue at national, regional and g!oballeve!s. 88. Although there are different interests at stake on issues related to drugs, the Committee advised that national drug polides should address the needs of the population, particularly those related to the implementation of the minimum health package at district leve!. 89. The Secretariat noted specifie comments and suggestions made by the Subcommittee to improve the document.
AFRlRC49f6
page 10
90. The Subcommittee prepared a draft resolution to be submitted to the Regional Committee for review and adoption (Annex 7). HEALTH TECHNOLOGY POLICY IN THE AFRICAN REGION (document AFRfRC49/ 12)
91. Dr B. K. Nguyen of the Secretariat introduced the document. 92. He reminded me Subcommittee that technology development had played and continued to play an essential role 10 promoting health care delivery. The introduction of technologies in the Region was currently influenced more by pressures from technology producers and users than by country needs. This situation stemmed from strong market pressure at the global and nationallevels, lack of standardization of medical equiprnent and me donation of equipment from various sources. 93. He added that the scope ofhealth technology was very wide and, merefore, mat me report submitted to me Committee focused on biomedical equipment which was one of the major concerns of the countries in the Region. 94. Paragraphs 5-9 of the report set forth the proposed health technology policy which aimed to strengthen the capacity of countries to optimize the acquisition, management and use oftechnological resources in order to assure universal and equitable access to essential quality care. Three guiding principles had been proposed to ensure effective implementation of the policy. Paragraphs 11-19 of the report contained the result of a situation analysis ofhealm technology in the Region whilst paragraphs 20-29 provided the justifications for the policy. The strategy for implementing the proposed policy was set out in paragraphs 30-51 in tenns of objectives, expected results and priority interventions. Paragraphs 52-56 presented the framework for me implementation of the proposed policy. The critical factors for successful implementation ofme policy were discussed in paragraphs 57 and 58. 95 . Successful implementation ofthis regional policy would depend, among other things, on long-tenn political commitrnent, the establishment of real conditions for ownership of the policy implementation process by Member States, continued availability of a critical core of trained technical staff, effective resource mobilization and adequate funding. 96. He concluded mat the Programme Subcommittee was expected to examine the various elements of me proposed regional health technology policy and make appropriate. suggestions for its improvement with a view to adopting it. The Committee was also to discuss how hest to assist Member States in formulating national policies on health technology development based on the regional policy and in drawing up coherent plans that would help improve the quality and quantity ofhealth care delivery, while reducing costs and external dependence. 97. The Regional Direetor indicated mat healm technology should include equipment and procedures. He added that healm technology, in the regional context, should he seen as possessing ham imported and local components. 98. The Programme SUbcommittee welcomed the document and described it as a breakthrough in the Region as most of our countries do not have clearly defmed policies or coherent strategies on health technology, a situation which had led to weaknesses in me various dimensions of health technology management - namely the selection, procurement, utilization, maintenance and replacement of equipment.
AFRJRC49/6 page Il
99. The Subcommittee noted that the potential areas for technical cooperation among countries in the Region with regard to health technology included training of health technology and equipment maintenance staff, bulk purchase and utilization of modern technology. 100. The Secretariat provided clarifications on the various issues raised by the Subcommittee. 101. The need to undertake an inventory ofboth imported and indigenous health technologies, no matter how rudimentary, as well as the extent of their functionality and appropriateness was stressed. The infonnation resulting from this exercÎse could be used to better plan the further selection of appropriate technologies. 102. The need to develop a maintenance culture with regard ta health technology was emphasized. This would involve budgeting for equipment maintenance as weIl as undertaking preventive maintenance. 103. The Subcommittee requested the assistance of WHO in the development of guidelines that would: (i) standardize types of health technologies at the various levels of the health system and/or health facilities; and (ii) regulate the donation or purchase ofhealth lechnology. 104. The Subcommittee noted that while training of an adequate number of maintenance staff was necessary, adequate motivation in order to ensure their retention was equally important. 105. The Secretariat noted the various comments and suggestions made to improve the quality of the document and assured the Programme Subcommittee that they would be incorporated during the revision of the document. 106. The Subcommittee recommended that the policy document on health technology should he adopted and that its implementation should take cognizance of resolution AFRlRC44/RI5 on the selection and development ofhealth technologies at district leve!. REVIEW OF THE IMPLEl'lfENTA TION OF THE BAMAKO INITIATIVE (document AFRlRC49/13) 107. Dr B. K. Nguyen of the Secretariat introduced the document. 108. He recalled that twelve years had elapsed since 1987 when the Bamako Initiative (BI) was launched with the aim of strengthening primary health care (PHC). In September 1997, the Regional Committee at ils 47th session requested for a review to be carried out. In response, the WHO Regional Office for Africa, together with the Govemment of Mali and UNICEF organized a meeting in Bamako, Mali from 8 to 12 March, 1999 to review the implementation of the Initiative in the African Region. 109. He added that the report presented the outcomes of the meeting as weil as the framework of the implementation of the Bamako Initiative in future. Il also defined the TOle of the Initiative in the ongoing health sector reforms in countries of the Region. 110. Paragraphs 6 to 9 of the document analysed the achievements and lessons leamed. The Bamako Initiative was wide1y considered to be a pertinent approach for realising the goals of PHC. In countries that had implemented the Initiative to a large extent, it had contributed to improving the accessibility and coverage ofhealth services. Through the Initiative, a legal framework for community participation was developed. ImpTOved drug management with cost recovery, co-financing and retention of funds at the community level had been realized. Most countries had defined a minimum package ofhealth care al district leve!. The Initiative had also played an important catalytic TOle in the strengthening of the district health system.
AFRJRC49f6 page 12
III. Pohtical will and stability, involvement of other seetors including the private seetor, and avoidance of over-dependence on external funding were sOrne important lessons leamed in the process of implementing the Initiative. 112. The future perspectives were addressed in paragraphs 10 to 13 of the report. The Bamako Initiative should address the community dimension of the health scctor refonns. Thus the focus of the Initiative should continue to he on empowering the communities to improve their own health in the context of the cutrent reforms. There would he need to relate the Bamako Initiative with income generating activities at the community level in an effort towards contributing to poverty alleviation and sustainable development. 113. A ncw implementation framework was proposed in paragraph 13 of the report. The Bamako Initiative remained an effective and pertinent strategy for promoting universal access to quality health care. Actions to be undertaken within the context of a strong leadership ofnational authority, in order to achieve the goal had been proposed. 114. The Programme Subcommirtee was invited to take note of the significant achievements made by Member States in implementing the Bamako Initiative and to endorse the implementation framework newly proposed in the report of the Regional Director. The Committee was requested to provide guidance on ways and means to commit countries to implementing the Initiative as the community dimension of the health seetor reforms and gel national as weil as international partners to supporting effectively the efforts of communities and govemments in this domain. 115. The Programme Subcommittee noted that countries that had been implementing the Bamako Initiative had found the approach pertinent and relevant in solving the major health problems facing the communities. Indeed, the communities had become more involved and active in addressing matters pertaining ta their own health. 116. Concem was expressed about the need for governrnents to continue to play their role in the provision of optimal health care to the population. The community contribution should be complementary ta govemments' efforts. The Subcommittee called upon WHO to assist in influencing govemments ta continue to play their fundamental role. 117. Il was noted that the current document was silent on constraints ta the implementation of the Initiative. Observations that were made in this regard included the following: Where the Bamako Initiative implementation was started without adequate preparations of the communities it was bound to encounter difficulties. Cost recovery should be backed by favourable legislative framework for it to succeed and provision should be made for those who are not able to contribute. Vaccinations should also be excluded from cost recovery efforts. It is important ta ensure proper accountability and transparency in managing community resources.
The issue of sustainability should be addressed early and donor funds should be directed to priority health needs as identified by the communities. Drug supplies in support of the Bamako Initiative should take into account the special needs of HIVlAIDS patients.
AFRlRC49/6 page 13 Fake generic drugs could easily and rapidly find their way inlO communities and peripheral health facilities. The need to enhance quality health care cannot be over emphasized.
118. The Subcommittee stressed the need to crea!e an enabling environment for partners and NGOs to provide resources in support of the Bamako Initiative and to look into the effective and relevant role of traditional medicine. It also recommended the need for dialogue and collaboration with other sectors and for WHO to facilitate this in the countries. 119. On the new implementation framework, the Subcommittee noted that more countries were considering introduction or furthel' development of the Bamako Initiative. In light ofthis, there was need to define more operationally the new implementation framework for the Initiative and for WHO to provide clear guidelines and support. Under this framework, it would he necessary to identify the changes envisaged within health sectar reforms. 120. The Subcommittee prepared a draft resolution for submission ta the Regional Committee for review and adoption (Annex 8).
ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE (document AFRlRC49(6) 121. After review of the document and sorne 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 122. The Programme Subcommittee decided that its Chairman, Dr Malick Niang, would present the entire report to the Regional Committee and that, in the event that he is unable to attend the Regional Comnmittee, the Vice-Chairman, Dr H. A. Attas, would present the report.
CLOSURE OF THE MEETING 123. The Chairman thanked members of the Programme Subcornmittee and the members of the Executive Board who participated in the meeting for facilitating his task and congratulated them for their excellent contributions. He also expressed his gratitude, on behalf of the Subcornmittee, to the Regional Director, other members of the Secretariat and the interpreters for their contribution to the success of the meeting. 124. The Regional Director acknowledged the guidance provided by members of the Programme Subcommittee as well as the members of the Executive Board who participated in the meeting and reaffirmed that ail recommendations made would be duly taken into account by the Secretariat. He warmly congratulated the Chairman for the excellent work he had done . 125. He informed the Subcommittee that his brief absence during the Course of the meeting was necessitated by the fac! !hat he had been invited ta receive extrabudgetary contributions from two don ors. W ith these contributions, extrabudgetary funds had risen from the US $30 million level in 1995 to US $155 million and that there were indications!hat the figure would rise to US $200 million by the end of 1999. He attributed !hat positive development to the confidence that the donor community had shown not only in the Secretariat but also in the Regional Committee and its Programme Subcommittee. 126. The Chairman then declared the meeting closed.
AFRlRC49/6 page 14
ANNEXIANNEXE/ANEXO l LIST OF PARTICIPANTS LISTE DES P ARICIPANTS LISTA DOS PARTICIPANTES
1. Member States of the Pro gamme Subcommittee Etats Membres du Sous-Comité du Programme . Estados-membros do Subcomité doPrograma ALGERIA* ALGÉRIE ARGÉLIA M. Mohamed Liamine Chergui Directeur des Etudes chargé des Relations internationales au Ministère de la Santé
TANZANIA TANZANIE TANZÂNIA Dr Hassan A. Attas Director-General for Health (Zanzibar) Dr Said Egwaga Ag. Director, Preventive Services
TOGO Prof. Aissah Agbetra Professeur de Médecine
RWANDA RUANDA Dr D. Ndushabandi Secretary General, Ministry of Health
UGANDA OUGANDA Dr Alex A Opio Assistant Commissioner of Health Services
SAO TOME AND PRINCIPE SAO TOMÉ ET PRINCIPE SAO TOMÉ E PRÎNCIPE Dr. Gilberto José da Costa Frota Director do PIano, Administraçào e Finanças
ZAMBIA zÂMBIA ZAMBIE M. Nelson L Magolo Deputy Permanent Secretary
SENEGAL Dr Malick Niang Directeur de la Santé
ZIMBABWE ZIMBABUE Dr P .L.N. Sikosana Secretary for Health and Child Welfare
SEYCIIELLES Dr Ruben E. Brewer Commissioner of Health Services
EXECUTIVE BOARD MEMBERS MEMBRES DU CONSEIL EXECUTIF MEMBROS DO CONSELHO EXECUTIVO Dr Juna Mohamed Kariburyo Ministre de la Santé publique Burundi Dr IIdo Carvalho Adviser to the Minister o f Health Cap-Vert Prof. Jean-Luc Mandaba Ancien Ministre de la Santé, ancien Premier Ministre, Chef du Gouvernement, Professeur de Chirurgie infantile, Chef du Service République centrafricaine
SIERRA LEONE SERRALEOA Dr Noah Conteh Deputy Director-General of Medical Services
SWAZILAND SUAZILANDIA
Dr Steven V. Shongwe Deputy Director of Health Services • Unable to attendfN'. pas pu participerlNao poder panicipar,
AFRJRC49/6 page 15 ANNEX2 PROGRAMME OF WORK
Day 1: Monday, 14 June 1999
09.00 a.m .. 12.30 p.m. -
Arrivai ofmembers Orientation of members Review of documents Lunch break Agenda items 1, 2, 3, 4 and 6 Agenda Item 1: Official opening Agenda Item 2: Rapporteurs Election of the Chairman, Vice·Chairman and
12.30 p.rn. - 2.00 p.m. Session 1 2.00 p. m. ·2.10 p.m. 2.10 p.rn. ·2.20 p.rn.
2.20 p.m. - 2.30 p.rn. 2.30 p.m .• 4.00 p.rn.
Agenda item 3: Adoption of agenda (document AFRlRC49/19) Agenda item 4: Health sector refom1 in the African Region: Status of irnplementation and perspectives (document AFRlRC4917) Agenda item 6: Regional mental health strategy (document AFRlRC49/9)
4.30 p.rn. - 5.30 p.rn.
Agenda item 6 (cont'd.)
Da)' 2: Tuesdoy, 15 June 1999
Session 2 09.00 a.m.. - 11.00 a.m. 11.00 a.m. - 11.30 a.m. 11.30 a.m.• 12.30 p.m.
Agenda items 7, 8 and 9 Agenda item 7: Integrated Management of Childhood IIIness: Strategie plan for 2000-2005 (document AFRlRC49/10) Tea break Agenda item 8: Essential drugs in the African Region: Situation and trend analysis (document AFRlRC49/l1) Lunch break Agenda item 8 (cont'd.) Agenda item 9: Health technology policy in the African Region (document AFRlRC49/ 12)
12.30 p.m. - 2.00 p.m. 2.00 p.m. - 4.00 p.rn.
4.00 p.rn.. 4.30 p.m. 4.30 p.rn.. 5.30 p.m.
Tea break Agenda item 9 (cont 'd.)
AFRfRC49/6 page 16
Annex 2
Do)'3: Wednesday,16 JUlie 1999 Session 3 10,00 a.m. - 1 \.00 a.m. Agenda item 5: Draft resolutions for items 4, 5 6 and 9 Agenda Item 5: Regional Health-for-AII Policy for 21st Century (document AFRfRC49/8) Tea break Agenda item 5 (cont'd,) Lunch break Agenda item 5 (cont'd,) Tea break Discussion and adoption of draft resollltÎons for items 4, S, 6 and 9
11.00 a.m - ll.ls a ,m, 11.15 a,m, - 12.30 p ,m, 12,30 p.m. - 2.00 p,m, 2,00 p.m, - 3.30 p.m . 3.30 p,m. - 4,00 p .m , 4 ,00 p,m, - 5.00 p,m,
Day 4: Thursday, 17 June 1999 Session 4 09,00 a,m. - 11.00 a.m. Agenda item 10: Draft resolution for agenda item la Agenda item 10: Review of the implementation of the Bamako Initiative: Report of the Regional Director (document AFRfRC49/J 3) DisCllssion and adoption of draft resolution for agenda item 1 \.00 a.m ,
la
Adjoumment of session (Preparation of report)
Day 5: Frida)', 18 JUlie 1999 Session 5 4 ,00p.m . Agenda items 11, 12 and 13 Adoption of report Assignment of responsibilities Closing session
AFRlRC49/6 page 17
ANNEX3 AGENDA 1. 2. 3. Opening of the session Election of the Chainnan, the Vice-Chainnan and Rapporteurs Adoption of the Agenda (docwnenl AFRlRC49/19)
4. Health sector refonn in the WHO African Region: Status of implementation and perspectives (document AFRlRC49(7)
5. Regional Health-for-AII poliey for the 215t century (documents AFRlRC49/8(a) and 8(b)) 6. 7. Regional mental health strategy (document AFRlRC49/9) Integrated Management ofChildhood IIlness: Strategie plan for 2000-2005 (document AFRlRC491l 0) Essential drugs in the WHO African Region: Situation and trend analysis (document AFRlRC49/ 11) Health technology policy in the African Region (document AFRlRC49/12)
8. 9.
10. Review of the implementation of the Bamako Initiative: Report of the Regional Director (document AFRlRC49/ 13) Il . Adoption of the report of the Programme Subcommittee (document AFRlRC49/6) 12. Assignment of responsibilities for the presentation of the report of the Programme Subcommitree to the Regional Committee 13. Closure of the session
AFRlRC49/6 page 20
Annex4 J. 2. ADOPTS the report of the Regional Direclor; CALLS UPON Member States: (i) to intensify their efforts 10 undertake appropriate health sector refonus Ihat are in confonnity with national health policies; (ii) 10 actively involve al! stakeholders - the pnvate sector, civil society, communities, extemaJ
partners - and govemment agencies outside the ministry ofhealth; (iii) to ensure that govemment assumes leadership at every stage of the reform process and secures the necessary support of national and international partners; (iv) to cooperate with one another, within the context of technical cooperation among developing countries, in designing and implementing their health sector reforms; 3. REQUESTS the Regional Director: (i) to make a synthesis of the experiences on health sector reforms as reported by countries of the Region and disseminatc it widely to Member States; (ii) to develop, on the basis of the synthesis of experiences, a framework that will guide Member States in designing, implementing and evaluating their health sector reform; (iii) to put in place effective mechanisms for providing timely and appropriate support to Member States and for contributing to the strengthening of national capacities, infrastructure and technology management in order to ensure sustainable health development; (iv) to take steps to further intensify the collaboration between World Health Organization, the World Bank. the African Development Bank, and other UN agencies concerned so as to ensure that the implementation of the health component of the UN Special Initiative on Africa facilitates the health seclor reform process in Ihe individual counlries; (v) to report to the fifty-second session of the Regional Committee on the progress achieved in implementation of health sector refonus in Member States and the added value of the implementation of the health component of Ihe UN Speciallniliative on Africa; 4. APPEALS 10 the African Development Bank, bilateral donors and UN agencies including the World Bank, to provide greater support 10 govemment-Ied health sector reform efforts in the countnes of the Region.
AFRlRC49/6 page 21
ANNEX5 AFRlRC49IWP12 DRAFT RESOLUTION REGIONAL STRATEGY FOR MENTAL HEALTH ORIGINAL: ENGLlSH
The Regional Cornrnittee, Aware of the magnitude and the public health importance of mental, neurological and psychosocial problems which have been aggravated by the stigma attached to them; Concerned about growing poverty, the increasing frequency of natural disasters, and the escalation of wars and other forms of violence and social disruption which are causing growing psychosocial problems such as a1cohoI and drug abuse, prostitution, the phenomenon of street children, child abuse and domestic violence; Recalling World Health Assembly resolutions WHA28.81 (1975) on the assessment ofproblems relating to alcohol abuse, WHA30.45 (1977) on the creation of the African Mental Health Action Group, Regional Committee resolution AFRiRC401R9 (1990) which called on Member States to implement community mental health care based on the district health system approach and AFRlRC44/R14 (1994) on accelerating the development of mental health in the African Region; Appreciating the efforts already made by Member States and their partners to improve the mental health of their people and prevent and control substance abuse;
Recognizing the need ta review existing approaches in this area and develop a comprehensive strategie framework for mental health and the prevention and control of substance abuse in the countries of the African Region; Having carefully examined the report of the Regional Director as contained in document AFRiRC49/9 which sels fortb WHO's regional strategy for mental health;
1.
APPROVES the proposed strategy aimed at strengtbening tbe capaeity of Member States to improve
the quality of Iife of their people by promoting healthy lifestyJes, and preventing and controlling mental, neurological and psychosocial disorders;
AFRlRC49/6
page 22
Aonex 5
2.
REQUESTS Member States: (i) to take into accouot mental health concerns in their national bealth policies and strategies; recognize the nced for the multisectoral approach and integrate mental health into their general health services, particularly at the district level, with adequate community participation; (ii) to establish or update national programmes and plans of action for the implementation of activities 00 mental health and the prevention and control of substance abuse, according to their priorities; (iii) ta designate a focal point in the ministry of health to manage the mental health programme thus established; (iv) to pro vide tinancial resources for the implementation of the related activities and consider introducing cost-sharing schemes where appropriate; (v) to intensify capacity building, taking into account the mental health dimension, when drawing up national humao resources deve10pment plans and to use regional health training institutions; (vi) to ensure that a research culture is buil! iuto their national programmes; (vii) to undertake community-based psychosocial rehabilitation interventions, targeting vulnerable and high-risk groups, especially displaced persons, refugees, victims of land mines, people with chronic mental and neurologieal conditions as well as people living with HIV/AIDS ; (viii) to formulate or review Legislation in support of mental bealth and the prevention and control of substance abuse;
3.
REQUESTS the Regional Director: (i) to provide technical support to Member States for the development of national policies and programmes on men laI health and tbe prevention and control of substance abuse;
. ,.
AFRlRC49/6 page 23
Annex 5
(ii)
to take appropriate measures to enhance WHO's capacity to provide timely and effective technical support, al regional and country levels, to national programmes on mental health and tbe prevention and control of substance abuse;
(iii)
to increase support ta tbe training ofhealtb professionals in mental bealth at different levels of the health system and promote the use of traditional medicine within the context of African realities;
(iv)
ta facilitate the mobilization of additional resources for the implementation of the mental health strategy in Member States;
(v)
to report to tbe 51st session of tbe Regional Committee on the progress made in the implementation of tbe regional strategy for mental bealth.
AFRJRC49/6 page 25
ANNEX6 AFRJRC49IWP/3 DRAFT RESOLUTION ORIGINAL: ENGLISH
JIWEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI): STRATEGIC PLAN FOR 2000-2005 The Regional Committee, Recalling World Health Assembly resolution WHA48.12 which adopted !MCI in May 1995 as a cost-effective approach for cbild survival and development; Recalling the regional PoNcy Frameworkfor Technical Cooperation with Member States, in whieh IMCI was confirmed as an appropriate and effective approach that should be implemented in the Region; Considering that 70% of childhood deaths are due to aeute respiratory infections, diarrboeal diseases, measles, malaria and malnutrition and !hat IMCI is an appropriate strategy for controUing these childhood killer diseases; Bearing in mind the spirit of international events such as tbe 1978 Alma-Ata conference on primary health care, the adoption of the Convention on the Rights of the Child in 1989, and the 1990 Warld Summit for Children during whieh gavemment leaders committed themselves to giving the child a better future; Aware of the high infant and child mortality rates in the cauntries of the Region and the need to support health sector develapment in a broad setting which provides opportunities far implementing preventive, promotive, curative and rehabilitative interventions; Aeknowledging that the integrated approaeh to childhood iHness will help reduce under-five morbidity and mortality and that the approach is capable of enhancing cost effeetiveness; Considering the present status of implementation of IMCI in the African Region and the need to give more intensive support for the implementation ofthis strategie plan; Recognizing the invaluable support that multiIateraI and bilateral cooperation partners have given to the cauntries to date for IMCI implementation,
AFR/RC49f6 page 26
Annex 6
1.
APPROVES the regional strategie plan for the integrated management of ehildhood iIlness (IMCI)
as presented in document A FR/RC49f 10;
2.
CALLS UPON Member States:
(i)
to include the IMCI strategy in national health polieies and plans of action;
(ii) to accelerate IMCI implementation, maintaining a step-wise approach and paying attention to quaIity, particularly during the expansion phase;
(iiil
(0
take the neeessary steps (0 ensure greater availability of buman and financial resourees, and
to strengthen district health systems, for sustainable Implementation of !MCI; (iv) to revise their essential drug Iist in order to facilitate the implementation of the IMCI strategy;
3.
REQUESTS the Regional Director:
(i)
to provide support to Member Slates to strengthen and accelerale the implementation of the strategie plan;
(ii) to mobilize regular budget and extrabudgetary resources to support the Implementation of the strategie plan;
(iii) 10 monitor the implementation of the strategie plan in the eountries and faeilitate the sharing of experienees and lessons leamed among the Member States;
(iv) to report to the flfty-tirs! session of the Regional Committee on the progress made in the implementation of the strategie plan;
4.
REQUESTS international and other partners eoneemed \Vith the Implementation of IMCI in the
Afriean Region to intensify their support to the countries for the implementation of the IMCI strategie plan.
AFRlRC49/6 page 27
ANNEX7
AFRlRC49IWP/4
ORlGINAL: ENGLISH
DRAFT RESOLUTION ESSENTIAL DRUGS IN THE WHO AFRlCAN REGION: SITUATION AND TREND ANALYSIS
The forty-ninth Regional Committee, Recalling World Health Assembly resolutions WHA39.27, WHA41.16, WHA43.20, WHA45.27, WHA47.12, WHA47.13, WHA47 .16, WHA47.17, WHA49.l4, WHA52.19 on the WHO revised drug strategy; Regional Committee resolution AFRlRC371R6 on essential drugs and vaccines; AFRlRC381R18 on the Bamako Initiative; and AFRlRC38/ 19 on local production of essential drugs;
RecalJing World Health Assembly resolutions WHA22.54, WHA31.33, WHA41.19, WHA42.43, WHA44.33 and Regional Committee resolutions AFRlRC281R3, AFRlRC331R3 , AFRlRC361R9 on the use of traditional medicines;
Concerned about the present situation where over 50% of the population in the Region lack regular access to essential drugs despite the fact that national drug policies exist;
Concerned further that prevailing economic difficulties and the effects of structural refonns on the social sector are adversely affecting access to essential drugs;
Noting with satisfaction the establishment for the African Region of the Intensified Essential Drugs Programme to help address present and future challenges in the pharmaceutical sector;
Reaffinning the commitrnent of the Member States to developing, implementing and monitoring national drug policies and programmes for improving the availability and accessibility of drugs of proven quality and ta ensuring their rational use; 1. APPROVES the report of the Regional Director on essential drugs in the WHO African Region;
AFRlRC49/6 page 28
Annex 7
2.
URGES Member States:
(i)
to establish mechanisms for consultation between the ministry of health and other relevant ministries on monitoring the impact on access to essential drugs of the glohalization of trade, international trade agreements, eeonomic reforms, and health sector reforms;
(ii) to review, and enforee legislation and regulations pertaining to the control of the illieit!rade in phannaceutieals and the use of traditional medicines and recognize generic drug substitution rights of pharmacists wberever applicable;
(iii) to collaborate with one another, particularly at subregionallevel, coordinate efforts for local production of essential drugs and implement joint bulk purchasing;
(iv) to strengthen national drug regulatory authorities and drug quality assurance mechanisms and, where feasible, establish national quality controllaboratories and make effective use ofexisting regionallaboratories;
(v) to collahorate actively with WHO and other partners in the implementation of the Intensifted Essential Drugs Programme for the African Region;
3.
REQUESTS the Regional Director:
(i)
to continue to support Member States in their efforts to develop and implement national drug policies and essential drug programmes;
(ii) to collaborale with Member States in the development oftools, guidelines and metbodologies for monitoring and evaluating programmes;
(iii) 10 support Member States: (a) monitoring and analysing the pharmaceutical and public health implications of
ID
globalization, regional and international trade agreements sucb as those in the World Trade Organization (WTO) and on the Trade-Related Aspects of Intellectual Property Rights (TRIPS);
AFR/RC49/6 page 29
Annex 7
(b) in promoting intercountry collaboration on local production, particularly of generic essential drugs; (c) in undertaking the joint bulk purchasing of drugs;
(d) in developing their human resources in the area of pharmaceuticals; (e) mobilizing resources for the implementation of the Intensified Essential Drugs
ln
Programme for the African Region al country level; (iv) to report to the fifty-first session of the Regional Committee on progress made and problems encountered in the implementation of the Intensified Essential Drugs Programme for the African Region.
AFRlRC49/6
page 32
Annex 8
4.
INVITES Member States: (i) to include the Bamako Initiative in their agenda for health sector reform, and to implement the Initiative as the community dimension of the reform; (ii) to ensure that national policies and strategies have a strong community focus, empower individuals and families 10 improve their own health and well-being and develop the capacity of communities to co-manage essential health services; (iii) to develop a new national framework for the implementation of the Bamako Initiative, including an essential package of cafe adapled to current priority areas such as Roll Back Malaria, the Integraled Management of Childhood lllness, the Safe Motherhood Initiative, Tuberculosis and HIV/AIDS prevention and control; (iv) to enhance equity by promoting national and local solidarity mechanisrns for health cafe financing, especially for the most vulnerable groups such as women, children, adolescents, people living with HlV/ AIDS and those living in remote areas; (v) to improve coordination among actors, especially govemments, communities and partners, in the implementation, monitoring and evaluation of the Bamako Initiative;
5.
REQUESTS the Regional Director: (i)
to develop a new implementation frarnework in which the Bamako Initiative wi1\ be Iinked with income-generating activilies al the cortimunity level, and, with the support of govemments, 10 operationalize the framework by contributing to poverty alleviation and sustainable developmenl;
(ii) to further promote community and home-based health interventions for priority public health programmes and initiatives, e.g., RoU Back Malaria, Integrated Management of Cbild Illness, the Safe Motherbood Initiative, Tuberculosis and HlVlAIDS prevention and control; (iii) to set up a mechanism with other partners, particularly UNICEF, for improving coordination and support to Member States for the implementation, monitoring and evaluation of the Bamako Initiative;
AFRlRC49/6 page 33
Annex8
(iv) 10 report to the 52nd session of the Regional Committee on the progress made in the implementation of the new framework for the Bamako Initiative; 6. APPEALS to partners to intensifY their support to Member States for tbe implementation of the
Bamako Initiative in the context of the overall development of tbe national health scetor.
....
. ..