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Regional strategy for health for all by the year 2000

31 décembre 1982 Organisation mondiale de la santé

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Regional Strategy for Health for All by the Year 2000

( WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC MANIl.A Utl1

Note

For rights of reproduction 1n part or in toto, application to the World Health Organization, for the Western Pacific, Manila, World Health Organization applications.

or translation, should be made Regional Office Philippines. The welcomes such , I

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

CONTENTS

Page

INTRODUCTION 1.

................................................................ ............. . '

MAIN HEALTH AND HEALTH-RELATED PROBLEMS

8 8 9

Introduction •••••..••••.•.••••..•.•.•••.•••••• Popu 1a t ion ........................ .. .•..• ".,e .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Socioeconomic situation •••••••••..•••••••••••• Health problems .............................................................. Problems related to the health care system Awareness of problems ••••.••••••••••...•.•.... II. III.

10 12 13

HEALTH AND SOCIOECONOMIC POLICIES CONCEPTUAL FRAMEWORK FOR ACTION

.. ..................... .

16 20

. .......................... .

IV.

LONG-TERM OBJECTIVES, TARGETS AN1> APPROACIlES .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

Introduction Country statement synthesis ••••••••••••••••••• Regional objectives, targets and approaches V. DEVELOPMENT OF THE HEALTH SYSTEM BASED ON PRIMARY HEALTH CARE ••••••••••••••••••

23 23 25 33

Modification of health care delivery systems Development of required health manpower ••••••• VI. REGIONAL SUPPORT MEASURES

33 35 38 38

Political support Economic support .......................................................... .. Technical 8upp-ort ....................................... .

39 40 41 42 43

Managerial and administrative support Research support

•••••••••

............................................. ..

Information support

................................ .

VII.

GENERATION AND MOBILIZATION OF RESOURCES Human resources development ••.•••••.••••••.•••

45 45

Financial and material resources VIII. COLLABORATIVE MECHANISMS

••••••••••••••

46 48

Intrasectoral and intersectoral collaboration •• Intercountry collaboration ••••••••••••••••••••

48 50

Intergovernmental organizations, voluntary agencies, agencies within the United Nations system ••••••••••••••• Technical cooperation among countries Economic cooperation among developing countries .... .. .... .. .. .. .. .. .... .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .... ..

50 52 53

IX.

MONITORING AND EVALUATION Framework .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

54 54

Level and process

•••....•••••••••••••••••••••.

Nat ional leve 1 Regional level

•• •• • • • • • • • • • • • • • • • • • • • • •• . • .... . ............ ...... .................... .. ...... ....

54 5S

Proposed national indicators •••••••••••••••••• Indicators for regional and global use •••••••• X. ROLE OF WHO WITH RESPECT TO REGIONAL STRATEGY ISSUES • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • • I ssues for WlIO ........................................ " .. .. .. .. .. .. .. .. .. .. ..

55 60 66 66

Guiding principles for WHO action ••••••.•••••• Nature of WHO collaboration ••••••••••••••••••• WHO's programme for the future •••••••••••••••• Organizational structure •••••••••••••••••• Management of the strategy •••••••••••••••• Programme content ••••••••••••••••••••••••• XI. TENTATIVE PLAN FOR IMPLEMENTATION OF THE REGIONAL STRATEGY, INCLUDING A TIMETABLE ••••••

68 69 70 71 73 74 81

INTRODUCTION

1. A regional strategy for health for all by the year 2000 (health/2000) was adopted by the WHO Regional Committee for the Western Pacific at its thirty-first session in 1980. Subsequently, the Strategy was revised in the light of the Global Strategy for Health for All by the Year 2000, adopted by the Thirty-fourth World Health Assembly. 1 The revised Regional Strategy was adopted by the Regional Committee at its thirty-second session in September 1981. 2 2. Early in 1979 Member States of the Western Pacific Region were asked to comment on document A32/8. 3 In October 1979, the Regional Committee adopted resolution WPR/RC30.RIl,4 which recommended that Member States should make proposals to the Regional Director on issues to be addressed by regional strategies. The information thus obtained, which consisted of observations, progress reports and draft national strategies, was used by the Regional Committee's Sub-Committee on the General Programme of Work as the basis for preparation of the

lSee resolution page 35).

WHA34.36

(document WHA34/1981/REC/l,

2See resolution WPR/RC32.R5, Handbook of Resolutions and Decisions of the WHO Regional Committee for the Western Pacific, Vol. II, 3rd ed., 1982, page 3. 3Formulating strategies for health for all by the fear 2000, Geneva. World Health Organization, 1979 "Health for A11" Series No. 2). 4See resolution WPR/RC30.RII, Handbook of Resolutions and Decisions of the WHO Regional Committee for the Western Pacific, Vol. II, 3rd ed., 1982. page 1. 5

Regional Strategy for Health for All

Regional Strategy. The Strategy follows a format which was adopted for all regions by the Programme Development Working Group in April 1980. 1 3. In the Regional Strategy the overall goal of health for all by the year 2000 is subdivided into ten broad ob ject i ves covering the following areas: nutrition, safe drinking water, adequate sanitation,' control of environmental pollution, control of communicable diseases, reduction of chronic diseases, promotion of psychosocial well-being and a life-style conducive to health, elimination of pockets of ill-health, fertility regulation, and access to appropriate health care for all. 4. The main thrust of the Strategy is the development of a health system based on primary health care. 5. The Strategy sets out the principles underlying the development of health systems based on primary health care and defines the regional measures required with respect to political, economic, technical, managerial and administrative, research and information support. It further deals with the issues of generation and mobilization of human, financial and material resources, and describes possihle mechanisms for collaboration. Particular importance is attached to intra- and intersectoral collaboration and intercountry collaboration. The Strategy finally addresses the issues of monitoring and evaluation and the role of WHO.

IThe Programme Development Working Group is composed of the Directors, Programme Management of the WHO Regional Offices for Africa, the Eastern Mediterranean, Europe, South-East Asia and the Western Pacific and the Operat ions Manager, Regiona I Office for the Americas, the Chairman of the Headquarters Programme Committee, and the Director, Programme Promotion in the Director-General's Office. 6

Regional Strategy for Health for All

6. The Strategy places special emphasis on enhancement of co_unity participation through a partnership approach, intersectoral coordination at all levels, use of appropriate technology, study and subsequent modification of the health care delivery system, development of the required health manpower, for and strengthening of the managerial process national health development. It envisages that activities will be initiated at national level, where the policy for reso~rce allocation is normally formulated in most countries of the Region, and at the periphery, where interactive processes with communities will be started and supported. 7. The Regional Strategy should be viewed as a dynamic document which needs to be updated from time to time in the light of ongoing and foreseen developments.

Regional Strategy for Health for All

MAIN HEALTH AND HEALTH-RELATED PROBLEMS

Introduction

1. The strategy to achieve a level of health permitting all citizens of the Western Pacific Region to lead a socially and economically productive life must address both eurrent and potential problems likely to impede heal th development. As the status of hea 1 th is a result of factors which are behavioural, environmental and hereditary, the strategy should focus on those behavioural and environmental problems that are amenable to change. 2. Socioeconomic factors in the environ~ent and the lifestyle of the people play a determining role in their health status and health develop~ent. It is therefore precisely to those factors that a strategy for health should be addressed. 3. Elements consider: of the strategy and should accordingly of the

the growth, population

composition

movement

the level and phase of economic development the health status of the people of the Region the health care system, and the social values and behaviour forces shaping society's

Regional Strategy for Health for All

4. Population growth, although it has slowed down in most countries of the Region, remains a problem which affects health both directly and indirectly. According to even the most optimistic projection for the next two decades, this problem will continue to be felt in the year 2000. 5. The population structure of the Region is characterized by a predominantly young population. Longer life expectancy will result in an increased proportion of elderly individuals (age-group 65 and over). The present high dependency ratio will thus increase further. 6. Population characteristics and projections from country reports and other sources are given below: I The annual growth rate during the period 1975-1980 in the 32 countries or areas of the Region ranged from close to 0% to 3.35%; 14 countries had annual growth rates of 2% and over in the same period. The predicted range by the year 2000 is from close to 0% to 2.74%. In terms 0 f ac tua 1 popula t ion size. in 1980 the population in the various countries ranged from 6000 up to 960 million, giving a total population of 1300 million. In the year 2000, the total population is predicted to reach 1600 million with a range from 7000 up to 1200 million.

Population

lFigures given in this and other sections of the document have been obtained from different sources. They should be interpreted with caution. 9

Regional Strategy for Health for All

In 1975-1980, the crude death rate varied from 4.2 to 20.3 per thousand, with 7 countries reporting values of over 10 per thousand and 24 of over 8 per thousand. It is predicted that in the year 2000 3 countries will still experience a crude death rate of over 10 per thousand and 20 a rate of over 8 per thousand. The birth rates In 1975-1980 ranged from 15 to 44.1 per thousand, with 22 countries having birth rates of 30 per thousand or more. The predicted range in the period 1995-2000 is from 14.1 to 31.9 per thousand, with only 5 countries or areas having rates of over 23 per thousand. 7. In addition to population growth and changes In the age structure, movement of population should be noted. The trend of rural/urban migration is expected to continue and to aggravate social problems related to the disadvantaged, caused by substandard hous ing, unemployment and poor water supply, among them juvenile delinquency and drug and alcohol-related problems. Emigration, particularly from small island countries towards larger and industria 1 ized ones, may be· expected to continue. SocioeconomlC situation 8. Uncertainty of peace, political instability and social unrest characterize the beginning of the two decades in the course of which a New International Economic Order is to be achieved. Shifting value systems are giving rise to new social relationships and new expectations. Economic systems are unable to respond adequately to these rISIng expectations, resulting in the unemployment, underemployment and low incomes characteristic of a period of financial insecurity and leading in extreme cases to social unrest. In 1977, the per capita GNP of the Region

Regional Strategy for Health for All

ranged from US$90 to US$7340, while annual growth rates varied from 1.9% to 7.7%. 9. The rate of food production has at best been keeping pace with population growth; the food supply has not increased to the levels expected to meet the dietary requirements. Moreover, the problem is the uneven distribution among countries and within countries, as well as the increasing cost to the consumer. Malnutrition of varying types and grades exists in developing countries and in certain areas of developed ones. Safe potable water is still not available to a great segment of the population. 10. Educational systems in the Region are not able fully to meet the demand and do not always provide the relevant education to enable people to gain an adequate livelihood. Twenty-four per cent. to 97% of the school-age population is enrolled in primary and secondary schools. Statistics indicate that the problem of adult illiteracy exists in some countries. 11. Women in many societies traditional occupations and roles. 12. The problems affecting most Region can be summarized as follows; are confined in to the

countries

continuing high rates of inflation punctuated by periods of recession chronic fluctuations in economic growth uneven distribution of income within and between countries continuing high underemployment levels of unemployment and

Regional Strategy for Health for All

increasing dependency on, and rising costs of, imports uncertain value of major export (largely agricultural in most countries) social pressure and stress rapidly changing lifestyles. Health problems brought cOlllllodities developing about by

13. In addition to the crude death rate, which was described earlier, the following observations on infant mortality, maternal mortality, life expectancy and causes of mortality and morbidity describe the health status of the Region. 14. There are 13 countries with infant mortality rates of over 50 per thousand and 9 with rates of over 20 per thousand. 15. The maternal mortality rates range from 0.1 to 17 per thousand. 16. Life expectancy at birth varies from 42 years to 77 years in 1980, and is expected to be frOID 52 years to 78 years in the year 2000. There were 8 countries with a life expectancy of less than 60 years in 1980. This is expected to change to 5 countries in the year 2000. 17. In su_ary, the Region present s a variety of health problems, ranging from those found in agricultural countries to those of the industrial countries and comprising: communicable diseases and malnutrition

Regional Strategy for Health for All

chronic degenerative diseases accidents, environmental pollution, conditions and mental health problems health problems of the elderly problems related to high fertility. 18. The socioeconomic environment also determines such factora aa the nature, composition and distribution of the high-risk groups, the populat ion deriving least benefit from economic growth, the population of remote areaa, the rural and urban poor, and, within those groups, mothers and children and elderly people. countries expressed 19. The reports of moat varying degrees of satisfaction regarding the quality and quantity of coverage of the popUlation with health care activities, as well aa deep concern for the rising coat of medical care. The other problems reported in a way shed light on these two basic problema and 1D8y be enumerated as follows: In a number of agricultural/rural countries Technology. Unsuitable, cumberaome, I imi ted in impact and diffusion and expensive or unacceptable to the population. Certain necessary technology is either absent or at a limited stage of development. This is the case, in a number of instances, in such areas as health administration, planning/programming, information systems, repair and maintenance of medical equipment, and the a rchitec tura 1 des ign of health facilities. Problems related to the health care system stress

Regional Strategy for Health for All

Manpower. Inadequate in quantity and quality, inefficient, . maldiatributed, lacking in motivation, and subject to an unsatisfactory career structure and difficult conditions of employment. In a number of instances, the development of health manpower has no relevance to the needs of the loeal situation. Furthermore, the possible contributions of traditional healers, birth attendants and herbalists have not been adequately explored or considered. Health facilities. Insufficient, inadequately located, of unsuitable supported, poorly architectural design and badly maintained. 0eerational proeedures. Cumbersome and t1me-consuming, rigid, difficult to understand and unresponsive to service demands. Organization. Overlapping, duplication or conflict between related services, insufficient intersectoral coordination, inadequate integration of functions, imbalance. Policy. Lacking, unrealistie or outdated.

Accessibility. Problems are related to geography, transport difficulties, etc. Logistic problems lead to shortage of drugs and supplies. Financial. Some of the problems are insufficient funding, uneven distribution of funds, and inefficient and inequitable provision of drugs, medical supplies and equipment. Motivation. The population in a number of instances is unaware of. or dissatisfied with, the services available. 14

Regional Strategy for Health for All

In a number of urban/industrialized countries Technology. Inappropriate and inefficient investment in high cost technology, especially in the private sector. Manpower. Overemphasis on tralnlng of highly specialized medical personnel and senior-level health workers. Overcentralization of training facilities. Proliferation of categories of health personnel. Facilities. Overinvestment in hospital buildings and inadequate facilities for basic health services. Operational procedures. Underutilization of health personnel at certain levels. Inappropriate use of staff, supplies and equipment. Organization. Lack of intersectoral coordination. Inadequate government control of standards and quality of services. Inadequate legislation for monitoring of the private sector. Policy and planning. Lack of proper problem identification mechanisms to proper allocation of resources. health ensure Awareness of problems

20. There seem to be varying degrees of awareness of the above-mentioned problems among policy-makers and the public, who, it appears, are more prone to think of health in terms of hospitals and clinics. It also appears that, in some countries, the health ministries require strengthening in order to influence top-level decision-making to a greater extent. In some countries, there appears to be a gap in communication within the health ministry between operational-level staff and policy-level staff.

"liona1 Strategy for Health for All

II.

HEALTH AND SOCIOECONOMIC POLICIES

1. The 80cial objective of health for all by the year 2000, which vas collectively adopted by the· 'I1tirtieth World Health Assembly,l is accepted by the leaders of all He.ber States and is explicitly mentioned in the policy statements of .. ny countries. The mission of the health ministries in the legion, in pursuing the goal of raiaing the level of health of the people, is to improve the quantity and quality of health care available, especially to the underaerved population, at a price the ca..unity and the nation can afford. The national policies to that end have not yet, however, been incorporated in exiating national health planl. 2. It is reco,nized by Hember States that the social -- goal will be realized through the primary health care approach in the spirit of the Alma-Ata Declaration. The trend is towardl a broader, more holistic, approach to health development, viewing health as an integral part of national locial and economic development. Health leaders are thus in the process of reinterpreting the concept of health and broadening their mission to include development of the people'. capabilities for leading a socially and economically productive life, thereby achieving co~nity leU-reliance in health. 'I1tis trend is discernible in the thinking of health expertl in all countries or areas of the Region. 3. The concept of coaaunity involvement is a vitll el ...nt in the extension of health care coverage, providing for the mobilization of co_unity resources in both the planning and the Management of health care. It

ISee resolution WHA30.43, WHO Handbook. of Resolutions and Decilions, Vol. II, 4th ed., i981, page 1.

Regional Strategy for Health for All

is recognized by practically all Member States that vigorous efforts must be made to encourage local communities actively to participate in health and developaent actions in such a way as to establish a working partnership between c~unities and government and private agencies. However, experience in developing such a partnership is as yet limited, though the principle of community self-reliance is universally accepted. 4. Another new dimension is the recognition of the interdependence of health and socioeconomic factors and the need for a multisectoral approach in health development. Although interest in the multisectoral approach has been expressed by practically all Member States, a beginning has yet to be made in developing an effective mechanism for continuing intersectoral coordination at all levels. In many cases, analysis of the priority problems is still confined to health sector activities and does not fully take into account the related social and economic problems.

,5. Given the limited resources available and the determination to expand and improve the coversge and quality of health services, much interest has been expressed in the development of appropriate health technology and research. 6. Attempts to translate political will into action have led to the realization that the new approach, based on an active and continuing partnership between cODlDunities and government agencies, will demand a new outlook, a new orientation and new skills on the part of health and related staff, who will have to develop qualities of leadership and managerial skills in order to facilitate and support the c~unity development approach in health and to strengthen both intrasectoral and intersectoral coordination.

Regional Strategy for Health for All

7. This recognition of the need for appropriate technology and health manpower development has brought into sharp focus the necessary interdependence of countries, which IIlUst share their limited resources for the training and reorientation of health _npower, development of appropriate technology and research, and exchange of information and experience. 8. In their efforts to evolve and implement policies and strategies for attaining the goal of health/2000, health ministries in several countries are reexamining and adapting their structures and resources to meet this challenge during the next two decades. The main focus and area of concern is the improvement of managerial processes for health development. In searching for solutions, some countries have embarked on the process of country health programming with a more holistic and broader view of health and its relationship to other aspects of social and economic development. However, the process is slow, problems encountered are many and the resultant structural and legislative changes and reallocation of resources needed are only beginning to emerge. The lack of reliable information and appropriate indicators is impeding progress. 9. In the light of the above-mentioned policy issues expressed by Member States, the Regional Strategy should aim at collaboration in: improving and developing managerial processes for health developMent; reorienting and training health and related personnel, particularly in management, organiza t ional deve lopment, communication skills and community development approaches; developing research on appropriate technology and heal th care delivery systems; devising practical evaluation procedures to monitor both the processes for implementation and the impact of health development strategies; exchanging informat ion and developing effective information systems; and Mobilizing external resources in support of national efforts for health development.

Regional Strategy for Health for All

10. In the sphere of economic development, there is a discernible trend towards the integrated area development approach, with the balanced development of various sectors. The value of traditional economic indicators such as GNP and per capita income is being questioned and concern has been expressed that development should be conceived to mean not only economic development but also the well-being of the broad masses. It is in this context that Member States place emphasis on health as an integral and vital part of development, benefiting by and contributing to economic development, as expressed 1.n United Nations General Assembly resolution 34/58 on Health as an integral part of development. l 11. In the spirit of the New International Development Strategy, the economic interdependence of countries has been recognized. Regional groupings, such as the Association of South-East Asian Nations and the South Pacific Forum, are being strengthened, and emphasis is being placed on the need for improved trade relations, transfer of technology and resources and regional planning.

ISee United Nations General A/RES/34/58, 29 November 1979.

Assembly

resolution

Regional Strategy for Health for All

III.

CONCEPTUAL FRAMEWORK FOR ACTION

1. The successful coordination of lnltlative and effort directed towards the attainment of the long-term objectives will largely depend on the collective and individual ability of Member States to function intersectorally. 2. Thus, a general framework within which action is to be taken to achieve health/2000 must be responsive to the conditions under which the population is provided with health services, such as: (a) the prevailing socioeconomic and health situation, which calls for a more balanced delivery of curative, preventive, promotive and rehabilitative health care, to meet the health needs of the majority of the people; and an

(b)

increasing population and the resultant demands for health services, which call for a reallocation of resources within the health and other sectors.

3. These considerations imply that the conceptual framework must essentially address itself to directing health knowledge and resources towsrds: (a) (b) (c)

laying the foundations for health, namely, providing adequate food, water and shelter; developing individual and community self-reliance in health; and providing appropriate and affordable health technology for the sick, the disabled, the chronically ill and the socially maladjusted.

Regional Strategy for Health for All

4. In the light of the above"'1llentioned conditions and directions, a partnership involving the cOJlllllunity, the government and private health organizations is suggested as a desirable conceptual framework for attaining health/2000. The partnership concept focuses on the mutual responsibilities, risks and rewards of all parties involved. From the point of view of the health authorities and the national governments. a number of important elements should be considered: (I)

The government must lead and assume initial responsibility for building community capability to plan, organize and implement health development activities. Reliance must be placed on community initiative, commitment and resources in identifying and resolving health development issues.

(J)

The government must permit and promote the adaptation of approaches or technology to suit the needs of or the situation in the community. Intersectoral and intrasectoral approaches must be adopted in problem-solving, planning, implementation and the development of appropriate technology. The government and communities must together in monitoring the results community health development programmes. work of

(4)

(5)

(6)

The government must provide communities with resources in terms of manpower with appropriate skills, technology, information and funds for the planning, implementation and monitoring of health development activities.

Regional Strategy for Health for All

5. (a) (b)

In this way. the health care systems will btl more responsive to the needs of co_unitie!, more capable of influencing other sect<1 sand also more receptive to influence froDI other sectors; more integrated in their approach to the fl and management of progra_esj and more concerned with the continuous and personal development of staff. profEI nning ionaI

(c)

(d)

and 6. In brief. this wi 11 require govern_HI ealth private health workers to play the roles of technician or scientist and facilitator in de'l! loping c~nity self-reliance in health.

Regional Strategy for Health for All

IV.

LONG-TERM OBJECTIVES, TARGETS AND APPROACHES

1. Interpretation of the current regional situation as it affects the health of the population should be considered in the light of Member States I commitments to health development and the constraints on meeting such commitments. These commitments are themselves determined to a great extent by what is perceived to be a socially and economically productive life in this Region by the year 2000. At the very leas t, such a pic ture wi 11 suggest that the basic needs of food, water and shelter will have been met by all governments of the Region. The total fulfilment of those needs will be reflected in a well-informed population with shared social values, the widespread availability of food and drinking water, the sanitary disposal of human and animal waste, the control of environmenta I pollution, the absence or reduction of preventable comBunicable diseases, the reduction of chronic diseases, and the psychoaocial well-being brought about by harmonious lifestyles. 2. However, this picture remains incomplete. Without social justice, health and its contribution to the quality of life can have little meaning. To ensure social justice, people must accept responsibility for their own health and develop their capacity for self-reliance. 3. The statement of objectives was extracted from national progress reports, the speeches of delegates of Member States of the Region at the Thirty-third World Health Assembly, and the country programme statements on national hea1th/2000 strategies submitted to the Regional Office in connexion with the proposed prograaae budget for 1982-1983.

Introduction

country statement synthesis

Regional Strategy for Health for All

4. 'l1tough all Member States expressecl their commitment to the goal of health for all throughj primary health care, some statements understandably stoPJ short of providing specific details or time-bound ob:1 Among the objectives reported were: ' Objectives related to the health status (a) (b) (c) (d) (e)

Number of ( or aress pll~~~a statementa

u.provement of nutritional status Provision of aafe drinking water and a sanitary environment Control of environmental pollution Access to appropriate health care Control of communicable diseases Control of noncommunicable diseases (cancer, heart diseases, cerebrovascular diseases, dental conditions, metabolic diseases and health problems of the elderly were among those commonly mentioned) Promotion of s lifestyle and habits conducive to health Promotion of psychosocial well-being Fertility regulation Drug production, essential drugs and drug policies Rehabilitation 12

III

(f)

(g) (h) (i) (j) (k)

2C 7

l Objectives related to the health care system (a)

Regional Strategy for Health for All

Number of countries or areas providing statements 24

Health services development, including for example, reorganization, development of health facilities and support mechanisms, development of referral systems, regionalization. integration Health manpower development, including strengthening of institutions, curriculum review and revision, reorientation of existing staff to primary health care care, training of lay workers and medical assistants, training of specialists, control of specialization, improvement of working conditions of staff, effective use of health manpower, more effective correlation of supply and demand for certain types of personnel Health services research, development and use of appropriate technology, biomedical research Development of planning and managerial skills, establishment of planning units, development of supervisors, improvement of managerial processes, including health management information systems

(b)

(c)

(d)

5. Taking into account the expresse4 objectives of individual Member States, a regional framework for health objectives to be attained by the year 2000 has been developed as follows:

Regional Objectives. targets and approaches 25

Objectives, tarlets and approaches Overall societal lmage by year 2000 Socially and economically productive individual/ population with: 1. Longer life expectancy 2. Low infant mortality 3. Low maternal mortality 4. Less disability 5. Adequate shelter, education, and means of livelihood: through strategies with the following essential characteristics: 1. Community involvement 2. Intersectoral coordinated efforts J. Equitable distribution of health and other resources 4. Health systems development 5. Development and use of appropriate technology at a cost the community can afford 6. Development of sound managerial procelses for health development 7. Development of necessary health manpower 8. Research

Broad objectives 1. A well-nourished

Specific objectives 1.1 Nutritious food available 1.2 Good dietary habits established 1.3 Healthy childfeeding practices 1.4 Services available for the prevention and care of malnutrition 1.5 Endemic goitre, nutritional anaemia, and xeropthalmia no longer public health problems 1.6 Number of low birth-weight babies reduced 1.7 Problem of obesity reduced 2.1 Safe water at a cost affordable to all available and accessible 2.2 Safe storage and use of drinking water

Aetivities a. Formulation and implementation of food and nutrition policy b. Nutrition education, both formal and informal c. Development of nutrition surveillance and care d. Fortification of food e. Supplementary feeding, with particular attention to high-risk groups

Health st4tus target a. Minimum alorie and protein ntake for all b. Goitre a~d xerophthalmia educed to lowest a tainable levels c. Nutritio al anaemia in pregn nt and lactatin mothers reduced 0 lowest attainab e levels d. Proporti n of low birth-we ght babies reduced 10% level e. No third~egree malnutri~ion in chi ldren I

Health services targets OVERALL TARGETS • Universal availability of health services in all countries; • All communities with health committees/councils at various levels part iei pat ing actively in the management of health services; • At least 5% of the GNP expended in the area of health care with emphasis on prevention; • An effective mechanism for intersectoral collaboration in the area of health established in all countries A. Nutrition and Maternal and Child Care :-At least 80% of pregnant mothers, deliveries, infants and young children receiving appropriate health care, including immunization;

popUlation

2. Safe drinking water for all

a. Feasibility studies for coqmunity water supplies b. Establishment/expansion of comqunity water supply systems (piped) c. Further development/ improvement of other sources of water, i.e. wells, springs, rain water d. Quality control e. Maintenance and repair of water systems f. Community education and involvement

a. Incidenc borne di reduced current countrie safe dri 200/1000 (diarrho b. Incidenc hoeal di among ch under 5 reduced

of watereases 0 the evels of with king water: a year al diseases) of diarreases ldren ears of age y 50%

Regional Strategy for Health for All

Overall societal -illlage by year 2000

Broad ohjectives 3. Sanitary disposal of human and animal waste

Specific objectives

Mtivities

Health statuI target a. Incidence of fa~cal borne diseases reduced to current levels of countries ~ith safe waste disposal facilities: 200/1000 (diarrhoeal diBeases) b. Incidence of diarrhoeal diseases among children under 5 years of age reduced by 50%

~ealth serviceR tArgets

3.1 Sanitary toilets available for all falllilies 3.2 Proper disposal of refuse, garbage, and animal ~astes

a. Oe~elopment of facilities (m~terials and technical guidance) and appropriate tedhnology b. Ed~cation and motivation f01 9afe vaste disposal c. En orcement of regulati ns/legislation

• Se rvices for nutrition surveillance, care, maintenance and education available in all cOlDlllunities B. Water

:-fOOx

,4.

Minimal environmental pollution and hazards

4.1 A code on pollution established and enforced

a. FOEulation and imple~. Targets shared with me tation of policy other activities, b. De elopment of effective the impact of which mo~itoring systellls ~ill be on the overall c. Ed+cation on environmental health status of the prcjltection community measured by d. Enforcement of regulations means or indices to le$islation be developed e. Imt~ovement of the enTlronment a. h. c. d. e. I unization Ch moprophylaxis Su ve i lIance Ca e/contact finding Sp cific treatment/case ma agement f. Ed cation g. En ironmental control, in luding control of ve tors

of the population using safe drinking water in all comqunities

C. Waste Disposal • 100% of the population with sanitarYI latrines and reasonable waste disposal and drainage facilities

5. COllllllunicable diseases no longer a major problem

5.1 The followiog absent: smallpox, faucial diphtheria, tetanua neonatorum, poliomyelitis, measles, congenital rubella syndrome, mortality from whooping cough and rabies, the advanced stage of filariasis (elephantiasis), new cases of blindness due to trachoma

D. Environmental Pollution • Systems to monitor •• Incidence of smallpox, environmental faucial diphtheria, pollution and to tetanus neonatorum, maintain it at poliomyelitis, measles, reasonable levels congenital rubella established syndrome reduced to zero; mortality from E. Disease Control Whooping cough and • Medical needs of rabies, the advanced 100% of the populastage of filAriasis tion met - simple (elephantissis) and care in case of new csses of blindness illness and injury due to trachoma available near the absent homes of the people;

__0" ____ "

.... - .. -

--b~

- - - .. ~ ••

.. .., ........ - - - -

Overa 11 societal Image by. year 2000

Broad objectives

Specific objectives 5.2 The following controlled: schistosomiasis, malaria, filariasis, tuberculosis, plague, parasitic infestations of the skin and intestines, cholera, typhoid, leprosy, viral hepatitis B, trachoma, tetanus 5.3 The following no longer major public health problems: diarrhoeal diseases, respiratory infections in children, sexually transmitted diseases, viral hepatitis A

Activities

Health

stat~s

target

He~lth

services targets

b. Morbidity 10m the following t to exceed the specified levels in a y country I or area: Malaria - 1 /10 000 annual parasite incidence rate (HPI) Filariasis - 5% prevalenc rate Tuberculosis - 5% infectio~ rate of schoo 1 enit rant s Parasitic i~festation - 15% in ~ge group below 15 ears Cholera - 1/100 000 incidence Typhoid - 11/100 000 incidence Diarrhoeal iseases200/1000 incidence Viral hepat'tis A less than 25% populatio at age 20 with a tibody Viral hepat'tis B 1/1000 HB Ag carrier r te Tetanus - I /100 000 in age gr(u p up to 10 years Leprosy - 0 5/100 000 incidence Schistosomirsis prevalenc~ reduced to at lea~t 40% of curre~t l~vel in endemlC areas I

, Services for the control of communicable and noncommunicable diseases established and provided to at least 80% of the target population, including immunization, surveillance, chemoprophylaxis case/contact finding and early detection, specific treatment/management, environmental control including vector control, and health education p,

Fertility Regulation , Information and ~prvices for fertility regulation avai lable in all communities. • Appropriate knowledge generated for programme improvement through research and a network of health information systems

Regional Strategy for Health for All

Overall societal image ~ear 2000

Broad objectives

Specific objectives

Activities

H~alth

status target

Health services targets G. Health Care • Availability of essential drugs in all communities ensured; • Adequate facilities available at all levels for delivery of basic health services and support of primary health care

c. Mortality from the following not to exceed the specified level in any country or area: Pneumonia/influenza 100/100 000 in infants; 10/100 000 for age group 1-4 years Cholera - 0.1% case fatality rate Typhoid - 0.1% case fatality rate Diarrhoeal diseases 0.1% case fatality rate 6. Chronic diseases reduced 6.1 The followin~ reduced: congenital heart diseases, rheumatic heart diseases, degenerative cardiovascular diseases, chronic bronchitis, pulmonary emphysema in the younger age group (below 50 years), preventable cancer, peptic ulcer, cirrhos is of the Ii vel'

.. ETat be b. Co c. Ea d. Ca e. re f. Co

ioo avioural change nselling ly detection e management ablishll8nt of isters trol of environme tal factors g. FI oridation of dr 'nking water supply

'0<

a. The following reduced to specified levels: - congenital heart diseases - rheumatic heart diseases - de~enerative cardiovascular diseases (under 50) - chronic bronchitis (under 50) - pulmonary emphysema (under 50) - preventable cancers

Regional Strategy for Health for All

Overall societal image by year 2000

Broad objectives

Specific objectives 6.2 Diabetes and hypertension controlled 6.3 Oral health in children at a satisfactory level

Activities

Health

statu~

target

Health services targets

- peptic ulfer - cirrhosis of the liver b. All diabetifs and hypertensives coptrolled medically I c. An average bf 3 DMF or less per ch~ld at age 12 years maintained I

7. Psychosocial well-being and lifestyle conducive to health

7.1 The following

7.2 7.3 7.4

7.5 7.6

a. reduced: alcohol-related problems, accidentrelated deaths and b. problems, stressrelated diseases Smoking and drug dependence controlled Good personal hygiene and dietary habits established Physical fitness activities undertaken c. Human sexuality 'd. better understood Discrimination based on ethnic, social, physical and age factors not encountered

Health education and supportive social action and legislation Promotion of: - social/recreational activities - parental and family harmony through counselling - healthy working environment and job satisfaction Value clarification Formulation and implementation of legislation/regulations against discrimination

a. The fOllowi~g reduced by at le .. tl 50% of cu rrent levle Is : CirrhOSiS'~ICOhOI related acc"dents, alcohol-de ndence syndrome, alcohol consumpt ion" inc idence of drug dep~ndence, consumption: of dependenceJproducing drugs for npnlIIedical reasons b. Smoking (to~acco consumption) among adults red~ed with correspondtng reduction of ischaemiic heart diseases and lung cancer c. Smoking in IPopulation 20 years a~d below reduced to Izero d. Incidence ~f neurosis, suicides, and other forms of ~ladjustment reduced to manageable levels e. Social justice in health achieved 30

lelional Strategy for Health for All

Overall societal i . . ge by vear 2000

Broad objectives

Specific objectives

Activities

Health status target a. Health status of disadvantaged groups should improve at a faster rate than the national average to achieve"equity in health

Health services

t~r~~ts

No pockets of ill-health

8.1

The following disa. Ide~tification of advantaged groups dis dvanta,ed groups given adequate atten- b. Equ'table 4istribution tion: slum dwellers, of service. and economically disoppprtunid,es advantaged populations, populations in remote areas, the elderly and disabled Accels to knowledge a. For.ulatioo and impleand to safe and mentation of populaeffective means of tion policy fertility regulation b. Facilities for available to all fertility regulation Pregnancy in adolesmad. acce .. ible centl reduced c. Edu~ation in population Contraceptives used andi family planning for Ipacing of births and fertility regulation Population growth reduced in harmony with economic development

Fertility regulated 9.1 to ensure better health and social well-being

9.2

a. Population growth rate reduced to less than 1% b. Incidence of pregnancy in adolescents reduced to zero

9.3

9.4

leilo0l1 stratelY for Healtb for All

Overall societal 1mage by year 2000

Broad objectives 10. Access to appropriate health care for all

Specific objectives

Activities

Health

statu~

target

Health services targets

10.1 An adequately funca. Development of community participation/partnership tioning health service network for health accessible to all 1n b. Development of health care deliv.ry system terms of reach and financial considera- c. Health manpower made available tion, delivering an acceptable level of d. Essential drugs made care with active available e. Development of financing involvement of the schemes, iocluding people 10.2 Comprehensive health efficient use of resources care, including f. Development of approhealth promotion, priate technology for prevention, treatment and rehabilihealth g. Development of managetation provided by ment and support the network systems h. Formulation and enforcement of aupporting legislation

a. Targets sh other acti the impact will be on nity measured b means or indices to be developed

Regional Strategy for Health for All

DEVELOPMENT OF THE HEALTH SYSTEM BASED ON PRIMARY HEALTH CARE

1. Existing health care delivery systems will need to be modified in varying degrees, depending on country conditions, in order to meet the objectives and targets set out in Chapter IV, within the conceptual framework described in Chapter III and consistent with the country health programme. As an initial step, countries will therefore need to review their health care delivery systems in the light of certain broad principles defined at the Thirty-fourth World Health Assembly, which are felt to be applicable to all health systems based on primary health care. These are: (1)

Modification of health care delivery systems

The system should encompass the entire population on a basis of equality and responsibility. It should include components from the health sector and from other sectors whose interrelated actions contribute to health, such as education, the water board or its equivalent, social welfare, housing or human settlement and agriculture. Primary health care, consisting of at least the essential elements included 1n the Declaration of Alma-Ata, should be delivered at the first point of contact between individuals and the health system.

(2)

(4)

The other levels of the health system should support the first contact level of primary health care to enable it to provide these essential elements on a continuing basis.

Regional Strategy for Health for All

(5)

At intermediate levels, more complex problems should be dealt with, and more skilled and specialized care as well as logistic support should be provided. More highly trained staff should give continuing training to primary health care workers, as well as guidance to cOlIIIDunities and community health workers on political problems arising in connexion with all aspects of primary health care. The central level should coordinate all parts of the system, and provide planning and management expertise, highly specialized care, teaching for specialized staff, the expertise of such institutions as central laboratories, and central logistic and financial support.

(6)

2. The structure of the health care system must provide for clear delineation of work and functions at its various levels. At managerial level, it must be oriented towards progranuning and problem-solving, have a research component and a planning function, providing the policy and operating framework for health prograllllDes, and permitting local levels to respond to health needs that are consonant with the political, cultural and administrative traditions of the society concerned. While planning skills will be developed at all levels, considerable attention will need to be given to enhanced individual and cODDDunity participation in deciding on health policy and in guiding the planning, management and control of the health infrastructure and the progranmes it delivers. In strengthening this "bottom-up" approach to planning and management, a clear national policy may be needed, as well as appropriate legislative and budgetary measures if necessary. Existing mechanisms for this approach may have to be reviewed and mod i fied, or new ones introduced. As a prerequisite to the success of

Regional Strategy for Health for All

this approach, the people will have to informed by the health personnel themselves.

well

3. Further detailed analysis should identify the actions to be taken by the health sector and by other sectors, which would constitute a plan of action for both. 11Ie problems related to health care systems set out in Chapter I, paragraph 19, provide a starting point for such an analysis. 11Ie implications, as far as the ministry of health is concerned, are that it must strengthen itself to enhance its leadership role in health development and to develop the capacity to draw upon the resources of other related sectors and/or external technical and financial collaboration. 4. In the case of external collaboration, specific measures will need to be taken to ensure continuous exchange and joint developmental efforts (TCDC) among countries sharing similar interests or priorities in health. 5. 11Ie development of health manpower will, as a general principle, be guided by the requirements of the proposed national health systems, of which primary health care will be the central function. 6. In fulfilment of this principle, it will be necessary for educational institutions to collaborate with the ministry of health and other ministries in planning for and producing an adequate number of health personnel to promote a more balanced delivery of health care in order to meet the needs of the entire population. 11Ie necessary manpower planning activities should not only take into account the number of staff needed but also use as a basis an analysis of the functions required for managing the health system. Such an analysis will enable countries to ascertain the types of personnel to be trained and will also serve as a basis for continuing Deve lopment of required health manpower

Regional Strategy for Health for All

education. The success of this intersectoral approach will depend on the formulation and application of policies ensuring harmonious collaboration. 7. In the actual development of training programmes, particular attention will be paid to the following: (1) Strengthening

training programmes and institutions in terms of faculty development, reviewing curricula to improve their relevance and to emphasize promotive and preventive health care, developing manuals and textbooks, strengthening library faciliti~s and teaching equipment, improving the assessment of student progress, and developing national institutes.

(2) Where

small countries or areas predominate, continuing the practice of sharing the facilities of one of the larger countries, with the prospect that the demands on its facilities will continue to lncrease. This applies particularly to the South Yacific. in health management which expected to administration, is health development centres provided in networks or similar mechanisms. and be or

(3) Training

(4) Attracting appropriate staff into the community health field and correcting the maldistribution of health manpower by directing it from urban to rural areas. Whi Ie there are various ways of achieving this, the ministries concerned, as well as the public administration in general, will take steps to ensure that health workers are socially motivated and provided with the necessary incentives. It is expected that continuing education, improved superVIsion and better career structures will be needed.

Regional Strategy for Health for All

The reorientation of health workers and other workers, such as teachers and community workers, towards primary health care and coordinated cooperative action at the community level for the development of community self-reliance, constitutes an essential activity planned by countries in their respective approaches to primary health care. (5) Action will be needed to identify the strengths and deficiencies of training institutions and to establish reciprocal arrangements whereby an activity in one institution can coaperisate for a deficiency in another. Heetings of heads of certain institutions, such as deans of public health schools, of medical schools, and of nursing schools, are considered very useful in this regard. Support wi 11 be needed for national training courses and institution strengthening. To ensure the highest level of relevance in teaching, training institutions will be encouraged to engage in health services res.arch.

Regional Strategy for Health for All

VI.

REGIONAL SUPPORT MEASURES

1. Country reports indicate various existing and planned support measures for health/2000 policies and strategies. Political support is explicitly stated in some cases, while in others it is implied through the goverMent I s support of Heal th Assembly and Regional Committee resolutions. Requirements for economic support are indicated. Country reports emphasize in particular existing and future needs with regard to managerial support, research and information. Political support 2. Political support will be obtained through the involvement of political and social leaders in appropriate regional and country activities. This will be effected through both regional and national forums. The latter might include legislative meetings at all levels, cabinet meetings, meetings of political parties, labour organizations, and non-governmental organizat ions. reI igious meetings and civic meet ings. The creation of national health councils that are eSlentially intersectoral is one of the measures that could be adopted to enlist political and legislative support. 3. The enactment of new legislation may be necessary to facilitate the introduction of the necessary health reforms: for example. to define the rights and obligations of various categories of health worker and to permit communities to develop and manage their health and related social programmes and services. 4. Intergovernmental groupings, such as ASEAN, will also contribute to the promotion and formulation of national policies and strategies by determining joint action in health development and bringing health development issues to the attention of Member States and other regional forums. 38

Regional Strategy for Health for All

the of 5. The Regional Committee has task formulating, monitoring and evaluating regional policies and strategies. In so doing, it also serves as a very important political mechanism for support of the Regional Strategy. 6. In addition to the World Health Assembly and the Executive Board of WHO, global forums, both within and outside the health sector, should be used for the pro.ation of health development efforts and, in particular, the concept of health as an integral part of socioeconomic development. 7. The support of economic planners for the national health for all strategy is essential, and ministries of health should take advantage of every opportunity that occurs for enlisting that support. It is also equally important for the ministries of health to detect any negative effects on health of development projects and to see to it that protective measures are made integral components of these projects; as, for example, in irrigation schemes, dams and industrial development projects. 8. Economic support will be secured from international development banks (World Bank, Asian Development Bank) and multilateral and bilateral agencies (Colombo Plan, USAID, ADAB, JICA, DANIDA, SIDA, SPEC) as well as from voluntary donors such as the Japan Shipbuilding Industry Foundation. The strategy will be to channel resources into activities for integrated health development and in particular to emphasize the health component of development projects funded by international cooperation. It is important to stress that economic support should be used for development activities that will foster self-reliance and not solely for the import and maintenance of technology. Economic support

Regional Strategy for Health for All

9. It will be necessary to develop and strengthen regional and global mechanisms for attracting bilateral and multilateral funds and to ensure that they are channelled to priority activities and countries. Technical support 10. Technical support will .be ensured through promoting, in traLnLng institutions for medical and allied health personnel, the concept of equal right to health and primary health care. The teaching of specific subjects related to health development, such as health planning and management with emphasis ~n primary health care, will be strengthened or introduced in schools of public health. 11. It wi 11 be of part icu lar importance to obtain the support of health professionals through associations of doctors, nurses and through other technical nongovernmental organizations deal ing with health and health-related problems. Activities to enlist such support will focus on mobilizing the health professionals and directing their actlvLtLes towards the objectives and strategies of health/2000, both at national and regional level. Promotion and exchange of information with organizations of health and related professional bodies through personal contact, formal and informal meetings, written cOlllDlunications and publications will be encouraged. 12. Special efforts will be made to promote the support of medical and related industries by encouraging them to produce equipment for appropriate technology and to manufac ture essent ia 1 drugs at reasonable cost. In those efforts, UNJDO, UNICEF and ESCAP will play an important role. Specific mechanisms for this are being developed in the Region. 13. The global strategy should develop mechanisms to promote collective action at high international level involving governmental and nongovernmental organizations, to mobilize the health-related professions and generate the active support of the media throughout the world.

Regional Strategy for Health for All

14. countries will need to strengthen their capacities for national health development to them to develop implement enable and their strategies. 'I1t is should lead to the following: (1)

Managerial and administrative support

Review and revision of health policies give a clear and more specific direction health resources and activities.

to to

(2)

Improved planning, implementation and evaluation processes which will ensure the more effective delivery of health care and provide the means by which new knowledge with regard to the health development needs of the people can be converted into appropriate action. The new knowledge will also be used to change the role of health workers and to equip them with essential understanding and skills so as effectively to support health development. The ministries of health will establish mechanisms to develop and apply their managerial processes and to provide adequate training for all those who need it. The Regional Strategy will include the establishment of, and support for, national health development centres/networks and national health councils, or similar intersectoral coordinating bodies, and efforts to strengthen capabilities to develop and apply the managerial process. It is envisaged that the national health development centres/networks will consist of a number of institutions which will have a working arrangement to share their resources and thereby overcome their deficiencies. The centres/networks are

Regional Strategy for Health for All

the expected to conduct training in managerial process, carry out health services research in identified priority areas, and provide the ministry of health highly with advisory services. It is desirable that the staff of academic actual institutions should be exposed to field experience ~n order to enhance their contributions. Initially six national health development centres/networks are proposed (China, Malaysia, Papua New Guinea, Philippines, Republic of Korea and South Pacific). Close cooperative relations will be established among them as well as with other selected institutions ~n other countries of the Region, thus constituting a regional network for health development. Relations will also be established with similar networks in other Regions to form a global network. (3) Provision of support to Member States in dealing with administrative problems, such as logistics, personnel matters, budgeting, accounts, reorganization, etc.

15. The Global Strategy should develop support for managerial and administrative processes by providing technical expertise and exchange of information between regions and obtaining financial assistance for national and regional health development networks. Research support 16. Research will be particularly oriented towards the solution of problems related to the goal of heal th/2000. Emphasis wi 11 be placed on research in primary heal th care and heal th services deve lopment, appropriate technology, tropical diseases, human reproduction, chronic diseases and environmental health.

Regional Strategy for Health for All

Research will, therefore, be coordinated at national level by health research councils or their equivalent (existing health research councils will be strengthened if strengthening is indicated, and where no such council exists the establishment of one will be encouraged). At regional level, the Western . Pacific Advisory Conunittee on Medical Research and its subconunittees will advise the Regional Conunittee on identifying priorities and improving coordination of, and extending support to, health and medical research. Health services research will be promoted as an integral function of a national health development centre/network. 17. The Global Strategy will include: coordination through the global Advisory Co_ittee on Medical Research, support to regional advisory co_ittees on medical research and establishment and strengthening of relations with global institutions concerned with research in health and related areas. 18. Of particular importance in a global strategy is the use of national expertise through WHO expert advisory panels. 19. To support the development and implementation of national policies and strategies, exchanges of information among countries will be promoted and supported, using TCDC and similar cooperative efforts already mentioned under paragraphs 10-15. 20. Of particular importance is the provision of relevant technical information. The WHO Secretariat, with WHO collaborating centres, will ensure that countries are provided with relevant technical information for national health development. In that connexion, research findings and information on experience gained in, for example, the formulation and Information support

Regional Strategy for Health for All

implementation of nationa 1 policies and strategies, the introduction of administrative reforms and the development and uae of indicators, will be widely disseminated. 21. Information of the public will be a major component of support strategies. Public opinion will be, mobilized at both regional and national level through the development of appropriate health education methods and approaches in community organization. The public will be kept informed through the mass media and through personal contacts with health sector personnel.

Regional Strategy for Health for All

VII.

GENERATION AND MOBILIZATION OF RESOURCES

1. To implement the Strategy, two types of resources will have to be mobilized: human resources, and financial and material resources. The Strategy involves mobilizing all human resources, and not only health personnel. Realizing that the best way to mobilize people is to get them involved, ministries of health will explore appropriat~ ways of involving people in deciding on the. health system required and the health technology they find acceptable, and of delivering part of the national health programme through self and family care and the involvement of local communities in action for health.

Human relources development

2. The following are some of the measures that will be considered, in order to promote community involvement: (1)

Delegation of responsibility, authority and resources to establish primary health care in the community such in a way that partnership with the community is developed in the delivery of health care. Creation of community development committees concerned wi th hea 1 th, composed 0 f representatives of a crosl-Iection of the communi ty , t o develop and support primary health care. Fostering individual responsibility for leI f and family care, and promoting a lifeatyle conducive to health. Enluring representation from the community in national or intermediate-level health councils/bodiel involved in the decision-making process of the country's health system.

(2)

(3)

(4)

Regional Strategy for Health for All

(5)

Ministries of health will launch nationwide health educational actiVities through health personnel, the mass media and educat ional institutions of all types, with the aim of enlightening the whole population with respect to prevailing health problems in their countries and c~unities and the most appropriate methods of preventing and controlling them. At the same time, full attention will be given to the reorientation and retraining, where necessary, of existing health workers, including measures to enab'le them to assume an active role in community health education. Consideration will also be given to the development of new categories of health worker, the involvement and reorientation, where necessary, of traditional medical practitioners and birth attendants, where applicable, and the use of voluntary health workers. Voluntary organizations/community groups will be fully encouraged to participate in health-promoting activities, first-aid and other heal th care in accordance wi th agreed courses of action and distribution of responsibilities.

(6)

(7)

Financial and material resources

3. Though information on the resources required to implement programmes to attain the goal of health/2000 is limited at present, Member States will soon be determining, with the development of activities in detail, the magnitude of the resources required. Particular attention will have to be given to the preferential allocation of resources to underserved population groups and least developed countries. 4. Various mechanisms and possibilities will be tried to generate fund a and to ensure that effective and coordinated use is made of whatever funds become available:

Regional Strategy for Health for All

(I)

National health councils or analogous bodies, with their expanded role, will be expected not only to stimulate multisectoral collaboration but also to take active steps to generate funds for health development and to ensure the effective use of external resources. The latter can be promoted through JOlnt programming at national level, preferably preceded by country health programming. Bilateral and multilateral agencies for international cooperation will be urged to make strong representations to their governments for a further increase in their budgetary allocations and to rationalize the use of their resources. Private foundations functioning at international level will likewise be urged to increase their aid. The possibility of creating mechanisms at regional level (for example, donors' meetings, focal groups at the WHO Regional Office, advisory bodies) to attract funds and ensure that they are used rationally will be studied. In the same way, mechanisms to improve the coordination and effective use of funds available from other agenc ies will be considered, such as periodic meet ings, at the regional level, of United Nations agencies and voiuntary organizations (see Chapter VII I, paragraphs 7-l0). The Global Strategy should include establishment of global mechanisms to ensure continuous monitoring of the availability and generation of funds and their distribution to priority problem areas throughout the world and to priori ty programmes. The recent ly established Health Resources Group for Primary Health Care is one such mechanism. 47

(2)

(3)

(4)

(S)

Regional Strategy for Health for All

VIII.

COLLABORATIVE MECHANISMS

Intrasectoral and intersectoral collaboration

1. Country reports stress the importance of collaboration and coordination between components of the health sector and sectors closely related to it, such as education, agriculture, public works, transport and human settlements.

2. Preparation of an inventory of agencies covering the health and health-related sectors, and an analysis of their resources and functions, has been mentioned or implied in some reports as an initial activity towards the establishment of a collaborative mechanism. The issues to be considered by the analysis would include: delineation of the responsibilities of the health ministry and the medical care insurance or social security system; the effectiveness of cooperation between the private and the public health sector as regards referral systems, extension of services, use of health facilities, and area/population coverage; the formulation of relevant curricula for the education and training of health manpower; policies with regard to nongovernmental organizations, their participation in national decision-making, their complementary and supplementary roles, and the support they need from, as vell as what they can give to, the health ministry. 3. Countries are unanimous in their opinion that health/2000 cannot be achieved through the health sector alone. Intersectoral collaboration and coordination are expected to resolve policy and operational difficulties in many areas, including the development and maintenance of community water supplies, the control of environmental pollution, the promotion of nutrition and food production, the drug industry, education and housing, the construction of health facilities, drug and aldohol problems, and road traffic accidents. 48

Regional Strategy for Health for All

4. Country reports recognize the need for advice, coordination or collaboration in health development activities at different levels of government, but especially at policy level. Some countries consider that new mechanisms should be developed, while others believe that existing ones are sufficient but need further strengthening. Some countries are apprehensive with regard to the proliferation of coordinating mechanisms and believe that rationalization of such mechanisms through an "umbrella" council would be useful. It is also quite likely that the mechanisms will be given different advisory boards, and that they will include representatives of other sectors as members. Intersectoral governmental ca.aittees are planned by some countries; for example, an interministerial body for primary health care, or an interministerial body for programme reviews. 5. Regional action will consist in supporting countries in the establishment or strengthening of their national mechanisms, ~rough promotional efforts and through advisory slrvices on the nature, composition, level, function and work procell of such mechanisms. Information will be disseminated on the experience of countries with such mechanisms.

6. The need (a) for a better understanding of the role of health development in general social and economic development and for multisectoral support for health/2000 strategies and (b) to provide expertise in these matters, points to the importance of establhhing a mechanism to facilitate multisectoral consideration of health development policies. One such mechanism might be a regional health development advisory council. Such an advisory council would help the Regional Director to support the Regional Committee adequately on all issues involving multieectoral policy and action for' health development. A regional health development advisory 49

Regional Strategy for Health forAH

council could derive support from, and in turn support, existing multisectoral national health councils or those that may be established in the near future by Member States. ' Intercountry collaboration Intergovernmental organizations, voluntary agencies, agencies within the United Nations system 7. Support to the implementation of national strategies for health development could be provided by a variety of organizations and institutions at regional level. (a) Intergovernmental organizations such as the Association of South-East Asian Nations (ASEAN) and the South Pacific Forum offer opportunities for promoting intersectoral ~oordination of health-related actlvltles and could identify resources and funds to facilitate TCDC processes for health development. The Southeast Asian Ministers of Education Organization (SEAMEO) could provide resources for undertaking research, particularly in the areas of biomedical and appropriate techno.logy, and means for the exchange of information and training of health workers. The Southeast Asian Medical Information Centre (SEAHIC) could cooperate in the exchange of technical information, the support of technical studies and the promotion of activities for health development. The South Pacific Bureau for Economic Cooperation (SPEC) and the South Pacific Commission (SPC) could provide promotional support to intersectoral coordination and technical support to health development activities in countries or areas of the South Pacific. \::. i'

(b)

(d)

Regional Strategy for Health for All

(e)

'l1Ie development bank., .uch a. the Asian Development Bank (ASOB) and the World Bank (IBID) are .ources of funds for development and could be means for integrating healtb with other development project •• Bilateral agencies .uch as the United Statea Agency for International Development (USAIO), the Au.tralian Development Assistance Bureau (ADAB) and the Japaneae Internationa I Cooperation Agency (JICA), could play important roles in tera. of technical and financial contribution •• Nongovernmental and voluntary organizations at the regional level could be seen as mechanisms for promotional activities, technical .upport and exchange of information, including fund-rai.ing from private .ources as contributions to health developmenti as an initial .tep, a liat of such organizations will be developed. Agencie. and organ. of the United Nation • • y.tem provide direct technical cooperation, .upport TCDC activitie., integrate health with other related development activitie. and re.ource., including the coordination and mobilization of fund., and help implement national health dev.lopm.nt .trategie.. 'l1Ie.e includ. UNOP, UNICEF, UNPPA, UNEP, UNlDO, lLO, FAO, ESCAP. The WHO Regional Committee for the We.tern Pacific, exereiaing iu coordinating function in intern.tional h.alth work, is exp.cted to provide policy .upport, to play an important role in prOllOtional activitie., e.p.ciaUy in brinaina .bout important r.fora. in national h•• lth .y.tem., and to monitor prolr••••

(f)

(g)

(h)

(i)

Regional Strategy for Health for All

8. The multisectoral advisory body mentioned under paragraph 6 above would be a means of providing national health councils and health development centres/networks with technical support. 9. The Regional Co~ittee ·Sub-Committee on the General Programme of Wo~k will provide technical support and joint technical monitoring of WHO collaboration in health system. development. 10. Resources and mechanisms to support national health development efforts to attain the goal of health/2000 exist in abundance at the regional level. However, the organizations and agencies concerned have varying, and at times diverging, philosophies and approaches to, and concepts for, development. Accordingly, the principal strategy for implementing regional support for national health development processes will be to draw the national bodies towards a cOlllDon understanding, so that efforts and resources are mobilized, synchronized, and directed towards the goal of health/2000. It ia proposed to organize coordination meetinga and to strengthen mechanisms for closer cooperation with the agencies mentioned. Technical cooperation alDOng countries 11. Technical cooperation should always be an essential conaideration in any programming activity of an international agency. Member States are also urged to take thia into consideration in formulating their health plans and programmes. National and regional mechanisms will have to be strengthened or developed in such areas aa informat ion exchange, training, procurement and manufacture of equipment and aupplies, intercountry exchange of expertise and collaborative reaearch. 12. In many instances such cooperation ia already being developed, including, for example: the exchange of information on appropriate technology for health; the development of a South Pacific Pharmaceutical Service and the ASEAN Task Force on Drug Policies and Hanagementi the

Regional Strategy for Health for All

strengthening of national training programmes and institutions in which other countries have a share, such as the training of health educators in Papua New Guinea and of assistant health inspectors in Solomon Islands; tra1n1ng in primary health care and traditional medicine in China; collaborative research in dengue fever; and the increased use of expertise from one developing country in another developing country. 13. The important contribution developed countries can make by supporting the health development efforts of developing countries is well recognized. This will be encouraged and facilitated by providing information on the health situation in developing countries and the magnitude and types of resources needed 1n a priori ty bas is.

14. This will stimulate and facilitate cooperation in the area of health. Moreover, certain activities 1n the health field, such as drug production and manufacture of equipment, will foster economic cooperation. In both these areas, health ministries have an important role to play.

Economic cooperation among developing countries

Regional Strategy for Health for All

IX.

MONITORING AND EVALUATION

Framework

1. Strategies formulated at national and regional level are expected to overcome constraints, to enable programqes to respond adequately to the need to solve the main health and health-related problems. Thus monitoring and evaluation will have to focus on the following; (1) Development activities. Close attention will be given to achieve. . nts in the areas of managerial processes for development, appropriate technology, health manpower development and health systems development, and their combined impact on community self-reliance and on progra_e delivery. Programme delivery. The effectiveness of programmes will be monitored and evaluated through selected indicators. Health status. The impact on health s-tatus will be monitored and evaluated through selected indicators. Two types of impact will have to be considered: on a specific health problem and on total health, such as the infant mortality rate, life expectancy at birth or the maternal mortality rate. at

(2)

(3)

Level and process National level

2. Monitoring and evaluation will be carried out national, regional and- global level.

3. The guiding documents will be the country reports on national policies and strategies for health/2000 and the medium-term plans formulated, or to be formulated, within that context, special attention being given to the three elements mentioned under paragraph 1 above.

Regional Strategy for Health for All

4. Monitoring and evaluation will be carried out routinely, at fixed intervals, as part of the administrative process; for example in connexion with the formulation of annual budgets, the preparation of annual reports, mid-term reviews of the medium-term plan, or formulation of a new plan. It may need to be carried out at various levels, including the community level, by the health authorities themselves and national health councils and agencies specially assigned for the purpose. 5. Monitoring and evaluation will be carried out collectively by Member States, through the WHO Secretariat, with emphasis on the involvement of participating countries. The WHO Secretariat is expected to carry out appropriate tasks, such as requesting national authorities for progress reports, and to submit its findings to the Regional CODDDittee, either directly or through any body that may be constituted or supported by the Regional Co_ittee, such as the Sub-CoDDDittee on the General Progra_ of Work. It is recognized that there are at least two instances when Member States come together and report on their work in the field of health: sessions of the Regional Committee and the World Health Assemblies. It is proposed that reports should be so structured as to be evaluative in nature as well as prospective. An intensive evaluation of impact will be conducted in the third year of each general programme of work period, a regional analysis of the health situation being carried out in the final year. 6. The following indicators could be considered to monitor implementation of the health/2000 Strategy, depending on their appropriateness and the information available at national level: Regional level

Proposed national indicators

Regional Strategy for Health for All

Ca)

Social and socioeconomic. development indicators primary school enrolment secondary school entrance/coapletion GNP per capita calorie availability per capita population growth rate dependency ratio urban/rural population ratio adult literacy ratio

Cb)

Health status health status)

indicators

(overall

co_unity

life expectancy at birth infant mortality mortality among children aged 1-4 age specific mortality 25-44, 45-54 age groups maternal mortality neonatal/post industrial injury neonatal/perinatal due to mortality illness or rates for 15-24,

absenteeism

Regional Strategy for Health for All

weight at birth anthropometric measurements (height weight developaent in children) (c) and

Specific health problem indicators (measures of reduction in specific health probleas to a level acceptable technically and to the coalUnity) incidence/prevalence seases incidence/prevalence tive diseases mortality diseases due to of of co. .unicable di-

chronic/degenera-

chronic/degenerative

incidence of specific nutritional deficiencies (nutritional anaemia, xerophthalmia and goitre) snd metabolic diseases (diabetes, gout) disease specific mortality indicators for oral health status (in terms of DMF) (d) Health services improvement indicators (Simple specific and basic measurement have to be developed) (i)

means

of health health and

Index of equitable distribution of resources social justice in health services' accessibility coverage

Regional Strategy for Health for All

health services' appropriateness ca-unity services satisfaction

quality with

and health

provision of essential drugs (ii) Heans of measuring lupport community participation and

measurement of community allocation for health action

resource

health habits aSlelsment of (use of latrinel and safe water, perlonal hygiene, child-rearing practices, regulation and immunization) fertility measurement of community participation in the management of health services (iii)

Ways of measuring the development appropriate technology

and use

of in and

index of the use of local resources the production of essential drugs construction of health facilities transfer of knowledge and members of the commmunity in of self-reliance (iv)

skills to the spirit

Ways of measuring intersectoral collaboration horizontal integration at various levels (including national level) in the planning and management of health and health-related programmes

Regional Strategy for Health for All

establishment councils (v) Measurement processes of

of the

intersectoral development of

coordination managerial

mechanisms for developing national health/2000 policies, strategies snd plans of action and for facilitating central planning and intersectoral coordination measure of decentralization of programme and management to provincial, planning district and community levels . index of health (vi) legislation and enforcement

Measurement of the development of health manpower progralllllles establishment of mechanisms monitoring of training needs for continuous

measures introduced to improve the status and career prospects of health manpower indices of adequacy and distribution of health manpower (vii) Resources allocation for health development budgetary allocation to the health sector in absolute and relative terms proportion of GNP for health changes in the pattern of resource allocation to primary, secondary and tertiary health care priority of disadvantaged groups 59

Regional Strategy for Health for All

(viii) Measurement of improvement 1n the delivery of health care immunization coverage deliveries personnel attended by trained by health

pregnant mothers antenatal care

covered

essential

provision of nutrition supplements eoverage with safe water supply coverage with sanitary latrines (e)

Indicators of rolitical commitment. These indicators are lncluded under the different categories already enumerated.

Indicators for regional and global use

7. Since average regional or global values of indicators have little meaning, monitoring and evaluation of implementation of the health/2000 strategy will rely on a short list of indicators. It is imperative that Member States of the Region should provide the necessary reliable information on these indicators. A list of indicators to be used for regional monitoring and evaluation is given below. Those with an asterisk (*) are the indicators to be used for global monitoring and evaluation of health/2000 strategy implementation. 8. This list of indicators will be periodically reviewed for individual relevance and modified as necessary.

Regional Strategy for Health for All

LIST OF INDICATORSI

The number of countries in which: (a)

Health foHcy 1ndicators

Health for all has received as policy at endorsement the highest official level (1) Mechanisms for involving people in the implementation of strategies have been formed or strengthened, and are actually functioning (2) At least 5% of the gross national product is spent on health (3) A reasonable percentage of national health expenditure is devoted to local health care (4) Resources are distributed (5) equitably

* *

lThe number in brackets shows the number given to the indicator in the global indicator list (Global Strateg for Health for All b the Year 2000, WHO, Geneva, 1981 ("Health for All" Series No.3, pages 75-76.

Regional Strategy for Health for All

Defined strategies for health for all are accompanied by explicit resource allocations (6)1

* *

Defined strategies for health for all need external resources (6) needs 'lbe resources strategies for are receiving support of countries (6) for of health the more external defined for all sustained affluent

80% of local At least communities at all levels have well-established voluntary and formal community organizations, which are committed to continuous primary health care action progr..-es 'lbe community contributes in cash and in kind to health or health related action. (b) Socio* economic indicatora of population 'lbe percentage served with aafe water in the or within 15 minutes' hOllle (7) walking distance is 100

lIn the global list, indicator 6 is atated as "'lbe number of developing countries with well-defined strategies for heal th for a 11, accompanied by explicit resource allocations, whose needs for external resources are receiving sustained support from more affluent countries". 62

Regional Str.ategy for Health for All

The percentage of population with adequate sanitary facilities in the home or immediate vicinity is 100 (7) The adult literacy ratio for both men and women exceeds 70% (11)

* *

The gross national product per head exceeds US$500 at 1980 market prices (12)1 The da i l y J;p.;::e.;::r_.;::c.;::aJ;p.;::i.;::t.;:;.a calorie availability exceeds 2500 calories The daily per capita protein availability exceeds 70 grams

(c)

Health status and quality of life IiidI'cators

* *

90% of newborn At least infants have a birth weight of at least 2500 grams (8) At least 90% of children have weight for age that a corresponds to reference values given in Annex I to Development of Indicators for Monitoring Progress Towards Health for All by the year 2000 2 (8)

lIn the global list, indicator 12 is stated as "The gross national product per head exceeds US$500". 2Development of Indicators for Monitoring Progress Towards Health for All b~ the Year 2000, Geneva, World Health Organization, 1981"Health for All" Series No.4). 63

Relional StratelY for Health for All

The infant .ortaHty rate for all identifiable subIroups is below 50 per 1000 live births (9) Life expectancy at birth is over 60 years (10) Maternal IIIOrtality is below per thousand 3 live births No cases of diphtheria, cough, tetanus, whooping . .asles, polia.yelitis occur or tuberculosis

(d)

Indicator of the del{verl of health care

care is Primary health the whole available to population with at least the following: I

* *

percentage of The by deliveries trained is health personnel 95 (7)

of The percentage i-.uniaed children diphtheria, alainst tetanus, whooping COUlh, measles, poliomyelitis and tuberculosis is 95 (7)

lIn the global list, precise values for different components of this indicator are not given. These values are considered relevant as regional targets for the Western Pacific Region. 64

Regional Strategy for Health for All

Local health care, including availability of at least 20 essential drugs, within one hour's walk or travel is 100% (7)

Tbe percentage of children up to at least one year of age given routine child care by trained health personnel i. 100 (7)

Tbe percentage of pregnant woaen with at lea.t three vi.its for antenatal care is 100 (7) The population growth rate reduced to lea. than 1% is

Regional Strategy for Health for All

ROLE OF WHO WITH RESPECT TO REGIONAL STRATEGY ISSUES

Issues for WHO

1. In accordance with the Constitution, the role of WHO includes coordination of the action which Member States undertake to attain the goal of health/2000 and the provision of technical cooperation. The coordinating function is the basis for, and is reinforced by, the technical cooperation function, which may cover both cooperation between Member States and WHO and cooperation among countries.

2. Previous chapters of the present document have outlined the Regional Strategy for achieving the goal of health/2000. This chapter will describe how WHO intends to fulfil its role, given the functions described above. 3. Several major issues will have to be faced by WHO in following the Regional Strategy. Changes will be necessary both within the Orgsnization and with respect to the relationship between WHO and Member States. 4. The issues identified in previous chapters are the following: (1)

To realize the goal of health/2000, Member States will adopt a broader approach to health deve lopment, which will bring together the community and all government sectors concerned. Member States and WHO are now aware that the health/2000 Strategy must take into consideration demographic, economic, soc ial and behavioural, and epidemiological factors affecting health. To implement the health development, new ho lis tic approach to changes may be required

(2)

(3)

Regional Strategy for Health for All

in the existing health systems, and above all in existinglllolnagerial procelles. This of course applies to Member States and to WHO.

(4)

The innovations required to Strategy will need to be the basis of correct information.

carry out the introduced on relevant and

5. To deal with the above_entioned illues and to modify ita role accordingly, WHO has been given full authority by the World Health Assemblyl and the Regional Committee 2 • Resolution A/RES/34/58 adopted by the United Nations General Assembly, alao acknowledges the vital role that ·heslth and health care play in the development of countries, particularly developing countries, and calls upon relevant bodiea of the United Nations system to coordinate with WHO in view of the Alma-Ata Declaration and the New International Development Strategy for the New International Economic Order. 6. A fnmework for action for the strategy h.. already been presented in Chapter III. The framework is built on the concept of a partnership between the community, the government and the private sector. The steps involved in this partnership have been described. WHO will endeavour to promote acceptance and implementation of this concept.

lSee resolution WHA33.24, Resolutions and Decisions, Vol. page 4.

WHO II,

Handbook I)f 4th ed., 1981,

resolution WPR/RC30.Rll, Handbook of 2See Resolutions and Decisions of the WHO Regional Committee for the We.tern Pacific, Vol. II, lrd ed., 1982, page 1. 67

Regional Strategy for Health for All

Guiding principles for WHO action

7. To develop the issues described in the previous paragraphs, certain principles can be listed, which will assist WHO in focusing its role in implementation of the Regional Strategy. (1) The health objectives expressed by Member States in the country statement synthesis will be used by WHO in establishing its own priorities when planning future technical prograllDDes (see Chapter IV, paragraph 4). The objectives form the basis of the regional objectives, targets and approaches (Chapter IV, paragraph 5). At regional level, political, technical, economic. reaearch and managerial support (including information) will be sought for the Strategy. the Emphaais will be placed on satisfying adequate food, water and basic need for shelter as a foundation for health. as well as on the development of cOlDlRunity self-reliance. Joint planning, monitoring and evaluation of national health strategies and programmes should be undertaken with health and healthrelated sectors at national level. including external bilateral and international agencies as required. The use of technical cooperation anong countries in developing and implementing national strategies should be promoted. This should play a major role in the context of regional support for the Strategy. In the spirit of the New International Economic Order, the resources of WHO, from both the regular budget and extrabudgetary resources, should be allocated according to the priorities established by the Strate8Y'

(2)

(3)

(4)

(5)

(6)

Regional Strategy for Health for All

8. The nature of WHO collaboration has already been considered in Chapters VI. VII. VIII and IX. It involves regional support meaaurea. generation and mobilization of resources. collaborative _chanisms. and monitoring and evaluation. Mechania.. for collaboration need to be reviewed and developed. 9. (1)

Nature of WHO collaboration

At the regional level. WHO will: enlist political support for programmes related to the implementation of national health/2000 strategies; mobilize identify and funds to extrabudgetary implementation of national coordinate the effective use sources of support the strategies and of such funds;

(2)

(3)

organize multidisciplinary teams to provide Member States with direct support in the development of national strategies and plans of action for achieving health/2000; ensure the monitoring the Regional Committee. of WHO support by

(4)

10. At the national level. WHO will:

support national . officials in national health/2000 strategies of action;

developing and plans in

(2)

cooperate when so requested implementing plans of action. including: (a)

the introduction processes for development; initiation approach.

of national

managerial health care and 69

(b)

of the primary health including research

Regional Strategy for Health for All

development activities level where applicable;

co-.nity

the strengthening of human resources development programmes in ministries of health; Cd) the design and development of coordination mechanisms for human resources development and for health research; the design and development of national health development centres/networks; the design and development of mechanisms to coordinate and monitor the implementation of national health strategies through the establishment of adequate health management information systems in the ministries of health; the design and development national health advisory councils; of

Ce> Cf)

Cg) (3)

initiate, encourage implementation of programmes within the strategies; for immunization, water sanitation programmes;

maintain the and priority technical context of national expanded example, supply and basic of the to

(4)

identify altd mobilize sources extrabudgetary funds to support implementation of national strategies.

WHO's prograume for the future

11. In the light of the foregoing, WHO will need develop its programme accordingly.

12. For the first time, a planning perspective of 20 years has to be considered. Planning must be undertaken 70

Regional Strategy for Health for All

in the light of incomplete information and uncertainty with regard to future trends in the Region. 13. At present., WHO plans its progralllllM!s in six-year periods known as General Programmes of Work. The current General Progr_e of Work ends in 1983, after which there will be three further General Programmes of Work up to the year 2000. For each WHO programme, there is a medium-term programme covering the six-year period of the General Programme of Work. The future programme structure and content, aa far as the Region is concerned, wi 11 have to be reviewed in the light of the Regional Strategy. WHO is already undertaking activities in preparation for the Seventh General Programme of Work (1984-1989) and the strategy for attaining the goal of health/2000 will be, and will continue to be, the theme for this. The future programme structure and activities of WHO will therefore have to take into account the following considerations:

14. At the allow WHO to: Ca)

regional

level,

the

structure

will

Organizational structure

approach heads of state and other national authorities to take the necessary steps to ensure that the goal of health/2000 is attained; communicate and promote health/2000 in all sectors; its vision of

(b) (c)

establish intersectoral linkages between and among international organizations, for mutual collaboration and support in health development; attract extrabudgetary funds for national and regional health development activities;

(d)

Regional Strategy for Health for All

(e)

adopt a learning posture which will generate and accept new ideas, critically review its experiences and develop a capacity for problem-solving; and respond appropriately and quickly to government requests for cooperation, having regard to the priorities established through the General Programme of Work.

(f)

15. At national level, WHO will be organized in the following manner: (a) WHO Programme Coordinator Facilitator and technical adviser in the development and implementation of national policies and strategies for health/2000. Manager of WHO activities programmes at national level. and support

Supervisor and supporter 'of all WHO staff and staff assigned to his area of responsibility. Technical adviser on health matters with respect to other international, bilsteral and multilateral agencies, including efforts to attract extrabudgetary resources. (b) Health programme teams Multidisciplinary groups of WHO formally or informally assembled: (i)

staff,

the WHO Programme to support Coordinator in the development and implementation of national policies and strategies for health/2000; and to coordinate WHO technical collaborative activities under var10US programmes.

(ii) 72

Regional Strategy for Health for All

16. While the Icope for initiating managerial procellel for health development il broad, a dual approach il propoled al an initial Itep in the implementation of the Itrategy. 17. At national level, the approach will be to encourage and lupport national health adminiltrators in the formulation and/or integration of national health policies conliltent with the goal of health/2000, through primary health care. 18. At the periphery, the approach will be to encourage and lupport the health system in developing interactive process.s with. selected communities leading to primary health care and to eltablish a monitoring IYltem for the management of heal th development. 19. WHO will provide national health development centrel/networkl or limilar mechanilml with timely and relevant lupport by coordin.ting and function.lly integr.ting national man.geri.l proce.... for health development with health servic.. development and prim.ry health care. Such support will be provided by multidilciplin.ry teams working in clole coordination with • regional health development group .. t.blished at the Region.l Office. Te.ms will contain experts in the following: (i) (ii) (iii) (iv) (v) (vi) community he.lth develppmenti policy and progr.... development; org.niaational development and planningi he.lth systems developeent; he.lth economici .nd behavioural Iciencel; he.lth manpower development.

H.nagement of the strategy

Regional Strategy for Health for All

20. The teams will work with the WHO Programme Coordinators and the WHO health services planning and management projects within countries. For practical purposes, the teams will be composed of both Regional Office and field staff implementing a joint plan of action. 21. (a)

The role of such teams will be to act as: in initiating and supporting facilitators national health managerial processes for development; points of coordination for international national management resources; and the development collaborators in appropriate managerial approaches prograllll1les methods, techniques, structures for bealth development. The functions of the teams will include: training consulting services researcb and development. and of and and

(b) (c)

22.

Progr&lllllle content

23. The implications of the Regional Strategy for WHO's programmes is that tbe following managerial activities should be supported at regional, national and intermediate and local levels: (a)

health policy and strateRY formulation, planning and evaluation as a means of providing leadership from national to community level;

Regional Strategy for Health for All

(b)

human resources development as a means of selecting, training and managing the human resources of the health system; information systems as a means of manager.s at providing dec is ion-makers and all levels of the health system with relevant information for maintenance its and development; research and development as a means of monitoring health at the community level and providing appropriate and affordable health technology to meet the community's needs; health development centres/networks, as a of facilitating the process of means intersectoral collaboration and providing health systems with training, consulting and research support in the management of health development.

(c)

(d)

(e)

24. For WHO, this does not detract from the importance of its technical programmes. The objectives listed in Chapter IV, paragraph 4, provide guidance with regard to the regional priorities as stated by Member States. 25. WHO's specific technical collaborative programmes will be directed, therefore, towards the ten broad objectives listeq in Chapter IV, paragraph 5, and organized and carried !ut through its General Programme of Work. For the last years of the Sixth General Programme of Work and the six years of the Seventh General Programme of Work, WHO will collaborate with countries/areas as follows:

Regional Strategy for Health for All

(a)

A well-nourished population: strengthening national and regional capabilities in the formulation and implementation of national food and nutrition policies and programmes; Safe drinking water for all and sanitary disposal of human and animal waste: developing national capabilities in the formulation and management of plans to attain basic needs in safe drinking water and adequate sanitation for all, through primary health care; Minimal environmental pollution and hazards: developing and implementing national policies and programmes for the control of environmental hazards. Communicable diseases no longer a major problem strengthening national capabilities ~n the planning and management of the following programmes: immunization, control of priority vector-borne diseases such as filariasis, malaria, dengue haemorrhagic fever and plague; control of diarrhoeal diseases; tuberculosis control; control of sexually transmitted diseases; investigating and resolving technical problems encountered in malaria eradication progr_s and in developing and managing optimal antimalaria programmes in countries where eradication is not at pre&ent applicable; strengthening operations for the control of appropriate parasitic diseases through technology;

(b)

(c)

(d)

Regional Strategy for Health for All defining the scope and magnitude of acute respiratory infections and demonstrating the effectiveness of interventions in significantly reducing mortality due to such infections in defined populations; initiating surveillance activities zoonoses and infections/intoxications animal origin; 1n of

initiating activities to implement regional programmes for the control/eradication of yaws, viral hepatitis and nosocomial infections, and ident i fying other emerging publ ic hea lth problems that are communicable in nature. (e) Chronic diseases reduced: developing and implementing programmes for the control of cardiovascular diseases and cancer as integral parts of the general health services; strengthening oral health programmes; and initiating activities against other noncommunicable conditions, especially diabetes mellitus, gout, chronic non-specific respiratory diseases and chronic rheumatic diseases. Psychosocial well-being and a lifestyle conducive to health: promoting policies and programmes on mental health, including the psychosocial factors involved in the promotion of health and human development, and on the prevention and control of alcoholism, smoking, drug abuse, mental and neurological disorders.

(f)

Regional Strategy for Health for All

(g)

pockets of ill health developing national policies and strategies, and preparing action plana for environmental health in rural and urban development and housing: in collaboration with Member States who have identified the needs of the aged as a priority problem, formulating and implementing policies and prograDDlles for the care of the aged as part of their overall social welfare and health programmes with emphasis on community-based services; developing national rehabilitation with. community-based services; progra_es emphasis on on

identifying other disadvantaged initiating/strengthening health for them. (h)

groups and activities

Fertility regulated to ensure better health and social well-being: strengthening family planning as an integral part of s maternal and child health progra_e (see (j». Access to appropriate health care for all !UJpporting health systems development through strengthening of capability in the analysis of the health situation and assessment of trends, implementation of the. managerial procell for national health development, including development of health information Iystems, and the conduct of health systems research;

(i)

Regional Strategy for Health for All

promoting policies and programmes for the organization of health systems based on primary health care to achieve total population coverage for the delivery of essential health programmes; promoting programmes for the development, application, and transfer of appropriate technology for diagnosis, treatment and rehabilitation and for the control of drug and vaccine quality, safety and efficacy. (j)

The objectives for nutrition, communicable disease control, psychosocial well-being, no pockets of ill-health. and access to appropriate health care will also be met through a maternal and child health programme. In th is connexion. WHO wi 11 collaborate with countries or areas in improving and strengthening their family health services for women of child-bearing age and children at all levels of the health system, within the context of primary health care. in order to reduce maternal, perinatal, infant and childhood morta Ii ty and morbidi ty, and in improving the physical and psychosocial development of children and adolescents, and reproductive health.

26. As a support to a 11 the programmes, WHO wi 11 collaborate with countries or areas in: promoting policies and programmes to meet the requirements of the health systems for health manpower and human resources development, production and management, using appropriate educational aupport;

Regional Strategy for Health for All

promoting and strengthening health education of the public and the provision of the public with health information with a view to enlisting active community involvement in health activities; promoting healthy lifestyles and community self-reliance in health; achieving

promoting national capability in health r.search that is relevant to the solution of tbe major health problems focused on the objective of health/2000.

Regional Strategy for Health for All

XI.

TENTATIVE PLAN FOR IMPLEMENTATION OF THE REGIONAL STRATEGY, INCLUDING A TIMETABLE

The major milestones and targets for the formulation, implementation, evaluation and updating of policies, strategies, and plans of action for health/2000 at national and regional level include the following; (1) Initial reports on national policies and strategies for health/2000 prepared National progress reports reviewed and a proposed Regional Strategy developed by the Regional Committee Sub-Committee on the General Programme of Work Regional Strategy for health/2000 reviewed by the Regional Committee Commitment obtained by the Regional Committee for Member States, with cooperation from WHO, to implement, monitor and evaluate the Regional Strategy Extrabudgetary resources identified through joint planning; for example, joint programming with UNDP for the period 1982-1986 April 1980

(2)

June 1980

(3)

September 1980

(4)

September 1980

(5)

September 1980

Regional Strategy for Health for All

(6)

Policies and strategies reviewed and updated by Member States and plans of action developed

March 1981 and subsequent Iv as required (see (9)) September 1981 and thereafter every 2 years by December 1981

(7)

Regional Strategy reviewed and updated by the Regional Committee (a) Appropriate and relevant indicators to monitor and evaluate progress established Monitoring and evaluation process introduced by Member States and the necessary mechanisms established for evaluating strategies National health information systems further strengthened to permit comprehensive monitoring, evaluation and updating of strategies

(8)

(b)

June 1982

(c)

by December 1985

(9)

National policies, strategies and plans of action periodically reviewed and updated by Hember States The following established: (a) intersectoral national health councils or similar mechanisms concerned with coordination, where appropriate

1981 and thereafter every 2 to 4 years

(10)

by December 1983

Regional Strategy for Health for All

(b) (11)

national health development centres/networks

by December 1985 by December 1982

The primary health care approach introduced in selected areas of Member States Health systems development policies formulated and manpower and other requirements identified Manpower policies developed, personnel reoriented and institutions strengthened Total coverage with primary health care in all countries, supported by health systems Regional mechanisms established for the following: (a) promotion and strengthening of technical cooperation among developing countries coordination with multilateral, bilateral and regional groupings in resource aobilization and implementation of strategies

(12)

by December 1982

(13)

by December 1985 by December 1990

(14)

(15)

by December 1982

(b)

by December 1982

by December coordination and collabo1982 ration within the United Nations system for developing a shared understanding 83

Regional Strategy for Health for All

and joint planning and regionalization of resources (for example with UNDP) (16) Medium-term programmes developed in the Regional Office for the Western Pacific for supporting countries in the formulation, implementation, monitoring and updating of national strategies and plans of action The Seventh and the two subsequent General Programmes of Work developed to support the implementation of regional and national strategies (Headquarters and all regions) A regional strategy for managerial processes for national health development formulated by Decemher 1982

(17)

1982 and subsequently as required

(18)

1981

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Publications

Date d'adoption 31 décembre 1982

Source Organisation mondiale de la santé