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Proposed programme budget for the financial period 1990-1991

31 декабря 1988 г. Всемирная организация здравоохранения

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WPR/RC39/5

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Thirty-ninth session Manila, 12-16 September 1988

PROPOSED PROGRAMME BUDGET FOR THE FINANCIAL PERIOD 1990-1991

The Regional Director has the honour to present to the Regional Committee for the Western Pacific the proposed programme budget for the financial period 1990-1991.

Manila, June 1988

ABBREVIATIONS

The following abbreviations are used in this document:

AIDAB ESCAP ASEAN FAO IAEA IARC IDWSSD MEDLARS PEPAS SPC UNDP UNFPA UNICEF WPACHR

Australian International Development Assistance Bureau Economic and Social Commission for Asia and the Pacific Association of South-East Asian Nations Food and Agriculture Organization International Atomic Energy Agency International Agency for Research on Cancer International Drinking Water Supply and Sanitation Decade Medical Literature Analysis and Retrieval System Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies South Pacific Commission United Nations Development Programme United Nations Population Fund United Nations Children's Fund Western Pacific Advisory Committee on Health Research

The symbols adopted in this document to indicate the sources from which activities are expected to be financed are as follows: AS DP DR FA FB FP Special Account for Servicing Costs United Nations Development Programme- Indicative Planning Figures United Nations Development Programme- Special Programme Resources Trust Fund for the Special Programme for Research and Training in Tropical Diseases Associate Professional Officers other than United Nations Development Programme United Nations Population Fund

FS FT FX RB ST UF VA VC VD VI VK VL VM VP VV VW

Trust Funds -Supplies Trust Funds - Project Agreement Trust Fund for the Global Programme on AIDS WHO Regular Budget Sasakawa Health Trust Fund United Nations Children's Fund Voluntary Fund for Health Promotion- Assistance to the Least Developed Among Developing Countries Voluntary Fund for Health Promotion - Diarrhoeal Diseases, including Cholera Voluntary Fund for Health Promotion- Miscellaneous Designated Contributions (Other) Voluntary Fund for Health Promotion- Expanded Programme on Immunization Voluntary Fund for Health Promotion- Miscellaneous Designated Contributions (Training Courses- DANIDA) Voluntary Fund for Health Promotion- Leprosy Programme Voluntary Fund for Health Promotion- Malaria Voluntary Fund for Health Promotion- Special Account for the Mental Health Programme Voluntary Fund for Health Promotion- Miscellaneous Designated Contributions- Special Assistance to Democratic Kampuchea, the Lao People's Democratic Republic and VietNam - Voluntary Fund for Health Promotion- Community Water Supply

CONTENTS Page Explanatory notes . . . . . . . . . . . Regional Director's programme statement

ix xiv

SUMMARIES Summary of regional health programme: estimated obligations and sources of financing Summary by programme and source of funds . . . . . . . . . . . . . . . . . . Summary by programme and organizational level . . . . . . . . . . . . . . . . Summary of regular budget estimated obligations and analysis of increases and decreases by programme Summary of the regular budget 1988-1989 and 1990-1991 by appropriation section, with percentages of the total 1 3 11 17 23

PROGRAMME ANALYSES DIRECTION, COORDINATION AND MANAGEMENT 1.

Governing bodies 1.3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 33

Regional Committee

WHO's general programme development and management 2.1 2.2 2.3 2.4

Executive management . . . . . . . . . . Regional Director's development programme General programme development . . . . . External coordination for health and social development

35 37 40 iii

Page

2.5 2.6

Health-for-all strategy coordination Informatics management

42 45

HEALTH SYSTEM INFRASTRUCTURE 3. Health system development 3.1 3.2 3.3 3.4 4. 5. 6. Health situation and trend assessment . . . . . Managerial process for national health development Health systems research and development Health legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

50 53 56 59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Organization of health systems based on primary health care Development of human resources for health Public information and education for health

. .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 64 . . . . . . . . . . . . . . . . . . . . . . . . . . 67

HEALTH SCIENCE AND TECHNOLOGY -HEALTH PROMOTION AND CARE 7. 8.

Research promotion and development, including research on health-promoting behav our General health protection and promotion 8.1 Nutrition Oral health Accident prevention

. . . . . . . . . . . . . . . . . . . . 70

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

74 77

8.2 8.3

Page 8.4

Tobacco or health

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Protection and promotion of the health of specific population groups 9.1 Maternal and child health, including fa:nily planning Adolescent health Workers' health Health of the elderly

87 90

9.2 9.4

92 95

9.5 10.

Protection and promotion of mental health 10.1 10.2 10.3 Psychosocial and behavioural factors in the promotion of health and human development Prevention and control of alcohol and drug abuse . . . . . Prevention and treatment of mental and neurological disorders

98 . 100 . 102 . 104 . 106 . . . . . 108 111 114 117 120

11.

Promotion of environmental health 11.1 11.2 11.3 11.4 11.5 . . . . . . . . . . . Community water supply and sanitation Environmental health in rural and urban development and housing Health risk assessment of potentially toxic chemicals Control of environmental health hazards Food safety . . . . . . . . . . . . . . .

12.

Diagnostic, therapeutic and rehabilitative technology 12.1 12.2 12.3 Clinical, laboratory and radiological technology for health systems based on primary health care Essential drugs and vaccines . . . . . . Drug and vaccine quality, safety and efficacy

. 123 . 125 . 128 . 131 v

Page 12.4 12.5 Traditional medicine Rehabilitation . 133 . 136

HEALTH SCIENCE AND TECHNOLOGY- DISEASE PREVENTION AND CONTROL 13. Disease prevention and control 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 Immunization Disease vector control Malaria ..... Parasitic diseases Tropical disease research Diarrhoeal diseases Acute respiratory infections Tuberculosis Leprosy ....... . Zoonoses ...... . Sexually transmitted diseases Research and development in the field of vaccines AIDS .. . . . . . . . .... . . ... . Other communicable disease prevention and control activities Blindness and deafness Cancer Cardiovascular diseases Other noncommunicable disease prevention and control activities . 139 . 141 . 144 . 147 . 150 . 153 . 156 . 159 . 162 . 165 . 168 . 170 . 172 . 175 . 178 . 181 . 184 . 186 . 189

PROGRAMME SUPPORT 14. Health information support . . . . . . . . . . . . . . . . . . . . . . . 191

Page 15. Support services 15.1 15.2 15.3 15.4 Personnel General administration and services Budget and finance . . . . . . Equipment and supplies for Member States . 194 . . . . 196 198 200 202

INFORMATION ANNEXES ANNEX 1 - SUMMARY OF COUNTRY ACTMTIES ANNEX 2 - COUNTRY OR AREA PROGRAMMES American Samoa . Australia . . . . Brunei Darussalam China . . . . . . Commonwealth of the Northern Mariana Islands Cook Islands . . . . . . . . Democratic Kampuchea . . . Federated States of Micronesia Fiji . . . . . . French Polynesia Guam . . . Hong Kong Japan . . . Kiribati . . Lao People's Democratic Republic Macao . . .. . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

. 213 . 216 . 218 . 223 . 238 . 243 . 249 . 250 . 259 . 265 . 271 . 273 . 276 . 279 . 287 . 297

Vll

Vlll

Page Malaysia New Caledonia New Zealand Papua New Guinea Philippines Republic of Bel au Republic of Korea Republic of the Marshall Islands Samoa .. . . Singapore . . . Solomon Islands Tonga Tuvalu Vanuatu VietNam ANNEX 3 - REGIONAL AND INTERCOUNTRY ACTIVITIES ANNEX 4 - SUMMARY OF INTERCOUNTRY ACTMTIES ANNEX 5 - CLASSIFIED LIST OF PROGRAMMES FOR THE PERIOD OF THE EIGI:.""TH GENERAL PROGRAMME OF WORK . 299 . 309 . 311 . 314 . 322 . 332 . 336 . 345 . 351 . 359 . 365 . 372 . 380 . 381 . 388 . 403 . 415 . 427

EXPLANATORY NOTES 1. DEVELOPMENT OF THE PROPOSED PROGRAMME BUDGET - The capacity of countries or areas to implement planned technical cooperation activities, judged mainly on the basis of the implementation of programmes in the past. - Estimated input from regional and intercountry programmes as well as expected support from extrabudgetary resources. Therearter, in compliance with the programme budgeting procedures adopted by the Thirtieth World Health Assembly In resolution WHA30.23, the proposed cw ntry programme activities were prepared by t he national authorities in close collaboration with WHO. Their task was to identify priority programmes for technical cooperation in support of national policies and strategies for 1he attainment of health for all by the year 2000. using guidelines established under the Regional Programme Budget Policy. With regard to the regional and intercountry programme activities , an allocation for regional office management and support services was developed in relation to its principal purpose of supporting Member Stat es through the work of the Regional Committee and its sub-committee, and th rough support to regional planning, management, monitoring and evaluation, as well as its coordinating role with ot her United Nations bodies and voluntary organizations. The proposed intercountry programme activities comprise the larger portion of the regional and intercountry allocation. After ascertaining, through WHO Representatives and Country Liaison Officers, the governments' interest in participating In technical collaborative activities, the intercountry activities were developed, using the following main criteria. They should: - represent a direct contribution to the current needs of the regional health-for-all strategy and support relevant national activities; - benefit two or more countries or areas; - favour least developed countries as far as possible; - include activities to promote technical cooperation among countries;

This document contains the Regional Director's proposed programme activities for the biennium 1990-1991, which have been formulated in accordance with the Eighth General Programme of Work covering a specific period (1990-1995), adopted by the Fortieth World Health Assembly in resolution WHA40.31 and keeping in mind the directives of the Executive Board as per resolution EB79.R9 at its seventy-ninth session in January 1987. Programme development was based on the Regional Programme Budget Policy for the Western Pacific Region adopted by the Regional Committee in 1986 by resolution WPR/RC37.R2. Two organizational levels are presented in the proposed programme budget, namely: (1) country programme activities and (2) regional and intercountry programme activities. For each of the two levels, a separate basic planning allocation was established by the Director-General.

For country programme activities, the Regional Director established a provisional basic country planning figure for each country or area within the overall allocation. In the allocation of such provisional country planning figures, the following main criteria were applied: - The extent to which a country or area is making use of WHO resources to build up its health system in accordance with collectively decided policies and strategies for "Health for All by the Year 2000", and providing adequate information in keeping with its accountability to WHO. - The level of need, measured in part by socioeconomic and health indicators of each country or area. These include factors such as population, physicians per 10 000 inhabitants, per capita GNP, life expectancy at birth, and geographical location. Least developed and newly independent countries were given special consideration as much as possible within the limits of the financial resources available.

Explanatory notes

- include an innovative activity, such as research and development; and - tend to attract external sources of funding. All regional and intercountry activities were reviewed to ensure maximum correlation with global, interregional and country activities. Following the review by the Regional Committee in September 1988, the proposed regional programme budget will be consolidated and finalized by the Director-General into the WHO Proposed Programme Budget for 1990-1991 which will be presented for consideration by the Executive Board (January 1989) and review and adoption by the World Health Assembly (May 1989).

The ptOposed programme budget for 1990-1991 also includes, for purposes of comparison, the approved budget for the biennium 1988-1989 as revised in Ma.., 1988 (WHA41.1 0). It should be noted that the reclassification of some 1988-1989 activities based on the classified list of programmes covering the Eighth Ge-neral Programme of Work has resulted in some corresponding changes in tre appropriation sections.

CONTENTS

The Regional Director's programme statement on pages xiv to xix presents the .. ighlights of WHO's proposed programme of cooperation in the Region durin~ the biennium 1990-1991. This is k>llowed by various budgetary tables on pages 1 to 23 presenting: (1) summary of regional health programme: estimated obligations and sources of financing; (2) summary by programme and source of funds; (3) summary by programme and organizational level; (4) summary of regular budget estimated obl~ations and analysis of increases and decreases by programme; and (5) surrrnary of the regular budget 1988-1989 and 1990-1991 by appropriation section, with percentages of the total. The programme analyses are given on pages 27 to 203. Under each programme h3ading, there is a statement presenting the objective and targets for the period of the Eighth General Programme of Work (1990-1995), a situation analysis, a de:;cription of the proposed programme activities for the biennium 1990-1991, aiD a brief analysis of the budgetary implications. Each statement is supported ty a summary budgetary table showing the estimated obligations at country level and at regional and intercountry level. The pre gramme analyses are followed by information annexes: Annex 1 presents a summary of country activities. Annex 2 presents the country programme statements, comprising a description of the national health development situation, the proposed WHO collaborative health programme for 1990-1991 , and a brief analysis of budgetary irrclications, followed by a budgetary table broken down by programme.

FORM OF PRESENTATION

The proposed programme budget has been presented in accordance with the classified list of programmes of the Eighth General Programme of 1 The classified list comprises four broad interlinked categories: Work. (1) Direction, coordination and management; (2) Health system infrastructure; (3) Health science and technology, subdivided into Health promotion and care and Disease prevention and control, and (4) Programme support. Each programme covers the budgetary provision for the country and regional and intercountry activities. The proposed programme budget does not provide details of the activities proposed or their estimated cost by component but by broad programme only. This is in accordance with the policies and process for programme budgeting at the country level as stated in resolution WHA30.23 as follows: "Detailed plans of operation or work and budgetary estimates for individual projects and activities planned within defined health programmes will be developed at a later stage, closer to and as a part of programme implementation at country level". The budgetary tables contain proposals to be funded under the regular budget as well as those expected to be funded from extrabudgetary resources, based on available information at the time of the preparation of this proposed budget.

See Annex 5.

The estimates for the WHO Representatives' offices are shown under the country in which the office is located, under the programme heading "Managerial process for national health development". . . .Annex 3 presents a summary of the proposed regional and intercountry act1v1t1es. Annex 4 gives a description of the intercountry activities which are in direct support to countries/areas. Annex 5 presents the classified list of programmes of the Eighth General Programme of Work.

(b) Allocation for regional and intercountry activities Original approved 1988-1989 budget (WHA40.37) Less: WPRO's pro rata share on global budgetary reduction of US$25 million Revised approved 1988-1989 budget (WHA41.1 0) Add: Reallocation from country activities Basic regional and intercountry planning allocation Add: Inflation and statutory cost increases (8%) Subtotal - Proposals for regional and intercountry activities Total regional programme budget proposals for 1990-1991

US$ Amount 23 290 000 917 500 22 372 500 500 000 22 872 500 1 829 800 24 702 300

FUNDING, COST FACTORS AND BUDGETARY CONCEPTS

58 103 300

In accordance with instructions from the Director-General, as endorsed by the Programme Committee of the Executive Board, cost increases to cover inflation and statutory cost factors should be reasonable and carefully justified, and at any rate should not exceed a total maximum of 10% for country activities and a total maximum of 8% for regional and intercountry activities, above the basic planning allocations. The regional programme budget proposals for 1990-1991 as compared with the regional share of the approved programme budget for 1988-1989 can be summarized as follows:

It may be noted that in accordance with the recommendations of the Programme Committee of the Executive Board and the Director-General's directives, the 1990-1991 proposed programme budget has been prepared using the same budgetary rate of exchange for the Philippine peso to the US dollar as applied for the 1988-1989 budget, i.e. P19 = US$1. In all aspects of developing the regional and intercountry activities, limited zero-base budgeting techniques were used. Bearing in mind the need to make optimal use of scarce financial resources, cost projections and assumptions applied in this programme budget were very closely formulated. The cost increases applied were based, to the greatest extent possible, on an analysis of actual expenditures incurred over the past biennia, particular1y 1984-1985 and 1986-1987, supplemented by official statistics and forecasts available at the time of preparation of the budget. Specifically, the following steps were taken for the main components, with measures applied whenever possible to absorb at least part of the expenses during the implementation period:

(a) Allocation for country activities Original approved 1988-1989 budget (WHA40.37) Less: WPRO's pro rata share on global budgetary reduction of US$25 million Revised approved 1988-1989 budget (WHA41.1 O) Less: Reallocation to regional/ intercountry activities Basic country planning allocation Add: Inflation and statutory cost increases (10%) Subtotal - Proposals for country activities

US$ Amount 32 132 000 1 267 500 30 864 500 500 000 30 364 500 3 036 500 33 401 000

(a) Salaries and allowances for professional posts in Manila Averages were first established by Headquarters based primarily on the actual cost of staff in the previous four years, and cover salaries and statutory

Explanatory notes

Explanatory notes costs such as within-grade salary increases and other staff entitlements. These averages take into account the period for which posts are expected to be required as well as a factor for anticipated delays in recruitment. The Regional Office then added to these averages the expected post adjustment component based on its best projections and the exp~<;:ted_trend in inflation and other cost of living factors, including housing, in Manila. This came to post adjustment multiplier 13. Due to the freezing of the post adjustment multiplier in New York and several other duty stations and its consequent effects on field duty stations such as Manila, the actual post adjustment for professional staff in Manila in 1986-1987 was lower than projected for that biennium and this trend was likely to continue into 1988-1989. Consequently, a net catching-down by 10 multiplier points was included in the post adjustment projections for 1990-1991.

xii tuition, book allowances and miscellaneous expenses plus projected cost increases of these items were then taken into account. The trends concerning places of study the fellows were likely to go to and the duration of their study time were also taken into account. The cost increase used was 15% which is sligbtly lowerthan the budgeted .rate for_L988-1989, owing to an element of catching-down as actual cost increases for the current biennium may be lower than originally foreseen.

(e) Consultants Actual expenses incurred for consultants in the Region over the last and current biennia, including the total man-months spent, were examined. An analysis was also made of the place of origin of the consultants because the cost of airfares is a major factor in the averages, especially for contracts of short duration. Based on this, the average man-month cost in 1990-1991 was projected at US$8000 but the average used was actually US$7000, resulting in a cost absorption of US$1000 per man-month. (f) Common Services The projected cost increase was arrived at by taking into account actual expenditures in the current biennium and projected trends for common services items, such as contractual services, cables, telexes, electricity and maintenance of the Regional Office, which are substantially peso based, and supplies and materials which are purchased abroad. Other elements taken into account included estimates of future inflation, exchange-rate fluctuations and cost trends for imported goods. The projected rate used for common services was 25% which includes an element of cost absorption. This incorporates approximately 5% to cover a 'catching up' resulting from cost increases which were actually higher than budgeted in previous biennia as inflation proved to be much higher than projected. Other highlights of the 1990-1991 programme budget proposals are as follows:

(b) Salaries of the general service staff in Manila The cost averages for the biennium were developed taking into account the actual changes in the salary scales approved between 1985 and 1987 as well as the current trends, and in accordance with local practice for salary surveys, projected through 1990-1991. This resulted in a projected cost increase of 18% and contains an element of cost absorption.

(c) Supplies and equipment The projected cost increase was arrived at by comparing the cost of supplies and equipment most commonly purchased for the countries of the Western Pacific Region in 1985, 1986 and 1987 and on the basis of projected cost increases of such supplies and equipment in 1988-1 989 and 1990-1991, including shipping costs, and taking into account the movement of the US dollar against local currencies. Special attention was paid to shipping cost increases, particularly with regard to South Pacific countries, as well as to figures for inflation both from within and outside the Region, wherever purchases are made. Although the cost of a number of items traditionally procured have in many cases risen above 20%, a maximum cost increase of 20% was applied, in order to absorb some part of the costs.

(d) Fellowships The estimated actual requirements of fellows coming from the different countries in the Region as well as the projected places of study were first prepared. Assumptions were based on the actual confirmed placements of fellows made during the past biennium. The current cost of airfares, stipends,

(1) Country activities The 1990-1991 country allocation of US$33 401 000 compared with the revised approved 1988-1989 budget (WHA41.1 0) reflects a net increase of US$2 536 500, or 8.22%. The increase represents inflation and statutory costs totalling US$3 036 500 offset by a reallocation of US$500 000 to regional and

intercountry activities. It should be pointed out that although projected cost increases of most of the main components were expected to be higher than 10% over the biennium, these inflation and statutory cost increases had to be contained within a maximum 10% overall ceiling. The projected Inflation and statutory cost Increases came. to US$3 969 400 or 12.86% but had to be reduced by US$932 900 or 3.02% in order to remain within the 10% cost Increase ceiling of US$3 036 500.

(3) Proposed regional regular budget for 199G-1991 It should be noted that the proposed regional budget Is subject to adjustment when the Director-General will have finalized his overall budgetary proposals in October 1988.

EXTRABUDGETARY RESOURCES

(2) Regional and Intercountry activities The 1990-1991 regional and intercountry allocation of US$24 702 300 compared with the revised approved 1988-1989 budget reflects a net increase of US$2 329 800 or 10.41 %. The increase is in respect of inflation and statutory costs in the amount of US$1 829 800 and a reallocation of US$500 000 from the country allocation. The overall cost Increase was projected at US$3 082 300 or 13.78% but had to be reduced by US$1 252 500 in order to remain within the 8% cost increase ceiling of US$1 829 800.

The proposed programme budget includes, as in previous years, all activities for which financing may reasonably be expected from extrabudgetary resources. The estimates for 1990-1991 compared with the latest available estimates for 1988-1989 now reflected in the budget document show a decrease of US$15 980 000. Nevertheless, it is expected that further resources will become available closer to and during biennium 1990-1991.

Explanatory notes

xiii

Regional Director's programme statement

xlv

REGIONAL DIRECTOR'S PROGRAMME STATEMENT The proposed programme budget for the Western Pacific Region for the biennium 1990-1991 reflects the continuing concern of Member States and WHO to make optimal use of the limited resources available for health development efforts In the Region. Following the guidelines contained In the reglo~l programme budget policy adopted by the Regional Committee In 1986, the proposed programme budget for 1990-1991 has been prepared In close consultation between Member States and WHO at country level, and Includes activities directed to the Implementation of the national health-for-all strategies, within the frameworr of the Eighth General Programme of Work, covering the period 1990-1995. Reflecting WHO's continuing support for the national strategies for health for all, the 1990-1991 programme budget accordingly maintains the following health-for-all priority development areas: (a) further strengthening and reorientation of the health system Infrastructures of countries, based on primary health care; (b) the continuing Improvement of the managerial process for national health development, and strengthening of Information and research support; (c) development and strengthening of health manpower policies and programmes to ensure that health personnel become more responsive to the needs of communities and the requirements of the reoriented health systems; (d) the application of cost-effective and appropriate technology In the control of major communicable diseases; (e) lntersectoral coordination and mobilization of external resources for health development. In accordance with these major programme thrusts, the largest allocation under the proposed programme budget Is for disease prevention and control, followed by the development of human resources for health, health system development, the organization of health systems based on primary health care, and the promotion of environmental health.

As In previous biennia, WHO's programme of cooperation In the Region during 1990-1991 will be provided mainly through country programmes. In addition, an Intercountry programme has been maintained In view of the heterogeneous nature of the Western Pacific Region which, In some Instances, makes this kind of programme a more effective means of providing cooperation. The highlights of the programme activities of the Region Included In the programme budget for the biennium are given below. Under WHO's general programme development and management, efforts will continue to focus on ensuring effective application of WHO's managerial processes to strengthen the Organization's support of Member States In their health development efforts. The second evaluation of health-for-all strategies by countries and areas of the Region will be supported by WHO in order to provide the basis for adjustment of future joint collaboration In priority programmes. The WPRO Learning Centre In Manila will continue to foster the communication and managerial skills needed for health-for-all leadership. The health system development programme, In order to strengthen managerial capabilities, will frequently employ a learning-by-doing approach. This will be applied to the problems and needs involved in operating and developing health services, notably at the district level. There will be Intercountry sharing of such learning and problem-solving experiences, in the spirit of technical cooperation among countries. Among the priority Issues to be addressed are health sector financial planning and management information systems. Managerial needs will guide the determination of minimum basic data sets as elements of national health Information systems. Where appropriate, countries will be supported to introduce automation in Information processing.

1 2

Reaolution WPRIRC37.R2 Reaolution WHA 40.31

Epidemiological surveillance will be strengthened to provide Information for priority programmes such as Immunization, diarrhoeal disease control, hepatitis B, acute respiratory Infections, acquired human Immunodeficiency syndrome and sexually transmitted diseases. Training will be provided on health systems research which will provide another source of Information to support health services management. Another area of training and review will concern health legislation, which Is Increasingly recognized as necessary for the support of needed changes In health systems. The organization of health systems based on primary health care programme will use practical research and development to resolve pertinent issues, particularly In the district health systems, which must be strengthened In order to provide total population coverage with effective health care. The Issues will Include planning and maintaining suitable facilities and equipment as well as supervision , logistics and manpower development . Partnership-building with communities and related sectors will continue to require strong efforts. Reorientation of trainers and staff to primary health care approaches and appropriate technologies will be consolidated so that both experienced and new health workers may contribute effectively to a high standard of service to their communities. Experiences In the Improvement of health systems organization and functioning will be documented and exchanged so that countries may help each other's progress. Motivated and competent human resources are the key to Implementing health-for-all strategies. Reorientation of health personnel toward s community problems and primary health care still requires further strengthening. Emphasis needs to be placed on t raining categories of health personnel such as community health workers and/or nurse practitioners. WHO will continue to collaborate with Member States in formulating national policies of human resources for health, developing strategies and plans to ensure that adequate numbers of types of health personnel are property trained and rationally deployed. Such personnel should be socially responsible and possess relevant technical and managerial competence to deliver appropriate primary health care services. Emphasis will be given to strengthening coordination between educational institutions, health services and communities to make training programmes more relevant to health needs of communities. In view of the need to Improve managerial capabilities at various levels of the health care system, health management training will be Intensified. Support will be provided for teacher training opportunities, to reorient curricula, Improve educational technology and develop health learning materials. Regional Director's programme statement

National capability and Initiatives to develop health manpower Information systems and decision-linked research will be further promoted to help Improve qualitative aspects of developing human resources for health. The regional fellowship programme will be continuously evaluated to make It more relevant to national policies In human resources for health for all by the year 2000. The programme on public information and education for health will receive continued emphasis In efforts to develop integrated health education and communication policies, programmes and activities. Special emphasis wHI be given to motivating the public for active Involvement ih health activities, promoting and maintaining a healthy life-style and achieving community self-reliance in health. The programme will be strengthened by Incorporating innovative approaches to the planning and programming of health Information and education activities such as advocacy at various levels, Interpersonal and intersectoral approaches, and social marketing. To further improve the effectiveness of public information and education support to health programmes, cooperation will be extended In the areas of formulating health Information and education planning and strategies, designing the administrative and operational framework to facHitate programme Implementation, producing educational materials, strengthening school health education, and training health personnel in health education. More efforts will be made to Involve major national and regional media groups In disseminating health messages, Increasing public awareness and Influencing policy-makers to support the health sector. The promotion and coordination of activities relevant to biomedical, health systems and health behavioural research remain the prime objective of research promotion and development. The programme will continue to collaborate In developing the infrastructure needed for carrying out priority health research, and In strengthening the required mechanisms to ensure efficient coordination and research management within each country. The WHO Regional Centre for Research and Training In Tropical Diseases, Institute for Medical Research, Kuala Lumpur, continues to play an Important role In the promotion of research and research training in tropical diseases. The general health protection and promotion programme Includes nutrition, oral health, accident prevention and 'tobacco or health'.

Regional Director's programme statement

XVI

In the area of nutrition, emphasis will continue to be made on decreasing the undernutrition which persists in certain countries of the Region, especially among the vulnerable groups. WHO will collaborate with countries in the Implementation of national nutrition programmes based on national policies of nutrition with more emphasis on protein-energy malnutrition and control of specific nutritional deficiencies where these problems are Identified. The level of oral health will be raised through wider coverage of populations with promotive and preventive activities and the development of more efficient and relevant oral health care delivery systems. Special attention will be given to oral health education in schools with oral hygiene instruction and dietary counselling as major components. To overcome manpower shortages, the training and greater utilization of dental auxiliaries and other non-traditional dental manpower such as teachers will be encouraged and supported. In the area of accident prevention, collaboration will concentrate on the development of intersectorai national bodies for the prevention and control of road traffic accidents. The programme on 'tobacco or health' is a new programme area produced by the growing awareness in the majority of the countries in the Region that diseases related to tobacco use are among the leading causes of death. Tobacco use Is becoming a major health problem especially in the developing countries of the Region. WHO will collaborate In establishing national 'tobacco or health' policies and programmes in order to reduce the consumption of tobacco products, and In the promotion of national legislation to restrict the use of tobacco. The training of health workers and the development of educational materials will also be supported. The programme on protection and promotion of specific population groups includes maternal and child health, family planning, adolescent health, workers' health, and health of the elderly. These programmes are of particular concern as they cover specific population groups which are vulnerable to health hazards leading to considerable morbidity and mortality. There has been significant progress especially with respect to the reduction of infant and child mortality, but maternal and perinatal morbidity and mortality remain a major problem in many developing countries. WHO will continue to strengthen and expand maternal and child health and family planning programmes so as to Increase the percentage of births which are

attended by trained health workers. Collaboration with UNFPA for national efforts in family planning will continue. Adolescent health will receive Increased attention, the emphasis of this programme being on fostering proper growth and development, reducing risk-taking behaviour, and solving sexually related problems. For the protection of workers' health, the main thrust will be on promoting the development of occupational health services, particularly for the working population in small-scale industries and in agriculture. With respect to the programme on health of the elderly, WHO will primarily focus on improving the quality of life of the aged with emphasis on community-based health service. Support for specific national studies on identified problems of the aged and research activities on priority problems of this special group will continue. The main emphasis of WHO collaboration under the programme for protection and promotion of mental health Is to promote the training of health workers and to support specific research activities directed to high-risk groups, such as the adolescents and the elderly who are under the pressure of rapid changes in socioeconomic and !He-style patterns in many countries of the Region. While supporting formulation of comprehensive mental health policies and programmes, WHO will support the development of community-based mental health services In most countries of the Region. This will also require the development of coordinating mechanisms of different national agencies and groups. Alcohol and drug abuse is gaining recognition as a causative factor for many social and health problems. WHO will continue to support the development of national policies and programmes for the prevention of alcohol and drug abuse, as well as for the treatment and rehabilitation of abusers. The promotion of environmental health programme continues to be an Integral part of WHO's health for all strategy. As a continuation of the activities carried out in support of the International Drinking Water Supply and Sanitation Decade (1981-1990), efforts in the community water supply and sanitation programme will be directed

towards promoting national programmes to provide safe drinking water and adequate sanitation systems. The development of appropriately trained manpower will be emphasized, as well as the use of appropriate technology, and the Importance of proper operation and maintenance of equipment will be stressed. Environmental health activities In rural and urban development and housing will focus on the provision of technical cooperation to governments for the promotion of national programmes, with emphasis on developing policies, legislation and plans, Including the setting of guidelines for control, monitoring and surveillance programmes. WHO will encourage Member States and socioeconomic development agencies to Incorporate environmental health considerations Into the development of planning activities, to strengthen public awareness of the environmental health aspects of development and housing programmes, and to promote environmental and health impact assessment studies. The emphasis of activities In health risk assessment of potentially toxic chemicals will be on providing technical cooperation to promote timely assessment, monitoring and corrective action, including the development of necessary enforcement legislation. WHO will collaborate in carrying out toxicological and environmental epidemiological studies to collect specific Information on health effects and to forecast and model different health scenarios to estimate risks. In the programme area concerned with the control of environmental health hazards, WHO will continue to collaborate In detailed strategy formulation at the national level with the overall aim of adequately controlling environmental health hazards while fostering sustainable economic and Industrial development. lntersectoral coordination will be given special consideration In the course of programme formulation and Implementation. The main activities In the food safety programme will be directed towards cooperating with governments In the development of national food safety programmes to reduce morbidity and mortality caused by foodbome hazards. In this regard, WHO will continue to collaborate with Member States In formulating national food safety policies and strategies involving producers, distributors, food processors and manufacturers, retailers and consumers. Diagnostic, therapeutic and rehabilitative technology appropriate to the circumstances of each country Is an Important support to primary health care

and Indispensable In achieving the goal of health for all. Health laboratory services will be strengthened, particularly at Intermediate and peripheral levels, to meet the diagnostic, case-management and monitoring needs of curative and preventive medicine. Laboratory quality assurance, surveillance of antimicrobial resistance and supply Qf safe blood and blood products will be strengthened. Major efforts will be made to develop basic radiological services at the district level. Measures will be taken to further promote and Improve the use of Ionizing radiation and other Imaging technologies. Continuous efforts will be made to ensure the avaHabHity for primary health care of drugs and vaccines with adequate quality, safety and efficacy and at affordable prices. Cooperation will be provided to governments In the formulation or updating of national drug policies and essential drug lists, and enhancing local production capabilities to conform with good manufacturing practices. The quality, safety and efficacy of drugs and biological products will be further promoted by means of support for Institutional strengthening and training of personnel. Promotion of technical cooperation among developing countries will continue to be the main approach In regional activities. WHO will continue to promote the Integration of traditional medical practices Into the general health system. Further cooperation will be provided for research activities to establish the value of traditional medicine within a scientific framework. particularly with regard to herbal medicine and acupuncture. This will be done by supporting Inventory surveys and standardization of terminologies on herbal medicine, and strengthening national research capability to ensure quality, safety and efficacy. In the field of rehabilitation, the main efforts will be focused on the development and expansion of community-based rehabilitation services Integrated Into primary health care. A regional Information network on rehabilitation will be established and strengthened. Disease prevention and control continues to be a major concern In the Region, where a number of specific communicable disease problems have still to be overcome. Efforts are still needed In many developing countries before full control of the diseases preventable by Immunization can be achieved. In the light of this situation, more emphasis Is being placed on management, training and the development of Infrastructure and logistics. Diarrhoeal diseases and acute respiratory Infections continue to be a major health problem in the Region. Support will be continued for proper case management and

Regional Director's programme statement

xvii

Regional Director's programme statement health education with regard to diarrhoeal diseases. Continued support will be given to the development of more effective Intervention measures for the control of acute respiratory Infections such as early diagnosis and proper administration of antibiotics. Among the viral Infections, dengue fever/dengue haemorrhaglc fever and hepatitis B are still highly endemic In the Region. WHO will continue to collaborate In the promotion of self-reliance In hepatitis B vaccine provision through technology transfer for local hepatitis B vaccine production or HBsAg positive plasma collection to be used for vaccine and the development of hepatitis B Immunization. Efforts to expand the hepatitis B Immunization of newborns In several countries or areas will be Intensified, so that eventually the hepatitis B immunization programme can be Integrated Into the expanded programme on Immunization. Vector control measures to reduce transmission of arthropod-borne viral Infections such as dengue fever and Japanese encephalitis will be promoted. Immunlzatlon by vaccines has been one of the most effective measures for prevention and control of certain communicable diseases. Progress In biotechnology has provided basis for Improvement of the quality of existing vaccines and development of new vaccines for which WHO technical support will be provided. The steady Increase In the cumulative number of AIDS cases and HIV Infected persons Indicates that AIDS Is becoming an important health problem In the Region. With support from the Global Programme on AIDS, collaboration will continue In the development and Implementation of national AIDS control plans through the development of an epidemiological surveillance system, the strengthening of laboratory diagnostic capability and the promotion of health education. Malaria remains a major health problem In the Region. Support will continue to be provided with emphasis on the development of malaria control programme In the country's health system based on primary health care. Community participation In the antimalarla activities such as the use of pyrethroid-treated mosquito nets will be further promoted. The situation of tuberculosis, once one of the major public health concerns In the Region, has Improved markedly In most of the countries experiencing rapid socioeconomic development. However, In some countries with difficult economic and social conditions, tuberculosis remains a major

xviii cause of morbidity and mortality among the Infectious diseases. WHO collaboration In tuberculosis prevention and control will emphasize short-course chemotherapy regimen Implementation and case-finding through direct microscopy to strengthen national tuberculosis programmes. Support will continue for wider coverage and adequate monitoring, as well as the training of health workers. Leprosy remains a health problem In the Region and endemic In a few countries. Multiple drug therapy has been Introduced In several countries of the Region covering a major portion of registered leprosy cases. The training of health personnel and the provision of health education for leprosy patients will be supported to further increase multiple drug therapy coverage with proper supervisory activity aiming at the total control of leprosy in selected countries and eventually in the whole Region. In the area of blindness, the major constraint remains the huge backlog of cases which require attention due to paucity of staff trained to handle these cases. WHO's efforts will primarily be on training health workers In essential eye care. With respect to deafness, countries will be supported In assessing the extent of the problem and on the initiation of control programmes. In many countries cancer Is the leading cause of mortality, and efforts to formulate national policies on cancer control have yet to be developed. WHO support will principally focus on the development of cancer registries, the strengthening of laboratory facilities and Improvement of clinical management of cancers, and the promotion of cancer control programmes with emphasis on prevention, early detection and public Information. Cancer pain relief activities will also be supported. There Is Increasing concern about cardiovascular diseases, even In developing countries, owing to the Increasing number of people affected by coronary heart diseases, stroke and hypertension. WHO will support national policies on prevention and control of cardiovascular diseases and promote the development of community-based prevention programmes. Health education will form a major input in order to support healthy life-style patterns which will decrease the problem of cardiovascular diseases. For other noncommunicable disease prevention and control activities, the main emphasis will be on diabetes mellitus, as it poses a serious problem, especially In the South Pacific countries. WHO's collaboration will be in training

health workers In noncommunicable diseases and health education, emphasizing appropriate dietary patterns and exercise habits.

The health Information support programme wHI continue to emphasize the enhancement and strengthening of national capabHitles In health literature and Information services and will also undertake regional biomedical Information activities. National core groups and focal points wHI be encouraged to play an active role In the development of national policies for health literature and Information services. Staff of the support services concerned with the general administration of regional activities In the fields of personnel, budget and finance, general services and supplies will be available upon request to cooperate with Member States In their areas of responsibility. As regards budgetary and financial aspects, the proposed 1990-1991 programme budget for the Western Pacific Region have been prepared (as were the 1988-1989 estimates) during a period In which the United Nations system, as well as many countries In the Western Pacific Region, struggle through difficult economic times. This proposed programme budget therefore reflects the realities of the present and forecasted economic situation.

Strenuous efforts have continued to be made to curtail or absorb costs and to apply the austerity measures necessary to ensure that the largest possible portion of the budgetary resources Is devoted to country activities. At the same time, continuing efforts will be made to generate and mobilize extrabudgetary resources to supplement the financing of priority health programmes not fully available In the regular budget. The proposed 1990-1991 regional programme budget amounts to US$58 103 300, of which US$33 401 000 or 57.49% has been allocated for country activities and US$24 702 300 or 42.51% for regional and Intercountry activities. In view of the need to sustain technical programmes benefiting Intercountry activities, a one-time reallocation of US$500 000 was made from the country to the regional and Intercountry allocation. This will not, however, have any adverse Impact on the level of overall regional allocations available for technical cooperation and In tact will strengthen the efforts being made at country level. The proposed regional budget for 1990-1991 represents a net Increase of US$4 866 300 or 9.14% over the 1988-1989 approved budget of US$53 237 000 as revised In May 1988 (WHA41.10). Note 4 of the Explanatory Notes on page xi gives further details and explanations on the funding, cost factors and budgetary concepts of the 1990-1991 proposed programme budget.

Regia

Regional Director's programme statement

XIX

SUMMARIES

SUMMARY OF REGIONAL HEALTH PROGRAMME: ESTIMATED OBLIGATIONS AND SOURCES OF FINANCING 1988-1989 US$ I. ESTIMATED OBLIGATIONS Regular budget programme Other programmes TOTAL II. SOURCES OF FINANCING Regular budget Other sources: Associate Professional Officers other than United Nations Development Programme Sasakawa Health Trust Fund Special Account for Servicing Costs Trust Fund for Special Programme for Research and Training in Tropical Diseases Trust Fund for the Global Programme on AIDS Trust Funds - Project Agreement Trust Funds - Supplies United Nations Children's Fund United Nations Development Programme United Nations Population Fund Voluntary Fund for Health Promotion Sub-total- Other sources TOTAL ..

1990-1991 US$ 58 103 300 6 728 600

53 237 000* 22 708 600

75 945 600

64 831 900

53 237 000

58 103 300

150 200 3162 200 1 611 200 81 100 965 000 75900 1 295 800 62000 2 686 500 8 927 300 3 691 400

1 600 000 1 089000

518 600 2 521 000 1 000 000

22 708 600 75 945 600

6 728 600 64 831 900

*The proposed programme budget for 1988-1989 considered by the Reg1 onal Comm1ttee for the Western Pac1flc and submitted to the World Health Assembly was US$55 742 000 but the final budget was US$53 237 000.

Summary of regional health programme: Estimated obligations and sources of financing

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in US$ and percentages) Regular budget PROGRAMME Other sources Increase %

1988-1989 US$ %

199G-1991 US$

(Decrease) %

1988-1989 US$

199G-1991 US$

US$

Governing bodies

1.3 2.

Regional Committee

393 000

0.74

393 000

0.68

WHO's general programme development and management

2.1 2.2 2.3 2.4

Executive management Regional Director's development programme General programme development External coordination for health and social development Health-for-all strategy coordination Informatics management

423 600 903 000 1 463 400

0.80 1.70 2.75

440 000 922 000 1 582 800

0.76 1.59 2.72

16400 19000 119 400

3.87 2.10 8.16

305 400 571 600 332 400 3 999 400

0.57 1.07 0.62 7.51

317 500 1 062 500 659 200 4 984 000

0.55 1.83 1.13 8.58

12 100 490 900 326 800 984 600

3.96 85.88 98.32 24.62

2.5 2.6

Summary by programme and source of funds

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in US$ and percentages) Regular budget PROGRAMME Other sources Increase %

1988-1989 US$ %

1990.1991 US$

(Decrease) %

1988-1989 US$

1990-1991 US$

US$

Health system development

3.1 3.2

Health situation and trend assessment Managerial process for national health development Health systems research and development Health legislation

1 970 100

3.70

1 679 800

2.89

(290 300)

( 14.74)

162 400

4 231 200 175 000 119 100 6 495 400

7.95 0.33 0.22 --

4 574 800 249 000 147 200 6 650 800

7.87 0.43 0.25

343 600 74000 28100 155 400

8.12 42.29 23.59 2.39

301 400 46600

210 500

3.3 3.4

12.20

-11.44 --

510 400

210 500

Organization of health systems based on primary health care Development of human resources for health Public information and education for health

5 697 000

10.70

5 986 600

10.30

289 600

5.08

1 458 000

1197 000

- 5. 10 306 200 19.36 9 024 500 15.53 ( 1 281 700} ( 12.44) 794 800 18 800

- 6. 1 166 500 2.19 1 439 100 2.48 --

272 600

23.37

2 500

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in US$ and percentages) Regular budget PROGRAMME 1988-1989 US$ %

Other sources Increase (Decrease) %

1990-1991 US$ %

1988-1989 US$

1990.1991 US$

US$

Research promotion and development, including research on healthpromoting behaviour General health protection and promotion 8.1 8.2 8.3 8.4 Nutrition Oral health Accident prevention Tobacco or health

1 339 200

2.52

1 513 100

2.60

173 900

12.99

149 600

-735 300 1 040 100 55 400 227 900 1.27 1.79 0.09 0.39 61 200 109 100 (4 700) 227 900 393 500 23.63 9.08 11.72 ( 7.82)

674100 931 000 60100

1.27 1.75 0.11

- 2 058 700 3.54 --

1 665 200 -

3.13 -

Protection and promotion of the health of specific population groups 9.1 Maternal and child health, including family planning Adolescent health Workers' health 263 700 0.50

511 500

0.96

807 600 7 200 339 900

1.39 0.01 0.59

296 100 7 200 76 200

57.89

9 009 700

2 585 000

9.2 9.4

28.90 5

Summary by programme and source of funds

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in

US$ and percentages) Regular budget Other sources Increase %

PROGRAMME

1988-1989

1990-1991 %

(Decrease) %

1988-1989

1990-1991

US$ 9.5 Health of the elderly

US$ 395 100 1 549 800

US$ 63600 443 100

US$ 120 400 9 130 100

US$

331 500 1 106 700

0.62 2.08

0.68 2.67

19.19 40.04

2 585 000

10.

Protection and promotion of mental heaHh

10.1

Psychosocial and behavioural factors In the promotion of health and human development Prevention and control of alcohol and drug abuse Prevention and treatment of mental and neurological disorders

214 600

0.40

218 700

0.38

4100

1.91

10.2

187 600

0.35

115 000

0.20

(72 600)

( 38.70)

19100

10.3

255 800 658 000

0.48 1.23

343 300 677 000

0.59

87 500 19 000

34.21 2.89

16 800 35900

-1.17 --

11.

Promotion of environmental heaHh

11.1

Community water supply and sanitation

2 224 200

4.18

1 985 600

3.42

(238 600)

( 10.73)

644 200

SUMMARVBVPROGRAMMEANDSOURCEOFFUNDS {expressed in US$ and percentages) Regular budget PROGRAMME Other sources Increase %

1988-1989 US$ 11.2 %

1990-1991 US$

(Decrease) %

1988-1989 US$

1990-1991 US$

US$

Environmental health in rural and urban development and housing Control of environmental health hazards Food safety

1 627 200 401 000 227 000

3.06 0.75 0.43 --

2 511 500 484 400 271 700

4.32 0.83 0.47

884 300 83400 44 700

54.34 20.80 19.69 340 800 2 700

11.4 11.5

4 479 400 12. Diagnostic, therapeutic and rehabilitative technology 12.1

8.42 --

5 253 200

-9.04 -

773 800

17.27

987 700

Clinical, laboratory and radiological technology for health systems based on primary health care Essential drugs and vaccines Drug and vaccine quality, safety and efficacy

1 285 000

2.41

1 727 800

2.97

442 800

34.46

18600

12.2 12.3

1 161 100

2.18

1 264 200

2.18

103 100

8.88

994600

211 100

298 500

0.56

348 000

0.60

49 500

16.58

115 300

Summary by programme and source of funds

SUMMARY BY PROGRAMME AND SOURCE OF FUNDS (expressed in US$ and percentages) Regular budget PROGRAMME Other sources Increase %

1988-1989 US$ %

1990-1991 US$

(Decrease) %

1988-1989 US$

1990-1991 US$

US$

12.4 Traditional medicine 12.5 Rehabilitation

511 000 285 900 3 541 500

0.96 0.54

636 300 235 900 4 212 200

1.09 0.41 --

125 300 (50 000) 670 700

24.52 ( 17.49) 18.94 4 700 1 133 200 211 100

-6.65

7.25

- 13. Disease prevention and control

13.1 13.2 13.3 13.4 13.5 13.6

Immunization Disease vector control Malaria Parasitic diseases Tropical disease research Diarrhoeal diseases

915 100 513 500 2 253 800 377 700 137 100 580 500 439 300 564 700 140 000

1.72 0.96 4.23 0.71 0.26 1.09 0.83 1.06 0.26

913 800 585 900 2 319 400 489 100 176 500 576 200 508 500 499 200 269 500

1.57 1.01 3.99 0.84 0.30 0.99 0.88 0.86 0.46

(1 300) 72400 65 600 111 400 39400 {4 300) 69200 (65 500) 129 500

( 0.14) 14.10 2.91 29.49 28.74 ( 0.74) 15.75 ( 11.60) 92.50

834 000 35500 250 000 115 300 81 100 514 100 41100 259 800 2 213 300 800 000

13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in US$ and percentages) Regular budget PROGRAMME Other sources Increase % 0.19 0.04 US$ 50900 4000 (Decrease) % 84.83 21.51 1 200

1988-1989 US$ 13.10 Zoonoses 13.11 Sexually transmitted diseases 13.12 Research and development in the field of vaccines 13.13 AIDS 13.14 Other communicable disease prevention and control activities 13.15 Blindness and deafness 13. 16 Cancer 13.17 Cardiovascular diseases 13.18 Other noncommunicable disease prevention.and control activities 60000 18 600 % 0.11 0.03

199D-1991 US$ 110 900 22 600

1988-1989 US$

199D-1991 US$

82 BOO 273 300

0.14 0.47

82 800 273 300 965 000

983 300 201 500 391 900 580 300

1.85 0.38 0.74 1.09

1 004 000 402 200 497100 451 300

1.73 0.69 0.86 0.78

20 700 200 700 105 200 (129 000)

2.11 99.60 26.84 ( 22.23)

1 324 800 194 700

500 000

401 800

300 000

127 000

0.24

376 300

0.65

249 300 1 274 300

196.30

8 284 300

-15.56

9 558 600

-16.45

15.38

7 231 700

1 600 000

- Summary by programme and :Source of funds

-9

Summary by programme and source of funds

SUMMARYBYPROGRAMMEANDSOURCEOFFUNDS (expressed in US$ and percentages) Regular budget PROGRAMME 1988-1989 199Q-1991 %

Other sources Increase (Decrease) % 1988-1989 199Q-1991

US$

14. 15.

Health information support Support services 15.1 15.2 15.3 15.4

636 000

1.19

823 600

1.42

187 600

29.50

1 200

-Personnel General administration and services Budget and finance Equipment and supplies for Member States 318 300 2 434 300 493 900 222 700 3 469 200 0.60 4.57 0.93 0.42 6.52 100.00 333 BOD 2 849 700 540 500 255 100 -

0.57 4.91 0.93 0.44 6.85 -

15 500 415 400 46600 32400 509 900 4 866 300

4.87 17.06 9.44 14.55 14.70 9.14

19 700 1 151 100 47900 54 BOO 1 273 500 22 708 600

24000 BOOOOO 82 200

3 979 100 -

906 200 6 728 600

TOTAL

53 237 000

- -

58 103 300

100.00

- -

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL Estimated obligations Programme 1988-1989

Regular budget 1990-1991 Increase (Decrease)

Other sources 1988-1989 1990-1991

US$ 1. Governing bodies Country or Area Regional and Intercountry TOTAL 2. WHO's general programme development and management Country or Area Regional and Intercountry TOTAL 3. Health system development Country or Area Regional and Intercountry TOTAL

US$

393 000 393 000

3 999 400 3 999 400

7 000 4 977 000 4 984 000

7000 977 600 984 600

24.44 24.62

4 900 900 1 594 500 6 495 400

5 455 700 1 195 100 6 650 800

554 800 (399 400) 155 400

11.32 ( 25.05) 2.39

101 500 408 900 510 400

100 000 110 500 210 500

Summary by programme and organizational level

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL Estimated obligations Programme 1988-1989

Regular budget 1990-1991

Other sources 1988-1989 199Q-1991

Increase (Decrease) US$ %

US$ 4.

US$

Organization of health systems based on primary health care Country or Area Regional and Intercountry

4179 500 1 517 500 5 697 000

4 300 500 1 686 100 5 986 600

121 000 168 600 289 600

2.90 11.11 --

46000 1 412 000 1 458 000

1 000 1 196 000 1 197 000

TOTAL 5.

5.08

-Development of human resources for health Country or Area Regional and Intercountry

8 772 600 1 533 600 10 306 200

7 677 800 1 346 700 9 024 500

(1 094 800~ (186 900 (1 281 700)

f2.48~ 12.19 ( 12.44) --

633 500 161 300 794 800

18 800 18 800

TOTAL 6.

Public information and education for heaHh Country or Area Regional and Intercountry

654 200 512 300 1 166 500

863 100 576 000 1 439 100

208 900 63 700 272 600

31.93 12.43

2500

TOTAL

-23.37

-2 500

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL Estimated obligations Programme 1988-1989 US$

Regular budget 199Q-1991 US$ Increase (Decrease) US$ %

Other sources 1988-1989 US$

199Q-1991 US$

Research promotion and development, including research on heaHhpromoting behaviour Country or Area Regional and Intercountry

685 000 654 200

776 600 736 500

91 600 82 300

13.37 12.58

149 600

TOTAL

1 339 200 1 513 100 173 900

149 600

12.99 --

General heaHh protection and promotion Country or Area Regional and Intercountry

918 200 747 000

1 166 000 892 700

247 800 145 700

26.99 19.50

TOTAL

1 665 200

2 058 700

393 500

-23.63

-Summary by programme and organizational level

Summary by programme and organizational level

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL

Estimated obligations Programme 1988-1989

Regular budget 199Q-1991

Other sources 1988-1989 199Q-1991

Increase (Decrease) US$ %

US$ 9.

US$

Protection and promotion of the health of specific population groups Country or Area Regional and Intercountry 617 400 489 300 1 072 900 476 900 455 500 (12 400) 73.78 (2.53) 7916200 1213900 1 693 100 891 900

TOTAL 10.

1 106 700

1 549 800

443 100

-40.04

9 130 100

2 585 000

Protection and promotion of mental health Country or Area Regional and Intercountry 349 200 308 800 340 500 336 500 (8 700) 27 700

-(2.49) 8.97

35900

TOTAL 11.

658 000

677 000

19 000

-2.89

35 900

Promotion of environmental health Country or Area Regional and Intercountry

-2 287 200 2 192 200 4 479 400 2 552 100 2 701 100 264 900 508 900 11 .58 23.21 --

985 000 2 700

TOTAL

5 253 200

773 800

17.27

987 700

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL Estimated obligations Programme 1988-1989 US$

Regular budget 199G-1991 US$ lncrease(Decrease) US$

Other sources 1988-1989 US$

199G-1991 US$

12.

Diagnostic, therapeutic and rehabilitative technology Country or Area Regional and Intercountry

2 565 300 976 200 3 541 500

3115300 1 096 900 4 212 200

550 000 120 700 670 700

21.44 12.36

597 200 536 000 1 133 200

211 100 211 100

TOTAL 13. Disease prevention and control Country or Area Regional and Intercountry

-18.94

-4 891 000 3 393 300 8 284 300 5 897 800 3 660 800 9 558 600 1 006 800 267 500 1 274 300 20.58 7.88 2 165 700 5 066 000 7 231 700 1 600 000 1 600 000

TOTAL 14. Health information support Country or Area Regional and Intercountry

-15.38

-44000 592 000 636 000 175 700 647 900 823 600 131 700 55900 187 600 299.32 9.44 1 200 1 200

TOTAL

-29.50

-Summary by programme and organizational level

Summary by programme and organizational level

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL Estimated obligations Programme 1988-1989

Regular budget 1990-1991

Other sources 1988-1989 199Q-1991

Increase (Decrease) US$ %

US$ 15.

US$

Support services Country or Area Regional and Intercountry TOTAL 3 469 200 3 469 200 3 979 100 3 979 100 509 900 509 900 14.70 1 273 500 1 273 500 906 200 906 200

-14.70

-TOTAL Country or Area Regional and intercountry 30 864 500 22 372 500 53 237 000 33 401 000 24 702 300 58 103 300 2 536 500 2 329 800 4 866 300 8.22 10.41 12 445 100 10 263 500 22 708 600 1 794 100 4 934 500 6 728 600

-9.14 --

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME (b) Real Increase (Decrease)

(d) %

(e)

1988-1989 Appropriations

% over (a) %

Increase (Decrease)

over (a) %

Total increase (decrease) (b) + (c)

1990-1991 estimates (a) + (d)

US$ 1. Governing bodies 1.3 Regional Committee 393 ()()()

US$ (52 300)

US$ 52300

US$

US$ 393 ()()()

(13.31)

13.31

2. WHO's general programme development and management 2.1 2.2 2.3 2.4 2.5 2.6 Executive management Regional Director's development programme General programme development External coordination for health and social development Health-for-all strategy coordination Informatics management 423 600

- 3.87 2.10 8.16 3.96 85.88 98.32 440 ()()()

16400 19 ()()() 52600 2.10 3.59 66800 12100 390 500 286 200 748 300 68.32 86.10 18.71 100 400 40600

3.87

16 400 19 ()()()

903 ()()() 1 463 400 305400 571 600 332 400 3999 400

922 ()()() 1 582 800 317 500 1 062 500 659200 4 984 ()()()

4.57 3.96 17.56 12.22

119 400 12100 490900 326800 984600

- 236300 3. Health system development 3.1 3.2 3.3 3.4 Health situation and trend assessment Managerial process for national health development Health systems research and development Health legislation 1 970 100 4 231 200 175 ()()() 119 100 6 495 400 (390 200) (49 200) 57800 16 100 (365 500) (19.81) (1.16) 33.03 13.52

- 5.91

-24.62

-99900 392 800 16200 12000

-5.07 9.28 9.26 10.07 (290300) 343600 74 ()()() 28 100 155 400

- (14.74) 8.12 42.29 23.59 1 679800 4 574 800 249 ()()() 147 200 6650800

-(5.63)

-520 900

-8.02

-2.39

Regular budget estimated obligations and analysis of increases and decreases by programme

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME 1988-1989 Appropriations (b) Real Increase (Decrease)

(d) %

(e) 199G-1991 estimates (a) + (d)

% over (a) % (2.28)

Increase (Dea-ease)

over (a) % 7.36 --

Total increase (decrease) (b) + (c)

US$ 4. Organization of health systems based on primary health care 5697000 10306 200 1166 500 1 339 200

US$ (130 100) (2152 100) 178 800 53900

US$ 419 700

US$ 289600 (1 281 700) 272600 173 900

% 5.08

US$ 5986600 9024500 1 439 100 1 513 100

-5. Development of human resources for health 6. 7. Public information and education for health Research promotion and development, including research on health- promoting behaviour General health protection and promotion 8.1 8.2 8.3 8.4 Nutrition Oral health Accident prevention Tobacco or health 1 665 200 674 100 931 000 60100 12 500 19700 (7 700) 211 200 (20.88)

- 87D 400

-(12.44) --

8.44

-15.33

-93800 -1Z) 000

-8.04

23.37

-4.03

- 8.96

-12.99

- 8. 1.85 2.12 (12.81)

- 48700 83400 3000 15 700

-7.23 9.60 4.99 61 200 109 100 (4700) 227900

-9.08 11.72 (7.82) 735300 1 040100 55400 227900

-157 800

-9.48 393 500

-23.63 2058 700

235 700

14.15

-9. Protection and promotion of the health of specific population groups 9.1 9.2 9.4 Maternal and child health, including family planning Adolescent health Workers' health 263 700 511 500 233 500 6500 45900 17.41 45.65

&2600 700 30300

12.24

296 100 7200

57.89

807600 7 200

11 .49

76200

28.90

339900

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME 1988-1989

(b) Real Increase (Decrease) over (a) % 9.69 28.74

(d) %

(e) 199D-1991

Appropriations

Increase (Decrease)

over (a) % 9.50

Total increase (decrease) (b) + (c)

estimates (a) + (d)

US$ 9.5 Health of the elderly 331 500 1106 700 10. Protection and promotion of mental health 10.1 Psychosocial and behavioural factors in the promotion of health and human · development Prevention and control of alcohol and drug abuse Prevention and treatment of mental and neurological disorders

US$ 32100 318 000

US$ 31 500 125100

US$ 63600 443100

% 19.19

US$ 395100 1 549800

-11.30

-40.04

- -

-4100 (72600) 87500 19000 1.91 (38.70) 34.21 218 700 115 000 343300 677000

214 600 187 600 255800 658000

(1800) (81 1()()) 59100 (23800)

(0.84) ( 43.23) 23.11 (3.62)

5900 8500 28400 42800

2.75 4.53 11.10

10.2 10.3

-6.51

-2.89

-11. Promotion of environmental health 11.1 11.2 11.4 11.5 Community water supply and sanitation Environmental health in rural and urban development and housing Control of environmental health hazards Food safety 2224200 1 627 200 401 000 227000 4 479400 (366100) 548 200 39900 16100 238100 (16.46) 33.69 9.95 7.09 127 500 336 100 43500 28600 535 700 5.73 20.65 10.85 12.60 (238600) 884300 83400 44700 773800

-(10.73) 54.34 20.80 19.69 1 985600 2511500 484400 271 700 5253200

-5.31

-11 .96

-17.27

- Regular budget estimated obligations and . analysis of increases and decreases by programme

- 19

Regular budget estimated obligations and analysis of increases and decreases by,programme

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME (b) Real Increase (Decrease)

(d)

(e)

1988-1989 Appropriations

% over (a) %

Increase (Decrease)

% over (a) %

Total increase (decrease) (b) + (c)

1990-1991 estimates (a) + (d)

US$ 12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and. radiological technology for health systems based on primary health care Essential drugs and vaccines Drug and v.accine quality, safety aQd effiC8CY Traditional.medicine Rehabilitation

US$

1 285000 1 161 100 298 500 511 000 285900 3 541 500

302 200 (14000) 16300 73300 (69700) 308100

23.52 (1 .21) 5.46 14.34 (24.38)

140 600 117 100 33200 52000 19700 362600

10.94 10.09 11.12 10.18 6.89

442 800 103 100 49500 125 300 (50 000) 670700

34.46 8.88 16.58 24.52 ( 17.49)

1 727 800 1 264 200 348000 636 300 235900 4 212 200

12.2 12.3 12.4 12.5

-8.70

-10.24

-18.94

-13. Disease prevention and control 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 Immunization Disease vector control Malaria Parasitic diseases Tropical disease research Diarrhoeal diseases Acute respiratory infections Tuberculosis 915 100 513 500 2 253 800 377 700 137 100 580 500 439300 564 700 (66 900) 31400 (123 000) 74000 1700 (36 500) 31 800 (.112600) (7.31) 6.12 (5.46) 19.59 1.24 (6.29) 7.24 ( 19.94) 65 . 600 41000 188 600 37400 37700 32200 37400 47100

-7.17 7.98 8.37 9.90 27.50 5.55 8.51 8.34 (1 300) 72400 65600 111 400 39400 (4300) 69200 (65500)•

-(0.14) 14.10 2.91 29.49 28.74 (0.74) 15.75 ( 11;60)· '

91;J,800 585900 2319400 489100 176 500 576200 508 500 499200

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME (b) Real Increase (Decrease) % over (a) % 84.00 66.50 13.44

1988-1989 Appropriatiora

(d) %

(e)

Total Increase (decrease) (b) + (c)

199G-1991 estimates (a) + (d)

US$ 13.9 Leprosy 140000 60000 18600 13.1 0 Zoonoses 13.11 Sexually transmitted diseases 13.12 Research and development in the field of vaccines 13.13 AIDS 13.14 Other communicable disease prevention and control activities 13.15 Blindness and deafness 13. 16 Cancer 13.17 Cardiovascular diseases 13.18 Other noncommunicable disease prevention and control activities 983300 201 500 391 900 580300 127 000 8 284 300 14. Health information support 15. Support services 15.1 15.2 Personnel General administration and services 318 300 2434300 636000

US$ 117 600 39900 2500 74300 248900 (29900) 162 400 60700 (169 700) 228 100 534 700 125 200

US$ 11 900 11 000 1 500 8500 24400

% 8.50 18.33 8.07

US$ 129 500 50900 4000

% 92.50 84.83 21.51

US$ 269 500 110900 22600

82800 273300 5.15 19.00 11.35 7.01 16.69 20700 200700 105200 (129 000) 249300 1 274 300 187 600 2.11

82800 273300 1 004 000 402200 497100 451 300 376300 9558600 823600

(3.04) 80.60 15.49 (29.24) 179.61

50600 38300 44500 40700 21 200 739600 62400

99.60 26.84 (22.23} 196.30

-6.45

-8.93

-15.38

-19.69

-9.81

-29.50

-15 500 (13 000) (0.54) 428400

- 4.87 17.60 15500 415 400

-4.87 17.06

333800 2849700

Regular budget estimated obligations and analysis of increases and decreases by programme

Regular budge~ estimated obligations and ana1ysis of increases and decreases by programme

REGULAR BUDGET ESTIMATED OBLIGATIONS AND ANALYSIS OF INCREASES AND DECREASES BY PROGRAMME (a) PROGRAMME 1988-1989 Appropriatiors

(b) Real Increase (Decrease) % over (a) % (3.99) 7.05

(d) Total increase (decrease) (b) + (c)

(e) 1990.1991 estimates (a) + (d)

US$ 15.3 15.4 Budget and finance Equipment and supplies for Member States 493900 222700 3469200

US$ (19 700) 15 700 (17 000)

US$ 66300 16 700 526900 4866300

US$ 46600 32400 509900 4866300

% 9.44 14.55

US$ 540500 255100 3 979100 58 103 300

-(0.49)

-15.19

-14.70

-TOTAL 53237000

-9.14

- -

REGULAR BUDGET 1988-1989 AND 1990-1991 BY APPROPRIATION SECTION, WITH PERCENTAGES OF THE TOTAL ESTIMATED OBLIGATIONS APPROPRIATION SECTION ·9ss-19s9 1990-1991

Country

Regional and interceuntry

Total

Country

Regional and intercountry

Total

1. Direction, coordination and management 2. 3. Health system infrastructure Health science and technology - Health promotion and care Health science and technology - Disease prevention and control Programme support TOTAL 18507200

4 352 400 5157 900

4 392 400 23 665 100

8.25 44.45

7000 18 297 100

5 370 000 4 803 900

5 377 000 23 101 000

9.25 39.76

7 422 300

5 3E7 700

12 790 000

24.03

9 023 400

6 240 600

15 264 000

26.27

4 891 000 44000 30 864 500

3 3S3 300 4 OE1 200 22 372 500

8 284 300 4 105 200 53 237 000

15.56 7.71

5 897 800 175 700 33 401 000

3 660 800 4 627 DOD 24 702 300

9558 600 4 802 700 58 103 300

16.45 R27 100.00

- 100.00

- -

Regular budget 1988-1989 .and 1990-1991 by appropriation section, with percentages of the total

PROGRAMME ANALYSES

1. GOVERNING BODIES Objective To determine and give effect to the policies of WHO and, in particular, to monitor the implementation of strategies for health for all, promote and coordinate their Implementation by countries and by other sectors, and evaluate their effectiveness.

Governing bodies

1. GOVERNING BODIES

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$

Country or area Regional and Intercountry 393 000 393 000

Total

393 000

1.3 REGIONAL COMMITTEE The functions of the Regional Committee are defined In Article 50 of the WHO Constitution. The estimates cover expenses directly Identifiable with the holding of a regular session In 1990 and again in 1991. Provision Is also made for the organization of meetings of the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation. Through this Sub-Committee, the Regional Committee Is Intensifying Its Involvement In the work of the Organization. In addition to the direct costs of holding the above-mentioned sessions and meetings, preparation for and servicing of the Regional Committee and Its sub-committee are Integral parts of many other programmes.

Budgetary Implications The allocation has been maintained at the same level as in 1988-1989.

Governing bodies

1.3 REGIONAL COMMilTEE

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$

Country or area Regional and intercountry 393 000 393 000

Total

393 000

2. WHO'S GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

Objective To promote the policies enunciated by the governing bodies of WHO for supporting strategies for health for all by the year 2000; to strengthen capability to implement those policies through general programme development and management in coordination with other international bilateral and multilateral agencies within the context of overall socioeconomic development.

WHO's general programme development and management

2. WHO'S GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

Estimated obligations

Regular budget

Other sources

1988-1989

199o-1991

Increase

(Decrease) %

1988-1989

199o-1991

US$ Country or area Regional and Intercountry 3 999400

US$ 7000 4 977 000

US$ 7000 977 600

US$

24.44

TOTAL

3 999 400

4 984 000

984 600

24.62

2.1 EXECUTIVE MANAGEMENT The Regional Director acts as technical and administrative head of the Regional Office, subject to the overall authority of the Director-General. Within the framework of the general programme of work and the policies established by the Wor1d Health Assembly, he is responsible for the planning and execution of the WHO regional programme and for ensuring Secretariat support to the Regional Committee, of which he is ex officio Secretary, and for the determination and implementation of the Organization's policies, specifically with respect to the regional strategy for health for all by the year 2000. He formulates the proposed programme budget for submission to the Regional Committee and, to that end, maintains direct contact with governments of the Member States of the Region and with international organizations and professional bodies. The Regional Director ensures coordination of WHO regional and country programmes and keeps the Director-General informed of major developments affecting the health situation of the Region.

Budgetary Implications The slight budgetary increase is due to staff costs.

WHO's general programme development and management

2.1 EXECUTIVE MANAGEMENT

Estimated obligations

Regular budget

Other sources

1988-1989

199o-1991

Increase

(Decrease) %

1988-1989

199o-1991

US$

Country or area Regional and intercountry

423 600

440 000

16 400

3.87

TOTAL

423 600

440 000

16 400

3.87

2.2 REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME The funds provided under this heading will be used to finance collaborative programmes with governments which could not be foreseen when the programme budget proposals were being developed, and also to provide seed money to enable genuinely Innovative programmes or other Important activities to commence, Including those that are likely to attract substantial extrabudgetary funding.

Budgetary Implications Due to budgetary reductions effected during the implementation of the 1988-1 989 programme budget, the overall allocation of the Regional Director's Development Programme was reduced by US$19 000 and has now been reinstated to Its original level.

WHO's general programme development and management

2.2 REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$

Country or area Regional and intercountry

903 000

922 000

19 000

2.10

TOTAL

903 000

922 000

19 000

2.10

2.3 GENERAL PROGRAMME DEVELOPMENT Objectives To ensure that managerial processes are effectively applied for health development, In an Integrated manner, In the formulation and implementation, monitoring and evaluation of programmes of cooperation with countries or areas of the Region. To enable WHO to provide support to national efforts to Implement strategies for health for all by the year 2000 by Improving the managerial and technical skills of WHO staff, and national staff as appropriate, at all levels.

Situation analysis The continuing concern expressed by Member States regarding optimum use of WHO's resources led to the decision by the Executive Board and the World Health Assembly In 1985 for the preparation by regional committees of regional programme budget policies. A regional programme budget policy for the Western Pacific Region was therefore developed and adopted by the Regional Committee at Its thirty-seventh session In 1986. The policy sets out guidelines for the formulation and Implementation of programme budgets, and was used In the elaboration of the programme budget starting In 1988-1989. Other steps taken by the Regional Office to strengthen its managerial process included the more precise Identification of Member States' needs for technical cooperation, Including a more realistic definition of priorities through strong support to the country planning and programming process; conduct of In-depth country reviews of high priority programmes like Immunization and diarrhoeal disease control; more effective programme Implementation through Improved monitoring at the regional level based on an informatlc-supported Information system linking financial and programme management data. In addition to the regional mechanisms and procedures for monitoring and evaluating programme implementation, a financial audit In policy and programme terms was conducted In one country by an audit team composed of Headquarters and Regional Office staff. At national level, joint reviews of programmes and projects were carried out with national authorities and with other organizations such as UNDP, UNFPA, or UNICEF as part of the coordinated efforts to implement the health-for-all strategies. In the area of staff development and training, emphasis was given during the period of the Seventh General Programme of Work to informatics

Targets By 1995: (1) WHO's managerial methods, Including its Information support, will have further Improved to enable the Organization to collaborate more effectively with Member States and support them In achieving the goal of health for all by the year 2000. (2) Staff development and training will have been strengthened, enabling WHO staff, particularly WHO representatives and country-based staff, to provide cohesive and effective support to governments. (3) Staff development and training programme will ensure that WHO staff at all levels in the Region will have been given initial briefing/orientation and In-service training to adapt to the changing environment and that technical and management training, including language and communication skills as well as computer training, will be strengthened for them to be fully prepared to provide efficient support to countries in the Region In carrying out their strategies for health for all.

WHO's general programme development and management

training to strengthen the Organization's Information support mechanism, and language and communication skills training as well as management training to provide efficient and effective managerial support to WHO programme management in the Region. Continuous briefing and orientation were also given to both professional and general service staff at all levels to enable them to adapt to the changing environment - new policies, programmes and procedures. While reasonable progress has been achieved under this programme, the following problems need to be further addressed in order to contribute to more effective programme development and management: (1) inadequate linkage between different components of the managerial process of WHO programme development; and, (2) need for WHO staff to recognize and adjust quickly to the changing modalities of WHO collaboration.

At the reg ional level , programme management skills will be strengthened, with special emphasis on the formulation of better quality projects and on streamlining mechanisms for monitoring and evaluation. Programme Implementation will be strengthened through a strong monitoring system aided by effective and efficient informatics support. More efficient formats for periodical country and programme reviews will be developed to enhance their evaluation potential. The regional programme budget policy will be reviewed periodically In the light of developments In the health field In the Region and the changing socioeconomic environment. Staff development and training Staff development and training will be intensified for the benefit of both professional and general services staff, whether country-based or Regional Office-based. Understanding of WHO policies and managerial process, as well as development of the leadership potentials of certain categories of staff, will be among the basic elements of the training. Briefing and orientation for staff, particularly new staff, will be continued, with emphasis on developing communications, management and computer skills for WHO staff at all levels. New technologies In education and training which have proved effective may be tested and adapted to WHO needs where appropriate.

Proposed programme activities for 1990-1991 Managerial process for WHO's programme development At the country level, governments and WHO will review the present mechanisms and procedures for the formulation and implementation of cooperative activities to ensure optimal use of WHO resources directed towards priority areas of the national health strategies. The ministries of health will be encouraged and supported to strengthen their mechanism or focal point for International liaison In the field of health. WHO will promote country health reviews and programme evaluations, which will form the basis for the preparation of the country programme budget and will be taken into consideration In the formulation of the regional and intercountry programme.

Budgetary Implications The budgetary Increase Is due to staff costs.

2.3 GENERAL PROGRAMME DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989

1990...1991

Increase

(Decrease) %

1988-1989

1990...1991

US$

Country or area Regional and intercountry 1 463 400 1 582 800 119 400 8.16

TOTAL

1 463 400

1 582 800

119 400

8.16

WHO's general programme development and management

2.4 EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT Activities In this area are undertaken In pursuit of WHO's mandate to give force and effect to the concept of health as an Integral part of development. In this regard, the Regional Office for the Western Pacific seeks to promote and develop effective collaboration with the United Nations and other agencies In the United Nations system and with bilateral and multilateral agencies and to Involve Itself with the activities of other sectors In the total development process. Coordination, whether of a technical, administrative or policy nature, comprises a wide range of activities undertaken to support and enhance technical programmes. WHO will continue to promote Inter-agency collaboration at the national and regional level with United Nations agencies, bilateral or multilateral donors, In order to Identify possible areas of technical cooperation with Member States. Mechanisms will be developed and further strengthened for coordination of extrabudgetary resources for health programmes with a view to rationalizing the use of resources for health and mobilizing a greater share of development resources for the health sector. Joint activities will be further developed with International banking Institutions and regional development banks, such as the World Bank and the Asian Development Bank, with a view to furthering large-scale health-related projects. Collaboration will be Intensified with regional governmental organizations such as ASEAN. Efforts will also be made to further strengthen cooperation with regional and national nongovernmental organizations concerned with primary health care to ensure their collaboration In the implementation of regional and national health strategies.

Budgetary Implications The slight budgetary Increase Is due to staff costs.

2.4 EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989 '

199o-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$

Country or area Regional and Intercountry 305 400 317 500 12 100

3.96

TOTAL

305 400

317 500

12 100

3.98

WHO's general programme development and management

2.5 HEALTH-FOR-ALL STRATEGY COORDINATION Objective To support the development and implementation of health-for-all policies and strategies at national and regional levels, and to develop a critical mass of leaders at all levels and In all sectors related to health, In order to further mobilize human and material resources for health for all. - The difficulties experienced by many countries in making progress in the face of severe economic constraints. - The need for changes in the health systems in many countries, particularly as regards the promotion of community involvement and reaching the underserved population groups. - The changing health situation and demographic trends in many countries. The evaluation identified areas for major action. Enlightened political commitment and leadership, together with vigorous managerial practices to channel and use the limited resources most productively, will be the key to the achievement of national goals In a large majority of the developing countries. Extraordinary efforts to Increase the motivation of health workers and to stimulate and promote individual responsibility and commitment to health will also be crucial. However, for the poorest countries of the world, the goal of health for all by the year 2000 will remain a dream unless substantial resources are mobilized and channelled In a more efficient manner to support their national health efforts. The health-for-allleadershlp initiative, launched by the Director-General in 1985, is aimed at developing a core or critical mass of leaders at all levels and all sectors committed to, motivated for, and above all informed about the values and principles of health for all. The Initiative and its implications will also be explored In the Technical Discussions at the Forty-first World Health Assembly.

Targets By 1995:

(1) All countries or areas will have carried out periodic monitoring and evaluation of their national health strategies, on the basis of which, their strategies will be adjusted or reformulated as necessary. (2) A critical mass of national as well as WHO leaders will have been developed for the implementation of health-for-all policies and strategies. (3) The development plans of the various components of the economic and social sectors will have health components which explicitly declare their support for the implementation of the national health-for-all strategies.

SHuation analysis The situation of Member States as far as progress toward health for all by the year 2000 is concerned is best indicated in the Evaluation of the strategy for health for all by the year 2000, contained in the Seventh Report on the World Health Situation. Key issues arising from that evaluation included : - The ability or otherwise of countries to provide adequate Information support for the development of the managerial process.

Proposed programme activities for 1990-1991 The second evaluation of the strategy for health for all by the year 2000 will be undertaken by countries in early 1991, and reviewed at regional level in September 1991. The second evaluation will be compared with the first

evaluation, completed In 1985, and special emphasis wll be placed on progress made In addressing the key Issues mentioned above. National and subnatlonal meetings and seminars will be organized to promote health for all by the year 2000. Themes wHI be determined by Issues Identified by countries as part of their ongoing evaluation of progress. Training and orientation of WHO staff on health-for-allleadership Issues will be provided as part of the management development of Regional Office and field staff. The Organization wHI be responsive to leadership development needs and problems as assessed by countries. A regional colloquium on health-for-all leadership will be organized in 1990, to be followed by national meetings in selected countries. Leadership development for national officials will continue to be a priority. The course in WPRO is aimed at middle-1!3Vel personnel in the health

sector, and In addition to developing language skills, develops skills In management and knowledge on the role and function of WHO. The potential leadership roles of the fellows Is greatly enhanced by the skills and knowledge gained during the ten months in WPRO. Further emphasis will be placed on the additional development of English language facilities for health personnel In China and Viet Nam. The WPRO Learning Centre In Manila will continue to operate as a regional facility; the number of countries may be expanded although the number of participants will be kept to the present limit of 25.

Budgetary Implications This programme shows significant growth, particularly In Its provisions for training aimed at developing effective communication skills and capabilities for leadership. This being a new programme under the Eighth General Programme of Work, the major part of the 1990-1991 provision Is for the continuation of activities relating to health-for-all strategy coordination and the development of health-for-all leadership, which were previously classified under programmes 3.2 and 5.

WHO's general programme development and management

2.5 HEALTH-FOR-ALL STRATEGY COORDINATION

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) · %

1988-1989

1990-1991

US$

Country or area Regional and Intercountry 571 600 1 062 500 490 900 85.88

TOTAL

571 600

1 062 500

490 900

85.88

2.6 INFORMATICS MANAGEMENT Objective To support executive management, technical programmes and support services of the Regional Office with cost-effective Informatics services: to provide advisory services on health Informatics in order to strengthen and support national policies and strategies: and to promote health Informatics programmes in coordination with other technical programmes. Rationalization of these rapid advances In Informatics technology and Its application to WHO programmes Is becoming Increasingly critical. The current Informatics programme can best be characterized as two areas of support to the managerial process. First, the development and operation of an Internal WHO Regional Office Information system In support of regional programme management. In this area, advances have been made In office automation and computerization. The Regional Office component of the WHO administrative and finance Information system has been Implemented as an. Important element In the overall management Information system, together with the Introduction of microcomputers h1to the offices of WHO representatives and country liaison officers, streamlining and computerization of the country programme budget proposals, and an automated project Implementation monitoring system. Second, slow but steady progress In applying Informatics is being made, In collaboration with Member States, in bringing Informatics technology to their offices by supplying personal computers, developing application software and providing staff training. Technical cooperation has been extended to several countries In strengthening data-processing capabilities in health statistics and health management. To Increase the capability of Member States to absorb new Informatics technologies, efforts have been made through technical discussions, exhibits, training and other means to Improve their understanding of informatics. Current problems related to Informatics management can be summarized as follows : (1) The Regional Office is rapidly introducing informatics in its management structure. This has caused problems associated with the need for staff at all levels to become familiar with the technology, adjust quickly to changing administration and management methods, accept training, and conceptualize informatics applications within their sphere of work. (2) There Is a lack of national informatics policies and strategies for implementation. (3) The knowledge and basic infrastructure

Targets By 1995:

(1) All offices and programmes of the Regional Office will have direct and cost effective access to informatics support services. (2) All offices and technical programmes of the Regional Office will have developed the ability to make use of common Informatics systems and computer-based automation applications. (3) Most countries or areas will have developed their own national policy or strategy on health Informatics and an intermediate level of Informatics technology in support of their health management.

Situation analysis Through the decade of the Sixth and Seventh General Programmes of Work, informatics functioned as an extremely important and rapidly growing element of the general programme development activities, together with health management and staff development. The rapid advances in the application of informatics in support of health programmes resulted in the policy decision to identity informatics as a separate programme within the Eighth General Programme of Work.

WHO's general programme development and management

necessary tor the utilization of Informatics technology are lacking In some Member States. (4) The shortage of trained and skilled manpower Is retarding the development and Implementation of health Informatics In several Member States.

of national policies and strategies on health Informatics. A meeting of national focal points in informatics will be held In 1990.

Proposed programme activities for 1990-1991 Within WHO, emphasis will be given to the continued strengthening of management Information support. This will be accomplished by strengthening the word processing facilities, developing on-line multiuser capabilities In support of the regional Information system for programme management, strengthening telecommunications facilities to enable WHO to respond more quickly to Member States' requirements, streamlining administrative procedures through the greater use of informatics technology to Improve organizational efficiency, and training staff to better utilize their Informatics skills. The main emphasis of intercountry activities will be on strengthening and developing national policies and strategies on health informatics. Technical advisory services will be provided to countries for the establishment

Collaborating centres will be designated to exchange, assess and strengthen health Informatics. National workshops on health informatics for training central and district health officers In Implementing and developing their health Informatics programme will be supported, Through the computer laboratory In the Regional Office, information bulletins will be prepared on recent Informatics technology developments. Available application software will also be monitored and modified for use by Member States. Prototype computer programmes on the primary health care management Information system at district health system level will also be developed.

Budgetary Implications This being a new programme under the Eighth General Programme of Work, the budgetary Increase Is due to the inclusion of activities on Informatics technology previously classified under programmes 2.3 and 3.1.

2.6 INFORMATICS MANAGEMENT

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease)

1988-1989

199G-1991

US$

"' 96.21

US$

Country or area Regional and intercountry 332 400

7000 652 200

7000 319 BOO

TOTAL

332 400

659 200

326 800

98.32

WHO's general programme development and management

Health system development

3. HEALTH SYSTEM DEVELOPMENT

Objective To support health system development in analysis of the health situation and assessment of trends, in the managerial process for national health development, In health systems research and development, and in health legislation.

3. HEALTH SYSTEM DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and Intercountry

US$ 5 455 700 1 195 100

US$ 554 800 (399 400)

US$ 101 500 408900

US$ 100 000 110 500

4900 900 1 594 500

11.32 ( 25.05)

TOTAL

6 495 400

6 650 800

155 400

2.39

510 400

210 500

Health system development

HeaHh system development

3.1 HEALTH SITUATION AND TREND ASSESSMENT Objective To promote and further support the development of national capability In the collection, analysis and use of health Information for the Identification of major health and management problems and their trends In support of health development. years, gradual Improvement has been noted with regard to the availability of reliable data at the national level to Identify Individual and collective health problems, estimate their prevalence and evaluate the effectiveness of programmes being Implemented to ameliorate these conditions. The situation, however, has only improved at national level. For the extension and reorientation of health statistical systems at the peripheral level and the Intermediate level and to link information system development to the health systems management process, development of a national health Information policy Is being encouraged, and some progress has been achieved. Current problems related to the health situation and trend assessment programme can be summarized as follows: (1) lack of clear and consistent policies on the health Information system In some countries, and lack of mechanisms to determine Information requirements. (2) Weaknesses in basic records, in standardization of classification and In nomenclature used at the source of data. (3) Inadequate capability for analysis and synthesis of health data and for training in the area of health statistics.

Targets By 1995:

(1) All countries will have the capability to generate, analyse and disseminate health and socioeconomic Information necessary for the establishment of social policy and the provision of direction to health system development. (2) All countries will have developed their national health information system so that they can have available a continuous supply of essential data for the monitoring and evaluation of health-for-all strategies. With the use of these Indicators, the health situation will be established and trends determined to facilitate formulation of short- and long-term programmes of health development. (3) All countries will have established an integrated epidemiological surveillance system.

Proposed programme activities for 1990-1991 Strer.gthening information support. The main emphasis will be on strengthening information support at district and peripheral levels. Guidelines will be developed for determining national minimum basic data sets. National mechanisms and capability for data management will be improved on a country-by-country basis. Technical advice will be provided to countries in a position to introduce automation at various levels of their health systems. The programme will work with countries through the establishment of a priority list based on agreed needs In a wide range of areas, including determination of records management data needs, data analysis and interpretation, and the use of data in rna 1agement tasks.

Situation analysis There has been Increasing recognition among Member States of the need for a comprehensive and credible health information system in support of health systems management. Usable information is regarded universally as a desirable ingredient in optimal management decision-making. In the past few

Training. The programme will support national training programmes for training district and peripheral health workers In records management, abstracting, coding and reporting of health Information from data sources. It will also support the reorientation of existing health Information staff, Including national supervisors and trainers. The programme will collaborate with countries In strengthening the curricula of national training Institutions, through advisory services and use of fellowships. Health-for-all monitoring and evaluation. Countries will receive technical cooperation In developing their health Information systems, to support evaluation and monitoring of their health-for-all strategies. This support will focus on the application of evaluation methods at the Intermediate and peripheral levels of the health system. Establishment of epidemiological surveillance systems. Technlcal advisory services will be provided to countries for the strengthening of

epidemiological surveillance In general and, specifically, for priority health programmes such as Immunization, diarrhoeal disease control, hepatitis B, acute respiratory Infections and sexually transmitted diseases. Particular attention will be given to the preparation and updating of plans of operation at country level, training of senior level, mid-level and peripheral workers In the South Pacific, monitoring and evaluation of the epidemiological situation In general and trends of target diseases under priority health programmes.

Budgetary Implications The decreased allocation at regional and Intercountry level Is largely accounted for by the Eighth General Programme of Work's reclassification of Informatics management as a separate programme, which had been partially categorized In 1988-1989 under programme 3.1. There Is also a decrease in Intercountry support for national workshops and for specific Improvements In national systems, the purposes of which have now been accomplished.

Health system development

3.1 HEALTH SITUATION AND TREND ASSESSMENT

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 919 500 1 050 600

US$ 929000 750 800

US$ 9500 (299 800)

US$

1.03 ( 28.54) 162 400

TOTAL

1 970 100

1 679 800

(290 300)

( 14.74)

162 400

3.2 MANAGERIAL PROCESS FOR NATIONAL HEALTH DEVELOPMENT Objective To collaborate with countries or areas In reorienting and Improving their managerial process to support health systems based on primary health care. This will include (a) determining those areas of ttie health system that must be changed or improved to be consistent with health-for-all policies; (b) organizing the system and ensuring the proper functioning of Its components; and (c) managing the system efficiently. Most national efforts to address these changes are focused on the district health system. This emphasis on the district health system has highlighted a number of critical Issues that must be resolved before the district health system In most countries can be considered effective. A few examples of such issues are policies concerning authority and responsibility associated with decentralization, alternative financing and financial management, lnte rsectoral coordination and supervision to achieve quality care. Consequently, the thrust of management development in most countries is now on defining, Implementing and monitoring an effective management support system centred around the district health system approach.

Targets By 1995:

Proposed programme activities for 1990-1991 Technlcal collaboration will be provided to promote further training activities to strengthen the managerial process for national health development. Depending on the explicit focus of management development in a particular country, programme collaboration will be directed either towards strengthening district health systems or towards Improving general managerial capabilities In countries such as China, Malaysia and Papua New Guinea. In either situation, the emphasis of WHO support will be on immediate operational matters, for example in the Philippines and Viet Nam. In strengthening district health systems, activities will be oriented towards research and development while In the case of managerial capabilities the specific supporting activities may c~m ~rise formal training and workshops. In either case, countries are seeking pnority support to strengthen their middle management and programme management. However, additional support will also be directed to senior level staff and policy-level decision-making, as in the case of Kiribati and Vanuatu. The strengthening of management capabilities of middle managers will be supported primarily through the learning-by-doing approach such as in Fe?~rated States of Micronesia, Fiji and Samoa. This approach involves the tram1ng of management facilitators, who in turn guide the learning and development process in their respective country. The specific focus of the learning will vary from country to country but will involve priority issues such as

(1) A majority of countries or areas will have developed a managerial process appropriate to the organization and operation of their health systems. (2) A majority of countries or areas will have Implemented projects to achieve specific management Improvement goals. (3) An Increasing number of countries or areas will have participated in a national or regional health development network. ~4) Some countries or.areas will have Integrated management training . with the Improvement of specific components of the managerial process.

Situation analysis . A ~umber of ~hanges are taking place in the health systems of the Reg1on, wh1ch are designed to further improve the delivery of essential care. These changes, depending on the country or area, include decentralization reorganization of health services, allocation of a larger share of health servic~ responsibility to ~he private sector, approaches to upgrade the quality of human resources, and mcrease of the number of community-centred primary health care workers.

Health system development

HeaHh system development

management Information; community development, financial pl:~nning and management, health systems research and hospital services. A v-orkshop on health sector financial planning will be held In 1991. Many countries are becoming Increasingly aware of the contribution as well as learning that technical cooperation among countries provides. Consequently, support will be Increased to create and promote opportunities for the sharing of experience and information, both individually and collectively through?ut the Region.

Budgetary Implications There are increased provisions at country level, Including a new long-term post In support of the managerial process for national health development. These Increases are offset by a decrease at regional and Intercountry level, due to the transfer of two posts and training provisions to the new programme of health-for-all strategy coordination.

3.2 MANAGERIAL PROCESS FOR NATIONAL HEALTH DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989

1990.1991

Increase

(Decrease) %

1988-1989

1990.1991

US$ Country or area Regional and intercountry

US$ 4 277 300 297 500

US$ 447 500 (1 03 900)

US$ 101 500

US$ 100 ()()() 110 500

3 829 800 401 400

11.68 ( 25.88)

199 900

TOTAL

4 231 200

4 574 800

343 600

8.12

301 400

210 500

Health system development

3.3 HEALTH SYSTEMS RESEARCH AND DEVELOPMENT Objective To promote and support the development of national capabilities to plan, implement and use health systems research as part of the managerial process for national health development. proving quite useful in solving some of the problems related to the good management practices that are needed to support the health-for-all strategies related to decentralization and district health system development. The abovementioned trends have significantly Increased the demand for training, both In terms of numbers of people involved and, equally Important, in terms of new methods for acquiring health system research capabilities.

Targets By 1995:

Proposed programme activities for 1990-1991 (I) A majority of countries or areas will have implemented health systems research projects on priority health development issues. (2) An increasing number of countries or areas will have used health systems research as an integral part of their managerial process. (3) Some countries or areas will have used the results of their health-for-all evaluation to formulate health systems research projects. (4) Most countries or areas will have access to an Inventory of health systems research projects and resources in the Region. The priority activity of the programme is to support efforts !ilmed at improving organizational capabilities to use health systems research as part of a managerial process. Collaboration in this area will include support for regional and national workshops and the provision of technical support as required. The priority issue addressed by this support is the institutionalization of health systems research as part of the managerial process, for example in China, Papua New Guinea and Tonga. Support will also be provided for the training of staff who will play a key role in the national health systems research programme. The increasing demand for health systems research calls for continued WHO collaboration with countries in training on specific health systems research techniques In countries such as Malaysia and Viet Nam. This training will include support for Intercountry and country workshops. In addition, collaboration will be extended through TCDC mechanisms. This will involve the exchange of individuals between countries to participate in national training activities as well as to assist in preparing and conducting research projects. The regional health systems research inventory will be further developed to facilitate the collection and exchange of information through the health systems research network. The full potential of health systems research collaborating centres wilt be used to support all regional programme activities.

Situation analysis The level of awareness on the part of health system managers concerning the usefulness of health systems research to strengthen management and resolve problems is relatively high. Health systems research is increasingly being used to solve specific operational problems. It is also being used to provide new information and knowledge on priority development problems such as organization and management of the district health system and to reduce inequities in the health system. A significant emerging trend is the use of health systems research as an approach to strengthen the overall management capabilities of the health system. This is an approach that is

Budgetary Implications Five additional countries have provided allocations for this programme, resulting In a moderate overall Increase and reflecting the growing realization of the value of health systems research In support of the management of health programme development.

Health system development

3.3 HEALTH SYSTEMS RESEARCH AND DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 32500 142 500

US$ 116 200 132 800

US$ 83700 (9 700)

US$

257.54 (6.81) 46600

TOTAL

175 000

249 000

74000

42.29

46600

3.4 HEALTH LEGISLATION Objective To modify existing legislation or to develop new legislation to provide a sound legal basis for health policies and strategies for achieving the goal.of health for all by the year 2000. The regional situation is a mixture of the above situations. Several Pacific Island countries still have legal systems which were In existence at the time of Independence, and find themselves with legislation which is applicable to devel oped, no rt hern hemisphere countries but not t o their own circumstances. Other countries have major deficiencies In their own legislation, and some have actual impediments to the achievement of health for all by the year 2000.

Targets By 1995:

Proposed programme activities for 1990-1991 The programme utilizes two major approaches: an Individual country request- g en e ra ted approach , and a multlcountry promotional, Information-exchange approach. At the country level, WHO will collaborate with Member States to strengthen national capacities to assess and reappraise existing legis. lation or draft new legislation as required. Country activities are planned on the development of new public health legislation in Cook Islands and Kiribati; an overall review of current legislation In Viet Nam; nursing legislation in Tonga; training of personnel to develop and draft legislation in China; and on the Implementation of existing legislation In the Republic of Korea. At the regional level, WHO will promote the exchange of information and expertise between c ountries and support t raining programmes, paying particular attention to legislation of common interest to countries. Where appropriate, the development of common bases between countries for national legislation will be encouraged.

(1) Most countries or areas will have assessed their health legislation situation. (2) The majority of countries or areas will have introduced a process

of modification to this health system In order to provide a sound legal basis for these national strategies for health for all.

Situation analysis Many developing countries have inherited health laws and regulations which do not constitute a suitable framework for the attainment of health for all by the year 2000. In some cases, strategies for achieving health for all are actually in conflict with existing legislation, for example with regard to the employment of certain categories of health workers. Many countries, both developed and developing, have inadequate legislation in Important health fields such as disease prevention and health promotion, ensuring equity of health service provision, and environmental and occupational health.

Budgetary implications Although the growth in budgetary provisions for this programme is modest, it is worthy to note that the number of countries participating has increased from 5 to 7, reflecting the growing awareness of countries on the need for a suitable legal framework to achieve the health-for-all goal.

Health system development

3.4 HEALTH LEGISLATION

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and intercountry 119100

US$ 133 200 14000

US$ 14 100 14000

US$

11.84

TOTAL

119 100

147 200

28100

23.59

4. ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE Objective To promote and support the further development and strengthening at all levels of the organization of health systems based on primary health care to achieve total population coverage for delivery of essential health programmes. organization cf community action, training and utilization of community health workers, and assessment of local health problems and needs. There remains a very visible ;Jap between these two levels with respect to organizational and management capacity, which must be bridged. Cour"fries have all taken steps to restructure their health systems based on the prima~ health care approach. The resources of WHO have been applied in Member States for the development of selected aspects of primary health care which h<Ne a higher potential for regional transfer or application in another setting, eitherwithin a given country or in other countries. This transfer can take place througr technical cooperation among developing countries, networking of centres of excellence such as the WHO collaborating centres in China, pilot project documentation, or Information exchange, sharing In seminars, workshops, e-:c. There is still much to be done in spite of notable successes in many areas of primary health care development. There need to be demonstrable methods of developing primary health care through selected programme entry points as we-4 as generalized Infrastructure development, particularly at the district health system level . Community involvement needs to grow Into full partnership. Mechanisms of intersectoral collaboration are not yet fully established, ~.articularly at the district level. A ch311enge now is how to consolidate and apply the technical information and experience gained in the past to district health system development for accelerated implementation of health-for-all strategy at the" national level While hospitals are major consumers of the national health budget, they face serious problems in relation to their planning, design, maintenance 3.nd management as well as maintenance and repair of biomedical equipment. T1e regional workshop on health facility planning and development held in Tokyo in 1986, followed by the Bi-Regional Conference on Technology Transfer in tre Health Field, together with the training support provided to Member States, have helped to some extent not only to create awareness but also to correct some of the existing problems. However, concerted and

Targets Byl995: (I) Most countries or areas will have health systems based on primary health care which provide total coverage of their populations with the essential elements of primary health care, provided through expanded peripheral health units adequately supported by sound referral systems. (2) Most countries or areas will have effective mechanisms in all their communities for participation in health development. (3) Most countries or areas will have intersectoral coordinating mechanisms for health effectively supporting the activities of the health system at peripheral, intermediate and national level. (4) Most countries or areas will have developed adequate capabilities in the health managerial process and in health systems research, which will enable them to closely monitor, evaluate and reformulate their health systems development programmes.

Situation analysis Many countries have made impressive progress in implementing primary health care. However, much of this progress has been either at the national level in the collaborative development of policy, management capability and training capacity or at the local community level in the Organization of health systems based on primary health care

Organization of health systems based on primary heaHh care continuing efforts by Member States are still needed to achieve the desired results and derive the full benefit from the funding incurred.

- strengthening of training Institutions and programmes, Including training In ecucational methodology and review and revision of curricula in terms of appropriateness for health systems based on primary health care; - trafnlng programmes for continuing staff development. Information exchange on health systems development. Support will be provided tlr Information exchange on health systems development within co~ntries and for sharing Information between countries through workshops at . national and ~~egionallevels, documentation of experiences, and networking of selected tra1ring, research and health service institutions. Healf':l systems research on community participation and intersectoral collaboration To ensure effective community participation and lntersectoral collaboration for health development, support will be provided for research and development approaches In urban and rural settings. Technical support will also be provided for national efforts to consolidate and extend community participation and lntersectoralaction. Partnership-building mechanisms will be promoted at national level, Including Involvement of communities In bottom-up planning and in decision-making processes. Exchange of experiences In community participation and intersectoral collaboration will also be supported. Capebilities for research and development, planning and management. To strengthen capability in management and research in order to monitor, eV3.1uate and reformulate health systems development programmes, support will be provided through training in the research and development approach and planning and management, and through documentation of country expel iences and intercountry exchanges with networks of institutions and individua s.

Proposed programme activities for 1990-1991 Assessing and setting the strategy for health systems. WHO will encourage and support governments to assess and set the strategy for health systems, with regard to changes In Infrastructure, management, technology and health manpower, through reviews at district and national level. Health systems research will be used to assess relevant Issues. National and regional strategies will be updated. Strengthening of referral, supervisory and logistical support at district level. Referral, supervisory and logistical support of the expanded peripheral health services, particularly at district level, will be strengthened through development of guidelines and provision of advisory services. Technical collaboration such as training, guidelines, manuals and advisory services will also be provided to upgrade capabilities In hospital planning, design, management and maintenance, as well as maintenance and repair of biomedical equipment.

Studies will be supported, and advisory services provided, to strengthen r~erral syster:ns and ~llization patterns. Training will be supported for the pla~n1ng a~ des1gn of district hospitals, aimed at Improving technical backst~ppmg pn~ary health care. Support will be provided to improve superv1s1on, mcludmg use of appropriate communication skills and communication technology, through the development of networks to enhance m~na9ement capabilities at district level and through advisory services and gwdehnes.

Training_ of he~lth manpower for primary health care and supportive le~els . WHO Will continue to support the training of manpower required for

Budgetary implications While ma~y c~untries have made progress in implementing primary health care, t;,ere IS st1ll much to be done particularly at the district level. A number of countries, particularly the developing countries in the South Pacific have slightly increased their provisions for primary health care and this account~ for the moderate overall budgetary Increase in the regular budget provision Additional funds are expected from extrabudgetary sources mostly fro~ UNDP. '

pnmary health care and supportive levels, including the following : - tr~ining of community health workers and of the general public for health functions and self-care at national level; - ~eorient~ti~n to the primary health care approach and appropriate technologres of exrstrng health staff, trainers and supervisors at national level;

4. ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 4 179 500 1517500

US$ 4 300 500 1 686 100

US$ 121 000 168 600

US$ 46000 1 412 000

US$ 1 000 1 196 ()()()

2.90 11.11

TOTAL

5 697 000

5 986 600

289 600

5.08

1 458 000

1 197 000

Orgamzat1on of health systems based on primary health care

Development of human resources for heaHh

5. DEVELOPMENT OF HUMAN RESOURCES FOR HEALTH Objectives To promote, and cooperate with countries in planning for, the training and deployment of the types and numbers of health personnel the~ require and can afford, who are socially responsible and equipped with the necessary scientific, technical and managerial competence; and to help ensure that such personnel are utilized optimally to meet the requirements of national strategies to achieve health for all. To promote policies and programmes for health manpower planning, production and management in order to meet the requirements of the health systems. (5) Most countries will have Introduced effective educational processes through the training of teachers and the provision of adequate educational materials.

Situation analysis Human resources for health are the key to ensuring the effective functioning of national health care systems. Appropriate categories of health personnel must be purposefully planned, effectively produced and efficiently managed in direct relation to the tasks they are expected to perform, to enable countries to achieve national goals of health for all and primary health care objectives. The landmark Conference, ''Towards future health and medical manpower: New strategies In education for the twenty-first century'', held In Tokyo in 1985, affirmed that reorientation of medical services towards primary health care and social equity could best be achieved through changes in health manpower planning, production and management. The Tokyo Declaration has made an Impact on national policies. There has generally been a positive drive towards reorientation of human resources towards primary health care, and a number of important national and international initiatives have been taken. Several national conferences have been convened, with WHO support, which recommended country-specific actions. About half of the countries have drawn up national manpower policies for at least one category of health personnel. A series of national workshops was organized to deal with policy issues. At the international level, a workshop on management of change in training institutions was conducted at the WHO Regional Teacher Training Centre in Sydney in 1986. Activities were also expanded to bring nursing education curricula closer to primary health care. Despite difficulties, most of the countries have improved their national mechanisms for health manpower planning. A series of national workshops in Lao People's Democratic Republic, Papua New Guinea, Republic of Korea, and VietNam have also dealt with issues of work-force planning. In the Philippines,

Targets By 1995:

(1) On the basis of explicit manpower policies, the majority of countries will have Improved the manpower planning component of their managerial process for national health development, specifying both qualitative and quantitative requirements appropriate to health-for-all priorities. (2) The majority of the countries or areas will have developed national education programmes for training health service staff in the managerial process for national health development. (3) Most countries will have strengthened the capacity of educational institutions to ensure that the required categories and quantities of health manpower are produced. (4) Most cou"ntries will have reconstructed their training J:Yogrammes in order to increase their relevance to local needs, using a task- and community-oriented approach.

methods of forecasting the needs In human resources were Improved. The Lao People's Democratic Republic continued to make use of the inventory of national health personnel, while In Malaysia, a computerized approach to manpower projections has been used. Reorienting curricula towards community- and problem-oriented learning and developing appropriate teacher-training activities for this have been the main thrusts in many countries. Developmental activities related to job . d escription and task analysis in curriculum design for various categories of health personnel are being carried out to define what to learn in order to be relevant and how to o rganize learning tor It to be effective. Although considerable progress has been achieved, problems remain. These include: (1) lack of understanding and coordination between health planners, educators, health care managers and the communities they are supposed to serve, resulting in inappropriate categories of personnel and irrelevant training curricula;

(2) inadequate management of health personnel, adversely affecting work motivation and productivity; (3) absence of decision-linked research at all stages of the health manpower development process, leading to uncertainty in decision-making; (4) inadequate development of continuing education systems, thus failing to maintain professional standards of competence and performance in health staff.

Formation of health personnel. The major focus will be on strengthening training institutions by providing technical and managerial support for staffing, curriculum design and evaluation, educational technology, equipment and health learning materials. Efforts will be made to encourage and provide technical support for national and regional educational and training Institutions with responsibilities in leadership training, to identify needs and priority areas for decision-linked research, to redesign educational processes and curricula towards relevance for primary health care functions, to introduce, promote and evaluate teacher training activities for community and problem-based educational programmes, to disseminate information on success stories of Implementing Innovative educational programmes, and to strengthen continuing education of health personnel for primary health care fun ctions. Special efforts will be made to improve the planning and management of WHO fellowship programme by carrying out comprehensive evaluation studies encouraging countries to make fellowship programmes as relevant as possible to long-term national policies aimed at achieving WHO health-for-all and primary health care goals and objectives. A meeting of national fellowship officers will be held in 1990. National and regional activities In the areas of teacher training and developing relevant and innovative health learning materials will be expanded.

Budgetary Implications The development of human resources for health continues to be given high priority, as almost all countries/areas in the Region have included provisions for this programme within their country allocations, with three countries showing significant increases. The programme, however, shows an overall budgetary decrease because of significant reductions made by three countries which had, in the past, traditionally allocated a large portion of their country planning figures to this programme. In one of these countries, the reduction is due to the discontinuation of one long-term nursing education post, since support will be provided under the intercountry programme. In the other two countries, the fellowship programmes have been reduced but provision for training of all levels of health workers has been included in other programme areas. Apart from fellowships, which comprise about 20% of the total regional budget, WHO support will be concentrated on reorientation of health personnel towards primary health care, strengthening educational institutions and enhancing management training in relation to human resources for health.

Proposed programme activities for 1990-1991 Management of human resources for health. Emphasis will be placed on formulating national policies and plans through country reviews by using methods of economic analysis and other methods and models in human resource development, and promoting relevant decision-linked research aimed at designing appropriate and affordable national health manpower development strategies. Training programmes in managerial processes for national health development, specific managerial techniques and health manpower management information systems will also be expanded. A regional workshop on health manpower management systems will be held in 1990, and a regional workshop on health manpower research and evaluation will be held in 1991.

Development of human resources for health

Development of human resources for heaHh

5. DEVELOPMENT OF HUMAN RESOURCES FOR HEALTH

Estimated obligations

Regular budget

Other sources

19B8-19B9

1990-1991

Increase

(Decrease) %

1988-19B9

1990-1991

US$ Country or area Regional and intercountry 8 772 600 1 533 600

US$ 7 677 800 1 346 700

US$ (1 094 800) (186 900)

US$ 633 500 161 300

US$

( 12.48) ( 12.19)

18 800

TOTAL

10 306 200

9 024 500

(1 2B1 700)

( 12.44)

794 BOO

1B BOO

6. PUBLIC INFORMATION AND EDUCATION FOR HEALTH Objective To promote and strengthen health education for the public and the provision of health information for the public with a view to stimulating active community involvement in health activities, promoting a healthy life-style and achieving community self-reliance in health. In mast countries, efforts continued to be made to expand educational components h major health programmes, and added emphasis was given, In addition to the traditional educational approach, to the principle of advocacy for health Incorporating the social marketing concept to encourage people to adopt health practices and take more responsibility for their own health. To lrrprove the effectiveness of health education support for health programmes, cooperation was Increased In the areas of formulating health education pla,ning and strategies, designing an administrative and operational framework to facilitate programme implementation and production of educational materials. and training of health personnel in healt h education. SchoJI health has been Intensified In several countries through a series of training activities during which the current health education curriculum and teaching progammes in the primary and secondary schools were reviewed and suggestions were made for further improvement. More efforts are being made to attract major national and regional media group~ to participate In disseminating health messages, increasing the public visibil itt of WHO, and Influencing policy-makers to support the health sector. Probl 3ms Include: (1) inadequate preparation of health educators as well as general personnel in health education ; (2) lack of professional leadership in planning, implementing and evaluating public information and health educaton activities; (3) lack of audiovisual support and other teaching materials for health information and education.

Targets By 1995:

{1) All countries or areas will have updated their health education and public information policies and strategies, incorporating Innovative approaches to the planning and programming of health education activities, such as advocacy at various levels, interpersonal approaches and social marketing. They will have strengthened the corresponding infrastructure at various levels, with emphasis on family health, safety in the home, nutrition, environmental health, Immunization and disease prevention and control. (2) The ministries of health In all countries or areas will have further enlisted the support of the ministries of information, education, agriculture, environment, community development and other related sectors In coordinating programmes of public information and health education, so as to enhance Individual and community capabilities for self-reliance in health and to promote healthful behaviour and community action for health.

Proposed programme activities for 1990-1991 Situation analysis More countries are convinced of the importance of public information and education in enhancing active community involvement in health activities, promoting and maintaining a healthy life-style and achieving community self-reliance in health.

Updating health education and public information policies and strategies. Tine programme will continue to support updating health education and public infJrmation policies and strategies Including identification of needs and future directions, and strengthening health education and information units at the nationa and provincial levels in Cook Islands, Fiji, Kiribati, Philippines, Samoa, Tonga, Vanuatu and Viet Nam. Collaboration will be provided in

Public information and education for health

Public Information and education for heaHh

formulating and updating medium and long-term country-specific health education and public Information strategies and plans in China, Lao People's Democratic Republic, Malaysia, Papua New Guinea and Solomon Islands.

distribution of health teaching and learning materials, including audiovisual aids for use in the schools.

Strengthening training activities in health education. Practical and realistic health education training has been organized at field level for primary health care workers In China, Kiribati and the Philippines. Health education training at national level for health staff has been organized in China, Kiribati, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Philippines, Tonga and VIetNam. Similar training will be started In Fiji, Samoa and Vanuatu. The quality of health education provided In the basic training programmes of various categories of health personnel education will be reviewed and strengthened. The number of health education specialists required in each country will be assessed and training opportunities will be provided. In training, emphasis will be placed on upgrading knowledge and skills among education and Information personnel in the field of health, Increasing technical capability for the formulation of various health-oriented media programmes, and producing and making Innovative use of educational materials designed to promote healthy life-style in the general public.

Use of mass media. Efforts will be made to ensure more active Involvement of news reporters, radio and television broadcasters, and journalists, in order to expand the coverage of health subjects in the news media. Encouraging and supporting behavioural research. Health behavioural research will receive continuous attention in order to improve the effectiveness of health education programmes. Eligible persons or institutions for health behavioural research will be lder:-~tified and properly supported. Further opportunities will be sought for training researchers In health behavioural research. Coordination with other sectors. A mechanism for inter-ministerial or Inter-sectoral coordination will be established for the development of multisectoral activities supporting community involvement in action for health.

Strengthening school health education programmes. Continuous support will be given to Member States, among others Fiji Kiribati Malaysia Papua New Guinea, Solomon Islands, and Tonga, In dev~loplng turthe~ str~ngth_en i ~!l ~ealth teaching in primary and secondary schools and In teacher tramlng mstitut1ons. Special eff~rts will be made to support the production and

Budgetary Implications The programme shows a moderate overall budgetary Increase, reflecting the countries' increasing awareness of the Importance of information and education support in health activities.

and

6. PUBLIC INFORMATION AND EDUCATION FOR HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 654 200 512 300

US$ 863 100

US$ 208 900 63700

US$

31 .93 12.43 2500

576 000

TOTAL

1 166 500

1 439 100

272 600

23.37

2 500

Public information and education for health

Research promotion and development, including research on health-promoting behaviour

7. RESEARCH PROMOTION AND DEVELOPMENT, INCLUDING RESEARCH ON HEALTH-PROMOTING BEHAVIOUR Objective To promote national capability In health research that Is relevant to the objective of health for all by the year 2000. Institutions and research training programmes dealing with biomedical, health systems, behavioural and related socioeconomic research; and to promote Information exchange and the dissemination of research results In order to help solve health and health-related problems.

Targets By 1995:

Proposed programme activities for 1990-1991 At the country level, efforts will be made to have the WHO collaborating centres play an Increasing role In the development of national research management mechanisms, for example by setting up national research priorities. Research proposals lnvofvlng priority areas in health systems, health behavioural and problem-solving oriented biomedical research will be given primary consideration for support. Training courses In research design and methodology will be held In China and Viet Nam to strengthen the research capabilities of these countries. At the regional level, the development of technical and managerial manpower resources In developing countries will be supported through grants for research training and visiting scientist and through various workshops and training courses. Th ese efforts will be complemented by the special programmes for human reproduction research and for tropical disease research. The Western Pacific Advisory Committee on Health Research (WPACHR) will be encouraged to correlate national and regional research priorities, by having its members maintain close liaison with their national health research communities and national health authorities as well as with the Western Pacific Regional Office. The development of the regional biomedical information programme for the dissemination of scientific and technological Information will be encouraged to facilitate technology transfer from country to country.

(1) Most countries or areas will have developed a national health research policy and established adequate mechanisms for ensuring the efficient coordination and management of health research at national level. (2) Most countries or areas will have produced the essential resources, manpower and Infrastructure necessary for carrying out the research required for the Implementation of their health-for-all strategies.

Situation analysis An effective national organization for the management of health research Is still non-existent In many developing Member States. However, some countries are making an effort to develop such coordinating mechanisms and to define a single national focal point for cooperation In health research. The resources, manpower and Infrastructure required for health research, as well as career structures for research workers, are lacking in most developing countries of the Region. Poorly equipped and manned research facilities and Inadequately prepared research proposals submitted to funding agencies such as WHO are major impediments to successful research promotion in many developing countries. This is the basis for the commitment to promoting research and development and to strengthening national research capabil ities. Efforts will be made to reinforce national research management mechanisms such as policy formulation and planning; to strengthen research

Budgetary implications The programme shows a moderate overall budgetary increase mainly In the country allocation to cover additional support for upgrading the research and training capability of WHO collaborating centres.

7. RESEARCH PROMOTION AND DEVELOPMENT, INCLUDING RESEARCH ON HEALTH-PROMOTING BEHAVIOUR

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease)

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 776 600 736 500

US$ 91 600 82300

US$

685 000 654 200

13.37 12.58 149 600

TOTAL

1 339 200

1 513 100

173 900

12.99

149 600

Research promot1on and development, mcludmg research on health-promoting behaviour

General heaHh protection and promotion

8. GENERAL HEALTH PROTECTION AND PROMOTION Objective To develop policies and programmes to promote health in relation to

food and nutrition, oral health, accident prevention and use of tobacco.

8. GENERAL HEALTH PROTECTION AND PROMOTION

Estimated obligations

Regular budget

Other sources

1988-1989

1990..1991

Increase

(Decrease) %

1988-1989

1990..1991

US$ Country or area Regional and Intercountry

US$ 1 166 000 892 700

US$ 247 800 145 700

US$

918 200 747 ()()()

26.99 19.50

TOTAL

1 665 200

2 058 700

393 500

23.63

General health protection and promotion

General heaHh protection and promotion

8.1 NUTRITION Objective To promote and support Improvement of the nutritional status of all sectors of the population, especially that of mothers &nd children and other vulnerable groups, and to significantly reduce the incidence of specific nutritional deficiencies. Governments were encouraged to develop national food and nutrition policies and programmes, but the progress has not been completely satisfactory, although national capability to formulate appropriate national policies and programmes has been considerably Increased in almost all countries of the Region. The preoccupation of many developing countries has been economic stagnation resulting In decreased production, Inadequate distribution patterns and limited availability of food in sufficiently large quantities, especially to the vulnerable groups. Increased urban migration, especially In some developing countries, Is a major problem, and the migrant urban population Itself has grown, producing a large population group which Is Increasingly malnourished. In spite of the availability of a considerable body of scientific knowledge, inertia and shortage of resources hamper its application. The decline in the practice of breast-feeding could be considered to have stopped In the majority of the countries of the Region and further promotion of breast-feeding will improve the nutrition of the young child. Noncommunicable diseases associated with nutrition are gradually gaining attention and these problems will be tackled In collaboration with other programme areas in WHO.

Targets By 1995: (1) Most of the countries or areas will have formulated national nutrition policies and programmes as part of their integrated socioeconomic development. (2) Most of the countries or areas will have functioning surveillance systems and appropriate monitoring and evaluation procedures, including nutrition relief in emergencies and disaster preparedness, whenever necessary. (3) Control programmes will have ensured that specific nutritional deficiencies will not be a public health problem in any country or area of the region. (4) The Region as a whole will have built up adequate institutions and programmes of activities to make it self-sufficient In training and in undertaking basic and applied research of national and regional relevance, focused on priority areas and the problems of vulnerable population groups.

Proposed programme activities for 1990-1991 Development of national food policies and programmes. This will continue to be a priority within national socioeconomic development plans, with emphasis on the health sector's responsibility and intersectoral coordination. These will be supported through the organization of four national workshops and the facilitation of Information exchange with technical support from WHO. Strengthening information support. The development of appropriate nutritional surveillance systems in countries which do not have them will be supported, especially in Laos, Papua New Guinea, the South Pacific and Viet Nam and this in turn will help In the development of appropriate national

Situation analysis During the past years the programme was able to make reasonable estimates of the extent and geographical distribution of all types of malnutrition.

programmes. Routine monitoring of nutritional surveillance will be emphasized In most of the countries, especially the growth and development of the young child and the nutritional status of the mother during pregnancy and lactation. Efforts to slmpiHy the collection of data and the use of them by health workers at the periphery will be reinforced with technical support and the design of simple monitoring tools.

as well as the existing regional training programmes. This will Include nutrition planning, nutrition surveillance and monitoring.

Nutrition education. Priority will be given to supporting nutrition education efforts In conjunction with other related programmes, and this will include the problems of both undernutrition and affluence. Specific target groups will Include the urban poor, the elderly, and working adults. A regional seminar on nutrition education In training Institutions will be organized In 1991 . Epidemiological studies. The programme will support specific studies In selected countries on the Interrelationship of nutrition with many other problems such as no_ncommunlcable diseases, problems arising from changing life-styles and migration, and problems of specific age groups as well as specific mineral or vitamin deficiency In selected countries.

Training. The programme will support national efforts to train health workers at Intermediate and peripheral levels, through In-service training In the majority of the countries, to strengthen national priority programmes such as the encouragement of breast-feeding, dealing with specific nutritional deficiencies (e.g. vitamin A deficiency, goitre), Improvement of the nutritional status of pregnant and lactating mothers and providing for the nutritional needs of the elderly. Support will be provided for strengthening national capabilities, particularly In the development of health workers within the country and within the Region, which will Include national training programmes in larger countries

Budgetary Implications The budgetary Increase under the regional and Intercountry allocation Is due to the inclusion of a regional seminar to be held In 1991.

General health protection and promotion

General heaHh protection and promotion

8.1 NUTRITION

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(DecreaH) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 253 700 420 400

US$ 262 100 473 200

US$ 8400 52 800

US$

3.31 12.56

TOTAL

674100

735 300

61 200

9.08

8.2 ORAL HEALTH Objective To promote the development of appropriate oral health care delivery systems, so that national oral health programmes can be cost -effective and efficiently operated and result In the maintenance of the highest possible level of oral health In all communities. years on the other hand, most developing countries, which previously had relatively low caries prevalence, are now experiencing a steady increase, particularly in their urban populations. In contrast, periodontal diseases continue to be widespread and show little change. Being conscious of these trends, most countries In the Region are Increasingly adopting preventive programmes to counter the unfavourable trends. A major constraint In the Region, except In the case of a few Industrialized countries, Is the acute shortage of dental manpower. This problem Is however being addressed through the Increasing use of dental auxiliaries. To offset the acute shortage of dental manpower further, school teachers and other available manpower are also Increasingly trained and deployed In organizing and conducting preventive activities, with encouraging results. With the advent of pit and fissure sealants which have been demonstrated to be very effective in preventing and arresting early caries occurring in pits and fissures of molar teeth, countries should now strengthen their present caries prevention activities by introducing and stepping up the use of these sealants. With the combined use of fluorides and these sealants, most cavities, and hence much of the need for restorative treatments which are costly, can be prevented. Promoting better oral hygiene through intensive toothbrushing instruction and regular toothbrushing drills in kindergartens and primary schools, should form the basic approach in tackling the present high prevalence of periodontal diseases. Support is needed regionwide, however, In the wider use of pit and fissure sealants and the implementation of toothbrushing programmes in schools.

Targets By 1995: (1) Most countries or areas In the Region will have 80% coverage of the population with appropriate preventive programmes against dental caries and periodontal diseases to achieve an oral health status equivalent to the following: (a) not more than three decayed, missing or filled permanent teeth at the age of 12 years; (b) scaling and oral hygiene Instruction required for not more than 25% of the 15-19 age group. (2) All countries or areas will have assessed the oral health status of their populations on the basis of sufficient data on the prevalence of oral diseases.

Situation analysis Dental caries and periodontal diseases continue to be the two most prevalent oral diseases and the major causes of poor oral health in the Region. In recent years however, some Industrialized countries with very high caries prevalence In the past have reported significant reductions resulting from the extensive use of fluorides and other caries preventive measures. During these

Proposed programme activities for 1990-1991 Strengthening of preventive programmes. The major focus will be on the development of appropriate preventive programmes with increasing coverage of the child population. These will include the use of pit and fissure sealants and fluorides where smooth surface caries remain a problem, and the promotion of better oral hygiene. Oral health promotion in the schools and for

General health protection and promotion

General heaHh protection and promotion

the adult population through the media, exhibitions, posters and other educational materials, will be stepped up. Training of dental manpower. Emphasis will be placed on the judicious use of dental manpower and the wider use of dental auxiliaries of varying levels with adequate training to carry out the less specialized procedures. Where numbers can justify It, the establishment of local training programmes will be encouraged. Responsible dental officers will be Increasingly exposed to public health dentistry and be trained to play the role of programme managers more effectively, particularly In resource management and delivery system planning and development. WHO support will be required In the training of key dental personnel In programme management and clinical skills in pit and fissure sealant application and the training of auxiliaries. Development of appropriate delivery systems. Greater effort will be made to develop existing oral health care delivery systems to achieve wider

coverage of populations, especially with basic care. Attention will be given to the development of centre-based mobile teams to bring services to the periphery, using centres mainly for referral cases requiring sophisticated care.

Budgetary Implications The overall budget for the oral health programme In biennium 1990-1991 has not shown significant Increase over the 1988-1989 provision, but the provision for country and area activities has Increased significantly, while the provision for regional and intercountry activities has decreased. Ten countries and areas have significantly Increased their allocation for oral health In the 1990-1991 biennium and this fact indicates the· greater Importance governments In the Region are attaching to the oral health programme. Under the regional and Intercountry activities, the absence of a regional meeting In 1990-1991 biennium accounts for the reduction.

8.2 ORAL HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 656400 274 600

US$ 795 600 244 500

US$ 139 200 (30 100)

US$

21.21 ( 10.96)

TOTAL

931 000

1 040 100

109 100

11.72

General health protection and promotion

General heaHh protection and promotion

8.3 ACCIDENT PREVENTION Objective To develop policies and programmes to promote health In relation to accident prevention, especially the prevention of road traffic accidents and the rehabilitation of accident cases. In many developing countries of the Western Pacific Region, the proliferation of vehicles and Increasing road traffic accidents are so rapid that existing road traffic safety measures and preventive education activities have not been able to cope with the problem. In some Industrialized countries In the Region, safety education, effective law enforcement, control of driving under the influence of alcohol, seat belt wearing, and other safety measures have resulted in the reduction of road traffic accidents. There Is an urgent need for the exchange of experience between Member States and strengthening of national capabilities to Introduce comprehensive programmes for road safety, particularly In developing countries.

Targets By 1995:

(1) National policies to reduce morbidity and mortality from road traffic accidents will have been developed In most countries or areas of the Region. (2) Epidemiological studies on the magnitude, nature and trends of road traffic accidents will have been undertaken in most countries or areas in the Region. (3) Multidisciplinary and lntersectoral national bodies for the prevention and control of road traffic accidents will have been organized in most countries or areas in the Region and appropriate legislation for accident prevention introduced. (4) Appropriate legislation for prevention and control of road traffic accidents will have been introduced in most countries or areas of the Region.

Proposed programme activities for 1990-1991 Multi-sectoral national committee. Efforts will be continued to collaborate with Member States to strengthen multi-sectoral national committees for the prevention of road traffic accidents. In the developing countries, technical services will be provided to establish national bodies consisting of multi-sectoral experts concerned with road safety such as education, law enforcement, social welfare and transportation, to plan and orient national safety programmes. Training. Collaboration will be provided to strengthen training at national level to develop effective preventive programmes and emergency systems for health workers, education experts and law enforcement officers.

Situation analysis Member States have continued to strengthen their efforts to develop comprehensive national policies and programmes for the prevention of road traffic accidents.

Research. Technlcal and financial support will be provided to promote research capabilities for the prevention of road traffic accidents. Particular emphasis will be placed on epidemiological and behavioural studies on accident prevention. The technical expertise of the WHO Collaborating Centre In Research and Training In Road Traffic Accident will be utilized to strengthen regional programmes.

Budgetary Implications The budgetary provision for this programme does not show any significant change.

General health protection and promotion

General heahh protection and promotion

8.3 ACCIDENT PREVENTION

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 8100 52000

US$ 10 400 45000

US$ 2 300

US$

28.40 ( 13.46)

(7 000)

TOTAL

60100

55 400

(4 700)

(7.82)

8.4 TOBACCO OR HEALTH Objective To promote prevention and control of tobacco use In order to prevent tobacco-raated diseases.

Proposed programme activities for 1990-1991 National policy and programme development. Countries which have not developed a national policy on tobacco or health will receive support for policy and programme development. A regional working group on tobacco or health In 1990 will further encourage the strengthening of national activities and information exchange. National workshops will be held in China, Guam, the Republic of Korea, Samoa and Tonga. Promotion of legislative action to restrict the use of tobacco. Support to develop appropriate national legislation will be provided to Fiji, Guam and the Republic of Korea. Training and educational activities. The programme will support national training programmes for health workers and teachers and will provide support for the development of educational materials at both national and reg ional levels. Information exchange will be promoted by a regional newsletter and by the educational activities of the WHO collaborating centres on 'tobacco or health' in Australia, China and Japan, and other collaborating centres for health education. Research and epidemiology. Countries will be supported in conducting operational and behavioural research on the use of tobacco, and on the effectiveness of various ways of discouraging tobacco use, especially by young people. Epidemiological data on tobacco use will be collected and analysed.

Targets By 1995: (1) Most countries or areas will have established national tobacco or health policle~ and programmes. (2) Several countries or areas will have shown a significantly declining trend in the annual consumption of tobacco products per adult.

Situation analysts Tobacco use Is highly prevalent In this Region especially amongst men. In a majority of countries in the Region, diseases related to tobacco use are among the leading causes of death. Tobacco use is becoming a major public health problem even In the less developed countries. Many countries have very limited restrictions on sales and advertising and no national policy on tobacco or health. Tobacco-or-health activities are being undertaken by many groups but national coordinating committees are rare. WHO support has been In the areas of national programme development, support for surveys on tobacco use and support for the preparation of educational materials. WHO is developing a role in the coordination and dissemination of regional information. A Working Group on Tobacco or Health was held in Tokyo In 1987. General health protection and promotion

Budgetary implications This Is a new programme area with activities previously funded by other programmes such as noncommunicable disease prevention and control activities, cancer and cardiovascular diseases. Activities will include a regional working group on 'tobacco or health' in 1990, national workshops, the production of educational materials and support for the development of national programmes and legislation.

General health protection and promotion

8.4 TOBACCO OR HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 97900 130 000

US$

TOTAL

227 900

9. PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS Objective To promote policies and programmes for the protection and promotion of the health of specific population groups, particularly women of child-bearing age and children, workers and the elderly.

Protection and promotion of the health of specific population groups

Protection and promotion of the heaHh of specific population groups

9. PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1890-1991

US$ Country or area Regional and Intercountry 617 400 489 300

US$ 1 072 900 476 900

US$ 455 500 (12 400)

US$ 7 916 200 1 213 900

US$ 1 693 100 891 900

73.78 (2.53)

TOTAL

1 106 700

1 549 800

443 100

40.04

9 130 100

2 585 000

9.1 MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING Objective To strengthen the health services at all levels of the health care delivery system, In the context of primary health care, particularly those for women of child-bearing age, Infants and young children, in order to reduce maternal, perinatal, Infant and childhood mortality and morbidity; and to improve the physical and psychosocial development of children. (5) In most developing countries, maternal mortality will have been significantly reduced from the 1985 level.

Situation analysis Significant progress has been made especially in the area of child health. Most countries or areas have reached an infant mortality rate of below 50 per 1000 live births. This Is largely due to the synergistic effect of various activities, particularly those related to Immunization, oral rehydration therapy, control of acute respiratory infection and nutrition and family planning care. Similarly, there has been a slight but perceptible downward trend in the regional fertility level. A steady Increase in contraceptive use has been observed in many countries of the Region. However, despite the impressive gains made In reducing infant mortality, there Is still a long way to go, especially in curtailing the prevailing high level of maternal and perinatal mortality in many developing countries of the Region. Even In countries where the overall maternal and perinatal morbidity/mortality has fallen, there are still areas where these indicators are unacceptably high owing to uneven distribution of resources, health care facilities and low socioeconomic status of women. The maternal mortality rates In some developing countries of the Region are even 100 times greater than those in some developed countries of the Region. It is also evident that a major proportion of infant deaths occur during the neonatal period for reasons primarily related to maternal factors. While the accomplishment In terms of decline in Infant mortality has been remarkable, existing high maternal and perinatal morbidity and mortality, together with unregulated fertility, are common health concerns among most countries of the Region.

Targets By 1995: (1) In all countries or areas, maternal and child health/family planning programmes will have been further strengthened or expanded. In less developed countries, at least 75% of births will be attended by trained health workers (including traditional birth attendants) . In more developed countries, at least 90% of births will be attended by trained personnel. Access to preventive and curative care for women and children will be provided to 70% of the eligible population in developing countries, while in the developed countries 90% of women and children will have such access. (2) At least 70% of all couples desiring family planning service will have access to them. (3) Appropriate health technologies, applicable to maternal and child health, will have been developed and adopted, in particular for hypertensive diseases during pregnancy, prevention of complications in childbirth, low birth weight and perinatal infections and nutrition. (4) In half of the developing countries, national capability for biomedical and health systems research in maternal and child health and family planning will have been promoted and strengthened. Protection and promotion of the health of specific population groups

Proposed programme activities for 1990-1991 The main thrust of the programme will be on improving coverage with prenatal care, diagnosis and referral of at-risk pregnancies and newborns, and family planning services to prevent high-risk or unwanted pregnancies,

Protection and promotion of the health of specHic population groups Including the development of support for Involvement of local women organizations in maternal and child health/family planning care. Cooperation will continue with Member States in expanding the adoption locally of home-based maternal records (HBMR), aimed at improving the management of maternal and newborn health care, including family planning care based on the risk approach and reliable Information. A regional workshop on evaluation and monitoring of maternal and child health/famNy planning programmes wUI be organized In 1991 . Training activities related to strengthening of the clinical and programme management competencies of health personnel at all levels of maternal and chHd health/family planning care will be supported. Research on local adaptation of already proven technologies related to pregnancy, childbirth, neonatal, growth and development during childhood and adolescence will be promoted. Cooperation with Member States will continue in the production of health education and media materials appropriate to the local situation and In training of health personnel In health education related to maternal and child health/family planning care. The programme will continue to coordinate with WHO collaborating centres In the Region on maternal and child health/family planning and biomedical research activities related to human reproduction. WHO will cooperate with Member States in developing support for the Involvement of women's organizations In maternal and child health/family planning care, especially at the community level.

WHO will continue to coordinate with UNFPA, UNICEF and other United Nations agencies In formulating, implementing and monitoring their respective country and intercountry support In this field. The maternal and child health/family planning programme will have continued linkage with various programmes within and outside the health sector. Within the health sector, it will be closely linked with Immunization, oral rehydration therapy, acute respiratory Infections, nutrition, health education, mental health, the programme on AIDS and the organization of health systems based on primary health care. The programme will also be linked with other United Nations agencies and nongovernmental organizations, especially women's organizations outside the health sector. At the country level, close links will be maintained between the local community and women's organizations for maternal and child health/family planning care.

Budgetary Implications The significant Increase of budgetary provision at country level Is expected to support the training of health manpower, the organization of national training programmes for health workers, and the strengthening of maternal and child health services. For regional and Intercountry activities, the budgetary Increase Is mainly in support for national training activities concerned with maternal and child health and the provision of technical services for research on causes of maternal death and perinatal mortality and morbidity. Funds from exrabudgetary resources, mostly from UNFPA, are expected to continue to support activities under this programme.

9.1 MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 521 100 266 500

US$ 257 900 36200

US$ 7 916 200 1 093 500

US$ 1 693 100 691 900

263 200 246 300

97.99 15.36

TOTAL

511 500

807 600

296100

57.89

9 009 700

2 585 000

Protect aon and promotaon of the health of specific population groups

Protection and promotion of the heaHh of specific population groups

9.2 ADOLESCENT HEALTH Objective To Identify the special health needs of adolescents and to cevelop and Implement appropriate measures to ensure the health of this group.

Proposed programme activities for 1990-1991 WHO will collaborate In collecting and Interpreting data on various health problems of adolescents. These Include growth and development, the problems and consequences of pregnancies, abortion, sexually transmitted diseases, risk-taking behaviour, and the relations between social and other factors which cause stress. These efforts are necessary to develop programmes designed to reduce such problems facing adolescents. National activities will be focused on health education for adolescents and studies on specific Issues and related problems In selected countries. In most countries these activities will form part of related programmes, namely maternal and child health, family planning, health education, nutrition, prevention and control of alcohol and drug abuse, and mental health. WHO will collaborate In the exchange of experience between countries and explore the possibility of support for collaborative research on specific problems of adolescents. Governments will be encouraged to identify a focal point in the ministry of health and to set up an lntersectoral body for coordination of the activities of various sectors. Efforts wll be directed at providing more training for health personnel to support programmes for adolescents.

Targets By 1995: (1) WHO will have made available appropriate technologies and methodologies for the protection and promotion of adolescent health, with particular emphasis on growth and development, risk-taking behaviour, and sexually related problems. (2) At least a majority of the countries or areas will have developed or adopted appropriate measures to meet the special health needs of cdolescents and youth and to ensure the active participation of young people in :heir health care.

Situation analysis There Is general awareness at national level of the health 170blems of adolescents though detailed Information on their nature and ex:ent is not known. So far, very little attempt has been made to isolate and c: nafyse the problems of this particular segment of the population, in terms of realth care. Few countries have undertaken research studies In relation to 3Spects of reproduction and specialized service though counselling has been attempted on a limited scale. The contribution to the health of the adolescent of youth programmes like sports, recreation and cultural activities has yet to be determined. The recommendations of regional meetings held on tile subject Indicate the concern of countries to deal with specific health pll)blems of adolescents. Collection of precise Information on the nature and e)1ent of the problem, as well as the need for dissemination of knowledge about the health needs of adolescents, have been stressed.

Budgetary implications This is a new programme under the Eighth General Programme of Work. Additional programme support Is expected to be provided through other related programmes such as maternal and child health, health education, and protection and promotion of mental health.

9.2 ADOLESCENT HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 7 200

US$ 7200

US$

TOTAL

7 200

Protect1on and promot1on of the health of specific population groups 91

Protection and promotion of the health of specific population groups

9.4 WORKERS' HEALTH Objective To promote the development of occupational health services Integrated Into general health systems; and to promote the Improvement of working conditions, particularly for workers in small-scale industries and in agriculture. unabated In Industrialized countries of the Region, where new work hazards continue to arise or require more vigorous Intervention. In developing countries, Industrialization, modernization of agriculture and stressful conditions at work are associated with many physical and mental health problems. The number of toxic chemicals produced and handled by workers Is rapidly increasing. Exposure to toxic chemical substances constitutes a growing threat to the health and even the life of workers and the population. The situation is more serious In developing countries, where experience and resources to control chemical exposure are lacking. The main hazards In the Region are rural and Industrial chemical poisoning, dust and skin diseases and hearing loss. In many countries or areas, the limited statistical data underestimate the magnitude of occupational health problems, particularly In agriculture and small-scale Industry. Pursuant to the resolutions adopted by the Regional Committee and the World Health Assembly, WHO and most of the Member States are now according increasing attention to the problems of occupational health. Collaborative efforts have been directed mainly to supporting the formulation of national programmes, drafting legislation (including sanitation standards), development of services and Institutional organization and strengthening. Training of national staff in various aspects of occupational health is a major activity of the programme.

Targets By 1995: (1) Most countries or areas will have developed occupational health programmes to provide promotive, preventive, curative and rehabilitation care to workers, Including the rural workforce, based on mechanisms which promote the participation of workers and employer organizations. (2) Most countries or areas will have formulated legislation which Includes standards to protect the health and safety of workers. (3) Most countries or areas will have developed programmes for surveillance, selection of exposure limits, control, early detection and appropriate care of occupational and work-related diseases and conditions.

Situation analysis The working population, being the most economically prod uctive as well as being very sizeable In many Instances, constitutes a very important sector In any community. Promotion of workers' health thus plays an important role In attaining the goal of a level of health that will permit a socially and economically productive life for everyone by the year 2000. The enormous toll In morbidity and mortality from diseases and accidents Is directly or Indirectly related to working conditions and continues

Proposed programme activities for 1990-1991 The main thrust of the programme Is to promote the development of occupational health services, particularly for working populations in small-scale industries and in agriculture.

WHO will collaborate with Member States In Identifying occupational health problems and needs, In developing ahd strengthening national occupational health programmes, and In Integrating these programmes Into primary health care. Support will be provided for training of different categories of occupational health personnel. Relevant occupational health research recommended by the WPACHR Sub-Committee on Research In Occupational Health will continue to be supported. Collaboration between WHO collaborating centres and other national centres for occupational health will be promoted and strengthened.

Information e::change will be further Improved through the established regional Information network.

Budgetary Implications The significant Increase In the budget provision reflects the growing Interest of Me-mber States concerning workers' health. Four countries have Increased their budget provision, whHe two countries have Initiated workers' health activities. UndEI' the regional and Intercountry allocation, the decrease Is due to the reduced provision for research activities, considerable support having been provided In 1988-1989.

Protection and promotion of the heaHh of specific population groups

Protection and promotion of the health of specific population groups

9.4 WORKERS' HEALTH

Estimated obligations

Regular budget

Other tources

1988-1989

199o-1991

Increase

(Decrease) %

1988-1989

199o-1991

US$ Country or area Regional and Intercountry

US$ 281 900 58000

US$ 116 200 (40 000)

US$

165 700 98000

70.13 ( 40.82)

TOTAL

263 700

339 900

76 200

28.90

9.5 HEALTH OF THE ELDERLY Objective To Improve the well-being and quality of life of the aged through the provision of community-based health services. planners, especially In developing countries, of the Implications of the Increasing numbers of elderly people and their needs. There are a number of factors, Including promotion of mental health, provision of primary health care, provision of aid and community assistance, as well as financial independence, which determine the well-being of the elderly. An aspect which is more often neglected Is the contribution that the elderly can make to the social and economic Improvement of the community in which they live. The well-being of the elderly Is not confined to the health sector alone, and the role of other sectors is crucial.

Targets By the end of 1995: (1) Most countries or areas will have determined the nature, extent and magnitude of the health and related problems of the elderly. (2) The majority of the countries will have formulated and will be Implementing policies and programmes on community-based hsalth care of the elderly, paying special attehtion to encouraging care within the family and their social integration in the community. (3) The majority of countries will have completed studies a'ld research on priority problems of the elderly.

Proposed programme activities for 1990-1991 National coordinating bodies. There is an urgent need for the establishment of multidisciplinary bodies which will support the coordination and Implementation of national programmes for care of the elderly in different sectors, especially by the health sector at community level. Establishment of such national mechanisms as well as strengthening of capabilities in data management will be supported on a country-by-country basis. Development of geriatric services and promotion of geriatric and gerontology education. The programme will support the establishment of appropriate country-specific geriatric services and the utilization of peripheral health workers In the management of simple health problems of the elderly. A review of geriatric and gerontology training in the schools of medicine and nursing will be undertaken to update the curriculum, which currently does not give adequate emphasis to these areas. Development of community-based model projects. Support will be provided to develop at least two model projects in two selected countries, which would provide adequate geriatric services. These would be community-based and provide for the participation of the local community. The objective of the programme Is to expand such services on a wider scale.

Situation analysis The data available from studies In the developing cour:trles of the Region Indicate that the problems faced by the elderly are comparable with those prevailing In developed countries In the Region, as well as lr other parts of the world. Further in-depth studies have shown that many of these problems could be tackled by making health care available at the communit{ and home levels and increasing the social awareness of the community cor earning the welfare of the aged. Further research is still required to define this p-oblem with reference to the situation in each country and to define activities at both national and community levels. There is still a lack of awareness among na:ional policy

Protection and promotion of the heaHh of specific population groups

Protection and promotion of the heahh of specific population groups A regional meeting on training in geriatrics and gerontolo~y. to be held In 1990, will enable more trainers In this particular field to update the present system of training at the national level and to coordinate train ng systems throughout the Region.

countries on specific health Issues of the aged, utilizing WHO collaborating centres, will be provided to selected countries.

Budgetary Implications An Increase In the regular budget provision has been noted for this programme for 1990-1991, mainly due to new requests from two countries for technical expertise and training activities, reflecting the growing concern over the problems of aging.

Studies and research on priority problems of the elderly In order to clearly understand the contributory factors which affect the health and well-being of the aged and to develop Intervention strategies for specific problems of the aged In selected countries, support will be provided for In-depth studies and research. Research training of health workers frorr developing

9.5 HEALTH OF THE ELDERLY

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease)

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 188 500 143 000

US$ 262 700 132 400

US$ 74200

US$

39.36 (7.41} 120 400

(10 600)

TOTAL

331 500

395 100

63 600

19.19

120 400

Protection and promot1on of the health of specific population groups

Protection and promotion of

men~l

heaHh

10. PROTECTION AND PROMOTION OF MENTAL HEALTH Objective To promote policies and programmes on mental health, taking Into account the psychosocial factors Involved In the promotion of health and human development, and policies and programmes on the prevention and control of alcohol and drug abuse and mental and neurological disorders.

10. PROTECTION AND PROMOTION OF MENTAL HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease)

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 349200

US$ 340500 336 500

US$ (8 700) 2770)

" (2.49)

US$

308 800

8.97

35900

TOTAL

658 000

677 000

19 00•)

2.89

35 900

Protection and promotion of mental health

Protection and promotion of mental heaHh·

100

10.1 PSYCHOSOCIAL AND BEHAVIOURAL FACTORS IN THE PROMOTION OF HEALTH AND HUMAN DEVELOPMENT Objective To promote policies and programmes on the psychosocial factors involved in the promotion of health and human development. causes of mortality and morbidity. However, health personnel are not sufficiently trained to deal with their clients' psychosocial or social problems. Certain population groups such as the elderly, children or women, are particularly vulnerable to psychosocial factors and suffer greater health damage.

Targets By 1995:

Proposed programme activities for 1990·1991 Development of national bodies. Support will be provided to selected countries undergoing rapid socioeconomic changes to develop national bodies to provide effective remedial measures to alleviate various psychosocial problems such as juvenile delinquency, violence, suicide, alcohol and drug · abuse. Promotion of training at national level. Collaboration will be provided to promote training in dealing With psychosocial problems. This will cover areas such as counselling, elementary psychotherapy and communication skills, etc. The importance of the training of general health workers and general physicians will be stressed In dealing with patients who are primarily suffering from psychological and family problems. Research at national and regional levels. Continuous collaboration will be made to promote research on the psychosocial well-being of high-risk groups. Particular priority will be given to research on psychosocial aspects of care for children and the elderly In different sociocultural settings In the Region and on the possible measures for alleviating problems.

(1) Research and surveys will have been undertaken In some countries or areas on the harmful consequences of rapid socioeconomic changes and on preventive strategies for alleviating them. (2) Information on and knowledge of the psychosocial aspects of problems of high-risk groups will have been Introduced Into the education and training of health workers and planners In most of the countries or areas. This will include health education and public Information. (3) Specific measures related to the psychosocial aspects of health will have been fully Integrated into primary health care activities in most countries.

Situation analysis Rapid social change resulting from economic development, Industrialization and urbanization In many countries or areas In the Region has had profound effects on the psychosocial well-being of Individuals. The resulting social disorganization Is causing various psychosocial problems such as juvenile delinquency, violence and accidents, alcohol and drug abuse, and psychosocial problems among the elderly, adolescents and childr~n. In both developed and developing countries or areas in the Region, diseases related to stress and an unhealthy life-style are becoming major

Budgetary Implications The budgetary provision does not show any significant change.

10.1 PSYCHOSOCIAL AND BEHAVIOURAL FACTORS IN THE PROMOTION OF HEALTH AND HUMAN DEVELOPMENT

Estimated obligations

Regular budget

Other sources

1988-1989

199Q-1991

Increase

(Decrease)

1988-1989

199Q-1991

US$ Country or area Regional and Intercountry

US$ 23 200 195500

US$ 3 400 700

US$

19 800 194 800

17.17 0.36

TOTAL

214 600

218 700

4100

1.91

Protection and promotion of mental health

101

Protection and promotion of mental heaHh

102

10.2 PREVENTION AND CONTROL OF ALCOHOL AND DRUG ABUSE Objective To promote policies and programmes on the control of alcohol and drug abuse. Increase In the abuse of amphetamine, organic solvents and psychotropic drugs In many parts of the Region.

Proposed programme a. ctlvttles for 1990-1991 National policies and programmes. Efforts will focus on collaboration with Member States to develop and strengthen national policies and programmes for the prevention of alcohol and drug abuse, and the treatment and rehabilitation of abusers In Fiji, Malaysia, Papua New Guinea, the Phtlippines, Republic of Belau, Republic of the Marshall Islands, and Tonga. Training. Support will be provided to organize national training programmes In selected countries or areas for health workers, education experts. health administrators, In order to develop comprehensive programmes to alleviate alcohol-related problems.

Targets By 1995: (1) All countries or areas will be Implementing national policies and programmes for the prevention of alcohol and drug-related problems. (2) Effective networks at global, regional and national levels for Information exchange on alcohol and drug-related problems and preventive measures will have been developed.

Situation analysis There Is growing recognition throughout the Region that alcohol and drug abuse Is creating major social and health problems. Alcohol-related problems continue to be a major public health and social Issue In a number of developing countries undergoing rapid socioeconomic changes. In some developed countries, there has been a steady decrease In the per capita consumption of alcohol due to comprehensive moderation campaigns. Drug abuse, particularly the abuse of heroin, continues to be a serious and long-standing problem In some Asian countries. There has been an

Extrabudgetary sources will be sought to strengthen training activities both at regional and national levels to prevent and control .alcohol and drug abuse problems in the Region. Research. Continuous efforts will be made to promote research on alcohol and drug abuse In the Region. Special attention will be paid to epidemiological studies, the behavioural aspects of addiction, the biological characteristics of abusers and educational measures to combat abuse.

Budgetary Implications The budgetary reduction Is mainly due to the decreases of allocations by two countries. Efforts will, however, be made to locate extrabudgetary resources to support this programme.

10.2 PREVENTION AND CONTROL OF ALCOHOL AND DRUG ABUSE

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 67000 48000

US$ (57 600) (15 000)

US$

124 600 63000

( 46.23) ( 23.81) 19100

TOTAL

187 600

115 000

(72 600)

( 38.70)

19100

Protection and promotion of mental health

103

Protection and promotion of mental heaHh

104

10.3 PREVENTION AND TREATMENT OF MENTAL AND NEUROLOGICAL DISORDERS Objective To promote policies and programmes on mental and neurological disorders within the framework of national health programmes. not well developed In many countries. In developing countries, prevention and cure of these diseases are neglected.

Proposed programme activities for 1990-1991 National mental health policies and programmes. Support will be provided to selected countries to organize national coordinating groups on mental health, which are multlsectoral and Interdisciplinary In composition, In order to plan, review and orient national mental health policies and programmes. The Fourth Regional Coordinating Group Meeting on the Mental Health Programme will be convened In Manila In 1990 to evaluate the regional and national mental health programmes In the Region and to recommend ways and means of Improving lntersectoral coordination In mental health.

Targets By 1995: (1) All countries or areas will have developed mental health policies and programmes, and will have established national coordinating mechanisms and groups on mental health programmes. (2) Community-based mental health services which are humane, cost-effective and socioculturally relevant will have been developed In most countries or areas.

Situation analysis In a few countries, there has been a steady development In formulating comprehensive mental health policies and programmes. National coordinating groups on mental health with multisectoral and interdisciplinary members have been established, and the formulation and revision of mental health legislation has been carried out in some countries. In many countries In the Region, mental health services are poorly organized and much remains to be done to provide humane, socioculturally relevant and cost-effective mental health services. Research and training on prevalent mental and neurological disorders, such as schizophrenia, depression, epilepsy, stroke and mental retardation are

Training. Technical support will be provided to develop community-based mental health services In selected countries or areas and to promote training and research In mental health and neurosciences. Research. Special efforts will be made to make the best use of WHO collaborating centres for mental health/neurosciences (4 in China, 2 In Japan, 2 in Australia) to develop regional and national research on priority areas In mental health/neurosciences.

Budgetary implications The budgetary increase Is due to the increased number of Member States allocating funds to this programme In recognition of the importance of mental health problems. The inclusion of a provision for the fourth meeting of the Regional Coordinating Committee on Mental Health in 1990 accounts for the Increase In the regional and intercountry allocation.

10.3 PREVENTION AND TREATMENT OF MENTAL AND NEUROLOGICAL DISORDERS

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 204 800 51 000

US$ 250300 93000

US$ 45500 42000

US$

22.22 82.35 16 800

TOTAL

255 800

343 300

87 500

34.21

16 800

Protection and promotion of mental health

105

Promotion of environmental health

106

11. PROMOTION OF ENVIRONMENTAL HEALTH Objective To promote policies and programmes for the Improvement of drinking water supply and basic sanitation, the control of environmental health hazards, the health risk assessment of potentially toxic chemicals, the enhancement of food safety, and the improvement of environmental health in rural and urban development and housing.

11. PROMOTION OF ENVIRONMENTAL HEALTH

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease)

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 2 287 200 2 192 200

US$ 2 552100 2 701 100

US$ 264900 508 900

"" 11.58

US$ 985 000 2 700

US$

23.21

TOTAL

4 479 400

5 253 200

773 800

17.27

987 700

Promotion of environmental health

107

,Promotion of environmental heaHh 108

11.1 COMMUNITY WATER SUPPLY AND SANITATION Objective To control diseases through the promotion and development of community water supply and sanitation services, thereby leading to Improvement in the quality of life. management activities carried out in support of the International Drinking Water Supply and Sanitation Decade (1981-1990). A review of the current situation, however, reveals that very few countries have comprehensive national plans for the water supply and sanitation sector. Although most countries have programme activities to expand services, these mostly comprise projects that are not Integrated in long-term plans. A major problem In plan development and Implementation is the shortage of trained manpower. At the national level, there is a need for administrators who can effectively plan and Implement comprehensive programmes. At the middle-government level, the effectiveness of programme implementation Is adversely affected by the lack of both technical and managerial expertise. At the community level, the ability to operate, maintain and repair facilities Is seriously hampered, and on-line service is constantly Interrupted, thereby minimizing or negating expected health benefits. Closely related to the ability to maintain and operate systems is the use of appropriate technology suitable to the rural environment. The capital-Intensive utility service approaches used In urban environments have serious technical, economic and social limitations in rural communities where the lack of technical adaptability can lead to project failure. Community participation can mitigate many of the Institutional, operational and administrative constraints, however. In some countries, the primary health care approach has used water and sanitation programmes as the focal point of community action. This, together with health education, can provide the sustained community interest and participation that are essential to success. Although financial commitments to the sector have increased in many Member States, there remains a major gap between needs and available funds. The lack of coordination among and support from international loan institutions and Insufficient bilateral cooperation remain major problems. Finally, monitoring and surveillance of the safety of water supplies and the appropriateness of sanitation systems are now being given greater

Targets By 1995: (1) Most countries or areas will have attained their national goals with respect to safe drinking water supply and adequate sanitation; the remainder will have achieved some Improvement In the level of service. (2) Most countries or areas will have established national plans and programmes for adopting water quality surveillance procedures and standards. (3) A majority of the countries or areas will be actively Implementing these comprehensive plans and will be monitoring and evaluating water quality, using their national standards.

Situation analysis Despite the best efforts of governments and International agencies, the lack of safe and accessible drinking water supplies and appropriate facilities for the disposal of sanitary wastes still adversely affects the health and welfare of over half of the rural populations in the Region. In some developing countries, only 10% of the rural population has access to appropriate sanitation facilities. During the early part of 1980, the primary component of the community water supply and sanitation programme was Its promotional effort. Great emphasis was placed on cooperation with countries in planning and in related

emphasis. These monitoring and surveillance activities are Important for evaluating programme effectiveness with respect to service levels and health Implications.

programmes, such as diarrhoeal disease prevention and control, will be encouraged. At regional level, WHO will provide support for training In programme development, appropriate technology, Information transfer/exchange, long-term operation and maintenance of equipment, and monitoring and dissemination of Information among countries. In this regard , specific activities will Include the organization of workshops and seminars; the development of appropriate technology demonstration projects; the promotion of programme evaluation methodologies; and the formulation and execution of pre-Investment planning studies.

Proposed programme activities for 1990-1991 The main thrust of activities In community water supply and sanitation will be directed toward the provision of technical cooperation to governments for the promotion of national programmes for Increasing the levels of service In providing safe drinking water, appropriate excreta disposal and solid waste management systems. At country level, WHO will collaborate In developing and Implementing national programmes In community water supply and sanitation, Including the development of appropriately trained manpower with emphasis on sector planning and management. The use of appropriate technology applicable to the customs and technical capabilities of the country will be encouraged, Including consideration of solar and wind power, on-site sewage and solid waste disposal, pour-flush latrines and hydrogeological monitoring techniques. WHO will collaborate In promoting Institutional development to ensure better monitoring and Implementation of programmes for both rural and urban water supply and sanitation systems. For example, national action committees or other coordinating bodies will be promoted. Also, community participation will be supported to ensure appropriate Input In planning facilities and, subsequently, In their construction, proper operation and maintenance. Special emphasis will be placed on cooperation with other primary health care elements such as health education and training of community workers. Support will be provided in developing information transfer/exchange systems. Multisectoral approaches to coordination with other health

Budgetary Implications The significant budgetary decrease is due to the phasing out of two Intercountry projects, one on environmental health for the South Pacific and the other relating to the International Drinking Water Supply and Sanitation Decade which formally ends In 1990. Support for post-Decade activities and water supply and sanitation work, previously covered by the South Pacific project, will be provided through the Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEP AS) under programme 11.2. At country level, a moderate budgetary Increase Is shown. This Is due to new requests from three countries mainly for support in training of health personnel In environmental health and from two other countries In the South Pacific for long-term technical support of their water supply and sanitation activities.

Promotion of environmental health

109

Promotion of environmental health

110

11.1 COMMUNITY WATER SUPPLY AND SANITATION

Estimated obligations

Regular budget

Other aourcn

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 1 484 100 740100

US$ 1 632 600 353 ()()()

US$ 148 500 (387 100)

US$ 644200

US$

10.01 ( 52.30)

TOTAL

2 224 200

1 985 600

(238 600)

( 10.73)

844 200

11.2 ENVIRONMENTAL HEALTH IN RURAL AND URBAN DEVELOPMENT AND HOUSING Objective To Improve health and psychosocial well-being through the promotion, development and Implementation of environmental Impact assessment programmes In relation to rural and urban development and housing. The major problems In promoting environmental health In urban and rural development and housing are economic and political In nature. Conventional planning approaches concentrate primarily on the economic benefits of programmes and projects. Under these approaches, controversial decisions to carry out programmes and projects are usually politically biased. Thus, the environmental health aspects of development efforts are accorded a lower priority than economic and political concerns. Another major problem Is the lack of planners and managers trained In the Integration of development and environmental health programmes. A strong mult isectoral and multidisciplinary approach Is required, as the components of these programmes affect many other areas and Involve broad concepts of technology and administration. Environmental health Impact assessment requires an understanding of complex technologies, legislative policies, Institutional development strategies and the evaluation of benefits and costs In economic as well as health and sociocultural terms. The lack of public awareness Is also a problem that hampers programme planning and Implementation. This often carries over Into the political arena where environmental health Issues are frequently relegated to a fairly low level of concern. ·

Targets By 1995, most countries or areas will have Incorporated environmental health measures Into rural and urban development and housing programmes as an Integral part of their policies for socioeconomic development.

Situation analysis The late 1960s and the early 1970s saw the recognition of the need for a balanced approach to development and environment. The United Nations Conference on the Human Environment (Nairobi, 1972) focused on the importance of the environment as an Integral part of national development. Over the past decade, progress has been made, albeit slowty, in the protection and preservation of the general environment. Concern for human health during this period has been largely overshadowed by the concern of natural conservationists tor the preservation of the environment. This has resulted primarily from the relatively weak position of health agencies and has been aggravated by the lack of understanding by health administrators of the necessity of Integrating multidisciplinary programmes. This perceptual weakness on the part of health administrators has led to weak organizational structures In th e health sect or, inadequate hum an resources and Ineffectiveness In the planning and implementation of environmental health programmes. In many countries, this has resulted in the creation of environmental protection agencies Independent of the basic health agency structure.

Proposed programme activities for 1990-1991 Activities In environmental health in rural and urban development and housing will focus on the provision of technical cooperation to governments for the promotion of national programmes, with emphasis on developing policies, legislation and plans, including the setting of guidelines for control, monitoring and surveillance programmes. At country level, WHO will support the efforts of Member States and socioeconomic development agencies to Incorporate environmental health

Promotion of environmental health

111

Promotion of environmental heaHh

112

considerations in development planning activities. In collaboration with national agencies, support will be given to efforts to strengthen public awareness of the environmental health aspects of development and housing programmes. The preparation of environmental impact assessment studies, including health impacts, will be supported. The development of health components in planning activities related to zoning, housing, traffic, recreational facilities and parks will be promoted. WHO will collaborate with national agencies In technology development and information exchange. At the regional level, WHO will promote and support environmental and health impact assessment studies, primarily through the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies. Regional workshops and seminars on various aspects of environmental health will be organized. Coordination will be maintained with other international agencies and nongovernmental organizations concerned

with development and housing. WHO will also promote technology development and Information exchange, Including support for national centres, applied research relating to appropriate technology development, and the conduct of case studies.

Budgetary Implications The significant increase In the regional and intercountry allocation will cover expanded activities of the Regional Centre for the Promotion of Environmental Planning and Applied Studies, particular1y directed towards chemical safety and food safety. The transfer under this programme of the Sanitary Engineer previously assigned to the International Drinking Water Supply and Sanitation Decade team, and additional provision for support services to the Centre, also account for the Increase.

11.2 ENVIRONMENTAL HEALTH IN RURAL AND URBAN DEVELOPMENT AND HOUSING

Estimated obligations

Regular budget

Other sources

1988-1989

1990.1991

Increase

(Decrease) %

1988-1989

1990.1991

US$ Country or area Regional and Intercountry 175 100 1 452 100

US$ 163 400 2 348100

US$ (11 700)

US$

(6.68) 61.70

896000

TOTAL

1 827 200

2 511 500

884 300

54.34

Promotion of environmental health

113

Promotion of environmental heaHh

114

11.3 HEALTH RISK ASSESSMENT OF POTENTIALLY TOXIC CHEMICALS Objectives To Improve awareness and understanding of potential untoward health risks that may result from Improper management of toxic materials. To Instigate and enhance programmes for the assessment and continued monitoring of existing environmental conditions and associated health risks In Member States. To reduce the number of P<>tentially harmful conditions associated with hazardous materials. to the environment and the potentially harmful materials carried by water, land, air and food. An assessment of environmental conditions Is needed to determine potential and real health problems that may exist In each country, the possible effects of these conditions on neighbouring countries and possible solutions to existing problems. A continuing monitoring and evaluation scheme Is also needed to detect changes In environmental conditions. An Information exchange programme Is needed to create ari awareness of potentially carcinogenic, mutagenic and teratogenic problems that may result from biological, chemical, physical and radiological exposure; toxicology training programmes,: comprising fellowships, study tours, workshops and seminars, are also needed to examine various aspects of these problems, such as the effects of multiple ~xposure, monitoring and epidemiology.

Targets By 1995:

(1) Most countries or areas will be aware of potential health risks associated with Improper management of toxic materials. (2) Some countries or areas will have developed or strengthened national programmes for assessment of the adverse health and environmental effects of potentially hazardous materials. (3) Some countries will have prepared or upgraded their laws/regulations pertaining to production, use and disposal of potentially hazardous materials.

Proposed programme activities for 1990-1991 The emphasis of activities in this programme will be on providing technical cooperation In promoting assessment and monitoring activities as well as corrective action. This will include the development of necessary enforcement legislation. At country level, WHO will collaborate in carrying out toxicological and environmental epidemiological studies to collect specific information on health effects and to forecast and model different health scenarios to estimate risks. Support will be provided for the development and Implementation of programmes to raise awareness of health and environmental hazards. At the regional level, WHO will promote the use of appropriate methodologies for the health risk assessment of potentially toxic chemicals. It will also promote the collection and analysis of information on health effects

Situation analysis Recent industrial and energy facility disasters have created a worldwide concern for the potential mutagenic and teratogenic effects on man. Increasingly Important In WHO's work with Member States is man's exposure

obtained from various environmental, epidemiological and toxicological studies. WHO will disseminate Information and data originating from this programme through an appropriate Information network (e.g. national Institutions) and will promote the use of data In national programmes for the control of environmental health hazards. Coordination will be maintained with other International agencies and nongovernmental organizations Involved In this field.

Budgetary Implications This Is a new programme under the Eighth General Programme of Work. At present, there Is no regional budget specifically allocated to this programme area; however, technical support can be provided through the Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) under programme 11 .2.

Promotion of environmental health

115

Promotion of environmental health

116

11.3 HEALTH RISK ASSESSMENT OF POTENTIALLY TOXIC CHEMICALS

Estimated obligations

Regular budget

Other sources

1988-1989

1990..1991

Increase

(Decrease) %

1988-1989

1990..1991

US$ Country or area Regional and intercountry

US$

TOTAL

11.4 CONTROL OF ENVIRONMENTAL HEALTH HAZARDS Objective To reduce environmental hazards through the promotion, development, planning and Implementation of control programmes. National responses to this situation have been largely ad hoc, driven mainly b~ errergency situations. There remains a need to develop environmental health policies and strategies for the management of toxic and hazardous materials. WHO programmes can respond to this need by cooperatl g with countries In the development of national plans for the control of environment31 health hazards.

Targets By 1995, most countries or areas will have formulated national policies, strategies and legislation for the control of environmental health hazards (biological, chemical and physical) and will be actively Implementing related programmes.

Proposed programme activities for 1990-1991 In the control of environmental health hazards, activities will focus on cooperation wi":h governments In the development and promotion of national programrr-es. At country level, WHO will collaborate In detailed strategy formulation with the overat alm of adequately controlling environmental health hazards while fostering sustainable economic and Industrial development. lntersectoral coordinati:M1 w:ll be given special consideration In the course of programme formulatio, and implementation. Support will be given to various aspects of national contrd programmes, Including the monitoring and surveillance of environmental health hazards resulting from the manufacture, transport, storage, lS8 allld disposal of chemicals and chemical residues. Support will also be given to the development of national manpower training programmes. At the 119glonallevel, WHO will promote programmes for the control of envi ronrne ntaJ health hazard s, Incl ud ing hazards resulting from the manufactue, transport, storage, use and disposal of chemicals. Studies of Intercounty problems, Including transboundary air pollution, will be promoted. Training actlvltl~s relating to the control of environmental health hazards will be supportec . Information will be collected and disseminated through an appropriaE network, which will include WHO collaborating centres and other national lrlStitutions. Coordination will be maintained with other international agencies and nongovernmental organizations in this field.

Situation analysis In the past decade, the abatement and control of water, air and land pollution formed the major thrust of activities In this programme area. In some countries, the programme has been quite successful In selected areas. Many countries, however, are faced with the growing degradation of their environment, and problems remain largely unsolved, mainly because of financial constraints. These problems have been compounded by Increasing quantities of waste consisting of toxic and hazardous substances that have health Impacts In terms of genetic changes, cancer and birth deformities. The problems of storing, transporting and using chemical compounds are also a cause for great concern as evidenced by incidents of accidental spills and dumping of oil and other Intentional releases. The long-term Impact of these uncontrolled discharges Into the environment Is largely unknown, except for the reports and documentation of the more dramatic Incidents. Large volumes of toxic and hazardous chemicals continue to contaminate the environment and pose long-term threats to human health.

Promotion of environmental health

117

Promotion of environmental heaHh

118

Budgetary Implications A significant Increase has been made In the control of environmental health hazards programme budget for one rapidly developing country In the

Region, which reflects Increased emphasis on cost -benefit analyses, hazardous waste management and risk assessment activities. Also, In one Island country of the South Pacific, a new control of environmental health hazards programme effort will be Initiated. This effort will be directed towards resolving water pollution problems Identified through prior WHO collaboration.

11.4 CONTROL OF ENVIRONMENTAL HEALTH HAZARDS

Estimated obligations

Regular budget

Other sources

1988-1989

1990..1991

Increase

(Decrease) %

1988-1989

1990..1991-

US$ Country or area Regional and Intercountry 401 000

US$ 484400

US$ 83400

US$ 340 800

US$

20.80

TOTAL

401 000

484 400

83400

20.80

340 800

Promotion of environmental health

119

Promotion of environmental health

120

11.5 FOOD SAFETY Objective To ensure the safety of food with a view towards reducing morbidity and mortality caused by food borne hazards. the most Important public health problem is the Ingestion eX food contaminated with pathogens leading to diarrhoeal syndromes. which can become life-threatening when superimposed on malnourished states. Nevertheless, efforts should be made to reduce all causes of unsafe food, whether they lead to acute or to chronic illness. While many national governments have established the necessary legislative framework for ensuring food safety, national Infrastructures frequently lack sufficient human and financial resources to Implement effective food control programmes. Persistent problems usually cited Include lack of qualified staff, inadequate or outmoded laboratories, and poorly coordinated regulatory systems. In many developing countries, mechanisms are needed to assess the extent of morbidity and mortality from food borne diseases. The general lack of Information and statistics related to food safety not only prevents the formulation of appropriate control strategies, but also obscures the true priority of food safety activities In health planning and policy-making. Rapid industrialization and urbanization accompanied by fundamental changes in the distribution, composition and consumption offood have created a critical need for greater awareness of food safety at all levels of society. In many Instances, legislators and administrators of agricultural, environmental and health programmes have not developed the political commitment to provide the continuous support for food safety programmes which Is necessary for their ultimate success. In many countries, the food Industry and occupational personnel at various stages of the food chain have not Integrated food safety concepts, especially hazard analysis methods, Into the total food production system. Involvement of the general public (especially housewives, parents and children), which is essential for the ultimate acceptance of safe food practices, has not been adequately encouraged through educational and information approaches. In summary, many countries do not have the capability to fully address their food safety problems. Inadequate infrastructures, lack of awareness and support for food safety objectives, and poor management are the predominant

Targets By 1995: (1) In half of the countries or areas, awareness will have been promoted on the Importance of food safety. (2) Half of the countries or areas will have developed or strengthened the basic infrastructure to plan, implement, monitor and evaluate food safety programmes. (3) Half of the countries or areas will be collecting and disseminating data and Information on food safety through a regional Information-sharing network.

Situation analysis Control of foodborne health hazards, for both health and socioeconomic reasons, continues to be of great significance for all countries of the Region. However, the impact of foodborne diseases on health has not been fully appreciated by many governments. Because of the ubiquitous nature of the problem, food borne diseases are less visible and more difficult to control and prevent than the more dramatic, but less regionally significant, outbreaks of other diseases. Food may become unfit for consumption for many reasons, including contamination and growth of pathogenic organisms, Improper use or accidental addition of chemicals, contamination by environmental pollutants, and nutrient degradation. It is generally agreed that

obstacles. A general strengthening of educational and Informational services Is also necessary to meet the special needs of various segments of society, Including government Industry and the public.

Governments will be supported In enlisting the support of nongovernmental organizations, the food industry, and consumers In a comprehensive effort to improve food safety, using culture-specHic information on food and nutrition practices. At the regional level, WHO will continue to support the work of the regional Codex Coordinating Committee for Asia, promote training courses for food safety personnel, and provide guidance in training primary health care personnel In the domestic aspects of food safety. WHO will foster technical cooperation activities among countries and cooperate with other regional United Nations bodies and selected regional nongovernmental organizations.

Proposed programme activities for 1990-1991 The main activities In the food safety programme will be directed toward cooperating with governments In the development of national food safety programmes. At the country level, WHO will continue to collaborate with Member States In Identifying national food safety problems and in formulating national food safety policies and strategies Involving all elements of the food chain, Including producers, distributors, food processors and manufacturers, retailers and consumers. WHO will support governments In reviewing legislation and strengthening Its Implementation, and In advocating lntersectoral coordination and cooperation. It will collaborate In the establishment and strengthening of foodborne disease surveillance and food contamination monitoring .

Budgetary Implications While the budgetary Increase Is minimal, Increased emphasis on the training of food safety personnel is evident In the 1990-1991 country programme for four countrieS/areas, most of which Is directed toward enhancing the Implementation of new or revised food safety legislation.

Promotion of environmental health

121

Promotion of environmental heaHh

122

11.5 FOOD SAFETY

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 271 700

US$ 44700

US$

227 000

19.69 2700

TOTAL

227 000

271 700

44 700

19.69

2700

12. DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE TECHNOLOGY Objective To promote 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.

Diagnostic, therapeutic and rehabilitative technology

123

Diagnostic, therapeutic and rehabilitative technology

124

12. DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE TECHNOLOGY

Estimated obligations

Regular budget

Other sources

1988-1989

199o-1991

Increase

(Decrease) %

1988-1989

199o-1991

US$ Country or area Regional and Intercountry 2 565 300 976 200

US$ 3115300 1 096 900

US$ 550 000 120 700

US$ 597 200 536000

US$

21.44 12.36

211 100

TOTAL

3 541 500

4 212 200

670 700

18.94

1 133 200

211 100

12.1 CLINICAL, LABORATORY AND RADIOLOGICAL TECHNOLOGY FOR HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE Objectives (1) To develop or strengthen national health laboratory services, In order to meet the diagnostic, case management and monitoring needs of curative and preventive medicine, using appropriate technology, with particular emphasis on support for primary health care. (2) To promote the development of the basic radiological services and the use of Ionizing radiation and other Imaging technologies. (7) Most countries or areas will have In operation basic radiological services at first referral level hospitals and will have trained an adequate number of radiological staff to provide basic radiodiagnostlc services. (8) At least half the countries or areas will be developing radiation protection programme against avoidable exposure to radiation.

Situation analysis Major emphasis was placed on the Introduction of laboratory quality control to countries through participation of national central laboratories In the International quality control scheme. The number of countries joining the International assessment scheme Increased from one in 1985 to eight in 1987. Training was provided to laboratory personnel of many developing countries to strengthen laboratory diagnostic capability, particularly through the introduction of simple and rapid diagnostic methods. There has been an Imbalance In the development of laboratory services In developing countries. Frequently, the central laboratory, particularly the clinical part, is much more developed than the Intermediate and peripheral laboratories, which In some countries are only rudimentary. The increase of microorganism resistance to antibiotics is a problem In the region. Although this problem is known to health authorities in many countries, only a few measures have been taken to prevent the situation from further deteriorating. A recent review of blood transfusion services in some countries in the Region revealed a number of serious deficiencies in their organization and management of safe blood and blood products supply.

Targets By 1995: (1) All countries or areas will have developed and strengthened clinical, public health laboratory services as an Integral part of the national health system. (2) Most countries or areas will have laboratory diagnostic technologies for most common diseases. (3) Most countries or areas will have established quality control procedures. (4) Most countries or areas will have introduced continued refresher training for local laboratory staff. (5) Most countries or areas will have established a surveillance system and Information network of antimicrobial resistance. (6) Most countries or areas will have developed a system for the supply of safe blood and blood products.

Diagnostic, therapeutic and rehabilitative technology

125

Diagnostic, therapeutic and rehabilitative technology

126

Radiological services are unequally distributed across the Region. There Is a strong bias In favour of the developed countries and urban centres rather than developing countries and rural communities. Most developing countries face some common problems: shortage of trained personnel, Including radiologists, radiographic technicians, technicians for maintenance and repair of X-ray machines, and specialists for radiation medicine and radiation protection; shortage of basic radiological equipment at first referral level; lack of quality assurance of radiodlagnostlc and radiotherapeutic technology; and inadequate selection, utilization and maintenance of radiological equipment. During the period of the Seventh General Programme of Work, support was provided to most of the Member States for Improving basic radiological services through the training of national staff and the provision of basic . radiological equipment. With active participation In the IAENWHO postal dose lntercomparison programme, the quality of radiotherapeutic services has Improved In a number of countries. However, there is a need to continue collaborative efforts In improving the basic radiological services to support primary health care.

Cooperation will be extended to reference laboratories, collaborating centres, scientists and International organizations to establish and promote quality assessment schemes In most of the countries or areas In the Region.

Radiological technology Cooperation will be continued In the training of personnel for diagnostic and therapeutic radiology, as well as for the maintenance and repair of X-ray and other radiological equipment. Major efforts will be made to develop basic radiological services at the district level. Support will be provided to assess the needs of planning, establishment and management for basic radiological services. Guidelines for setting up district basic radiological services will be developed. WHO will further promote the setting up In Member States of basic radiological systems and efforts will be made to promote their production locally. Quality assurance and radiation safety will be further strengthened. WHO collaborating centres for radiology In the Region will be further used In the International exchange of Information and the development of research and training.

Proposed programme activities for 1990-1991 Laboratory technology Support will be provided to countries or areas In the development, selection and adoption of essential and simple laboratory diagnostic procedures. In this respect, WHO will collaborate in particular with countries in the South Pacific. Special attention will be given to training laboratory personnel for the Improvement of diagnosis of communicable diseases, and blood transfusion services. A regional workshop on quality assurance for blood transfusion and blood screening tests will be organized in 1990 in Malaysia. Technical support will be provided to promote local production and upgrading of quality of diagnostic reagents in countries such as China, Philippines and Viet Nam. WHO will collaborate with governments to identify a focal point in each country for the computerized collection and analysis of data on resistance to antimicrobial agents. This information will be sent to national laboratories and to the Regional Office.

Budgetary Implications The budgetary Increase at country level reflects the continued high priority given by governments to health laboratory services, especially In the South Pacific. This significant budgetary Increase will be applied mainly to manpower training and the strengthening of rural laboratory services. At regional and Intercountry level, the Increase Is due to the Inclusion of a project on radiation health.

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

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1891

US$ Country or area Regional and Intercountry 1017200 267 800

US$ 1 409 300 318 500

US$ 392100 50700

US$ 18600

US$

38.55 18.93

TOTAL

1 285 000

1 727 800

442 800

34.46

18600

Diagnostic, therapeutic and rehabilitative technology

127

Diagnostic, therapeutic and rehabilitative technology

128

12.2 ESSENTIAL DRUGS AND VACCINES Objective To ensure the availability of essential drugs and vaccines of adequate quality at an affordable cost to all In need, through collaboration with Member States In the establishment and Implementation of effective national drug policies and programmes. others are still dependent on external resources for the acquisition of even the most essential drugs. Most developing countries have formulated national lists of essential · drugs for the public sector. Some of these update the list on a regular basis. However, there is considerable variation In the way the list Is actually utilized in health care. With Increasing product diversification on the drug market, ensuring the rational use of drugs on the list requires an effective programme of educational, informational and moral support. The limited availability of trained manpower continues to be a major constraint in the development and maintenance of national essential drugs programmes, particular1y in small Island countries or areas in the South Pacific.

Targets By 1995:

(1) All countries or areas will be Implementing national drug policies on the selection, procurement, storage, distribution and utilization of essential drugs and vaccines. (2) Some countries or areas with adequate resources will have developed the capability to produce some essential drugs and vaccines of appropriate quality. · (3) Most countries or areas will have developed satisfactory networks for the distribution of essential drugs and vaccines to the periphery. (4) Most countries or areas will have sufficient legislation, administrative structure and trained personnel to implement the above activities.

Proposed programme activities for 199Q-1991 Drug policy and supply management. WHO will support Member States in the formulation, review and implementation of national drug policies and programmes with emphasis on updating essential drug lists through the provision of technical expertise, improvement of drug procurement and supply through training of personnel, and the promotion of Information exchange among countries on useful national experiences. Local production. Where Infrastructure exists, support will be provided to strengthen national capability for local production of essential drugs through the training of personnel and provision of necessary supplies. Promotion of technical cooperation among developing countries. WHO will promote subregional technical cooperation among developing countries, particular1y in the South Pacific and among the ASEAN countries.

Situation analysis The availability of essential drugs and vaccines varies considerably among Me.f!lber St~tes In the Region,.~epending on their stage of development and prevailing socioeconomic cond1t1ons. Some d eveloping countries have successfully developed efficient drug procurement and supply systems while

The main areas of this collaboration will be drug procurement and supply In the South Pacific and quality assurance, rational use of drugs, drug 11anagement at the peripheral level and training of personnel In these areas In the case of ASEAN collaborative activity.

Budgetary Implications The Increase In the regular budget provision Is attributable to the expansion of programme activities at the country level, and the Inclusion of one more country In these activities. Extrabudgetary support from UNDP for country actlvfties Is expected to decrease significantly In 1990-1991.

Diagnostie, therapeutic and rehabilitative technology

129

Diagnostic, therapeutic and rehabilitative technology

130

12.2 ESSENTIAL DRUGS AND VACCINES

Estimated obligations

Regular budget

Other sources

1988-1989

199Q-1991

Increase

(Decrease) %

1988-1989

199D-1991

US$ Country or area Regional and Intercountry 782 300 378 800

US$ 900 100 364100

US$ 117800 (14 700)

US$ 458600 536000

US$

15.06 (3.88)

211 100

TOTAL

1 161 100

1 264 200

103 100

8.88

994 600

211 100

12.3 DRUG AND VACCINE QUALITY, SAFETY AND EFFICACY Objective To support Member States in the establishment and implementation of effective national programmes for monitoring and maintenance of the quality, safety and efficacy of the pharmaceutical products. evaluation, constant development in related sciences and technology requires continued training to upgrade the capability of personnel. In small countries or areas in the South Pacific, constraints on the availability of trained personnel and funding support often hinder the establishment and maintenance of adequate regulatory control mechanisms.

Targets By 1995:

Proposed programme activities for 1990-1991 Training of personnel. In order to support Member States to develop or strengthen national capabilities for quality assurance of drugs and vaccines, emphasis will be placed on training personnel in such areas as drug evaluation, registration, good manufacturing practices, inspection and laboratory quality control. Institutional strengthening. Support will be provided to strengthen some national quality control laboratories in the form of technical expertise and necessary equipment. Subregional drug testing capability in the South Pacific will be developed in cooperation with a WHO collaborating centre.

(1) Most countries or areas will have developed means of monitoring and maintaining the quality, safety and efficacy of domestically produced and imported drugs and vaccines. (2) Most countries or areas will have established a suitable network for information dissemination on ail matters concerning drug efficacy and safety, including adverse drug reactions.

Situation analysis There Is increasing awareness of the need for adequate drug regulatory control programmes consisting of such elements as drug evaluation and registration, licensing of drug handlers, quality assurance through the implementation of good manufact uring practices. laboratory quality control and inspection programmes. Some developing countries have introduced adverse drug reaction monitoring programmes. In laboratory quality control and drug

Budgetary Implications Overall, there Is no significant change from the previous biennium. At the regional and intercountry level, provision for a workshop on drug information exchange accounts for the increase.

Diagnostic, therapeutic and rehabilitative technology

131

Diagnostic, therapeutic and rehabilitative technology

132

12.3 DRUG AND VACCINE QUALITY, SAFETY AND EFFICACY

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 287 500 11 000

US$ 299900 48100

US$ 12 400 37100

US$ 115 300

US$

4.31 337.27

TOTAL

298 500

348 000

49 500

16.58

115 300

12.4 TRADITIONAL MEDICINE Objective To promote applied research, particularly on safety and efficacy, and training In traditional medicine, with emphasis on herbal medicine and acupuncture, with a view to Integrating traditional medicine Into general health services. understanding between practitioners of modern and traditional medicine, and lack of political, legal, material and other necessary support. (2) Lack of Information on the quality, safety and efficacy, and cost-effectiveness of traditional medicine, and on existing traditional medicine practices, particularly In the South Pacific. (3) Lack of resources, particularly managers and field workers capable of pioneering effective programmes, organizations representing traditional medicine practitioners, financial resources, and infrastructural facilities for research, training, transport, communication and supplies such as traditional drugs. The Region continues to play a leading role in research, training and Information exchange on herbal medicine and acupuncture In the promotionaJI, preventive and curative aspects of health.

Targets By 1995, most countries or areas will have developed and strengthened traditional medicine activities and Integrated them Into the general health services.

Situation analysis The baseline situation of traditional medicine shows wide variations among countries or areas. On the one hand, highly developed systems of traditional medicine exist in countries In the northern part of the Region and among Immigrants from China and the Indian sub-continent. Herbal therapies generally predominate, while physical therapies, such as acupuncture and the regulation of life-style, are also prominent features. On the other hand, the simpler systems of smaller and more Isolated ethnic groups are to be found in which psychosocial therapies predominate, often merging with magical and religious practices. Economic, geographical, cultural and biomedical needs vary greatly, as do resources. Official attitudes also vary ranging from major Involvement to lack of Interest. However, there have been successful demonstrations of the Integration of traditional medicine Into general health services In some countries of the Region. There has been growing awareness of the value of traditional medicine In the last decade, particularly with regard to herbal medicine and acupuncture. Existing problems are summarized as follows: (1) Social factors: slow recognition of the value of traditional medicine by workers In the modern health sector, lack of mutual respect and Diagn· o stic, therapeutic and rehabilitative technology

Proposed programme activities for 1990-1991 Cooperation will be extended to Member States for the development of national policies Integrating traditional medicine Into the general health system, particularly Into primary health care. Research will be promoted to establish the value of traditional medicine within a scientific framework, particularly with respect to herbal medicine and acupuncture. This will be done through various forms such as (1) Inventory survey of medicinal plants and developing of bibliography on herbal medicine research In the South Pacific; (2) undertaking work In relation to standardization of the terminology of herbal medicine in the northern part of the Region; (3) supporting national workshops on herbal medicine research, particularly to ensure quality, safety, efficacy and cost-effectiveness; and (4) strengthening research capability for the basic and clinical study of acupuncture. Further cooperation will be provided for the training of various categories of personnel, such as programme managers, traditional medical doctors, and modern physicians. Information exchange will be strengthened, as this plays an important role in promoting cooperation between the groups

133

Diagnostic, therapeutic and rehabilitative technology

134

concerned. Information will be disseminated through meetings, seminars, publications, and cooperation with collaborating centres and nongovernmental organizations. A regional working group on herbal medicine will be organized In 1990.

appropriate regulations on traditional drugs and training of staff. The Increase In one ongoing project also Indicates that the government wishes to strengthen training and research activities In traditional medicine. At regional and intercountry level, the increase Is mainly due to activities related to the standardization of terminologies In herbal medicine and the development of guidelines on Its quality, safety and efficacy and to the holding of a regional working group on herbal medicine In 1990.

Budgetary Implications At country level, the increase is mainly due to two new country projects, which will be concerned particular1y with research In traditional medicine and

12.4 TRADITIONAL MEDICINE

Estimated obligations

Regular budget

Other sources

1988-1989

199~1991

Increase

(Decrease) %

1988-1989

199~1991

US$ Country or area Regional and Intercountry 249900 261 100

US$ 343 600 292 700

US$ 93 700 31 600

US$

37.49 12.10

TOTAL

511 000

636 300

125 300

24.52

Diagnostic, therapeutic and rehabilitative technology

135

Diagnostic, therapeutic and rehabilitative technology

136

12.5 REHABILITATION Objective To promote the development of community-based rehabilitation services and appropriate rehabilitation technology. In all countries or areas, national and local rehabilitation centres have been developed or strengthened. These centres could play a major role In the provision of referral services, organization of training programmes and rehabilitation services, and research and development, but only if their functions are reoriented towards the needs of the community. The tra ining of rehabil itation therapists and community-based rehabilitation personnel has made some progress, and technical cooperation between Member States and WHO collaborating centres for rehabilitation has been promoted. The major problems and constraints In developing the programme on rehabilitation are: (a) it remains a low priority area in some countries and areas; (b) many people, Including health workers, still think mainly in terms of institution-based rehabilitation services; (c) many developing countries lack the necessary resources and trained personnel to develop rehabilitation services.

Targets By 1995: (1) Most countries or areas will have initiated community-based rehabilitation services in the context of primary health care.

(2) Half of the countries or areas will have rehabilitation centres for the provision of referral services and technical expertise, and the training of rehabilitation personnel. (3) WHO will have in operation an effective mechanism for the exchange of information on rehabilitation programmes and on useful developments in technical cooperation between Member States.

Proposed programme activities for 1990-1991 The main thrust of the programme Is to promote further the development of community-based rehabilitation services in association with primary health care and to support appropriate international, educational and technological development.

Situation analysis . There are over 100 million mentally or physically disabled people in the Reg•on, at least 10 million of whom are in need of rehabilitation services. Since the International Year of Disabled Persons (1981), progress has been made In the development of rehabilitation services for the disabled, the prevention of disability and Improvement of the social life of handicapped people. Most cou nt ri es of the Region have Init iat ed or developed In some, a national plan for the rehabditat ron of drsabled persons has been draw n up and intersectoral coordinating bodies established . However, these activities Involve only a minority of disabled people, and general rehabilitation services are still not accessible for the majority. com~~nity-based ~ehabllitation activities.

Development of community-based rehabilitation. WH 0 will collaborate with Member States in expanding the community-based rehab_ilitation programme, In developing and upgrading national capacity for planmng and managing the community-based rehabilitation programmes, in integrating rehabilitation services Into primary health care and in improving intersectoral coordination. A regional working group on planning and management of community-based rehabilitation will be held in Manila in 1990 to exchange information and develop guidelines.

WHO will provide support to China, Lao People's Democratic Republic, Samoa and Viet Nam for the conduct of training activities and in planning and managing community-based rehabilitation programmes. Educational resources development. Support will be provided for the translation and adaptation of the new version of the WHO manual Training disabled people in the community and for the development of training curricula for rehabilitation therapists.

Budgetary Implications The decrease In the budget provision for this programme Is due to the discontinuation of one long-term post at country level.

Diagnostic, therapeutic and rehabilitative technology

137

Diagnostic, therapeutic an(f rehabilitative technology

138

12.5 REHABILITATION

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 162 400 73 500

US$ (66 000) 16000

US$ 4 700

US$

228400 57 500

( 28.90) 27.83

TOTAL

285 900

235 900

(50 000)

( 17.49)

4700

13. DISEASE PREVENTION AND CONTROL Objective To promote policies and develop programmes for the prevention and control of communicable and noncommunicable diseases.

Disease prevention and control

139

Disease prevention and control

140

13. DISEASE PREVENTION AND CONTROL

Estimated obligations

Regular budget

Other sources

1988-1989

1990.1991

Increase

(Decrease)

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 4 891 000 3393 300

US$ 5 897 800 3660 800

US$ 1 006 800 267 500

US$ 2165 700 5 066000

US$

20.58 7.88

1 600 ()()()

TOTAL

8 284 300

9 558 600

1 274 300

15.38

7 231 700

1 800 000

13.1 IMMUNIZATION Objective To reduce morbidity and mortality from diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis by providing Immunization against these diseases for every child In the Region by 1995 and by providing Immunization against neonatal tetanus as needed for women of childbearing age. (7) In most countries, the Incidence of diphtheria, tetanus neonatorum and poliomyelitis will have been reduced to zero and mortality from pertussis will be absent. In the South Pacific, most of the countries will have reduced · measles to zero. (B) Most of the countries In the region will have Introduced one or more vaccines to the six currently being used.

Targets By 1995: (1) All countries or areas will have provided Immunization services to all chHdren against the six target diseases and will have developed national self-reliance in cold chain system and provision of vaccines. (2) All countries or areas will have reviewed and ur:xtated their national Immunization plans so as to Include at least one yearty review/evaluation of the programme. (3) All countries or areas will be using vaccines which meet potency and safety requirements recommended by WHO. (4) All countries or areas will have established an effective and ?peratlonal cold chain system for the storage and transport of vaccines, and its maintenance. (5) All countries or areas will have developed effective surveillance of immunlzable target diseases. (6) All countries or areas will have organized training courses on all aspects of the national Immunization programme for middle-level health personnel and provided basic training for peripheral health workers.

Situation analysts The expanded programme on Immunization In the Region has been established and expanded In all the developing and developed countries, utilizing vaccine against all six target diseases - diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis. Through collaborative efforts, the estimated Immunization coverage of children under one year old, which was less than 10% at the outset of the programme, attained 40% In 1983 and over 60% in 1987 for all the vaccines. To achieve higher Immunization coverage, accelerated activities were Initiated In China, Democratic Kampuchea, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam. Developed countries and Island countries of the Pacific basin continued to consolidate and maintain high immunization coverage. lmmunlzable target diseases have continued to show a decreasing trend and several countries are showing a very low or zero incidence for some of the diseases such as poliomyelitis, diphtheria and tetanus. A number of national training courses for mid-level managers continued to be held In the main countries of the Region; intercountry training workshops were held In 1986 and 1988. Training material developed by WHO for the peripheral health workers has been adopted by several countries and used for in-service training.

Disease prevention and control

141

Disease prevention and control

142

Prototype health education materials developed by WHO have been provided to the countries to be adapted to local needs. Consultant services were provided to Fiji, Papua New Guinea and Tonga. Major comprehensive programme reviews were conducted In China, the lao People's Democratic Republic, Papua New Guinea, the Philippines and VIet Nam; revised plans were drawn up to achieve high Immunization coverage and attain the 1990 goal of immunization for every child. Several countries, where the hepatitis B virus carrier rate Is high have Initiated hepatitis B Immunization of newborns by Integrating It Into the Immunization programme, notably China and several of the Pacific basin countries. Poliomyelitis elimination In the Western Pacific Region Is becoming a goal and activities to achieve this goal have been Initiated. A regional workshop for Immunization programme managers and senior medical officers responsible tor communicable diseases was held in June 1988 to initiate regional and national activities to eliminate poliomyelitis and to reduce and control other target diseases so that they cease to be a public health problem.

receive more attention. Support will also be given at national level to Incorporating training materials Into the curricula of health manpower training Institutions. Comprehensive programme evaluation wMI be supported on a regular basis In order to u~ate Implementation plans and remove constraints. WHO will continue to make available to countries the services of Its Intercountry project staff, Its vaccine quality control system and testing facilities for cold chain equipment to ensure that vaccines meet the potency and safety requirements recommended by WHO. WHO will continue to support the development of new cold chain equipment, sterilization systems and better and longer-lasting needles and syringes. Research and trials on alternative energy sources will be given higher priority than in the past. Where feasible, Integration of additional vaccines, In particular hepatitis B vaccine, within the Immunization programme will be encouraged and supported. In China and the South Pacific Island countries, support will be continued and expanded. Poliomyelitis elimination activities will be developed and Implemented. Prototype health education materials will continue to be developed and distributed for adaptation to local use. WHO will continue to develop technical materials and guidelines for various Immunization activities for distribution to governments. The two-way exchange of Information will continue.

Proposed programme activities for 1990-1991 WHO will continue to cooperate with all governments in the Improvement, acceleration and consolidation of existing immunization programmes through better planning and replanning and an Improved monitoring system for immunization coverage. Greater emphasis will be placed on the development and surveillance of the target diseases to monitor trends. Support will be given to the development of activities for poliomyelitis elimination and measles and neonatal tetanus control. Support will continue for increasing the production and upgrading the quality of vaccines in China, Philippines and Viet Nam. Activities in the area of training will focus on development of management and supervisory skills, recognition and surveillance, including case or outbreak investigations and the laboratory aspects of target diseases. Training in logistics and maintenance and repair of cold chain equipment will

Budgetary implications There Is a decrease In the regional and Intercountry budget as there will not be any need to hold Intercountry meetings of the managers of EPI, but support for national workshops will continue. Efforts will also be made to obtain funds from other sources to support this programme, but the extent of this support is not presently known.

13.1 IMMUNIZATION

Estimated obligation•

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decreaae)

1988-1989

1990-1991

US$ Country or area Regional and intercountry

US$ 579 700 334100

US$ 46400 (47 700)

"" 8.70 ( 12.49)

US$ · 135 900 698100

US$

533 300 381 800

TOTAL

915 100

913 800

(1 300)

(0.14)

834000

Disease prevention and control

143

Disease prevention and control

144

13.2 DISEASE VECTOR CONTROL Objective To reduce the abundance of vectors and animal reservoirs of major public health importance so that they no longer constitute a threat to the health and well-being of the people. The alarming widespread dengue outbreaks that were occurring five and ten years ago In the South Pacific seem to be diminishing. The filariasis control programmes in China, Malaysia and the South Pacific are achieving good success and clinical symptoms are expected to be less frequent and severe in young population groups which will eventually replace older generations. However, transmission and infection Wilfcontinue in areas where there has been slow progress in Improving housing, sanitation and socioeconomic conditions. Little progress has been made in preventing large numbers of dengue cases in the Lao People's Democratic Republic and Viet Nam. Promising epidemiological results have been obtained with insecticide-impregnated mosquito nets in several malarious countries. This safe and low-cost technology, which communities can use with minimum training and equipment, has been expanded to large-scale operational undertakings in China, Papua New Guinea and Solomon Islands. Similar progress needs to be achieved in other malarious countries where alternate vector control measures are needed to complement DDT indoor residual spraying.

Targets By 1995:

(1) Most countries or areas which are seriously affected by vectorborne diseases will have implemented viable vector control programmes involving communities in their self-protection. (2) Ali countries or areas will have developed improved surveillance systems to enable them to readily detect the inception of outbreaks of arboviral diseases and thus make possible the carrying out of timely preventive measures against epidemics. (3) Improved control measures will have been implemented in major International airports and seaports to prevent the spread of insect vectors and rodents in international travel and commerce.

Proposed programme activities for 1990-1991 National activities will focus on achieving greater community participation in the programme and on application of personal protection measures to prevent mosquito bites and malaria infection. In addition to insecticide-impregnated mosquito nets and curtains, low-cost repellents in highly endemic malarious areas will also be promoted. Some progress has already been achieved with a repellent soap which can be made with coconut oil under rural village conditions. Communities will be encouraged to eliminate the breeding sites of dengue and filariasis vectors which breed in and around houses in countries or areas of the South Pacific. A solution to the dengue problem in countries such

Situation analysis The priority vectorborne diseases requiring the most attention are malaria, dengue haemorrhagic fever, filariasis and Japanese encephalitis. Scrub typhus and plague are becoming less important. Malaria is still a major health problem in several countries and outbreaks of dengue fever remain a constant threat in many countries of the Region. Seasonal epidemics of Japanese encephalitis still occur in China and Viet Nam. The mosquito-borne disease affecting the most people is filariasis.

as the Lao People's Democratic Republic and VietNam will require more efforts at the grassroots level to mobilize community action. Governments In the Region will be encouraged to give more attention to comprehensive health education programmes and legislation as a means of stimulating community Involvement In vector control. National training courses and workshops will continue to be organized for health Inspectors, laboratory technicians, entomologists and medical officers responsible for vector control. Technical cooperation will continue in the area of emergency preparedness against arboviral outbreaks and In maintaining effective vector and rodent control at international airports and

seaports. Operational research proposals will be promoted from scientists In the Region on innovative, cost-effective combinations of vector control measures, Including the use of Insecticide, personal protection and vector source reduction that can be used at the community level.

Budgetary Implications The Increase In the budgetary provision Is due to an expansion of activities in seven countries, with emphasis on training, quarantine, epidemic prevention and appropriate vector control techniques. The country activities will continue to be closely linked with the Intercountry programme.

Disease prevention and control

145

Disease prevention and control

146

13.2 DISEASE VECTOR CONTROL

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 283 200 230 300

US$ 370 400 215 500

US$ 87200 (14 800)

US$ 18100 17 400

US$

30.79 (6.43}

TOTAL

513 500

585 900

72400

14.10

35 500

13.3 MALARIA Objective To foster national and International action for controllng and, where feasible, eradicating malaria In the Western Pacific Region, and for preventing the re-establishment of malaria In countries or areas where It has been eradicated or was never endemic, so that malaria no longer constitutes a threat to the health and well-being of the population by the year 2000. health system based on primary health care. In this context, emphasis Is being laid on community participation In malaria control activities, and referral and specialized services by different levels of the health system. The various malaria control activities that a community should participate In are being tried out and expanded, although this Is a slow process. These include malaria diagnosis and drug distribution, distribution and use of mosquito nets impregnated with pyrethroids, and simple vector source reduction. In view of the Increasing technical problems, including widespread resistance of the parasite to antimalarial drugs and the decreasing response of vector mosquitos to Insecticide spraying, epidemiological and operational studies are being carried out to select the most locally suitable methods for controlling malaria.

Targets Byl995: (I) All countries or areas with endemic malaria will have established and will be implementing nationwide malaria control programmes based on primary health care principles. (2) Most countries or areas with endemic malaria will have developed national capabilities In applied field research In malaria.

Proposed programme activities for 1990-1991 Technical collaboration will continue In the development of national malaria control programmes with special emphasis on primary health care approaches. In some countries of the South Pacific, such development Is being pursued through a pilot project In districts or areas with contrasting ecological and epidemiological situations. Collection and dissemination of Information on changes In drug sensitivity or resistance at global and regional levels and on newer drugs will be continued, on the basis of which guidance and suggestions on the drug regimens suitable in different situations will be made available. Operational research will be promoted to identify suitable and available combinations of control measures, including vector control and personal prote.ctlon from mosquito bites In areas with different epidemiological situations. Such operational research Is most needed in the countries or areas with multifaceted technical and operational problems, including antimalaria drug resistance.

Situation analysis The malaria situation In the Region has remained unchanged in recent years, but, among the affected countries, considerable diversities exist in the epidemiology, control strategies and operations. Steady progress Is being made in China, whereas high malaria Incidence continues to occur In the Pacific countries and some areas of other countries. The malaria-free status In originally non-malarious countries and In countries or areas from which the disease has been eradicated has been maintained. Most countries Involved have gradually revised their antimalarial strategies and Integrated the malaria control programme within the country's

Disease prevention and control

147

Disease prevention and control

148

Training of antlmalaria personnel and other operational staff and development of specialized expertise will receive high priority. While national malaria training programmes will be further strengthened, support will be provided to enable staff to avail themselves of Intercountry/international training facilities. .

In the country allocations, there Is a significant increase in three countries, d•e to increased collaboration, including training activities, but this has been oflset by significant decreases attributable to the termination of one long-term staff post in one country .

Budgetary Implications The overall regular budget estimates for malaria for 1990-1991 show a slight increase compared to the previous biennium.

13.3 MALARIA

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 1515800 738 000

US$ 1 526 900 792 500

US$ 11 100 54500

US$ 241 900 8100

US$

0.73 7.38

TOTAL

2 253 800

2 319 400

65 600

2.91

250 000

Disease prevention and control

149

Disease prevention and control

150

13.4 PARASITIC DISEASES Objective To prevent and progressively control major human parasitic diseases other than malaria, such as schistosomiasis, filariasis, clonorchiasis, paragonimiasis, and protozoan and Intestinal helminthic infections.

by 78%. TM disease still persists In mountainous and lake regions where effective envi·onmental and snail control programmes are difficult to maintain. In t~e Philippines, 0.2 million people have been treated with prazlquantel in recent years, and It Is estimated that 0.5 million remain infected with schistos::>miasis In 22 provinces. In Leyte Province, the prevalence rate has dropped from 22% to below 9%. The target to reduce the prevalence to below 5% by 1990 is considered feasible. Prog ·ess continues to be made In controlling filariasis In Malaysia, Samoa and other South Pacific countries. Diethylcarbamazine has reduced microfilarial densities, prevalence rates and severe clinical symptoms. In China, the number d filariasis cases since the 1950's has been reduced from about 30 million to E million, and transmission has been basically interrupted In many counties. Filariasis often does not receive high priority In countries where malaria remai'ls an Important health problem, and more efforts are needed to control this dtsease in the Philippines and Viet Nam. Trerretode worms other than schlstosomes can cause parasitic liver and lung Infections such as paragonimiasis, clonorchiasis and opistorchiasis. Although the Infections can be successfully treated with praziquantel, more attention ne&js to be given to health education messages to avoid eating potentially in:ected or contaminated food . Ascariasis is a common and widespread n3matode Infection but more epidemiological data are needed on the possibly hgh rates of Infection causing nutritional imbalance and retarded development in children.

Targets By 1995, through national and International action, countries or areas which are affected by major human parasitic Infections will have developed national control programmes and achieved a further reduction in prevalence of 70% in schistosomiasis; 50% for protozoal and helminthic infections; and 50% for filariasis and 50% for trematode Infections, as compared with the prevalence rate in 1984.

Situation analysis Human parasitic diseases other than malaria which are Important health problems In some countries or areas of the Region are schistosomiasis, filariasis, clonorchiasis, paragonimiasis and protozoan and Intestinal helminthic Infections. An encouraging new development Is the greater use of the drug praziquantel to control schistosomiasis, which Is also effective against other trematode infections such as clonorchiasis. Schistosomiasis continues to be a major public health and socioeconomic problem in China and the Philippines. However, considerable progress has been made In controlling the disease. Among 372 counties and cities formerly endemic for schistosomiasis, the disease has been eradicated In 125, while in 141 It Is under control and 106 are still endemic. The number of Infected patients since the 1950's have been reduced from 11 830 000 to about 870 000. Snail habitats have been reduced

Proposed programme activities for 1990-1991 Technical support will be provided to countries in planning and Implementing national control programmes within the context of primary health care. Goverr ments also will be encouraged to hold national workshops to monitor the r:rogress and assess the Impact of the use of drugs to control

schistosomiasis and filariasis. The gains achieved In controlling both diseases with chemotherapy will be consolidated by promoting Improved environmental sanitation conditions and vector control of snails and mosquitos. Studies will be promoted on the epidemiology and human behavioural aspects of parasitic diseases. Unkages will be supported with priority health programmes such as environmental hygiene and sanitation, family planning nutrition, and diarrhoeal diseases control. ' Exchange of Information on new research findings will be facilitated at the regional level. Training activities will be promoted to provide opportunities

for more direct exchange of Ideas and knowledge among workers actively engaged In parasitic diseases control and research.

Budgetary Implications The significant Increase In the country provision Is due mainly to expanded activities in three countries. Chemotherapy programmes against filariasis, schistosomiasis and other trematode infections will receive considerable attention.

Disease prevention and control

151

Disease prevention and control

152

13.4 PARASITIC DISEASES

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 187 400 190 300

US$ 281 600 207 500

US$ 94200 17200

US$ 106 900 8400

US$

50.27 9.04

TOTAL

377 700

489 100

111 400

29.49

115 300

13.5 TROPICAL DISEASE RESEARCH Objective In collaboration with the Special Programme for Research and Training In Tropical Diseases, Headquarters, to strengthen the research capability of the tropical countries and to develop new and Improved tools for the control of major tropical diseases. (e) establishment of the epidemiological, social and economic bases for the development of more effective national strategies for the Integrated control of the six diseases. (2) Through the strengthening of national Institutions of the tropical countries affected by the diseases, the Programme will have assisted In developing: (a) a network of 80-100 self-reliant national research and training centres, and technical collaboration among developing countries; (b) through training, a base of 300-400 scientists from tropical developing countries for research careers In their home countries.

Targets 1 By 1995: (1) As a result of goal-oriented research and the development of new and Improved tools for controlling six tropical diseases - malaria, schistosomiasis, filariasis, trypanosomiases, leishmaniasis and leprosy - the activities of the Special Programme will aim to achieve: (a) field application or advanced clinical trials of improved or new chemotherapeutic agents for at least three of the six diseases; (b) field application or assessment of large-scale trials of a candidate leprosy vaccine, advanced trials of one or more possible malaria vaccine, and field application or advanced trials of one or more vaccines against cutaneous leishmaniasis; (c) field application or advanced trials of new simple tests and microtechnlques for diagnosing disease and for monitoring drug susceptibility; (d) field application or advanced trials of two or more new biological methods for the control of disease vectors;

Situation analysis Of the six target diseases covered by the Special Programme, four are problems within the Western Pacific Region, namely, malaria, schistosomiasis, filariasis and leprosy. The fifth, leishmaniasis, Is of Importance only In China. The last disease, trypanosomiases, does not exist In countries of the Region. As of the end of 1987, the Special Programme has supported 320 projects In the Western Pacific Region, with a budget of approximately US$13 800 000. Research projects In malaria, schistosomiasis, filariasis, leprosy, leishmaniasis, biomedical sciences, vector ecology, epidemiology and social and economic research were supported by the Programme. These have contributed to the development and application of disease control tools such as vaccines, drugs and diagnostic tests. The production (in the Philippines) and Introduction Into disease control programmes of P. falciparum drug sensitivity "microtest" kits Is one of the Important accomplishments of the Programme. Support from the Special Programme to the Western Pacific Region has been mainly for strengthening the capability of countries to conduct 153

1 The targets shown are global programme targets under the Eighth General Programme of Work.

Disease prevention and control

154

research needed to control the tropical diseases affecting them. This has been carried out through two mechanisms: training grants (for both individuals and groups) and grants to selected research Institutions. Individual training and visiting scientist grants have been awarded to selected researchers in developing countries of the Region such as China, Malaysia, the Philippines, Singapore and VIet Nam. Exchange of the latest technical Information on the target diseases has also been promoted through the organization of meetings, workshops and training courses on various aspects of the diseases. For example, the Special Programme supported a meeting of the workshop group on seroepidemiological tools for control programmes in tropical diseases in Kuala Lumpur in November 1987, followed by a training course on computer applications for malaria In Ho Chi Minh City in December 1987. Institution grants have been awarded to the following research institutions to help them develop their research capabilities: (a) China Institutes of Parasitic Diseases at Shanghai; Wuhan, Hubbei; Jining, Shandong; Guangzhou, Guangd ong; Nanning, Guangxi; and Guiyang, Guizhou; (b) Malaysia - Institute of Medical Research (Kuala Lumpur) ; School of Biological Sciences, Universlti Salns Malaysia; National Drug Research Centre, Universiti Sains Malaysia; (c) Philippines: College of Public Health, University of the Philippines (Manila); (d) VietNam -Institute of Malariology, Parasitology and Entomology, Hanoi. Grants are also provided for the development of master's degree courses. In the Western Pacific Region, courses were developed at the National University In Singapore (epidemiology) and at the University of the Philippines (health economics) .

Proposed programme activities for 1990-1991 The proposed activities for 1990-1991 Include: {1) the promotion of tropical disease research activities within the Region and increasing the awareness of availability of tropical disease research support; {2) field visits to tropical disease research projects In order to assess their progress; {3) evaluation visits to strengthened tropical disease research Institutions In the Region; (4) helping to Identify institutions In the Region for strengthening; ~nd {5) assisting qualified scientists In the Region In the preparation of project proposals.

Budgetary Implications The increase In the regular budget provision Is due to the increase In the Regional Office's share of costs of the tropical. disease research posts assigned to the Region from 75% In the previous biennium to 100% In 1990-1991. All other programme activities are supported by the WHO Headquarters' Special Programme for Research and Training In Tropical Diseases through extrabudgetary resources.

13.5 TROPICAL DISEASE.RESEARCH

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and intercountry

US$

137100

176 500

39400

28.74

81 100

TOTAL

137 100

176 500

39 400

28.74

81100

Disease prevention and control

155

Disease prevention and control

156

13.6 DIARRHOEAL DISEASES Objective To reduce mortality and morbidity due to acute diarrhoeal diseases and associated ill-effects, particularly malnutrition in infants and young children. (8) All countries or areas will maintain at least 75% middle-level and peripheral health workers trained in supervisory skills and case management to achieve better implementation of diarrhoeal disease control programmes. (9) Morbidity from diarrhoeal diseases will not exceed 200 cases per 100 000 of the population in any country or area. , (10) The incidence of diarrhoeal diseases among children under 5 years of age will be reduced to 50% of the incidence in 1985. (11) The case fatality rate in any country or area from diarrhoeal diseases will not exceed 0. 1%.

Targets By 1995:

(1) All countries or areas where diarrhoeal diseases are a public health problem will have established delivery systems for oral rehydration therapy. (2) All countries or areas will have developed their information system so as to be able to conduct a national evaluation every 3-4 years. (3) Regional self-reliance in production, distribution and quality control

Situation analysis The diarrhoeal disease problem varies considerably in magnitude and severity within the Region. WHO collaboration continued to be directed to those countries where diarrhoea is a major contributor to high childhood morbidity, mortality, malnutrition and resulting stunted growth. WHO has been collaborating with a number of Member States In establishing and revising national programmes for the control of diarrhoeal diseases. The main approach of such programmes remains the use of the WHO-recommended oral rehydration therapy. Access and use of oral rehydration therapy has continued to Increase (up to over 40%). Training of health personnel in supervisory skills and better case management has been accelerated. Programme reviews were conducted in Papua New Guinea, the Philippines, Vanuatu and VietNam. Collaboration has been established between the diarrhoeal disease control programme, maternal and child health and the environmental health programme through the organization of joint workshops and training courses.

of oral rehydration salts (ORS) will have been achieved. (4) In the developing countries of the Region, 95% of the population will have easy access to oral rehydration salts. (5) At least 75% of all diarrhoea cases will be treated with oral rehydration therapy. (6) All countries or areas will have established links between diarrhoeal disease control programmes and other related programmes such as maternal and child health, family planning, environmental health, health education, nutrition, Immunization, acute respiratory Infections, and epidemiological surveillance and health information systems. (7) Research activities will have been stimulated and carried out on critical issues related to diarrhoeal disease control.

Proposed programme activities for 1990-1991 Efforts to link the diarrhoeal disease control programme with maternal and child health, Immunization, nutrition and environmental health will be continued. Each national diarrhoeal disease control plan will be comprehensively reviewed periodically, and re-planning will be carried out as needed, so that the targets and goals are achieved. Effective case management of diarrhoeal diseases will be strengthened with emphasis on early use of home fluids in acute diarrhoea to prevent dehydration, use of oral rehydration salts to treat dehydration, proper use of antibiotics, continued feeding and prompt referral. The use of anti-diarrhoeal drugs will be discouraged.

Uninterrupted breast-feeding, preparation of safe weaning foods and good domestic and personal hygiene will be encouraged, to reduce morbidity and malnutrition resulting from diarrhoeal episodes. Training activities will be supported In the areas of (a) supervisory skills and (b) clinical management of diarrhoeal disease cases, and the establishment of diarrhoea training units will be supported.

Budgetary Implications There has been no significant budgetary change under this programme. Additional funds are expected from extrabudgetary sources but the extent of such funds is not presently known.

Disease prevention and control

157

r--

Disease prevention and control

158

13.6 DIARRHOEAL DISEASES

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 261 100 319 400

US$ 275 400 300 800

US$ 14300 (18 600)

US$

5.48 (5.82) 514100

TOTAL

580 500

576 200

(4 300)

(0.74)

514 100

13.7 ACUTE RESPIRATORY INFECTIONS Objective To reduce morbidity and mortality from acute respiratory infections, particularly pneumonia In children, by introducing prevention and control measures at the community level. .most prevalent agents of community-acquired pneumonia in children in many developing countries. Research conducted in Papua New Guinea and the Philippines showed that a majority of deaths from acute respiratory infections occur without any consultation with health staff in the community. This indicates an urgent need for the training of primary health care workers and for the health education of mothers on proper case management. WHO standard methods for case management have been developed to enable primary health care workers to: (1) recognize important signs and symptoms, such as fast breathing and chest indrawing; (2) determine the nature of cases, whether mild, moderate or severe; and (3) decide whether antibiotics should be given and whether patients should be referred to hospitals. The same Information will be given to mothers through health education. To introduce these standard methods to countries, the first regional workshop on acute respiratory infections was held in Manila in November 1986, in the course of which guidelines for the development of national acute respiratory infections programmes were drafted and later finalized. As a result, more than ten priority countries had initiated national control programmes by the end of 1988. For example, In Viet Nam, a control programme has been implemented in selected districts in 20 out of a total of 39 provinces and more than 1000 health staff at different levels were trained on case management. in China, the national workshop was attended by middle level programme managers from 17 out of a total of 29 provinces. Baseline data were collected which showed higher infant mortality rate from pneumonia in rural areas, and a training and health education programme started in selected areas. Major constraints for programme implementation are: (a) shortage of effective antibiotics at community level especially in the lao People's Democratic Republic, the Philippines and Viet Nam; (b) a weak health education programme; and (c) Inadequate training and supervision of peripheral health workers and community health workers.

Targets (1) By 1991, most developing countries or areas will have established national acute respiratory infections control programmes. (2) By 1993, most of these countries or areas will have assessed their national acute respiratory infections programmes and have reformulated them accordingly. (3) By 1995, 80% of the child population in the Region will have access to appropriate care for acute respiratory infections within the community and at first referral level. (4) Mortality in children under 5 years of age will have decreased by 25% between 1990 and 1995 in countries or areas where acute respiratory infection control programmes have been established.

Situation analysis Acute respiratory infections are the leading cause of mortality and morbidity in children In many developing countries in the Region. Data on the epidemiology of these Infections, collected from fourteen countries, have shown that about one third of Infant deaths that occur are related to acute respiratory infections In countries where the Infant mortality rate Is more than 30 per 1000 live births. The available evidence indicates that bacteria, particularly Streptococcus pneumoniae and Haemophilus lnfluenzae, are the

Disease prevention and control

159

Disease prevention and control

160

Proposed programme activities for 1990-1991 At country level, WHO will collaborate In the strengthening of national capability to assess the magnitude of the problem and develop Information collection systems on epidemiology and formulate national policies and planning of the programme. WHO will support programme Implementation through training of health staff at different levels on case management, recording, reporting and supervision. Health education programmes will also be strengthened by analysing the knowledge, attitude and practice of families, and supporting development of health education materials. Strengthening of coordination with other programmes, particularly diarrhoeal disease control, Immunization and maternal and child health will be encouraged . In order to monitor antibiotic sensitivity level, laboratory capability will be strengthened, Including development of surveillance network for antibiotic sensitivity tests in selected areas.

At the regional level, support will be given to WHO collaborating and national centres In the development of an Information network to facilitate exchange of technical cooperat ion and Information, particularly rtsk factors, preventive measures, drug resistance and rapid diagnostic methods. A workshop for acute respiratory Infections national programme managers will be organized In 1991 to evaluate country programmes and revise national plans.

Budgetary Implications Budgetary reductions In the 1988-1989 provisions, both at country and regional/Intercountry level, were effected during implementation which account for the Increase In the comparative figures for 1990-1991, but programme activities remained at the same level as planned.

13.7 ACUTE RESPIRATORY INFECTIONS

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry 221 700 217 600

US$ 254 300 254 200

US$ 32600 36·600

US$

14.70 16.82 41 100

TOTAL

439 300

508 500

69 200

15.75

41 100

Disease prevention and control

161

Disease prevention and control

162

13.8 TUBERCULOSIS Objective To reduce mortality, prevalence, Incidence and transmission of tuberculosis through appropriate control programmes, particularly short -course chemotherapy. · Philippines, Solomon Islands, Vanuatu and Viet Nam, effective management in implementing the national programme needs further improvement. All countries are implementing direct sputum microscopy In t heir case-finding activities, and short-course chemotherapy regimen in the treatment of tuberculosis, but there is still a need to improve case-finding, treatment and surveillance. The performance of the programme needs to be improved in order to detect more acid-fast bacilli (AFB) positive tuberculosis cases and to place them under short-course chemotherapy. Programme management needs to be strengthened to Increase sputum conversion rate of AFB positive cases to non-infectious cases. This will include high compliance to treatment regimen and regular supply of tuberculosis drugs. Countries In the South Pacific with a small number of bacillary positive cases will need support in the area of training, monitoring and evaluation. Health systems research will be needed In some countries to identify problems, constraints and their solutions. Because of paucity of data on tuberculosis, national prevalence survey should be conducted in some countries to establish the magnitude of the problem for planning and evaluation. The tuberculosis control programme is faced with the problem of maldistrlbution and/or lack of adequate number of trained personnel, Inadequate administrative support, and poor management in implementing the direct sputum microscopy and short-course chemotherapy. Lack of drugs owing to their high cost has contributed to non-compliance and treatment failure.

Targets By 1995: (1) All developing countries or areas will have an effective national tuberculosis control programme, as a component of primary health care. (2) The majority of acid-fast bacilli tuberculosis cases will have been detected and covered by an adequate and effective treatment regimen. (3) population. BCG vaccination will have been given to all of the eligible

(4) Adequate trained manpower support will be available to manage and Implement the national control programme.

Situation analysis In countries with a well organized health service delivery system such as Australia, Japan, New Zealand and Singapore, the prevalence and incidence of tuberculosis have continuously declined. However, tuberculosis remains a health problem In 14 countries, with a prevalence rate of one or more per 1000 population. All countries in the Region have established national tuberculosis control programmes, which are Integrated with the existing general health services. However, In most developing countries, Including Federated States of Micronesia, Lao People's Democratic Republic, Papua New Guinea,

Proposed programme activities for 1990-1991 WHO collaboration will give emphasis to short-course chemotherapy regimen implementation and case-finding through direct microscopy to strengthen the national tuberculosis programme. Collaboration will be in the

area of planning, monitoring, surveillance, BCG assessment and evaluation of the national tuberculosis control programmes. Emphasis will be given to the implementation of short-course chemotherapy regimen to all registered acid-fast bacilli positive tuberculosis cases and to strengthening of laboratory facilities to support detection of acid-fast bacilli tuberculosis cases mainly in China, Federated States of Micronesia, Papua New Guinea, Philippines, Republic of Korea, Tonga, Vanuatu and Viet Nam. Support will be provided for the conduct of training, epidemiological survey, BCG assessment and evaluation, specifically in China, Lao People's Democratic Republic, Malaysia, Philippines, and Viet Nam. National and subnational training activities on programme management, especially in planning, epidemiology, statistics, BCG vaccination, laboratory procedures and short-course chemotherapy regimen will be supported, especially in China, the Philippines, and Viet Nam. Key health staff will be trained in modern management and epidemiology of tuberculosis, especially for Malaysia. Support will be provided to selected countries in the conduct of health systems research to identify conditions or other factors that slow down the progress of the programme and for the appropriate solutions.

Collaboration will be extended to China, Philippines, Republic of Korea and VietNam In the assessment and increase in production of high quality BCG vaccine to meet the needs of these countries and other Member States In the Region. WHO will organize Intercountry group educational activities on management of short-course chemotherapy for tuberculosis and serve as a forum for exchange of experiences and Information on the Implementation of tuberculosis control programme, particularly for countries or areas In the South Pacific. Collaboration will be directed towards Improving patients' compliance with the short-course chemotherapy regimen and those with symptoms to submit to direct sputum microscopy. Support will be provided for the development and production of Information, education and communication materials in collaboration with other health education programmes.

Budgetary Implications There has been a significant decrease in the country level allocation mainly due to reduced collaborative requirements, particularly in the provision of drugs, of two countries in the Region. However, support from extrabudgetary sources is expected to continue but its extent is not presently known.

Disease prevention and control

163

Disease prevention and control

164

13.8 TUBERCULOSIS

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 399 200 100000 499 200

US$ (85 600)

US$ 66300 193 500 259 800

US$

484 800

( 17.66) 25.16 ( 11.60)

79900 564 700

20100 (65 500)

TOTAL

13.9 LEPROSY Objective To reduce the prevalence and Incidence of leprosy and to prevent deformities associated with the disease, through early detection and multidrug therapy regimen, and to rehabilitate disabled leprosy patients. developing countries, especially Cook Islands, Federated States of Micronesia, FIJI, Papua New Guinea, Philippines, Samoa and Tonga, have Implemented multidrug therapy nationwide. There Is a need to strengthen the management of the national control programme in most countries. The low compliance or non-completion of the treatment regimen and dapsone therapy In some countries have Increased the risk of development of drug resistance and treatment failure. The shortage of trained manpower, the lack of supplies and equipment, the Inadequate supervision and monitoring of cases under treatment and the stigma of the disease, have prevented the provision of leprosy control services to the population. However, many leprosy control programmes made notable progress In planning and programme management at national and subnational levels, and effective Implementation of the multidrug therapy regimen. Collaboration with Japan Shipbuilding Industry Foundation, New Zealand Leprosy Trust Board, the Netherland s Leprosy Relief Association , the Government of Switzerland and several nongovernmental organizations have permitted the expansron of training, research and consultant services and increased the provision of drugs, supplies and equipment to the national leprosy control programmes.

Targets By 1995: (1) All countries or areas In which leprosy Is endemic will have developed managerial capabilities to plan, Implement, monitor and evaluate the leprosy control programme In the context of primary health care. (2) All registered leprosy cases, especially multi bacillary cases, will be under multidrug therapy regimen. (3) There will be reduction In the Incidence of leprosy, at least among children, In countries or areas In which this disease is endemic.

Situation analysis Leprosy remains a health problem In the Region, with several countries or areas having one or more leprosy cases per 1000 population, such as American Samoa, Federated States of Micronesia, French Polynesia, Kiribati, New Caledonia, Papua New Guinea, Solomon Islands, and Vanuatu. In endemic countries and areas, a considerable number of leprosy cases remain undetected. In almost all countries, among the registered leprosy cases, between 40 and 60 per cent are Infectious multibacillary cases. In some countries, 10 to 20 per cent of the cases are still confined to leprosaria. All these countries In the Region have a national leprosy control programme and have Implemented the multidrug therapy regimen. Some

Proposed programme activities for 1990-1991 The main thrust of WHO's collaboration with countries on leprosy control will be programme management and case-finding and treatment. Collaboration will be provided to countries in planning, monitoring and evaluation of the national programme, especially in Malaysia and the Philippines. Collaboration will be provided to Lao People's Democratic Republic, Philippines and Republic of Korea and other countries to bring all leprosy cases

Disease prevention and control

165

Disease prevention and control

166

under multidrug therapy. The provision of drugs and laboratory equipment for more accurate diagnosis and treatment In some countries will also be provided. The programme will support national and subnatlonal training programmes on management, laboratory technology, epidemiology and statistics In Federated States of Micronesia, Lao People's Democratic Republic, Philippines and possibly In other countries In the Region. Support will be provided In the collection of data through surveys and Its analysis for planning, monitoring and evaluation of the national control programme, especially In the Lao People's Democratic Republic. Emphasis will be made In the conduct of training, epidemiological survey, monitoring and evaluation of programme and on records and reports, specifically In Lao People's Democratic Republic, Malaysia and Philippines. Collaboration will be provided in the conduct of health system research to determine and provide ways of overcoming factors/conditions that hinder or

slow down the delivery of leprosy control services to the population, especially In muitidrug therapy to countries, especially In the Philippines and the Republic of Korea. WHO will extend support In establishing sero-epidemlology of the disease and monitoring multidrug therapy treatment through ELISA and gelatin particle agglutination test using synthetic dissaccharlde antigen from M.leprae bacilli in China, French Polynesia, Malaysia, Philippines and Republic of Korea.

Budgetary Implications The significant increase of regional and Intercountry activities is mainly due to the inclusion of an Intercountry project to provide technical support to countries in planning and management of national leprosy control programmes, particularly multidrug therapy implementation. Extrabudgetary resources to supplement country and intercountry activities are expected to continue. ·

13.9 LEPROSY

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 68800 200 700 269 500

US$ 9900 119 600 129 500

US$ 1 012 400 1 200 900 2 213 300

US$

58900 81 100 140 000

16.81 147.47 92.50

800 000 800 000

TOTAL

Disease prevention and control

167

Disease prevention and control

168

13.10 ZOONOSES Objective To develop and further strengthen the surveillance, prevention and control of major zoonoses and related food borne intoxicc:\tions of animal origin. Leptospirosis and other zoonotic infections are widespread In the Region, although with varying intensity, depending on the state of veterinary services and the laboratory facilities available. Human rabies Is an Important problem in China and the Philippines. Plague is endemic in Viet Nam but the incidence has been greatly reduced since the 1960s. More attention is being given to hydatidosis and brucellosis in China.

Targets By 1995, through national and international action, strategies and practical methods for surveillance, prevention and control of major zoonoses and related food-borne diseases, adapted to specific situations where appropriate will have been made known to all countries or areas. Two-thirds of the countries or areas will have national control programmes In respect of priority zoonoses and related foodborne diseases of animal origin.

Proposed programme activities for 1990-1991 Under the financial and programme priority constraints, technical cooperation will continue with some coun~ries where. zoonoses give~ rise to health problems, mainly China. Emphasis will be gtven to preventmg and controlling leptospirosis, brucellosis, hydatidosis, rabies a~ plague. Health ed ucation, legislation and primary health care approaches w1 11 be strengthened whenever possible. Studies on the epidemiology of these major zoonoses, and the collection and dissemination of epidemiological information will be promoted. Information exchange will be facilitated through group training activities such as national workshops.

Situation analysis Veterinary public health activities are set aside as a low priority, and there has been a lack of effective collaboration among agencies dealing with human and animal health. The absence of veterinary public health units within the ministries of health also hampers programme development. With the need to increase animal food production, the prevention and control of zoonoses and related foodborne diseases are becoming more important.

Budgetary Implications The significant increase In the country provision is due to expanded activities in one country involving zoonoses such as echinococcosis.

13.10 ZOONOSES

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

lncrease

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry TOTAL 60000

US$ 110 900

.US$ 50900

US$

84.83

60000

110 900

50900

84.83

Disease prevention and control

169

Disease prevention and control

170

13.11 SEXUALLY TRANSMITTED DISEASES Objective To promote and develop effective measures for the prevention and control of sexually transmitted diseases. are few, as their Impact on male and female fertility and Infant health Is not realised and as laboratory capabilities are not fully utilized.

Proposed programme activities for 1990-1991 Activities will be aimed at strengthening surveillance of sexually transmitted diseases, the development of control strategies, including case detection and standard treatment procedures, the strengthening of manpower capability for laboratory diagnosis and for the elaboration of national policies and programmes aimed at the prevention and control of sexually transmitted diseases, and the promotion of health education, particularly for the high-risk population. Some of these activities will be further reinforced by those aimed at the prevention and control of AIDS. Special clinics for the control of sexually transmitted diseases are costly to operate and, moreover, reach only a small section of the population. The control of these diseases cannot rely on the development of a network of specialized services. It is of critical Importance to deal with the problem of sexually transmitted diseases and their prevention and .control within the broader framework of existing health services. Realizing that many health care units have little or no access to laboratory diagnostic facilities, a simplified approach to management and control needs to be applied which can be adjusted to different levels of diagnostic and clinical competence.

Targets By 1995, most countries or areas will have developed effe-:::tive control programmes on sexually transmitted diseases and taken appropriate action to make optimal use of existing health infrastructure for this purpose, by strengthening national capabilities to formulate and operate practical control programmes for sexually transmitted diseases.

Situation analysis Sexually transmitted diseases remain under-reported and there is a great need to ensure effective surveillance. Changes in sexual behaviour and life-style, urbanization and other factors have led to a tremendous increase in the number of sexually transmitted infections as is exemplified by the recent epidemic of the human immunodeficiency virus (HIV), the herpes virus and the human papilloma virus. Some countries have reported a reduction in the incidence of diseases such as gonorrhoea and syphilis but this is more than counterbalanced by an increase of other sexually transmitted pathogens, particularly chlamydia trachomatis. The problem of penicillinase-producing or spectinomycin-resistant Neisseria gonorrhoeae is of considerable importance in a number of countries or areas in the Region. The resulting change to alternative treatment regimens may be the cause for the recent increase in the number of syphilis cases in some areas of the Region. A recent outbreak of neonatal syphilis has been observed in the South Pacific and draws attention to the consequence of the sexually transmitted disease epidemic. Non-gonoccocal urethritis and non-specific genital infection in women seem to be more common than other infections, but countries reporting these diseases

Budgetary implications Overall, there has been no significant budgetary change under this programme. The decrease in country allocations, resulting from the number of countries requiring support decreasing from 3 to 2, has been offset by an increase in the regional and intercountry allocation due to the inclusion of an intercountry project on sexually transmitted diseases.

13.11 SEXUALLY TRANSMITTED DISEASES

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 8600 14000

US$ (10 000) 14000 4000

US$

18600

( 53.76) 1 200 21.51 1 200

TOTAL

18 600

22600

Disease prevention and control

171

Disease prevention and control .

172

13.12 RESEARCH AND DEVELOPMENT IN THE FIELD OF VACCINES Objective To develop and strengthen programmes for research and development In the field of vaccines. "anti-Immunopathology'' would open up an approach to Immunization against severe disease In schistosomiasis japonica using egg antigens. The first generation of HBV vaccines is highly purified HBsAg derived from plasma of human HBV carriers. Preparation of recombinant DNA HB vaccines In yeast and other mammalian cell lines has been developed. The recombinant DNA HB vaccines are equivalent to plasma-derived vaccine with respect to safety, lmmunogenecity and efficacy. Polypeptide vaccines are currently only experimental and their feasibility has yet to be established. The effectiveness of the Inactivated Japanese encephalitis vaccine has been demonstrated. WHO requirements for this vaccine will be distributed to Member States In 1988 and mass Immunization of young children will be explored as part of the Immunization programme. Attenuated Japanese encephalitis vaccines are being prepared and safely tested for use In humans. In China. Recent advances In the cloning and expression of Japanese encephalitis virus In Japan; Switzerland, and the United States of America Indicate the potential for a recombinant DNA Japanese encephalitis vaccine and genetically ~ble live attenuated Japanese encephalitis vaccines which might eventually be lower In cost than those currently used. Development of killed Hantaan virus vaccine has been progressing In China, Japan and the Republic of Korea. Rotavirus vaccine Is developed from the Nebraska calf diarrhoea virus and human strains. Attenuation has been made either by passages In a heterogenous host (pig) or by cold adaptation. Very limited data are available concerning the virulence of these vaccine candidates in man. Another high technology vaccine strain Is also being developed by cloning the rotavirus genome and Inserting the relevant genetic information into an appropriate vector. There are two types of non-A non-B hepatitis: bloodborne and waterborne. Etiological agents are not yet Isolated on the basis of study reports. Efforts will be directed towards the Isolation and characterization of the etiological agents, and development of a vaccine.

Targets By 1995: (1) Some countries or areas will have started activities directed towards developing: (a) new vaccines against communicable diseases which are of Importance In the Region such as, hepatitis non-A non-B. rotavlrus Infections, schistosomiasis, and haemorrhagic fever with renal syndrome; (b) more effective BCG, cholera and typhoid fever vaccines; and (c) low-cost hepatitis B and Japanese encephalitis vaccines. (2) Some countries or areas will be conducting field trials to determine the efficacy of certain vaccines such as pneumococcal vaccines.

Situation analysis A pneumococcal polysaccharide vaccine has provided 58% protection In children of 6 months to 5 years of age living in one area of Papua New Guinea, but no protection in another nearby area. There is a need to test the vaccine In ~ther populations. Experiments on the modulation of granuloma formation In mice are continuing in Manila and Melbourne. The operation of such a mechanism of

Proposed programme activities for 1990-1991 The activities will cover collaboration with Member States, WHO collaborating centres and selected centres of excellence In research and development for new and improved vaccines such as HBV vaccine, Japanese encephalitis vaccine, and Hantaan virus vaccine. Review of current research knowledge In this area, the conduct of field vaccine trials and the exchange of information on the current developments in this field will also be conducted.

Budgetary Implications This Is a new programme under the Eighth General Programme of Work.

Disease prevention and control

173

Disease prevention and control

174

13.12 RESEARCH AND DEVELOPMENT IN THE FIELD OF VACCINES

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and intercountry

US$ 82 BOO

US$

TOTAL

82 800

13.13 AIDS Objectives (1) To prevent and control human Immunodeficiency virus (HIV) In the Region. (2) To reduce morbidity and mortality from AIDS and HIV infection in countries or areas of the Region. 924 cases. About 97% (892 cases) of the cases, however, were from Australia (759), New Zealand (74), and Japan (59). Serological surveys for HIV antibody carried out In 17 other countries revealed the presence of HIV antibody positives in 13 countries. Low prevalence rates ranging from 1 to 8 per 10 000, even among high-risk groups, were noted in several countries or areas.

Targets By 1995:

National AIDS committees have been formed in 18 countries or areas. Through the visits of WHO AIDS teams, immediate and medium-term national prevention and control programmes on AIDS have been prepared in 8 countries or areas and will be Implemented soon. Visits are being planned by WHO AIDS teams to other countries in the Region. For the development of an effective AIDS control programme, approaches to integrate the AI OS control programme into existing viral disease control programmes such as hepatitis B have been tried out. A training course on the laboratory diagnosis of HIV, HTLV-1 and HBV infections In the South Pacific was held in Tonga in November 1987. The serological data provided by Member States and other information on AIDS have been summarized and published quarterly in the Virus Information Exchange Newsletter for South-East Asia and the Western Pacific. The first update was published in the December 1987 issue of the newsletter.

(1) Most countries or areas will have developed the laboratory capability to diagnose AIDS and HIV infections. (2) Most countries or areas will have developed effective surveillance mechanisms to determine the presence and extent of AIDS and HIV infection in target groups. (3) Most countries or areas will have developed effective health education programmes for the prevention and control of AIDS. At this stage in the rapid development of research and global experience with respect to HIV infection, it would be quite premature to identify specific targets for the period 1990-1995.

Proposed programme activities for 1990-1991 Activities will continue to be geared towards promoting the development, strengthening and support of national AIDS prevention and control programmes in the Region. Particular attention will be given to strengthening epidemiological surveillance so that the spread of AIDS and HIV Infection can be monitored. Laboratory diagnostic capability of AIDS and HIV infection will be developed and strengthened using simple and rapid diagnostic tests such as 175

Situation analysis The first case of AIDS in the Region was reported In Australia in 1982. In September 1985 the attention of the WHO Regional Committee for the Western Pacific was drawn to the occurrence of 132 cases in 5 countries of the Region. By March 1988, the cumulative total of AIDS cases amounted to

Disease prevention and control

176

gelatin agglutination and Immunofluorescent methods. Confirmatory tests will be carried out In collaboration with WHO collaborating centres for AIDS In Australia and Japan. Health education and counselling services will be strengthened and developed so that high-risk groups such as prostitutes, homosexuals/bisexuals, Intravenous drug abusers; high-school and college students and the public In general will become aware of the methods available for AIDS prevention and control. Action-oriented research related to behavioural studies and programme will be promoted and supported. Exchange of valuable Information on various aspects of AIDS will be encouraged and facilitated.

Activities to be undertaken will be Integrated within primary health care. aose collaboration will be maintained with other programmes, such as sexually transmitted diseases, maternal and child health, health Information, and health for all.

Budgetary Implications Following country visits made by WHO AIDS teams, short-term and medium-term national AIDS control plans have been Implemented starting In 1988, mainly through funding provided by the Global Programme on AIDS. In view of the Importance of this programme, ten countries/areas have additionally provided funds from their country allocations for national AIDS control programmes. Funding from the Global Programme on AIDS Is expected to be continued into 1990-1991 but Its extent Is not presently known.

13.13 AIDS

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry TOTAL

US$ 273 300

US$

965 000

273 300

965 000

Disease prevention and control

177

Disease prevention and control

178

13.14 OTHER COMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES Objective To prevent or control bacterial, viral and mycotic diseases for which separate programmes do not exist but which are of public health importance. start HB immunization of newborns in 1988. Mass hepatitis B immunization has been Initiated in Long Ahn County, China. Japanese encephalitis has been under control In China, Japan and the Republic of Korea where better agricultural practice, vector control and immunization have been applied. However, since the disease is still an Important health problem In Viet Nam, technical support was provided for the preparation of Japanese encephalitis vaccine and development of a Japanese encephalitis control programme. The Working Group on Japanese encephalitis vaccines, held in February 1987, drafted the WHO requirements of inactivated JE vaccine, which will be published in the latter part of 1988. Dengue fever/dengue haemormagic fever (DF/DHF) continue to be a problem in China, t he lao People's Democratic Republic, Malaysia, the Philippines, Singapore, the South Pacific countries and Viet Nam. Progress in the development of rapid diagnosis of dengue virus infection has been made In Australia, Japan and Malaysia. Genetic analysis of attenuated dengue virus strain has been carried out in Australia. Haemorrhagic fever with renal syndrome (HFRS) is considered .to be a public health problem in China and the Republic of Korea. Hantaan-like virus among rodents is widespread in many countries of the Region. Progress in the development of killed Hantaan virus vaccine has been made in China, Japan and the Republic of Korea. Human T lymphotropic virus type I (HTLV-I), a causative agent ofT cell leukemia/lymphoma, has been known to be endemic in the southwestern part of Japan. This infection is found to be present also in Papua New Guinea, the Philippines, Solomon Islands and Vanuatu.

Targets By 1995:

(1) Most countries or areas will have identified effective surveillance and vigilance mechanisms with respect to other communicable diseases to ensure that those showing signs of becoming major public health problems are immediately identified and controlled. (2) Most countries or areas affected will have developed programmes and initiated prevention and control activities against viral hepatitis, dengue fever, Japanese encephalitis and haemorrhagic fever with renal syndrome. (3) In some countries or areas, the chronic carrier rate of hepatitis B virus will not exceed 1 per 100 population.

Situation analysis Prevention and control of hepatitis B virus (HBV) infection by immunization calls for urgent action within the Region. Three countries are already producing HBV vaccines, through technological collaboration with WHO and Japan, five vaccine production centres in China have now produced 15 million doses. The target is to immunize 85% of ali newborns in 1995. Another system for the collection of high-titre HBsAg plasma, which is then processed into HBV vaccine in Japan and subsequently returned to the donor countries, has been established. This system has been developed in Fiji, Papua New Guinea, Samoa and Tonga. It is expected that they will obtain HB vaccine and

Proposed programme activities for 1990-1991 Activities will continue to encourage the development and strengthening of epidemiological services so that countries will be in a better

position to determine the extent of epidemiological features of bacterial, viral and mycotic Infections which have become of public health Importance. In the area of hepatitis B, WHO will continue to support the cevelopment of local vaccine production and diagnostic reagents, the streng:hening and development of diagnostic laboratories, the training of personnel. research on various aspects of hepatitis B virus Infection, and the formulation of strategies for the prevention and control of HBV Infection by Immunization or ether means. In the area of Japanese encephalitis, support will be provided with respect to upgrading this killed Japanese encephalitis vaccine, international collaboration in the supply of Japanese encephalitis vaccine, toea production of this vaccine, the development of laboratory diagnostic facilities, training of health personnel In laboratory diagnosis, epidemiological surveillance, and prevention and control of the disease. The development of recombinant DNA Japanese encephalitis vaccine and of sensitive and rapid diagnostic methods will be promoted. In the area of dengue fever/dengue haemorrhaglc fever, the development of rapid diagnostic methods for virus Isolation and antibody

detection will be supported, as well as the development of proper case management, and the strengthening of surveillance and research on dengue vaccine. In the area of haemorrhaglc fever with renal syndrome, WHO will collaborate In the development of simple rapid diagnostic methods and research on vaccines. Strengthening of epidemiological surveillance, particularly In relation to the pathogenicity of several Hantaan virus-related strains, will be supported. In t he area of HTLV-1 Infection, support will be provided for the development of laboratory diagnostic facilities and the training of health personnel in clinical and laboratory diagnosis, epidemiological surveillance and prevention and control of the disease.

Budgetary Implications There has been no significant change In the regular budget provision for this programme, which is also funded from extrabudgetary sources.

Disease prevention and control

179

Disease prevention and control

180

13.14 OTHER COMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and Intercountry

US$ 396 500 607 500 1 004 000

US$ 66800 (46 100) 20 700

US$ 421 200 903 600 1 324 800

US$

329 700 653 600 983 300

20.26 (7.05) 2.11

500 000 500 000

TOTAL

13.15 BLINDNESS AND DEAFNESS Objectives (1) To reduce avoidable and curable blindness, promote eye health and make adequate eye care available to all, especially underserved rural and urban communities. (2) To decrease the incidence and consequences of hearing impairment, especially in severe forms. Region. The Incidence of blindness within countries could be much higher In certain parts. In developing countries of the Region, the causes of blindness are more or less identical, and consist mainly of unoperated cataract, nutritional blindness, infection and Injuries. National programmes have so far been developed In only a few countries of the Region, but control activities have been Initiated in more than half the countries of the Region. There Is still a need for more In-depth study and analysis of data In order to obtain a clear picture for programme development. Essential eye care, which would prevent endemic problems like trachoma and xerophthalmia, has been Initiated in countries which faced these problems on a larger scale. These efforts need to be continued. Cataract, which Is the main cause of blindness in the older age group, Is still the main problem in the majority of countries owing, primarily to a large number of cases In need of surgery and the provision of spectacles. Early diagnosis and management of congenital and early childhood visual problems will have to receive more attention in the future.

Targets By 1995: (1) All countries or areas will have blindness prevention programmes directed to achieving the long-term objective of reducing national average blindness rates to less than 0.5%, with no more than 1% In any part of the country. (2) Most countries or areas will have sufficient facilities for the restoration of sight to the curable blind and for the prevention of trachoma and xerophthalmia. (3) The magnitude of problems relating to deafness will have been assessed, and on the basis of this, programmes will have been developed for essential ear care services, as well as screening programmes for the prevention and control of deafness, training programmes for health workers, and adequate referral systems, especially In underserved areas.

Deafness With respect to hearing Impairment, It Is hoped that by 1990, a clearer picture of the causes and extent of the problem will be available. It is expected that by that time, there will be a consensus on definitions to be used In analysing the causes of hearing impairment.

Proposed programme activities for 1990-1991 Blindness National surveys. It Is necessary to continue surveys In selected countries for a more in-depth analysis of the problem which would provide a more complete picture of the problems of blindness, especially where it is curable and preventable. A review of ongoing efforts to reduce blindness rates and to promote the use of appropriate technologies will be carried out. 181

Situation analysis Blindness With more reliable data being obtained, the prevalence of blindness is known to extend to as much as 0.8% of the population in some countries of the

Disease prevention and control

182

Health education and primary prevention. Efforts to prevent blindness through health education, especially regarding blindness caused by Infections, Injuries and malnutrition will continue to receive su~port in countries where this problem Is prevalent. , such as China, Lao Peoples Democratic Republic and Viet Nam. Primary prevention through health workers at the peripheral level will be encouraged as part of the routine activity. Training and development of appropriate technologies. Support will be extended to national Institutions for the development of appropriate technology for blindness prevention and of training for health workers at various levels. The production of health education and learning ajds In relation to blindness prevention will also be supported. During this period it is expected that the Region will become self-sufficient In these areas. Emphasis will be placed on information exchange and technical cooperation between countries. The role of collaborating centres will be enhanced to support developing countries In upgrading their capability for blindness prevention. Early diagnosis and treatment of blindness In infancy, with the extension of ophthalmological services, will be supported in selected countries.

developing countries. Selected epidemiological surveys are needed to develop primary prevention programmes.

Training of health workers and health promotion. Support will be provided for trained health workers carrying out preventive programmes and activities in sensory-neural deafness and early treatment of conductive hearing loss. Support will also be available for the development of facilities at the district level for the referral of cases for appropriate treatment and rehabilitation. Research and technical cooperation. Support will be provided for specific studies on operational problems of prevention and treatment at different levels of the health systems, the development of appropriate referral criteria and the application of available knowledge and technology. Developed countries will be encouraged to support developing countries in training and transfer of technology for the prevention and treatment of hearing loss and for the rehabilitation of partial deafness.

Deafness Assessment of the problem. With a clearer definition and standards, countries will be supported in assessing the extent of the problem of deafness, In particular those due to factors which could be controlled, especially in

Budgetary Implications The significant increase in budgetary provisions Is due to additional country activities planned in seven countries. This reflects an increased awareness of blindness prevention, and the inclusion of deafness in the programme.

13.15 BLINDNESS AND DEAFNESS

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country .or area Regional and Intercountry TOTAL

US$ 323200 79000 402 200

US$ 174 700 26000 200 700

US$ 143 200 51 500 194 700

US$

148 500 53 000 201 500

117.64

49.06 99.60

Disease prevention and control

183

Disease prevention and control

184

13.16 CANCER Objective To prevent and control common cancers prevalent In the Region for which effective preventive and control measures are available. Papua New Guinea and Tonga and the strengthening of existing activities In the Philippines, the Republic of Korea and Viet Nam. Cancer registries In Fiji, French Polynesia, Singapore and Viet Nam will be supported In association with the International Agency for Research on Cancer (IARC) , Lyon.

Targets By 1995: (1) Most countries or areas will have established national policies and programmes for the prevention and control of cancer, including priorities for action. (2) Most countries or areas will have developed appropriate preventive activities specific to cancers that are prevalent in the countries concerned.

Training. National workshops will be held on the control and prevention of cancers which are major causes of morbidity and mortality and for which treatment or methods of prevention are available. A regional seminar on cancer epidemiology and control will be held jointly with IARC in Manila In 1990. Support will be provided to strengthen national expertise in cancer control, detection and management. Cancer pain relief. National programmes to develop cancer pain relief activities in China, Papua New Guinea, the Philippines and Viet Nam will receive support through national and regional training programmes. A workshop to Introduce the programme in the South Pacific island countries will be held. Strengthening of laboratory and clinical capabilities. Support will be given to the strengthening of laboratory facilities and Improvement of clinical management of priority cancers such as stomach cancer In China and oral · · · cancer in Papua New Guinea. Research will be encouraged, especially In relation to the prevention and treatment of priority cancers In the Region. Oesophageal, gastric and nasopharyngeal cancer In China, oral cancer in Papua New Guinea, and liver cancer in many countries In the Region will receive priority as will cancer of the uterine cervix. Health education for the general public will be supported, emphasizing risk factors such as tobacco use, and the need for early detection of cancer.

Situation analysis Many countries In the Region have yet to develop a national policy on cancer control and to assign responsibility for cancer control programmes to units in the ministry of health. There Is a shortage of trained epidemiologists, laboratory facilities and treatment facilities In the field of cancer. Public Information on the prevention and early detection of cancers Is still limited. Available control and early detection measures are not always readily Integrated into the health infrastructure. Support at national level has been provided In the areas of the development of national cancer prevention and control programmes, the development of cancer registries, and training in both national and regional seminars.

Budgetary Implications Cancer control activities are being initiated or expanded in several countries, resulting in an increase in the country allocation. In 1990, a regional seminar on cancer epidemiology will be held and this has resulted in an increase in the intercountry allocation.

Proposed programme activities for 1990-1991 National cancer control programme development. WHO will support the development of national cancer control programmes in Brunei Darussalam,

13.16 CANCER

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area Regional and Intercountry 313 900

US$ 353 100 144 000

US$ 39200

US$

12.49 84.62

78000

66_000

TOTAL

391 900

497 100

105 200

26.84

Disease prevention and control

185

Disease prevention and control

186

13.17 CARDIOVASCULAR DISEASES Objective To promote community-based prevention programmes for cardiovascular diseases, especially hypertension, strok& and coronary heart disease. diseases are dten not available. A lack of trained epidemiologists and public health administrators can hinder programme development.

Targets By 1995: (1) Most countries or areas will have established national policies and programmes on the prevention and control of cardiovascular diseases, including priorities for action. (2) Most countries or areas will have developed appropriate preventive activities specific to cardiovascular diseases that are prevalent in the countries concerned. (3) Several countries or areas will be Implementing community programmes for the prevention and control of cardiovascular diseases for the whole population.

WHO has supported surveys on the prevalence of cardiovascular diseases, and training programmes for health workers In prevention and control measures. 1--: has also established comprehensive community-based cardiovascular disease control programmes In several countries. Support has also been given for the development of rheumatic fever/rheumatic heart disease control progra11mes. Count·ies are being encouraged to give priority to the preventive aspects of noncommunicable disease control (including cardiovascular diseases) wit, emphasis on appropriate diet, adequate exercise, smoking cessation, etc.

Proposed programme activities for 1990-1991 Natior.al programme development. Support will be given for the development. strengthening and evaluation of national comprehensive card iovascular disease community control programmes. Integrated noncommunic3ble disease control programmes will be promoted, taking Into account othei priority noncommunicable diseases, Including diabetes, especially in tl'le South Pacific countries, and tobacco-related diseases. Training. National workshops on cardiovascular disease control for both medical professionals and primary health care workers will be supported In China, Federated States of Micronesia, Malaysia, Philippines, Republic of Korea, Samoa, Tonga and Viet Nam. Rese~ch. Support will be made available for the development of comprehensive community-based cardiovascular disease control programmes In several coontries, including China. Surveys on the prevalence of cardiovascular diseases, and risk factors for cardiovascular diseases will be undertaken in Brunei Darussalam and other countries where this information is lacking. Epidemiological and research capabilities will be strengthened.

Situation analysis Changing dietary and exercise patterns have led to an increase In cardiovascular diseases in many countries and areas in the Region. Rheumatic fever/rheumatic heart disease remains an Important public health problem in some countries. In many countries, the ministry of health does not have a unit concerned with the development of a national control and prevention programme, and reliable data on the nature and extent of cardiovascular

Budgetary Implications As countries become more aware of the growing burden of cardiovascular diseases, requests for WHO cooperation have Increased, resulting In a larger country allocation. The decrease in the regional and

Intercountry allocation has been the result of a change In the classification of the regional adviser's activities from cardiovascular to noncommunicable diseases. This will not affect programme Implementation. Additional funds from extrabudgetary sources are expected In 1990-1991.

Disease prevention and control

187

Disease prevention and control

188

13.17 CARDIOVASCULAR DISEASES

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease)

1988-1989

199G-1991

US$ Country or area Regional and Intercountry 366100 214 200

US$ 417 300 34000

US$ 51 200 (180 200)

US$ 19800 382 ()()()

US$

13.99 ( 84.13)

300000

TOTAL

580 300

451 300

(129 000)

( 22.23)

401 800

300 000

13.18 OTHER NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES Objective To promote community-based prevention and control programmes for other noncommunicable diseases, in particular diabetes mellitus, emphasizing primary prevention activities. health with responsibility for this programme area is a serious constraint, but gradual improvement has been noted. A shortage of trained epidemiologists, public health administrations and associated professionals is also a major constraint.

Proposed programme activities for 1990-1991 Targets By 1995: (1) Most countries or areas will have established national policies and programmes on the prevention and control of other noncommunicable diseases (diabetes mellitus, etc.), including priorities for action. (2) Most countries or areas will have developed appropriate preventive activities specific to other noncommunicable diseases that are prevalent in the countries concerned. (3) Several countries or areas will be implementing Integrated programmes for the prevention and control of major noncommunicable diseases for the whole population.

National programme development. Support will be given to strengthen national programme development in selected countries, including China, Federated States of Micronesia, Fiji and Samoa. Training and research. National workshops for the training of health workers in noncommunicable disease control will be supported in the Federated States of Micronesia, Fiji, Republic of the Marshall Islands and Samoa. Educational materials will be developed for use in training health staff in the South Pacific countries, including the Federated States of Micronesia, Fiji and Kiribati. A manual on noncommunicable disease control and prevention will be prepared for use in health centres In the South Pacific island countries. Research on the management of chronic obstructive lung disease at the primary health care level will be supported.

Situation analysis As with cardiovascular diseases, changing dietary and exercise habits have been associated with an Increase in diabetes mellitus and other noncommunicable diseases in many countries in the Region. Chronic obstructive lung disease is also a problem in older populations in many countries. WHO has supported surveys of the prevalence of diabetes mellitus and other noncommunicable diseases in many countries, especially in the South Pacific, and countries have been encouraged to develop control and prevention programmes. In many countries, the absence of a unit within the ministry of Disease prevention and control

Budgetary Implications New training programmes and the Initiation of control programmes for diabetes and other noncommunicable diseases in several countries have resulted in an increase In country provisions. The regional and intercountry programme has shown an increase as it now includes funding for the regional adviser in noncommunicable diseases, a position previously included in the cardiovascular disease budget.

189

Disease prevention and control

190

13.18 OTHER NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and intercountry 108 000 19000

US$ 175 800

US$ 67800 181 500

US$

62.78 955.26

200 500

TOTAL

127 000

376 300

249 300

196.30

14. HEALTH INFORMATION SUPPORT Objective To ensure the continuing availability to Member States of valid scientific, technical, managerial and other Information relating to health, In printed and other forms, whether originating within or outside the Organization.

capabilities, through better Internal and external collaboration, was reemphasized. The national focal points were provided with guidelines for national planning of health literature services and were encouraged to develop policies and programmes in their respective countries. Access to International health literature by developing countries In the Region was provided through a Memorandum of Understanding between Australia and WHO In 1982 and was extended Into 1990. In the area of publications, a request of the Global Programme Committee resulted In a global study of WHO's publication policy carried out In 1984 Involving Headquarters and all regions. Emphasis was placed on the need for Improved quality, better Impact, greater cost-efficiency, closer adjustment to countries' needs, better accessibility of existing literature, more lively exchange of knowledge In a TCDC spirit and recognition of the countries' achievements and contributions. The problems related to biomedical Information exchange are as follows: (1) Inadequate support and trained personnel for library, Information, editorial and publishing services within countries. (g)_Jnadequate access and lack of facilities and mechanisms for Inter- and intra-national dissemination, retrieval and exchange of Information for research and health programme development activities. (3) Inadequate and Inefficient use of resources available In countries for biomedical Information exchange and publication dissemination.

Targets By 1995:

(1) Most countries or areas will have established or developed national policies and programmes designed to meet special needs in health information and biomedical publications. (2) Most countries will have mechanisms to screen WHO and other publications In the context of Improved exchange of scientific and technical Information. This will Imply better access to international bibliographical systems and other documentary data bases on health and related topics. (3) The availability of WHO publications will be Improved through adoption of better distribution and sales practices. Information on these will be reaching a greater number of health workers and Institutions.

Situation analysis The regional biomedical Information programme was formally established during the first meeting of it~; national focal points In 1981. Activities were formulated to strengthen national health literature and information resources and to encourage networking. A second meeting of the national focal points was convened In 1985 to review the progress of the programme. The need for support from within the countries themselves was recognized and the strengthening of national

Proposed programme activities for 1990-1991 Strengthening national capacities in health literature and library services. With the shift In emphasis from regional networking activities to national-oriented support, efforts will be directed to the development of services relevant to the needs of the individual countries, such as consultations and national workshops on library/information management and networking.

Health information support

191

HeaHh Information support

192

Establishment of national policies on health Information and literature services. To monitor the establishment or Improvement of the policies and to develop and plan further programme activities, a meeting of the national focal points will be convened In 1991. Access to International bibliographic databases. Continued access to the MEOUNE database through the Australian MEDLARS network will be provided to the developing countries In the Region. Direct online access to the network will be encouraged. Identification and strengthening of focal points. Focal points for the publications programme will be identified, either related to existing health and

biomedical Information focal points, or Independent from them. They will study the needs of Individual countries, ldentHy constraints and work out solutions with WHO's support. They will then be strengthened In various areas as required, Including book development, book production technology and management, book dissemination and distribution as well as adaptation and translation of existing materials Into national languages.

Budgetary Implications The Increase In budgetary provision results mainly from expanded activities In two countries.

14. HEALTH INFORMATION SUPPORT

Estimated obligations

Regular budget

Other sources

1988-1989

1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

US$ Country or area Regional and Intercountry

US$ 175 700 647900

US$ 131 700 55900

US$

44000 592 ()()()

299.32 9.44

1 200

TOTAL

836 000

823 600

187 600

29.50

1200

Health information support

193

Support services ··

194

15. SUPPORT SERVICES Objective To provide effective, efficient and flexible administrative support and services In the planning, preparation and implementation of the regional programme of cooperation.

15. SUPPORT SERVICES

Estimated obligations

Regular budget

Other sources

1988-1989 US$

199()..1991 US$

Increase US$

(Decrease)

1988-1989 US$

199()..1991 US$

Country or area Regional and Intercountry

3 469200

3 979100

509900

14.70

1 273 500

906200

TOTAL

3 469 200

3 979 100

509 900

14.70

1 273 500

908 200

Support services

195

Support seriices

196

15.1 PERSONNEL Personnel policies will be adapted to the overall goals of WHO, In coordination with those of related United Nations agencies. The programme will ensure timely recruitment of staff of the highest level of competence, Integrity and efficiency, consideration being given to the geographical representation of Member States and to the recruitment of a larger number of women, particularly in the professional grades. Support will be provided to the technical units with respect to recruitment of personnel and provision of the personnel information necessary for the smooth Implementation and monitoring of their programmes, through the extended use of text processing and computerization.

Budgetary Implications The slight Increase In this programme is entirely due to personnel cost factors.

15.1 PERSONNEL

Estimated obligations

Regular budget

Other sources

1988-1989 US$

1990.1991 US$

Increase US$

(Decrease)

1988-1989 US$

1990.1991 US$

Country or area Regional and Intercountry 318 300 333 800 15 500 4.87 19 700 24000

TOTAL

318 300

333 800

15 500

4.87

19 700

24000

Support services

197

Support services

198

15.2 GENERAL ADMINISTRATION AND SERVICES The programme will provide facilities and services in the Regional Office and WHO representatives' offices, particularly in relation to building management and maintenance, including energy m~nagement controls, communication facilities, document reproduction facilities, physical arrangements for meetings, records and archives management, travel and transportation services, overall security and ancillary services.

Budgetary Implications The Increase in this programme Is attributable to cost increases for personnel and to expected Increase In costs of common services Items. Extrabudgetary resources will be used to supplement the regional common services budget.

15.2 GENERAL ADMINISTRATION AND SERVICES

Estimated obligations

Regular budget

Other sources

1988-1989 US$

1990-1991 US$

Increase US$

(Decrease) %

1988-1989 US$

1990-1991 US$

Country or area Regional and Intercountry

2 434300

2 849 700

415-400

17.06

1 151100

800 ()()()

rTOTAL

2 434 300

2 849 700

415 400

17.06

1 151 100

800 000

Support services

199

Support services

200

15.3 BUDGET AND FINANCE The programme will prepare, monitor and control the regional programme budget, Including both regular and extrabudgetary sources, keeping programme management informed of the status of activities. It will organize, administer and control the regional finance and accounts services, particularly with respect to the settlement of claims, imprest accounts and invoices, and the preparation of financial reports.

Budgetary Implications The increase in this programme Is mainly due to personnel cost factors.

15.3 BUDGET AND FINANCE

Estimated obligations

Regular budget

Other sources

1988-1989 US$

1990.1991 US$

Increase US$

(Decrease) %

1988-1989 US$

1990.1991 US$

Country or area Regional and intercountry 493 900 540 500 46600 9.44 47900

82200

TOTAL

493 900

540 500

46600

9.44

47 900

82 200

Support services

201

Support services

202

15.4 EQUIPMENT AND SUPPLIES FOR MEMBER STATES The programme will ensure procurement and timely delivery of equipment and supplies as well as related supply services for the needs of the WHO programme of cooperation, including reimbursable purchases made on behalf.of c,ountries or areas of t~e Ae~ion. The supply information system will be ma1nta1ned and Improved, with a v1ew to lowering costs and enhancihg the quality of supplies and equipment procured.

Budgetary Implications The increase In this programme Is due to personnel cost factors and to the transfer of one general service staff member from extrabudgetary resources funding to regular budget funding.

15.4 EQUIPMENT AND SUPPLIES FOR MEMBER STATES

Estimated obligations

Regular budget

Other sources

1988-1989

199G-1991

Increase

(Decrease) %

1988-1989

199G-1991

US$ Country or area

US$

Regional and intercountry

222 700

255 100

32400

14.55

54800

TOTAL

222 700

255 100

32400

14.55

54800

Support services

203

204

INFORMATION ANNEXES

Annex 1 Annex 2 Annex 3 Annex 4 Annex 5

Summary of country activities Country or area programmes Regional and intercountry activities Summary of intercountry activities Classified list of programmes for the period oftbe Eighth General Programme of Work

205

206

ANNEXl SUMMARY OF COUNTRY ACTIVITIES

207

208

SUMMARY OF COUNTRY ACTIVITIES Estimated obligations

Country or area 1988-1989 US$ American Samoa Australia Brunei Darussalam China Commonwealth of the Northam Mariana Islands Cook Islands Democratic Kampuchea Federated States of Micronesia Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao 102 000 89500 82500 6 880 900 88500 432 400 198 900 471 700 1 734 800 83 500 83500 122 BOO 95 JOO 582 500 1818)00 61 500

Regular budget

Other sources Increase US$ 13 200 9500

1990.1991 US$ 116100 99000 82500 7 461 800 100000 ,47'8 ·400 200 '000 567 '600 1 897 400 92600 oo ~90o

(Decrease)

1988-1989 US$

1990-1991 US$

% 12.83 10.61

4900 580 900 11 500 46000 1 100 95900 162 600 9100 7400 9800 8.44 12.99 10.64 0.55 20.33 9.37 10.90 8.86 7.98 155 400 45900 2800 40300 83800 4 265100 100 000

132 600 95000 640 000 1 968300 66400

57500 150 300 4900

9.87 8.27 7.97

106 000 560 300

Summary of country activities

209

Summary 'of country activities

210

SUMMARY OF COUNTRY ACTIVITIES Estimated obligations

Country or area 1988-1989 US$ Malaysia New Caledonia New Zealand Papua New Guinea Philippines Republic of Belau Republic of Korea Republic of the Marshall Islands Samoa Singapore Solomon Islands Tonga Tuvalu Vanuatu VietNam TOTAL 1 284 600 66200 55000 2 787 000 1 735 200 113 000 1 493 600 170 800 1 316 200 556300 1 081 700 1 079 800 33000 1 083 600 5 079600

Regular budget

Other sources Increase US$ 156 600 5 800 4000 174 900 138 800 7000 134 600 39100 95800 43800 108 300 100 200 (33 000)

1990-1991 US$ 1 441 200 72000 59000 2 961 900 1 874 000 120 000 1 628 200 209900 1 412 000 600100 1 190 000 1 180 000

(Decrease)

1988-1989 US$ 214 600

1990-1991 US$

% 12.19 8.76 7.27 6.28 8.00 6.19 9.01 22.89 7.28 7.87 10.01 9.28 (100.00) 7.97 6.19

381 100 1 280 200 110 300 47800 69600 1 800 40200

778000 367 600 34400 204800 3 730 700 1 444900 167 700 1 000

1 170 000 5 394100

86400 314 500

30 864 500

33 401 000

2 536 500

8.22

12 445100

1 794100

ANNEX2 COUNTRY OR AREA PROGRAMMES

211

212

AMERICAN SAMOA NATIONAL HEALTH DEVELOPMENT SITUATION American Samoa continues to implement a national strategy oriented towards strengthening Its primary care services to achieve health for all by the year 2000. Appi icatlon has been made for a federal grant to design and develop a community health centre within the LBJ Tropical Medical Centre. The Centre would integrate health promotion, disease prevention. and primary medical care services In a common physical and organizational setting, with the village dispensaries as satellite clinics under the Centre. increased attention will be given to exploring the potential role of physician extenders in the primary care setting, including graduates of the Pacific medical officer training programme in Pohnpei, and the nurse practitioner. The one-year old diabetes control programme is having a significant impact on reducing complications from this common disease. A territorial programme of AIDS prevention and surveillance has been initiated, for which federal grant support is being sought. The programme is under the guidance of the Governor's Task Force on AIDS. Increased emphasis is being given by the Environmental Protection Agency to ensuring safe drinking water for the entire population. This effort is being translated into specific legislative and public works proposals. The two-year hepatitis B demonstration project has been successfully concluded. Blood samples have been taken from over 35 000 persons for the test of HBV markers. Ali those susceptible have been immunized, carriers registered and placed under surveillance, and blood samples taken have been stored for future studies. Maintenance immunizations have been integrated Into the general immunization programme. Improved organization and management of health promotion and disease prevention programmes, improved basic sanitation, and the effective integration of preventive and curative services in the primary care setting continue to be priority issues.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 WHO collaboration in the past has been mainly in fellowships. However, for 1990-1991, WHO collaboration will no longer be confined to fellowships but will cover a number of other programmes such as primary health care, immunization and filariasis control.

4. Organization of health systems based on primary health care Building on previous WHO collaboration in this area, specific methodologies for integrating health promotion, disease prevention and primary medical care in primary care settings will be developed with WHO support. This will include an appropriate information system, family-oriented health records system and appropriate use of health manpower. The activity will be implemented through a national workshop and direct consultation from WHO.

5. Development of human resources for health A national workshop on nursing planning and communication strategies will be conducted with WHO collaboration. Participation will be solicited from selected neighbouring island countries, and additional support will be sought from the intercountry programme. A national workshop will also be conducted on defining the role of new health manpower categories in developing the primary care system with WHO support. This activity will build on the activity proposed in 4 above, and is timely in that new manpower categories are being trained for use in the system. Regional invitations will be extended. The lack of adequately trained local health manpower remains a high priority problem. In the absence of local training institutions, off-island training

American Samoa

213

American Samoa Is necessary. Existing resources are Inadequate to meet this need. WHO collaboration Is needed if national health strategy manpower development goals are to be achieved. Emphasis will be given to upgrading the knowledge and skills of existing personnel through short- to medium-term programmes. Existing fellows will be supported up to completion of current courses of study, including one-year post-graduate training for medical students.

214 13.4 Parasitic diseases Technical collaboration Is requested for a local survey of filariasis prevalence and an assessment of the existing surveillance programme.

BUDGETARY IMPLICATIONS The 1990-1991 programme budget reflects a change In emphasis, with a more balanced programme rather than a predominantly fellowship-oriented programme. Fellowships reflect a need for more short-term training to upgrade the knowledge and skills of existing personnel rather than long-term education of doctors, dentists and the like.

13.1 Immunization Technical collaboration In Improving mid-level management of the expanded programme on immunization Is requested.

Estimated obligations

AMERICAN SAMOA Regular budget Programme 1988-1989 US$ 4. Organization of health systems based on primary health care 1990-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

6500

35100

28600

440.00

5. Development of human resources for health 6. Public information and education for health 11. Promotion of environmental health 11.2 Environmental health in rural and urban development and housing 91 500 69000 (22 500) ( 24.59)

2000

( 2 000)

(1 00.00)

2900

( 2 900)

(100.00)

13. Disease prevention and control 13.1 Immunization 13.4 Parasitic diseases 6000 6 000 6000 6000

-TOTAL- AMERICAN SAMOA 102 900 116 100 13 200 12.83 --

---

-American Samoa

-215

216

AUSTRALIA NATIONAL HEALTH DEVELOPMENT SITUATION Australia is a Federation of seven States and Territories. The Federal Government has only limited direct involvement in the provision of health care services, primary responsibility for which is vested in the various State governments and the government of the Northern Territory. In the Australian Capital Territory, the responsibility lies with a statutory authority, the Australian Capital Health Authority. In 1987, the Commonwealth (I.e. Federal) Department of Health was Integrated with the Department of Community Services. The new Department Is known as the Department of Community Services and Health. Australian health ministers have expressed their strong commitment to the development of a strategy to achieve the goal of health for all by the year 2000. There has been progress In identifying the significant health areas of concern in respect of the Australian population at large and the at-risk groups and In reaching a commonality of approach between the Federal Government, States and Territories. Concentrated efforts are being made to Increase the level of community and consumer involvement at all levels of strategy development. Significant recent developments include: - appointment of a Special Adviser to develop a national policy on women's health; - an inquiry into medical education and the medical workforce; -preparation of the report of the Health Targets and Implementation Committee, which is setting goals and targets and planning strategies to achieve health for all. The Australian Government looks forward to continuing its collaboration with WHO and the countries or areas of the Region in various health development programmes.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 5. Development of hu!Nin resources for heaHh

The provision of health manpower and training in Australia Is a complex process covering a number of different interests and authorities. WHO fellowships are keenly sought after as a valuable means of upgrading and updating skills. The National Selection Committee ensures the relevance of programmes to national health priorities.

BUDGETARY IMPLICATIONS The budgetary provision for the development of human resources for health is the same as for the previous biennium.

Estimated obligations

AUSTRALIA Regular budget Programme 1988-1989 US$ 1890-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1988 US$ 1990-1991 US$ Source of funds

5. Development of human resources for heaHh TOTAL- AUSTRALIA

89500 89 500

99000

9500

10.61

- 99 000 9 500 10.61

---

Australia

217

218

BRUNEI DARUSSALAM NATIONAL HEALTH DEVELOPMENT SITUATION Since primary health care was accepted as the best approach to meet the basic minimum needs of the people, national health policy and strategy have been modified to give effect to this policy. Development of the national health Information system has become a matter of urgency in order to plan future strategy and appropriate manpower training. WHO collaboration is required for health situation and trend assessment studies and research on the existing health services in order to reorient and further Improve health manpower resources. Infant mortality remains low at 10.2 per 1000 live births, while perinatal mortality at 11.9 per 1000 live births Is an Improvement on the previous year's records. However, morbidity and mortality trends Increasingly resemble those of developed countries with a high incidence of road traffic accidents, cancer, cardiovascular diseases and metabolic diseases. Improvements in data collection and analysis will give a better epidemiological understanding of health trends and assist In formulating preventive strategies. A substantial reduction in these disease trends is targeted for 1990. Brunei Darussalam has fulfilled the requirements of nine out of twelve important indicators for health for all. The remaining three are: (a) wider community participation and intersectoral coordination; 8.2 Oral health (b) a well-{jefined strategy for the future plan of action based on the primary health care approach; and (c) equitable distribution of available resources throughout the State.

The number of health facUlties has Increased and training programmes for reorientation of staff towards primary health care are ongoing. A trainers' training programme for community nursing has been already completed with WHO collaboration. However, there Is still a shortage of trained and motivated health personnel.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The main emphasis of the programme of cooperation with WHO in 1990-1991 will be on monitoring and evaluation of infrastructure development, and health services management, including activities initiated during the period 1988-1989. High priority is given to health Information management, and promotion of environmental health. 3.1 Health situation and trend aSiessment Collaboration is required to review the existing health statistics unit and the training needs of staff in support of the national health information system. 4. Organization of health systems based on primary health care Support is needed for the more effective training of community nurses through evaluation of the training programme.

The training of appropriate manpower for improving the community dental health services will be promoted.

9.1 Maternal and child health, including family planning WHO will be requested to provide technical support for the formulation of preventive programmes against low-birth-weight babies.

13.3 Malaria Support will be requested for the training of health workers In vigilance and surveillance of malaria.

10.3 Prevention and treatment of mental and neurological disorders Support is needed for the evaluation of community mental health services as a follow-up of the 1988-1989 programmes.

13.16 Cancer Technical support Is requested for screening procedures on early detection of cancers.

13.17 Cardiovascular diseases 11.2 Environmental health In rural and urban development and housing Collaboration is requested in the development of environmental health programmes for control of air pollution, chemical safety, and assessment of developmental impact on environment. Surveys will be conducted on health trends In noncommunicable diseases (particularly cardiovascular and metabolic), the results of which can be effectively utilized in planning preventive programmes.

BUDGETARY IMPLICATIONS Health system development continues to receive high priority In WHO collaborative activities. Other Important health programmes which will need WHO collaboration in 1990-1991 are environmental health, oral health, mental health, maternal and child health, and noncommunicable diseases. Continued training of malaria workers Is essential for the maintenance of malaria-free status.

11.5 Food safety Support will be requested for the training of public health technicians in food analysis.

12.5 Rehabilitation National staff will be trained in rehabilitation of the disabled through the introduction of new and appropriate technologies.

Brunei Darussalam

219

220

Estimated obligations

BRUNEI DARUSSALAM Regular budget Programme Other sources (Decrease) %

1988-1989 US$

1990-1991 US$

Increase US$

1888-1989 US$

160-1891 US$

Source of funds

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development

13 000

8500

( 4 500)

( 34.62)

19 500

(19 500)

(100.00)

4. Organization of health systems based on primary health care

7000

4900

8. General health protection and promotion 8.2 Oral health 6500 8000 1 500 23.08

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning

7000

Estimated obligations

BRUNEI DARUSSALAM Other eources Programme 1988-1989 1990-1991 lncreaae (Decreaae) %

1988-1989

1990-1991

Source of funds

US$ 10. Protection and promotion of mental heatth 10. 1 Psychosocial and behavioural factors in the promotion of health and human development 10.3 Prevention and treatment of mental and neurological disorders

US$

6500

( 6 500)

(100.00)

7000

11. Promotion of environmental heatth 11.2 Environmental health.in rural and urban development and housing 11.5 Food safety 13 000

7000 8500

7000 ( 4 500) ( 34.62)

Brunei Darussalam

221

222

Eatirnated obligations

BRUNEI DARUSSALAM Regular budget Programme 1988-1989 US$ 12. Diagnostic, therapeutic and rehabiiHative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.5 Rehabilitation

Other eourcn (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

6500 7000

( 6 500) 7000

(100.00)

13. Disease prevention and control 13.3 Malaria 13.16 Cancer 13.17 Cardiovascular diseases 6500 --

11 000

8500 7000 7000

( 2 500) 7000 500

( 22.73)

7.69

- 82 500

---

- 4900

TOTAL-BRUNEI DARUSSALAM

82 500 --

- -

CHINA NATIONAL HEALTH DEVELOPMENT SITUATION The fundamental tasks of the Chinese health services are to prevent and treat diseases, to raise people's health standards and to promote social productivity and the socialist modernization programme. The Government has always adhered to the principle of prevention first by energetically carrying out Its patriotic health campaign, strengthening urban ~nd rural preventive and health care services, implementing the planned Immunization programme and conducting disease prevention and treatment. As a result, great changes have taken place in the urban and rural health situation. According to statistics in 1986, t he national mortality rate has been reduced to 6.69 per 1000 population and average life expectancy has reached 68.9 years. The health service is an Important component of the national economic and social development programme. With a view to developing health services with Chinese characteristics to better serve the development of social produ?fivlty, the ~lnistry <;>f Pu~ic. Health has made great progress in ,recent years 1n accelerattng and 1ntenslfy1ng health reform, st rengthening preventive and '!ledical care services in urban and rural areas, promoting health manpower training, revitalizing medical Institutions and promoting health services development. . . . According to statistics, in 1986 the country had 203 000 health Institutions and 59 000 hospitals with 2 296 800 hospital beds and 4 445 900 health personnel, Including 3 506 500 technical personnel. The country also had 340 900 traditional Chinese doctors and 694 700 village doctors. Medical educa!ion and research. have also been greatly developed, while the establishment of the pnmary health care network has facilitated the development of the social economy:ln rural areas. In order to strengthen health legi~lation and its entor?~men!,. the·. c ountry has promulgated the law on Food Hyg1ene, the Drug Adm1n1strattonl.:aw, the Frontier Health and Quarantine law regulations governing pneumoconiosis control and public health management: and rules on management of labour health In township and vftlage enterprises. All these have provided a sound foundation on which to build up the people's health level and accelerate health service development. China Is a developing country, In spite of the great development of Its health service, but it still cannot satisfy the actual needs of the people, In the face of the remaining problems, namely, Inadequacy of health technical personnel, the need to upgrade the technical level and further strengthen preventive services, weaknesses in the surveillance system for disease <::0ntrol, problems In the prevention and control of certain communicable diseases such as viral hepatitis, Increasing Incidence of noncommunicable diseases such as cardiovascular and cerebrovascular diseases and cancer, and need to strengthen medical sciences research Institutions. It is essential therefore to introduce foreign advanced technology and equipment to facHitate the tasks of its health services. The main tasks to be undertaken In the future are as follows: ( 1) strengthen preventive and health care institutions in urban and·rural areas, especially rural primary health care organizations, accelerate health manpower training and upgrade technical standards;

. (2) implement the principle of prevention first, strengthen disease prevention and treatment, upgrade the disease surveillance system promote health education and reduce morbidity; ' (3) establish and develop maternal and child health institutions and strengthen technical guidance for family planning;

(4) develop traditional medicine and explore and build on the heritage of traditional medicine and pharmacology; (5) strengthen and promote medical science research and development;

China

223

China (6) develop medical education, particularly continuing education, so as to accelerate manpower training; (7) strengthen health management, train health administrators and upgrade health legislation. To carry out the above tasks, the Government will continue, in the context of developing its health services through self-reliance, to promote and expand technical cooperation and exchanges with WHO and other United Nations agencies and strive to attain the goal of health for all by the year 2000.

224 3.2 Managerial process for national health development Managerial mechanisms will be strengthened and managerial capabilities upgraded. Coordination between departments will be Improved and the health information system strengthened to ensure the attainment of the goal of health for all by the year 2000. With WHO technical support, It Is planned to hold a national seminar on health policy and the managerial process for national health development tor directors of public health bureaus of provinces/municipalities. Management training of health professionals will also require support.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 While the main focus for WHO collaboration remains the development of human resources for health, increased attention will be given to various aspects of health systems development and the health managerial process.

3.3 Health systems research and development Research studies on the exploitation and utlllzation of health resources are of great importance to national health development. However, experience is Inadequate, particularly In the field of exploration and utilization of health resources. Technlcal support will be required for the formulation of policies and the organization of coordinating activities with other countries.

3.1 Health situation and trend assessment 3.4 Health legislation The national health planning system will be strengthened, and a comprehensive indicator system tor health planning suited to the specific characteristics of this country will be developed. The Health Planning Department of the Ministry of Public Health will be strengthened, and the formulation, implementation and evaluation of the health programme improved. It is also necessary to strengthen epidemiological surveillance, define priority areas for national health development, and further improve macrocosmic management. A pilot project has been carried out in Shanghai Municipality, Ningbo, Zhejiang Province, and Baoji, Shanxi Province. The health information system needs to be strengthened at all levels in order to facilitate the collection and utilization of relevant data and information, and to promote implementation of the health development strategy. Training of professionals will be strengthened with WHO collaboration through study tours, the organization of training courses and the provision of equipment for use in health information activities. Health services must be developed within a legal framework. Health legislation needs to be upgraded, and procedures for the drafting of legislation strengthened. Training In health legislation will be given to professionals through the organization of seminars which will Include the topics of health Insurance and primary health care, and through overseas training.

4. Organization of health systems baled on primary health care Primary health care forms the basis of the health services. Emphasis has been given to the development of rural health infrastructure, manpower training, preventive medicine and health education. A pilot project In selected counties Is being conducted with the financial support of United Nations agencies, Including the World Bank. Cooperation with WHO wHI be further strengthened in the field of rural primary health care services.

Training of administrative workers of primary health care services will be strengthened. Shanghai County has been requested to organize short-term teachers' training courses for administrative workers at health institutions below the county level. This Is expected to upgrade the managerial capability of all rural health Institutions below the county level. The strengthening of township central health centres Is of importance to the development of the rural health services. Taking Into account the economic and health manpower situation, support to the central health centre, the Introduction of standardized management and strengthening of the role of the central health centre have assured Increasing Importance. Collaboration Is therefore requested In updating technical facilities for a phased training programme for officials In charge of central health centres. WHO Is also requested to support the compilation and dissemination nationwide of experience gained In the collaborating centres for rural primary health care.

in those areas Wiill be strengthened. Continuing education facilities will be provided at Xian Medical University, Jlangxl Medical College and three other medical colleges which are to sponsor training activities. The 1ational nursing centre will be strengthened. Teaching materials for nursing w ll toe prepared and nursing standards and qualifications defined. With WHO ~ u p~rt., it Is planned to train senior teaching staff In nursing education, to sJ)':msor workshops of various forms, and to Introduce advanced technologlesfro 11 abroad so as to enhance the quality of nursing In the country. Support will be given to professionals upon their return from postgraduate. training overseas, through provision of equipment and reagents necessary In their laboratory work. The J.Jpgrading of the English language centres at the Xlan Medical University ard the Hunan Medical College respectively Is expected to continue with WHO cc~laboratlon. Training of teachers remains Important.

5. Development of human resources for health Encouraging results have been obtained through WHO cooperatio n in manpower training. The award of fellowships to health professionals to study various technical and managerial subjects abroad has played an Important role In scientific and technological development. Manpower training, particularly In rural health technology, remains a priority of the health development programme. It is essential to provide suitable facilities and working conditions for those who have completed their training In order to give full scope to their initiative. The training of rural mid-level and basic health manpower will be strengthened through in-service audiovisual education In order to update knowledge and exchange information. Shunyi County in Beijing Municipality has been chosen as the pilot county for audiovisual education. Training will be carried out at various academic levels, combining clinical practice with field investigation. Collaboration is sought in strengthening audiovisual education facilities. Medical and health schools wHI be strengthened and education facilities improved in remote areas, areas peopled by the minority groups, or areas which used to be revolutionary bases. Training of mid-level professionals

Public Information and education for health

The strengthening of public Information and health education lnstitutloos, :!nd training of professionals are of great Importance to the development of preventive medicine. Of equal Importance are health education activities allred at helping the community to abandon unhygienic habits and to Improve Its raertal and physical health. A healtt- education training centre will be established at the Provincial Institute of Healt, Education, Gansu, with the aim of training a core staff of health education Institutions at county level In northwest China, where the minority groups live. Promotbn of health knowledge and healthy patterns of behaviour needs to be lnl":iated among primary and secondary school chHdren. It Is planned to select a number of counties or cities from the provinces and municipalities o f Hunan , Zhejiang, Shanxi, Fujlan, Liaoning, Yunnan, Heilongj lang B-3ljing and Shanghai, as models for the Integration of field experience llllto the curriculum, for dissemination to all parts of the country. Appropriate acher training also needs to be provided.

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225

China WHO Is requested to support training activities locally and abroad In order to Increase understanding of health education development In other countries.

226 dentists for hospitals and clinics at the township level. WHO Is requested to provide part of the equipment necessary for dental care. Preventive oral health activities among school chHdren need to be strengthened. It Is planned to set up task forces In certain provinces or municipalities to conduct pilot studies on the fluoridation programme. .The results will be disseminated to other parts of the country. In-service training will be conducted In areas peopled by minority groups. A workshop was sponsored in 1987 at the Gullln Medical College to upgrade technical capabHity In the control of oral diseases. Slmlar workshops and follow-up supervision are planned. Collaboration Is requested In the Improvement of teaching facHitles.

7. R....rch promotion and development, Including rHMrch on hNith-promotlng behaviour Scientific research Is the key to the modernization of the medical sciences. To attain the goal of health for all by the year 2000, medical research must be Improved. WHO collaborating centres such as those for helminthiasis, classification of diseases, Immunogenetics, and Immunology, must be strengthened, and their research and training capabHity upgraded If they are to play a leading role In medical research. It Is therefore Important to send professionals for overseas training and to provide the necessary equipment and facilities.

8.4 Tobacco or h•lth Smoking has become a global health problem. The Incidence of smoking In this country remains high. In order to attain the goal of reducing the number of smokers by an annual rate of 1% as set out In a programme of this country, a phased programme of health education must be carried out with teenagers as the main target group. Scientific research will be further strengthened. Collaboration Is requested in the training d professJonalsln controlling smoking. Academic exchanges will be conducted on relevant subjects such as research design, quality monitoring, and evaluation d resUts.

8.1 Nutrition There Is an Increase In the Incidence of disease caused by Irrational and unbalanced diets. It Is therefore Important to Improve epidemiological surveillance and scientific research on nutrition In order to provide the community with nutritious food on a rational basis. Health education and scientific guidance will be provided, partlcular1y on the nutrition status of children. In order to carry out this project successfully nationwide, manpower training wHI be conducted In selected model counties for primary health care. 8.2 Oral health In order to attain the goal of WHO, that the number of decayed, missing or filled teeth shall not exceed three among children at the age of 12, the control of oral diseases In rural areas must be strengthened and oral hygiene Improved. Efforts will be made to develop Institutions and train manpower. Yunchen In Shanxi Province, Gulyang In Gulzhou Province and Zhellmu-meng In Inner Mongolia Autonomous Region have been selected for the conduct of the pilot study on formulation of a control programme and measures for the control of oral diseases In rural areas. Yunchen centre for the control of oral diseases will conduct a training programme for mid-level professionals of oral health, while Zhellmu-meng centre will focus on training

8.1 Maternal and child hMith, Including family planning Women and children make up two thirds of the total pc>pUatlon ot this country, and 80% of them live In rural areas. The Improvement d maternal and child health services and reduction of maternal and infant mortality and morbidity have an Important bearing on the attainment of the goal of health for all by the year 2000. It Is of particular Importance to Improve maternal and chid health services In rural areas and those populated by minority groups. With support from United Nations agencies, encouraging results have been obtained In maternal health care, genetic counselling, and selentlflc research. It Is hoped that WHO will support the following activities: (1) a survey on maternal mortality and Its causes, and a pilot study on the management of high-risk population groups In maternal health care, to be

carried out In Xinjiang Autonomous Region and In the minority groups of Sichuan Province; (2) the establishment of a maternal and child health training centre for southwest China at the Municipal Institute of Maternal and Child Health In Chengdu City to raise the professional level of maternal and child health workers through continuing education;

10.3 Prevention and treatment of mental and neurological disorders Cooperation with WHO In mental health and neurology In recent years has yielded satisfactory results, and wHI, It Is hoped, continue In the fields of epidemiology, community control and scientific research. A general survey of neurological diseases will be carried out In selected urban and rural areas In Beijing, Shanghai and Shanxi. This wHI' Include cerebrovascular diseases, epilepsy and certain congenital diseases. Comprehensive measures for prevention and treatment will be strengthened to reduce morbidity and mortality. The professional level of health workers needs to be further raised through national workshops and postgraduate training abroad. Equipment for scientific research needs to be updated. Studies will be carried out on psychosocial problems among children. There is a sound health care Infrastructure at the grassroots level. A pilot study has been initiated In the urban and rural areas of Nanjlng City so as to determine the present psychosocial status of children. A three-tier system for mental and physical health care will be established and training provided for health workers.

(3) the continuation of a study focused on increasing the breast-feeding ratio, and Improving the nutrition status and healthy growth of Infants and children; (4) the continuation of the studies begun in 1987 on the etiology of mental retardation in the mountainous areas of Anhui Province.

9.4 Workers' hearth Great importance Is attached to the Improvement of working conditions through multisectoral studies on worker protection, the formulation of health standards, the development and strengthening of regulatory Institutions, and the improvement of preventive measures for the protection of workers' health. Studies are in progress on the Integration of primary health care, the occupational health of township Industries, and the protection of female workers. These studies also cover the strengthening of health supervision, the training of health administrators, and comprehensive measures for the control of occupational risks. WHO is requested to collaborate in training, monitoring and surveillance.

11.1 Community water tupply and untt.tlon Endemic fluorosis Is still prevalent In certain parts of China, and seriously endangers the people's health. The national survey In 1986 shows that about 40 000 ooo people were Infected with this disease. Collaboration wlU be requested for c onducting epidemiological surveillance on fluorosis, strengthening the training of professional personnel , and developing appropriate technology and equipment.

9.5 Hearth of the elderly The National Institute of Gerontology has conducted an epidemiological survey and scientific research of health problems of the elderly. Observation centres have been set up in both rural and urban areas. It is necessary to upgrade professional capabilities for the control of health problems related to aging. Lectures have been given by WHO consultants to good effect. It is hoped that this type of collaboration will continue in 1990-1991.

11.2 Environmental hearth In rural and urban development and housing With a view to improving housing and sanitation In rural and urban areas, continued collaboration Is required in formulating hygienic standards for housing in v_ illages and townships, preparing programmes on hygienic design, and promotrng the d evelopment of housing construction and sanitation. It Is planned to set up a group of model vHiages and townships In housing sanitation, and the experience of this group wMI be applied nationwide. The training of health personnel will be intensified with WHO technical support.

China

227

China 11.4 Control of environmental heaHh hazards With the development of Industrial and agricultural production, greater attention has been given to environmental pollution, and some measures have been adopted. However, Integrated methods of control and appropriate legislation are still needed. For example, coal is widely used in China as a major energy source. A study carried out at the Beijing, Shanghai and Liaoning epidemic prevention stations has revealed Its short- and long-term effects on human health. Asbestos has also been found hazardous to human health. Collaboration will be needed In upgrading the technical capability of staff in this area and in enhancing environmental monitoring. 11.5 Food ufety In order to implement the Food Hygiene Law and achieve the targets of the model counties, a number of counties such as Xinhui County in Guangdong Province, Heishan County In Liaoning Province, and Chuangsha County in Shanghai, have been selected as model counties for food hygiene. This experience needs to be summarized, and the training of professional staff needs to be Intensified. Support Is needed for upgrading the technical capability of staff and facilitating the transport of food hygiene Inspectors. 12.1 Clinical, laboratory 1nd radiological technology for heaHh systems based on primary heaHh care Collaboration will be continued in the field of clinical, laboratory and radiological technology based on primary health care as well as medical laboratory animals, so as to facilitate the development of research work in these areas. Two workshops, one on genetic monitoring and the other on microbiological examination of laboratory animals, are planned in collaboration with WHO. Training abroad for technical personnel and provision of equipment will also require support. With a view to strengthening radiation protection, ensuring the health and safety of radiologists and patients, upgrading the level of radio diagnosis-therapy and promoting the rational use of X-rays, a pilot project will be established In Shandong Province with a view to formulating integrated protective measures, with technical support from WHO. 12.2 Essential drugs and vaccines

228

To strengthen drug management In hospitals, It Is proposed to develop training programmes for clinical doctors and pharmacists at county level In Xinjiang and Sichuan Province, with collaboration from WHO. 12.3 Drug 1nd Vllcclne qUIIIIty, ufety 1nd efficacy The promulgation of the Drug Administration Law will ensure the safety of drug application. In this regard, the Government places emphasis on the training of technical personnel and upgrading of technical managerial capabilities oriented to strengthening drug administration and quality control, carrying out supervision and examinations, promoting quality control and ensuring enforcement of the Drug Administration Law. 12.4 Traditional medicine Development of traditional medicine Is a priority area of China's national health development. Collaboration with WHO and other International organizations is expected to continue, with emphasis on studies and research using modern technology, with a view to using systematizing and developing the nation's medical and pharmacological heritage for the benefit of the people of China and of other nations. It is planned to set up computerized Indexes of acupuncture materials in the Chinese Academy of Traditional Medicine for the further development of acupuncture at home and abroad. Collaboration is required for the provision or development of software for this project. In addition, technical and material support Is requested to facilitate construction of the Institute of Medicinal Plant and Resources Development as well as for manpower training programmes. There is a need to send professionals to study abroad In order to enlarge the scope of research areas related to traditional medicine. 12.5 Rehabilitation It is proposed to organize training courses on community-based rehabilitation for professionals In Guangdong, Shandong, JHin and Inner Mongolia with a view to strengthening the development of and research on community-based rehabilitation, Including research on traditional rehabilitation measures. In the meantime, It Is necessary to upgrade and expand the WHO

collaborating centre for community-based rehabilitation, located in Zhongshan Medical University, and Its training programmes. 13.1 Immunization

training by conducting workshops on parasitic disease control and management, immunization diagnostics technology and health education. Selected national staff will be trained abroad to gain experience in prevention. 13.8 Diarrhoeal di......

In addition to responding to WHO's call for measles elimination, China has proposed at the same time a project to eliminate poliomyelitis by selecting pilot areas at the community level, and formulating control methods. To achieve this aim, technical collaboration Is requested as well as support for the overseas training of Chinese technical staff. The main support for the Implementation of the immunization programme will come from the Government and UNICEF. 13.2 Disease vector control To strengthen the control of vector-borne diseases, attention has been given to the monitoring of vector-borne diseases at sea and airports as well as to staff training. It is proposed to set up a training centre In Guangdong with WHO technical support. Overseas training of specialized staff to learn advanced technology wit I also require collaboration. 13.3 Malaria In the past, the prevalence of malarla has been a serious problem. In recent years, It has still occurred In certain areas. Collaboration Is needed to strengthen research on prevention, especially for the control of falciparum malaria and the field study on drt,Jg-resistantfa/ciparum malaria, and for active participation In the global malaria programme. Attention needs to be given to staff training, the intrcx:luction of advanced technology, and provision of equipment for prevention and research. 13.4 Parasitic diseases Parasitic diseases are .common in China. In spite of some improvement, the Incidence •of ancylostomiasis, chlonorchiasis, paragonimiasis, etc., has increased .in certain areas in recent years. Kala-azar is under control by and large although recurrences have been reported In certain areas. Collaboration is 'requested to strengthen epidemiological surveillance and research on ;prevention and eradication, to develop staff

Diarrhoeal diseases are among the most prevalent In China. Though mortality has been kept at a relatively low level, people continue to suffer from their harmful effects. Concerted efforts will continue to enhance preventive and curative measures through health education, pathogen detection and the implementation of a control programme. Oral rehydration therapy is a simple and acceptable practice which needs to be further promoted as the key method for clinical treatment of diarrhoeal diseases In this country. Collaboration is sought In providing technical advice and providing standard reagents and equipment for surveillance. It Is hoped that funds will be available from Intercountry and interregional resources to expand activities in this area. 13.7 Acute respiratory Infections Acute respiratory Infections are among the common diseases which pose a threat to the health of children In China. Incidence Is high, partlcular1v; among children living in areas below county level. In order to reduce morbidity and mortality, efforts will be made to expand research on etiology, set up a pneumonia surveillance network and adopt effective preventive and curative measures, Including health education. Training of technical staff will be promoted and capabilities In prevention and control will be upgraded. It Is hoped that intercountry funds will be available to complement this effort 13.8 Tuberculosis Tuberculosis prevention and contrails one of the priority projects under the national health development programme In China. However, special attention needs to be given to surveillance and control In the minority areas. In order to strengthen Institutional control, emphasis will be given to setting up the health care network at grassroots level, Implementing effective preventive and curative measures, and promoting manpower training to upgrade professional capabilities. It Is hoped that WHO will provide support for detection and diagnostic activities.

China

229

China 13.1 o Zoonoses Continued collaboration will be needed to carry out studies and research on the transmission route of zoonoses such as echinococcosis to determine and eliminate the key links In transmission, and to launch effective control measures against the diseases. Plague has been basically controlled In China. However, In recent years, sporadic cases have been reported In remote and border areas. Although only a small group of people have been afflicted with plague, it poses a threat to public health. Greater efforts are therefore needed to control the spread of plague from the animal population. 13.12 Research and development in the field of vaccines In order to develop effective methods for the prevention and control of diarrhoeal diseases, a number of research institutions in China have in recent years carried out research on dysentery vaccine, as well as El Tor and other vibrio cholera vaccines. There are great hopes for the successful development of these vaccines. Collaboration is requested In the provision of equipment and reagents. 13.13 AIDS AIDS Is a serious communicable disease reported worldwide. So far, three cases of AIDS have been reported In China. It has become imperative therefore for the health departments and other sectors concerned to strengthen surveillance and screening and prevent the Introduction and spread of HIV infection. China will collaborate with WHO in strengthening AIDS surveillance and screening, promoting Information exchange and health education, and publishing educational materials. WHO technical and material support will be required in the areas of health promotion and education, surveillance and screening and short-term overseas training. It is hoped that the Global Programme on AIDS will also provide substantive support. 13.14 Other communicable disease prevention and control activities Research on the prevention and treatment of viral hepatitis continues to be a priority research project and needs further strengthening. Based on the situation In China, it is proposed to conduct hepatitis B Immunization for newborn babies in selected urban and rural areas, in order to inhibit the transmission of Infection. This activity will provide a basis for the further expansion of the prevention programme. 13.15 Blindness and deafness

230

It is estimated that there are 4 million blind persons In China, and that about 1 to 1.5 million of these cases are the result of cataract. Most of these are geriatric cataract. Since life expectancy Is Increasing, It is projected that t he total number of blind persons will double by the year 2000. The Government attaches great Importance to research on and prevention and treatment of blindness, and has requested doctors of ophthalmological hospitals and blindness prevention centres to actively treat the blind through surgical operation, by means of which 60% of the blind can recover or Improve their sight. Meanwhile, prevention and treatment of trachoma will also be carried out. 13.16 Cancer Cancer has become a formidable enemy of public health in China. As key research projects in the country, cancer prevention and treatment and cancer research have been given priority In the national health development programme. Collaboration will focus on strengthening laboratory, cflnlcal and field research on prevention and treatment of cancer at the WHO collaborating centres. 13.17 Cardiovascular diseases Like cancer, cardiovascular diseases have also become a great danger to public health. The national health development programme has given considerable attention to reducing morbidity and mortality rates. Continued collaboration is needed to further strengthen epidemiological studies, adopt effective preventive and curative measures, Improve the research capabilities of WHO collaborating centres, and train personnel, particularly at grasSroots level. 13.18 Other noncommunicable disease prevention and control activities The prevention and control of Kaschln-Beck disease and Iodine deficiency disease are key projects and have received considerable attention. Continued collaboration Is needed in carrying out epidemiological surveys, conducting field research on prevention and treatment, and implementing effective control measures. Support is also needed for the overseas training of national staff to study experience in the control of the Kaschln-Beck disease and for manpower training at the local level.

14. HeaHh Information aupport In order to provide better medical information and library services, efforts will be made to develop and strengthen medical information institutions, accelerate manpower training and upgrade the capabilities of professionals with WHO collaboration.

water supply and sanitation, immunization, disease vector control, parasitic diseases, zoonoses and noncommunicable diseases. Increased attention will be given In 1990-1991 to Infrastructure and process development, particularly those related to health planning and management and development of an Information base. Budgetary provisions for primary health care, health systems research and health Information support have therefore been Increased. The Importance of Improved maternal and chHd health services in achieving the health-for-all goal has been recognized and this accounts for the budgetary Increase for this programme. Other changes reflect new priorities such as programmes relating to tobacco or health, research and development In the field of vaccines, other communicable disease prevention and control activities, and AIDS.

BUDGETARY IMPLICATIONS The most significant budgetary change is the reduction under the programme on development of human resources for health, due to the reduced fellowship provision. However, health manpower development continues to be given high priority and training activities for different levels of health workers are provided for in other programme areas such as oral health, community

China

231

232 Estimated obligations

CHINA Regular budget Programme 1988-1989 US$ 199G-1991 US$ Increase US$ (Decrease) %

Other aourcu 1988-1989 US$ 199G-1991 US$ Source of funds

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development

. 100 000 88 700 ( 11 300) ( 11.30)

93500

88 700

( 4 800)

( 5.13)

Costs of WHO Representative's Office, located in Beijing, China 3.3 Health systems research and development 3.4 Health legislation

260 800

272 300

11 500

4.41

100000

100 000

43600 60000 66600

43600 6600 11.00

4. Organization of health systems based on primary health cere 200000 277 400 77400 38.70

5. Development of human resources for health 3 347 600 2 574 300 (773 300) ( 23.10) 14500

8. Public Information end education for health 60000 77600 17600 29.33

Estimated obligations

CHINA Regular budget Programme 1988-1989 1990-1991

Otheraourcn (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$

7. Research promotion and development, including research on health-promoting behaviour 685000 776 600 91 600 13.37

8. General health protection and promotion 8.1 Nutrition 8.2 Oral health 8.4 Tobacco or health 50000 115 000 66600 166 400 66600 16600 51 400 66600 33.20 44.70

9. Protection and promotion of the health of specific population groups 9.1 Maternal .a nd child .health, including farriily planning

60000

166400

106 400

177.33

3159200 6400

FP UF

9.4 Workers' health 9.5 Health of the elderly

60000 78900

88 700 88700

28 700 9800

47.83 12.42

China

233

234 E.tlrNted obligations

CHINA Regular budget Programme 1988-1989 1990-1991

Otheraourcee (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 10. Protection and promotion of mental heaHh 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological disorders

US$

40000

( 40 000)

(100.00)

80000

88 700

8 700

10.88

11. Promotion of environmental heaHh 11. 1 Community water supply and sanitation 11.2 Environmental health in rural and urban development and housing 11.4 Control of environmental health hazards 11.5 Food safety

33300

32600

49000

55500

6500

13.27

60000 100 000

66600 133 100

6600 33100

11.00 33.10

34 700

Estlrm~ted

obligations Otheraourc"

CHINA Regua.r budget Programme 1988-1989 1990-1991

Increase US$

(Decrease) %

1988-1989

1990-1991

Source of funds

US$ 12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines 12.3 Drug and vaccine quality, safety and efficacy 12.4 Traditional medicine 12.5 Rehabilitation

US$

122 700 50000

110 900 55500

( 11 800) 5500

( 9.62) 11.00

448900

DP DP

80000 150 000 50000

110 900 166 400 55 500

30900 16400 5 500

38.63 10.93 11.00

115300

13. Disease prevention .and control 13.1 Immunization 13.2 Disease vecto,.:.control 13.3 Malaria 70000 55 500 33300 55 500 33 300 29800 42.57

99800

China

235

236

Estimated obllg•tlons

CHINA Regu'-r budget Programme 1988-1989 1990-1991

OthersourcH (Decrease) % 58.43

Increase US$ 40900 33300 ( 3 000) 15 500

1988-1989

1990-1991

Source of funds .

US$ 13.4 Parasitic diseases 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy 13.10 Zoonoses 13.12 Research and development in the field of vaccines 13.13 AIDS 13.14 Other communicable disease prevention and control activities 13. 15 Blindness and deafness 13.16 Cancer 50000 69600 40000 70000

US$ 110 900 33300 66600 55500

US$ 26200

US$

( 4.31) 38.75 25500

110 900

60900

121.80

44400 110 900

136 900 50000 200000

221 900 88800 221 900

85000 38800 21 900

62.09 77.60 10.95

245500 47800

VD ST

Eatl11111ted obligations

CHINA Regular budget Programme 1988-1989 US$ 13. 17 Cardiovascular diseases 13. 18 Other noncommunicable disease prevention and control activities 14. Health Information support TOTAL- CHINA 6 880 900 191 900

Other sources pecrease) %

1990-1991 US$ 221 900

Increase US$ 30000

1988-1989 US$ 8500

1990-1991 US$

Source of funds

\ 15.63

50000

89600 111000

39600 111000

79.20

7 461 800

580 900

8.44 --

4265100

100 000

China

237

238

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS NATIONAL HEALTH DEVELOPMENT SITUATION The Department of Public Health and Environmental Services Is the sole provider of health care In the Commonwealth of tile Northern Mariana Islands.. The C~mmonwealth Heal~h Center (CHC) provides a wide range of preventrve (pubhc health) and curatrve health services aimed at protecting and improving the health and well-being of the population. The Department of Public Health and Environmental Services is headed by a Director (Ministerial level), who Is appointed by the Governor and serves as a Cabinet member. The Commonwealth health organization is characterized by a free standing, lnd~pendent agency responsible directly to the Governor, with ~II the charact~rlst1cs of a supra-agency structure, encompassing not only public health serv1ces but also curative (hospital), environmental health protection services and others. The newly built Commonwealth Health Center was opened in November 1986 and was dedicated In April 1987. The Center is a unified medical centre which a.ccommodates In-patient and out-patient services, emer~ency care, and diagnostic services and administrative offices. The hosp~al part has 74 acute care beds available for medical, surgical, obstetrical, paed1atnc and acute mental health patients. Being the principal medical centre for the Commonwealth, the hospital serves as the primary referral facility for the Rota and Tinian health centres. . The goal of the Center Is to consolidate in-patient, out-patient and

particularly because It departs from the former hospital system as the model from which the population receives both primary and secondary care. The goal also aims at Inculcating a stronger sense of belonging and participation by the community. Although the residents of the Commonwealth enjoy a health status superior in many respects to residents of most other developing countries, the population continues to experience a great deal of avoidable mortality and morbidity, and other "new" health problems. The birth rate continues to increase annually from 1984 with 32.7 births per 1000 to 37.9 per 1000 in 1986. The data d o seem to indicate that a major drop in the number of births will probably not take place In the near future. Because of the strong cultural emphasis on the family, In conjunction with a strong influence from the Catholic church, as well as the continual influx of a contract work force, which Is necessary given the tremendous economic boom, the birth rate in the Commonwealth will probably remain high for some time to come. t~e age of 35 (these women have an average of seven children) and 19% of

From 1980 to 1986, an average of 4.7% of births were to women over

p~bhc health programmes for the purpose of providing a systematic delivery of

btrths were to women under 19 years of age. It is estimated that over 55% of all births are categorized as "high risk". Although there is a gradual decline In the number of low-birth-weight infants born In the Commonwealth the rate remains high, averaging 22.4% from 1980 to 1986. Data from 1900 to 1987 indicate ~hat almost all mothers receiv~ some type of prenatal care. The problem IS that many mothers do not recerve any prenatal care until their second trimester of pregnancy. During 1987, 72% of all pregnant women did not receive prenatal care until the second trimester of pregnancy and only 28% received prenatal care in the first trimester. . Infant mortality Is relatively high. The average Infant mortality rate dunng the last seven years (1981-1987) was 19 deaths per 1000 live births. The average fetal death rate for the same year was 14 deaths per 1000 live births. The neonatal average death rate for the same year was 14%; perinatal deaths ayeraged 22%. The ~hree leading causes of infant mortality were: prematurity, diseases of the respiratory system and diarrhoeal and intestinal diseases It is Important to point out that many Infant deaths in the Commonwealth are preventable.

pnmary and secondary health care services that is efficient effective and responsive to the needs of the entire resident population of saipan, Rota and Tlntan, and to develop local resources and availability of such services. This goal represents a significant reorientation in the provision of health services,

Considered part of the Trust Territory of the Pacific Islands at the time the proposed 1990-1991 regional programme budget was prepared .

Another highly preventable disease prevalent In the Commonwealth is dental caries. Surveys conducted over a 20-year period Indicate a significant and continuing rise in caries among the population. In 1967, ltle "decayed, missing, filled" ratio for 12 years old was 5.3; In the 1977/1978 survey, the ratio was 7.7; and the most recent survey conducted in 1986 showed a ratio of 11 .1. The reasons for this rise are varied, but the most common cause is Imported foods, such as soft drinks. No water in the Commonwealth Is fluoridated. The combination of a westernized diet with lack of fluoride present a challenge to dental health workers to combine available technology (fluoride treatment) with dental health education in order to improve the dental health status of the populace. Diseases of the heart are the leading causes of death. These diseases were responsible for 19% of all deaths in the seven years, 1980-1986. This Is almost twice as many as other cause, making it by far the leading cause of death. The prevalence of chronic diseases In the population is expected to increase according to the current Five-Year Health Plan. Certain chronic diseases appear very frequently, and hypertension and diabetes seem to be particularly prevalent. These diseases often are secondary factors In causes of death. A leading cause of deaths, homicide, is higher than In many other areas in the world. Over the last few years, homicide has been ranked between seventh and eighth place. During the seven years (1980- 1986), the average death rate due to homicide was 1.6 deaths per 10 000 population per year. In every year, diseases of the respiratory system were the leading cause

(2) Diet recall Information from the "Nutrition Survey" Indicates that Intakes of milk, fruit and vegetables In children between the ages of one and four are low. {3) Although few data are available, use of alcohol and tobacco Is generally regarded as a health risk. The health status can be summarized as follows: (1) The birth rate for 1986 was 37.9 per 1000 population. (2) The death rate was 5.9 deaths per 1000 population In 1980-1986. (3) The Infant mortality rate was 19 deaths per 1000 live births In 1980-1987. (4) Thirteen percent of all deaths from 1980 to 1986 were children under four years of age. (5) The ten leading causes of death In 1986 were: diseases of the heart; malignant neoplasm (cancer) ; all accidents; cerebrovascular diseases (stroke); prematurity; Influenza and pneumonia; chronic pulmonary diSeases; homicide; diabetes mellitus; and renal failure. The programme plan proposed significant changes In the health care delivery system during mid-1988 and will continue to Improve the delivery of primary care services. Included In these changes are the consolidation of all p ublic health programmes, Including maternal and child health, other preventive health services, alcohol, drug abuse and mental health, famNy planning, sexually transmitted diseases, immunization, handicapped resources centre, the locally funded sanitation programmes and out-patient operations of the Commonwealth Health Center, and others Into an Integrated system of primary health care. Thus the emphasis Is to provide activities related to development and strengthening of health care management In planning, Implementation, monitoring and evaluation of health programmes. The primary responsibility for carrying out the health protection and promotion programme activities lies with the Division of Primary Care. During 1988-1989, staff expansion In the health promotion and protection services Is expected to Increase, for example, with additional health educators,

of total visits, as well as first visits. These diseases accounted for 20% of all ambulatory visits from 1975 to 1981; and total visits for these diseases have steadily risen each year from 1982 to over 30% of all ambulatory visits in 1985. Diseases of the skin and subcutaneous tissues, and diseases of the ear and mastoid are also important factors. Other health status factors In the population identified by the Commonwealth Health Plan are: (1) Breast: feeding Is not commonly continued beyond the first few months of infancy.

CommonweaHh of the Northern Mariana Islands

239

CommonweaHh of the Northern Mariana Islands nutritionists, social workers and sanitarians. Thus WHO collaborative efforts will be sought to strengthen and Improve the managerial abilities of these staff to carry out general health protection and promotion programmes In the Commonwealth.

240

The emphasis during 1990-1991 will be on strengthening the nutrition services by Increasing the managerial skills of the staff. Support for a nutrition status survey wHI be sought from other sources, such as UNICEF.

a.2 Oral heaHh

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 A large part of the 1990-1 991 biennial budget focuses on health manpower development in support of primary health care activities, which continue to be a pressing Issue. The need to strengthen national managerial capacities at programme level to implement health strategies and programmes to enhance health promotion and care, and disease prevention and control will be the focus of WHO collaboration in 1990-1991. 3.1 HeaHh sHuatlon and trend assessment WHO support will be needed in developing an integrated health information system, especially In refining the minimum basic data set (MBDS) and training of mid-level managers in data management systems. 5. Development of human resources for heaHh Manpower requirements have been specified in several health documents, including the Comprehensive Health Plan, Manpower Resources Development Proposal, and other health policy documents of the Government. The Division of Primary Care Is working on Increasing the managerial capabilities and responsibilities of all staff, particularly those involved in prevention and health promotion programmes. Emphasis will be placed on Improving the management capabilities of staff and making optimal use of available manpower resources, with special emphasis on maternal and child health, together with midwifery and nutrition training. 8.1 NutrHion The Commonwealth lacks a permanent nutritionist and has had difficulty In recruiting one. One of the primary care service objectives Is to provide a comprehensive nutrition education and promotion service, and to increase the number of dietary counselling encounters in public health clinics.

The Commonwealth has Implemented a successful community outreach oral health programme, with the support of WHO In providing transportation. Upgrading of the oral health services and promotion programmes will continue throughout the budget period. School oral health programmes will be emphasized in the coming years. 9.1 Maternal and child heaHh, Including family planning The Commonwealth will continue to seek WHO support for maternal and child health activities, especially In the management of specific programme monitoring and evaluation. Fellowships will also be sought from other funding sources, In the areas of midwifery for nurses and refresher training for an indigenous physician. 11. 1 Community water supply and unHatlon WHO collaboration will be sought In training staff In community water supply and sanitation, and in strengthening the capability of the community to maintain the water supply and sanitation system.

BUDGETARY IMPLICATIONS All six programmes have been Identified as priority areas, with emphasis placed on the development of human resources for health. WHO technical collaboration Is required for other programmes such as the managerial process for national health development, organization of health systems based on primary health care, public Information and education for health, and prevention and control of alcohol and drug abuse. However, In view of the limited resources available, the Government wHI try to explore other funding sources for those programmes which have not been budgeted for within the country planning figure.

Estimated obligations

NORTHERN MARIANA ISLANDS Programme 1988-1989

Regular budget 199o-1991

Other sources (Decrease) %

Increase US$

1988-1989

199o-1991

Source of funds

US$

3. Health system development 3. 1 Health situation and trend assessment 4. Organization of health systems

15 600

based on primary health care

13 000

{13 000)

(100.00)

5. Development of human resources for health 56000 36900 (19100) ( 34.11)

8. General health protection and promotion B. 1 Nutrition 8.2 Oral health 9 700 5400 16000 5400 6300 64.95

9. Protection and promotion of the health of specific population groups

9. 1 Maternal and child health, including family planning Commonwealth of the Northern Mariana Islands

20 700

20700 241

242

Eatlmated obligations

NORTHERN MARIANA ISLANDS Programme 1988-1989 US$ 11. Promotion of environmental health 11. 1 Community water supply and sanitation

Regular budget 1990-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

9800 --

5400

( 4 400)

( 44.90)

-100 000 11 500 12.99

----

-- -

TOTAL- COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS

88 500

COOK ISLANDS NATIONAL HEALTH DEVELOPMENT SITUATION The principal development objectives of Cook Islands for the period 1988-1990 are to enhance the social and economic well-being of its citizens, compatible with cultural values , to increase the levels of community participation in the development process, and to ensure close cooperation with neighbours within the Region in economic, social and other matters of mutual interest. The health sector plan will continue to provide the best possible comprehensive health service, both preventive and curative, for every individual resident at a cost the country can afford. This will Involve promotion of the physical, mental and social well-being of the people through primary health care. Health Indicators for 1986 Indicate a birth rate of 24.0 per 1000 population, Infant mortality rate of 16.8 per 1000 live births, death rate of 5.6 per 1000 population, and life expectancy at birth of 68 years. The principal causes of mortality by rank are diseases of the circulatory system, malignant neoplasms, diseases of the respiratory system, diabetes, injuries and poisoning, diseases of the genito-urinary system and perinatal conditions. The leading causes of morbidity on the main island, which may be considered an urban settlement, based on a study of hospital admissions, continue to be injuries, diseases of the digestive and respiratory system, disorders of the circulatory system, infections and parasitic diseases, and diseases of the genito-urinary system, followed by diseases of the skin and subcutaneous tissue and diseases of the nervous system. In the outer Islands, ·.whiCh may be considered rural in the Cook Islands context, the leading causes of :HI :health are upper respiratory tract infections, skin Infections, diarrhoeal diseases and parasitic infestations. Inadequacy of water supply and sanitation Is a contributing factor to such disorders, as well as lack of knowledge on health Issues. Owing to the geography of the country, the small scattered population and insufficient resources, the health development programmes have been difficult to irnplement at times. Continued WHO collaboration will be required to meet the health-for-all objectives.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 The main thrust of WHO collaboration for 1990-1991 will be:.lh; community water supply and sanitation. A WHO staff member Is proposad!to. be assigned to this programme for this biennium. Fellowships still; play ·an· Important part in WHO collaboration, but at a reduced level.

3.1 Health situation and trend aaeeSiment Collaboration under this programme will continue, particularly-' In respect to the health information collection system.

3.4 Health legislation

A review of certain public health legislation Is necessary for It to become relevant to present health needs. 4. Organization of health systems based on primary health;care Continued support for the management processes at all levels Is Important. Promotion of community participation In health programmes, and

Cook Islands

243

Cook Islands coordination by supporting units within the health delivery system and other sectors are vital to the development of primary health care. 5. Development of human resources for health The programme objective Is to ensure that adequately trained health workers are available to serve the needs of the country. Collaboration will be necessary in both undergraduate and post-graduate training in various fields. 6. Public information and education for heahh . The health education programme is an important component of national health development activities. Efforts will continue in the areas of organization, programme management, training materials, and development and extension of services to peripheral health units and the community.

244 11.1 Community water supply and unitatlon Priority continues to be given to the development of Improved water supply and sanitation, particular1y in the rural areas or outer Islands. Continued WHO technical support will be required for various activities In the water supply and sanitation sectors, including supervision of project construction and monitoring of progress of all water supply and sanitation developments In the ~ountry . WHO collaboration will be requested through the country and Intercountry programme.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Support will be needed for the further development of laboratory and radiological services, both at peripheral level and the referral centre.

8.1 Nutrition Collaboration will be sought In view of the Government's concern with the changing life-style and dietary habits of the population. Prog~r:nme activities will Include assessment of dietary patterns,

12.2 Essential drugs and vaccines Effective management and distribution of essential drugs and vaccines, through appropriate training, are Important. Essential drugs for the health units In outlying Islands are required for the delivery of health care to disadvantaged communities.

education, tra1mng, growth and weight monitoring, and support of field health workers. A nutritionist has joined the health establishment and it is proposed to intensify nutrition-related activities. 8.2 Oral health The state of oral health Is of concern to the Ministry of Health. There has been a change of emphasis within the Division of Dental Services towards preventive care recently. Support in training, educational activities and logistics will be necessary for the execution of programmes.

13.1 Immunization This programme will continue to be supported by the Ministry of Health ~ith WHO collaboration. Emphasis will be given to ensuring that the community

1s well served by health workers.

13.2 Disease vector control . Disease vector control will receive greater emphasis. To ensure that

msp?ctor~ are conv_ersant with present management methods, In-service

tra1mng will be orgamzed from time to time. WHO collaboration Is necessary to facilitate. field activities, partlcular1y for monitoring purposes and application of appropnate control agents.

13.13 AIDS Even though no cases of AIDS have been diagnosed, support for the control programme Is essential. Collaboration will be sought for logistical and other aspects. 13.17 Cardiovascular diseases Control programmes for primary and secondary prevention will be continued considering that certain contributing factors In cardiovascular diseases can be avoided. Recent studies indicate that morbidity and mortality from such disorders are likely to remain an Important health probl em.

BUDGETARY IMPLICATIONS Increased support for national training activities and for primary health care activities In rural settlements account for the significant Increase under organization of health systems based on primary health care. For community water supply and sanitation, the Government's decision to include a provision for a long-term sanitary engineer post In 1990-1991 accounts for the budgetary increase. The programmes for development of human resources for health and oral health show decreases due to the reallocation of provisions to other programmes requiring WHO support.

Cook Islands

245

246

Estimated obligations

COOK ISLANDS Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.4 Health legislation

US$

13 800

7400 7000

( 6 400) 7000

( 46.38)

4. Organization of health systems based on primary health care 30000 55000 25000 83.33

5. Development of human resources for health 157 800 103 500 (54 300) ( 34.41)

6. Public information and education for health 8000 14 200 6200 77.50

8. General health protection and promotion 8. 1 Nutrition 8.2 Oral health 62 800 8200 37 800 8200 (25 000) ( 39.81)

Estimated obligations

COOK ISLANDS Regular budget Programme 1988-1989 US$ 1990-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning 9.5 Health of the elderly

83 800

6500

( 6 500)

(100.00)

10. Protection and promotion of mental health 10.3 Prevention and treatment of mental and neurological disorders

7 800

( 7 800)

(100.00)

11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.5 Food safety

96600

186 600

90000 ( 5 700)

93.17 (100.00)

5 700

Cook Islands

247

248

IEitlrneted obligations

COOK ISLANDS Regular budget Programme 1988-1989 US$ 12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

18 500 7 800

10 200 12 000

( 8 300) 4200

( 44.86) 53.85

13. Disease prevention and control 13.1 Immunization 13.2 Disease vector control 13. 13 AIDS 13.17 Cardiovascular diseases 4100 13 000 15 400 10 600 5 800 4 700 2 400 10600 5 800 600 14.63 18.46

-TOTAL-COOK ISLANDS 432 400 478 400 46000 --

10.64

83800

Estlrn~~ted

obligations Other sources

DEMOCRATIC KAMPUCHEA Regular budget Programme 1988-1989 1990-1991

Increase

(Decrease) %

1988-1989

1990-1991

Source of funds

US$ 4. Organization of health systems based on primary health care TOTAL- DEMOCRATIC KAMPUCHEA 198 900

US$ 200 000

US$ 1 100

US$

0.55

-198 900 200 000 1 100 0.55

---

- -

Democratic Kampuchea

249

250

FEDERATED STATES OF MICRONESIA NATIONAL HEALTH DEVELOPMENT SITUATION National responsibility with regard to health services Is primarily that of coordination of services involving more than one state, such as medical consultations, standards of medical practice, and licensure regulation. The National Government Is responsible for the technical cooperation needs of the States, either through International agencies, such as WHO, SPC, and UNICEF, or through deployment of local expertise. It Is also responsible for the collection and dissemination of vital statistics. The administrative structure of the health services is divided Into state and national levels. At the national level, health services responsibilities rest with the Department of Human Resources. Five-year comprehensive health plans have been prepared for ail four 2 states. These plans stress the importance of the primary health care approach and recommend strategies for decreasing the cost of health care, Improving the availability and accessibility of health care services, Improving the quality and continuity of medical care, and emphasizing prevention of disease. National health development Is currently hampered by a number of constraints, which can be categorized as administrative and developmental. Administrative problems Include: (1) Budgeting and fiscal management. The budgets of the Health Departments do not Identify functional areas (cost centres) which expend and generate income. Inadequate recordkeeplng for collectibles results In inadequate reimbursements. Inaccurate Information on fiscal status leads to shortages In supplies and pharmaceuticals. Considered part of the Trust Territory of the Pacific Islands at the time the proposed 1990-1991 regional programme budget was prepared. 2 1

(2) Medical referral costs. From 1978 to 1982 expenditures on medical referral averaged 28% of state health budgets and 6% of the total state operations budgets. (3) Personnel management. Many supervisors lack sufficient knowledge about the system to act in an effective and timely manner In managing employees. (4) Supplies. Medical supply shortages constitute a critical short-range problem In the health care system. There are breakdowns in the supply system because of Inadequate follow-up procedures and delays In the ordering process. Among the developmental constraints, one may cite: (1 ) Manpower. The provision of senior administrative personnel requires priority consideration during the programme plan period. Two states rely upon expatriate administrators and the other states have requested similar assistance. As the hiring of expat rlate professional administrators Is a short-term solution, sufficient resources must be dedicated to the training of local citizens. (2) Training. Training opportunities through U.S. federal programmes and International and regional organizations, such as WHO and SPC, are limited to a small number of candidates. Often, Individuals who are selected are not prepared adequately for the training beforehand, so that they do not gain the maximum benefit from the learning experience. Local educational facilities are poorly equipped to provide the academic background necessary for successful post-secondarystudies In medicine. Moreover, there Is no present requirement that those Individuals that have completea out-of-country training return to their jobs. (3) Funding constraints for rural programmes. One of the programme plan priorities Is to build a system which encourages self-reliance. To achieve this there must be promotion of primary health care in which the communities take responsibility for the maintenance and promotion of healthful living

Kosrae, Pohnpei, Truk and Yap

practices. Primary health care projects have been started in selected villages in ail States to serve as model projects. Funding for these programmes has come through WHO with local resources being utilized to the maximum extent possible.

(4) Transportation and com"!unicatiC?ns problems. Inadequate communrcations systems between the d1spensanes and the hospitals located in the state c ent res hamper services to rural areas. An improved communications system would allow physicians to consult on cases which are beyond the Immediate capability of the health assistant and which require emergency medical treatment. The Federated States of Micronesia, under the National Health Plan, has defined several objectives which the Government wishes to address In the continuing effort to Improve the operating efficiency of the nation's health programmes. The proposed work plan with WHO for 1990- 1991 emphasizes primary health care with emphasis on practical aspects of health education and community organization. Thus the following objectives have qualified for implementation under the WHO work plan: (1) ensure that all residents have the opportunity to live healthful lives

(2) Improve the health status of the population by: (a) improving water, sewage, and solid waste disposal; (b) reducing the number of high risk and unwanted pregnancies by encouraging women to attend public health maternal clinics (including family planning programmes) ; (c) red ucing the Infant mortality rate by Increasing well-child, prenatal and postnatal services, promoting breast-feeding and Implementing health education programmes; (d) improving the health status of children by achieving a 90% immunization rate for two-year olds and 95% for six-year olds, improving detection of mal nutrition, and further developing health education In schools; (e) reducing the Incidence of communicable diseases such as leprosy, tuberculosis, and sexuall y transmitted diseases by Improving screening and detection programmes and ensuring that adequate drug and medical supplies are available for effective treatment programmes. . (3) Improve the capability of local medical staff by: (a) identifying pnority areas for health manpower development; (b) providing training for health services workers through on-the-job training, CCM extension courses, or training opportunities abroad. (4) Eli mi nat e medical supply shortages by: (a) streamlining procurement of medical supplies and drugs; (b) improving the Inventory control system; (c) establishing linkages with International organizations, e.g. WHO and UNICEF, to receive pharmaceuticals at lower prices.

free of preventable diseases and premature death; (2) increase the efficiency and cost-effectiveness of operations within the Department of Health Services; (3) develop effective community-based organizations working to Improve the health, social and economic levels in the community by utilization of local resources; (4) improve availability and accessibility of primary health care services to rural residents; and (5) enhance the quality of all health services. The following policies and strategies have been identified for implementation during the work period:

(5) Improve health statistics recording/reporting procedures and accuracy of data by: (a) providing training in vital statistics for health statisticians, medical records personnel, municipal recorders, and health providers; (b) Improving coordination between providers of health statistics at the municipal, state and national levels.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The collaboration provided by WHO and other funding agencies will be directed towards achieving the health goals of the Development Plan. 3.1 Health sHuation and trend assessment

.(1) Improve prima.ry heal!h care by: (a) redirecting emphasis towards prevention; (b) promotmg pnmary health care and health education progra~mes and improving living patterns; (c) improving the services provided by the dispensaries.

There is a strong infrastructure both at the federal and the state levels for proylding Information support to the Government in the administration of the vanous health programmes. The United States Government Is providing

Federated States of Micronesia

251

Federated States of Micronesia support In the area of computers, but WHO collaboration Is required In the training of Intermediate-level staff In statistics and medical records.

252 6. Public Information and education for heaHh Health education Is an area which has·only recently received proper recognition. For this reason, considerable support will be required for establishing an effective health education unit and for overseas training of health education staff.

3.2 Managerial process for national heaHh development The Federated States of Micronesia has been actively Involved In the WHO managerial scheme since Its earty days. WHO Is requested to provide support In the conduct of two workshops for mid-level management. In addition, it is hoped that technical support can be provided under the UNDP/WHO intercountry project on development of prlr.tary health care in the Pacific.

8.1 Nutrition UNICEF and SPC assisted the Government In undertaking a nutrition survey in 1987, the results of which will be used in developing the future nutrition programme. WHO collaboration Is sought In training of .staff In dietetics and In preparing suitable health education ~tterials on nutritional aspects of health.

4. Organization of health systems based on primary health care The Government Is in the process of reorienting the health services to the primary health care approach. A number of activities are being undertaken in the 1988-1989 biennium to change the emphasis in nursing to primary health care and these will continue through 1990-1991. Efforts are being made to extend the primary health care approach. In Truk, for example, a project entitled "Special programme of regional and national significance", is meeting with considerable success with limited funds. It Is hoped that the project can be extended to other States. WHO collaboration Is being sought in 1990-1991 in arranging suitable training for hospital assistants who are working at the community level. Collaboration is also being sought under other programmes in promoting the primary health care approach. These include the development of human resources for health, public Information and education for health and oral health. The Government Is making every effort to use primary health care strategies in all Its public health activities.

8.2 Oral heaHh There is a reasonable Infrastructure for undertaking the cflnlcal aspects of oral health. However, the Government Is most anxious to give more emphasis to the public health and prevention aspects of oral health. It would like to undertake a workshop on the public health aspects of oral health with WHO support. In addition, WHO collaboration Is requested In providing dental kits for the dispensaries and in overseas training of staff to learn dental health techniques.

9.1 Maternal and child hMHh, Including family planning With funding support from UNFPA, WHO will continue to collaborate in improving the health conditions of mothers and children through health education, child spacing, provision of medical care and distribution of family planning devices, both ln urban and rural communities.

5. Development of human resources for heaHh Many areas of health are suffering from a lack of trained manpower. In the· past, the emphasis has been on encouraging staff to undertake formal courses. This is still required with respect to medical staffing, but in other categories, the Government is anxious that more health staff be trained for short periods to see how activities are being undertaken In countries at a similar stage of development.

10.2 Prevention and control of alcohol and drug abuse Technical collaboration is required to review the nature and extent of the problems of alcohol and drug abuse.

10.3 Prevention and treatment of mental and neurological disorders There are limited services for the treatment of mental disorders. A psychiatrist Is being recruited to work at the federal level and assist In organizing services In the States. The rate of sulc~je among the young Is also a cause for concern. Collaboration is requested for training of health staff In psychiatric nursing and in the areas of mental health counselling and the health education aspects of mental health. 11.1 Community water supply and sanitation The Government Is proposing a number of environmental health programmes, including water supply, rural and urban development, food safety and vector control. Support Is requested for the environmental health programme of the Department, Including water supply. Water supply Is well established In all States organized through the Public Works and Health Departments. Maintenance of facilities remains the biggest problem. On the health side, efforts are handicapped by a shortage of trained personnel and the need to educate the communities to care tor their own systems. Support is also needed for the training of two qualified staff members In a diploma course In environmental health. 11.2 Environmental heaHh In rural and urban development and housing Solid waste disposal Is proving to be a problem. There Is 110 garbage collection system and selection of a suitable site for a tip Is complicated by the land tenure system. Collaboration is sought in sending two staff members to tackling the a town of similar size in another country, to observe how they are problem. 11.5 Food ufety Health Inspectors ha\le~been checking food stores and:restaurants for some years. However a number of local food processing p!ants are being

established and staff will have to be trained to ensure that proper health standards are maintained. Support Is requested for the training of two staff members In countries of the Western Pacific to observe seafood processing plants and canneries. Basic equipment for food analysis Is required for Kosrae and Yap States and It Is proposed that a workshop be conducted for sanitarians to teach them food analysis methods. 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Laboratories are well established in each of the States. The Government is proposing to send two personnel to undertake the laboratory assistants course in Papua New Guinea. In addition, WHO support Is requested for two special projects. There Is a very high prevalence of Intestinal parasites In the community, especially amoebiasis, hookworm and trichinosis. In view of the considerable amount of Inaccurate diagnosing, collaboration Is needed in training technicians In proper diagnostic techniques.

A similar problem exists In regard to bacterial culture techniques. There is a need to standardize methods and reduce tests to a small number which can be undertaken accurately. Technical collaboration Is required to review the performance level of radiological staff and recommend appropriate training for them. 12.2 Essential drugs and vacclnH The Government Is handicapped by a shortage of trained pharmacists. Support Is requested for training In pharmacy of a suitably qualified person. 13.2 01..... vector control There Is a need to reconsider government regulations and procedures in regard to the Inspection of ships arriving from overseas. It Is proposed to

Federated States of Micronesia

253

Federated States of Micronesia send an Inspector abroad for three months to observe port control and surveillance methods. 13.8 Tuberculosis Technical support Is requested from WHO, through the regional tuberculosis team. Support Is also needed for the purchase of laboratory equipment and health education materials for the four States. It is hoped that tuberculosis drugs will continue to be supplied through UNICEF. 13.13 AIDS Having regard to the grave Implications of any outbreak of AIDS, the Government feels that it is essential to Improve blood bank screening procedures, especially for AIDS. WHO collaboration through the Global Programme on AIDS will be requested for training In haematology blood bank technology and for the provision of equipment for the blood bank. 13.17 Cardiovascular dieeaaea Studies have shown that hypertension and obesity are problems. The Government, with WHO collaboration, has introduced a special hypertension programme. Further support to the programme is needed through a workshop on hypertension and obesity.

254

13.18 Other noncommunicable disease prevention and control actlvHies Diabetes mellitus Is another problem throughout the Federated States

of Micronesia. Support Is required In conducting a workshop for training health staff to educate communities on how to avoid the risks of diabetes. The Government would also like support In translating and producing health education materials developed at the Diabetes Centre In Suva.

BUDGETARY IMPLICATIONS This is the first budget developed by the Department of Human Resources since the signing of the Compact of Free Association. The Government has endeavoured to use WHO resources through a larger number of programme areas, Increasing the number from 4 to 18 areas for 1990-1991. The development of human resources for health continues to be given high priority. In addition, budgetary provisions have been Included for new priority areas such as health situation and trend assessment, health education, nutrition, oral health, alcohol and drug abuse, mental and neurological disorders, environmental health, clinical, laboratory and radiological technology, essential drugs and vaccines, disease vector control, cardiovascular diseases and noncommunicable diseases. These changes In approach have resulted In substantial reductions In the budgets for primary health care and tuberculosis. However, these reductions are offset by the Inclusion of funds In allied programme areas.

Estimated obligations

FEDERATED STATES OF MICRONESIA Programme 1988-1989

Regular budget 1990-1991

Other aources (Decrease) 1988-1989 1990-1991

Increase

Source of fundi

US$

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development

28000

12000

5 700

(

6300)

(52.50)

4. Organization of health systems based on primary health care

150 000

32600

(117 400)

(78.27)

5. Development of human resources for health 207 700 238100 30400 14.64

6. Public Information and education for health 32100 32100

8. General health protection and promotion 8. 1 Nutrition 8.2 Oral health

13 18lil .37 700

13100 37700

Federated States of Micronesia

255

256

Eatlmated obligations

FEDERATED STATES OF MICRONESIA Programme 1988-1989

Regular budget 1990..1991 Increase (Decrease) 1988-1989

Other sourcea 199o-1991 Source of funds

US$ 9. Protection end promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning 10. Protection end promotion of mental health · 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological disorders

US$

155 400

40300

7000

16200

11. Promotion of environmental health 11. 1 Community water supply and sanitation

26500

Eatlm1ted obligations

FEDERATED STATES OF MICRONESIA Programme 1988-1989

Regular budget 1990-1991 Increase J)ecrease) 1988-1989

Othersourcn 1990-1991 Source of funds

US$ 11.2 Environmental health in rural and urban development and housing 11.5 Food safety

US$

3 200 15 000

3200 15 000

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines

53300 13 600

13. Disease prevention and control 13.2 Disease vector control 13.8 Tuberculosis 13. 17 Cardiovascular diseases 102 000 5400 25200 4600 5400 (76 800) 4600 (75.29)

Federated States of Micronesia

257

258

Eatlrnated obligation•

FEDERATED STATES OF MICRONESIA Programme

Regular budget

Other .ourcn (Decrease)

1988-1989

199o-1991

Increase

1988-1989

199o-1991

Source of funds

US$ 13. 18 Other noncommunicable

US$

disease prevention and control activities 10 300 10 300 --

-20.33 -155 400

TOTAL- FEDERATED STATES OF MICRONESIA

471 700

567 800

95 900 --

40300

- -

FIJI NATIONAL HEALTH DEVELOPMENT SITUATION Fiji faced a difficult political crisis In 1987, as a result of which the national economy was most severely affected. Resources allocated for meeting the health needs of the people and the cost of national health services had consequently to be readjusted in order to continue to maintain and provide basic health services to all the people In the Republic. Financial constraints have continued into 1988, and are expected to continue for several years to come. The Government has lately Introduced strategies to minimize wastage and to provide at least essential health care accessible to all within its means and within the limits of resources available.or expected from abroad. The economic situation seems to be gradually stabilizing and even some improvement is expected for the next biennium. In the NInth Development Plan covering the period 1986-1990, the Government emphasizes manpower development with the explicit aim of producing a relevant as well as adequate number of staff with appropriate expertise and competence to meet local needs. This applies not only to medical training but also to courses for auxiliary health workers and basic and post-basic ·nursing courses. This will certainly support the required training needs of neighbouring island countries with traditional ties In manpower development In the South Pacific. Fiji has strengthened Its preventive and primary health services through the primary health care approach in the past. However, because of the setbacks observed in 1987, there Is a greater need for all types of manpower, including specialists, to be assigned to the Fiji School of Medicine and in three major hospitals, and multipurpose health workers, especially at the subdivisionallevels and below. These health workers should be able to develop their professional and technical ability and capacity to deal with most medical, surgical and obstetric ailments at the subdivisionallevel and below to avoid referral to divisional and tertiary levels. This will ease the congestion In the major hospitals. Another area of concem.is the community health worker at the village level. Achievement in the community worker schemes has been remarkable. However, It is often the case that some of the workers are not well support~ or eva Iuated In their activities, to establish whether the needs of the c<;>mmunity have been met as expected. There Is a need to develop an appropnate ~sic curriculum for the training of community health workers. The exist1ng infrastructure of the health care system In the Republic Is optimal, with appropriate deployment of multipurpose professional health workers such as doctors, nurses and medical assistants. Although Fiji has made a marked improvement In maternal and child health in terms of a decrease in infant and child mortality rates over the past few years, owing to an improved perinatal CS:re system, and has. promoted a successful immunization programme and partially increased hospital deliveries in the country, ear1y neonatal mortality figures have remained static and the perinatal mortality rate has not declined as expected, owing to various factors such as prematurity, low birth weight, nutritional factors. etc .. Other areas of concern include acute respiratory infections as well as blindness and deafness among Infants and children, which require further attention and support from the national health administration and International agencies. Likewise, diabetes and tlypertenslon have been reported to be Increasing among the adult population, requiring continual support from the central government and international agencies. Community water supply continues to exhibit problems with maintenance, particular1y in rural areas which have suffered cyclone damage. Severe water shortages were experienced in the drier areas during a recent drought. Support for the development of rural water supplies is a continuing need. While the national health education programme has made a great impact in the areas of family planning awareness and other health concerns. most of the target population seems to lack a clear understanding of the causal factors of various preventable conditions. Public Information and education efforts should be further strengthened with respect to certain health conditions such as diabetes, hypertension, smoking and health, as well as AIDS prevention.

Fiji

259

Fiji The Government has encountered problems in handling health records and It Is becoming Increasingly difficult to manage the health Institutions In terms of proper and safe storage, usage, retrieval and analysis of data and Information owing to a shortage of expertise and management/analytical skills, and a lack of appropriate Instruments and equipment to take care of such data and information.

260

such as training of community health workers, provision of health education materials at community level, promotion of nutrition education and demonstrations In depressed areas, and promotion of an Integrated community-based family planning/maternal and child health programme. An appropriate basic curriculum for the training of community health workers will be developed in collaboration with WHO.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

5. Development of human resources for health Manpower requirements have been specified in several documents, Including the Ninth Development Plan and other health policy documents. At this stage of reorganization and development of its health manpower resources, WHO collaboration should focus on the following priority areas: (1) training of multipurpose professional health workers; (2) strengthening of the post-basic training courses for nurses in midwifery and public health; (3) encouraging an attachment period for rural medical officers in the divisional and tertiary hospitals; (4) technical support to both the Fiji School of Medicine and the School of Nursing.

1990-1991 The support provided by WHO and other funding agencies will be directed towards achieving the health goals of the Ninth Development Plan. The nature of WHO collaboration to remedy the problems outlined and to achieve the major goals and objectives spelt out in the Development Plan during 1990-1991 is summarized below.

3.1 Health situation and trend assessment Major hospitals and health centres are holding old records and raw data which could be best utilized in the future in improving financial management. The Government proposes to request WHO collaboration in designing a cost-effective information and recording system for the country.

3.2 Managerial process for national health development 6. Public Information and education for health Fiji has been actively involved in the WHO managerial network scheme since Its ear1y inception. Technical support is requested for a survey on health care development and for workshops for mid~evel management. It is hoped that the UNDP/WHO Intercountry project on primary health care can provide further support and strengthen the various research and development activities. The administration has encouraged the implementation of activities related to the use of media and health education. Health advocacy, public Information, and mobilization of public opinion will continue to be the focus of attention. Information will be disseminated through regular broadcasting programmes in conjunction with the Ministry of Information and other statutory and nongovernmental organizations.

4. Organization of health systems based on primary health care Fiji's health care system was strengthened until by 19871t had become one of the best in the Third Wor1d. This can be attributed in no small measure to the Government's drive and initiative in building new hospitals, upgrading health centres and setting up a number of rural health clinics with a thrust towards primary health care. However, the trend already pursued will be slightly shifted back to local training In the form of In-service training and other activities

8.1 Nutrition Programme activities will focus on strengthening the managerial skills of staff to carry out nutrition programmes, with emphasis on the health sector's responsibilities and intersectoral coordination through national workshops and facilitation of exchange of information.

9.1 Maternal and child health, Including family planning In spite of Improvements In the Infant and child mortality rates over the past few years, It Is noted with concern that the early neonatal death rate seems static, and the perinatal mortality rate Is still relatively high. Collaboration will be mainly requested to review perinatal approaches adopted In the country, to carry out studies In order to establish the main contributing factors and formulate appropriate strategies and effective programmes to counter them, to establish a family planning/maternal and child health community-based integrated programme to tackle the problems at the grassroots level, and to strengthen family life education at the community level tl1rough seminars and workshops. 10.2 Prevention and control of alcohol and drug abuse This Is a new project area which is being developed In conjunction with the Ministry of Home Affairs and police campaign. The Government Is concerned at the excessive use of alcohol in many parts of the country and Its possible relationship to the high Incidence of traffic accidents. WHO collaboration is requested for the development of a prevention and control programme. 11.1 Community water supply and sanitation The community water supply and sanitation programme requires further support from WHO to help provide safe water supplies through community-based self-help projects, etc. in depressed and devastated areas. 13.7 Acute respiratory infections A development effort has been Introduced to analyse contributing factors and the impact of various interventions in the Western Division of Fiji in 1987. Based on the analysis of factors and impact, the Government is expected to develop an effective surveillance system and a standardized child pneumonia control programme nationwide. During the next biennium, before a national control programme is introduced tor acute respiratory infections, collaboration is requested to review the developmental activities in the Western Division and to introduce a new strategy for the control of acute respiratory infections.

13.13 AIDS AIDS Is becoming a new public concern to the Government, which Is trying to develop a master plan of national AIDS prevention and a counselling programme. A request has been made to WHO to collaborate In developing the national plan for prevention and control. However, owing to Increasing political and socio-cultural demands and pressure by the communities, the Government seeks WHO collaboration In Introducing new developments In preventive measures and In promoting counselling technologies. 13.15 Blindness and deafness This Is a new area for WHO collaboration in securing appropriate hearing and eye-sight testing Instruments and machines for the screening of preschool and primary-school children throughout the country. The programme has been discussed among and endorsed by public health administrators and school educationists. 13.18 Other noncommunicable disease prevention and control activities Support has been provided to the Diabetes Centre over the past few years to develop posters and information materials tor use by the patients and health workers. In-house courses have been run for nurses and it Is planned to continue WHO support at an increased level In this period.

BUDGETARY IMPLICATIONS The shift in emphasis has resulted in a reduction of the health manpower development programme due to the expected return of qualified fellows at the end of their studies and in increased provisions tor the managerial process for national health development, organization of health systems based on primary health care, community water supply and sanitation and other noncommunicable disease prevention and control activities. New provisions are made in the areas of health situation and trend assessment, public information and education for health, nutrition, maternal and child health, prevention and control of alcohol and drug abuse, AIDS and blindness and deafness.

Fiji

261

262

E8tlmeted obligations

FIJI Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) 1988-1989 1990-1991

Increase

Source of funds

US$

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Suva, Fiji

68600

23000

37400

14 400

62.61

650 500

714 700

64200

9.87

4. Organization of health systems based on primary health care 60000 147 500 87 500 145.83

5. Development of human resources for health 931 300 612 000 (319 300) ( 34.29)

8. Public Information and education for health

58000

Estimated obligations

FIJI Regular budget Programme 1988-1989 US$ 8. General health protection and promotion 199G-1991 US$ Increase US$ (Decrease) %

Other aources 1988-1989 US$ 199G-1991 US$ Source of funds

8. 1 Nutrition 9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning

15 200

34 800

34800

44900

10. Protection and promotion of mental health 10.2 Prevention and control of alcohol and drug abuse

21 800

11. Promotion of environmental health 11. 1 Community water supply and sanitation

30000

90400

60400

201.33

FIJI

... 263

264

Eltlrnated obligations

FIJI Regular budget Programme 1988-1989 US$ 13. Disease prevention and control 13.7 Acute respiratory infections 13.13 AIDS 13.15 Blindness and deafness 13. 18 Other noncommunicable disease prevention and control activities 2 200 10 900 18400 2 200 10 900 18400

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

1 ()()()

40000 1 734 800

65500

25 500

63.75

-TOTAL- FIJI 1 897 400 162 600

-- -

9.37

45800

FRENCH POLYNESIA NATIONAL HEALTH DEVELOPMENT SITUATION French Polynesia Is rapidly changing from a traditional society, which still exists in the remote archipelagos, to a consumer society like that found on the Island of Tahiti, where 125 000 of the 180 000 inhabitants live. The problems linked to both types of society thus coexist: the situation is typical of developing countries, with a high child mortality rate, Infectious diarrhoeas among children due to lack of hygiene and unsafe water, malnutrition, etc. At the same time, the morbidity Is typical of the developed countries, with obesity, cardiovascular diseases, cancers, road accidents, diabetes, alcohol abuse, smoking and psychosocial pathologies. In the coming years, priority will continue to be given to the decentralization of preventive activities In the remote archipelagos and Islands (MCH, school health, oral health). The Health Education Service will be Increasingly involved in the Implementation of preventive programmes. The Health Environment and Hygiene Service activities will be decentralized as well. The recent change, In September 1984, of French Polynesia to an Internal autonomy status, calls for some reorganization of the health system which Is now under territorial jurisdiction. The development of autonomy in the health system in the coming years requires the following: - the further development of the training of local personnel for the health professions, which Is already being carried out to some extent through the establishment of the Health Sciences Training Institute (nurses, mOClical auxiliaries, health auxiliaries, midwives); - the development of .self-sufficient health care structures, in order to avoid the numerous .medical evacuations to the Metropolis (for heart diseases and cancers). This Includes the acquisition of a scanner, the planned establishment of a::radlother~py service, the development of a multidisciplinary cancer control team, the extension and upgrading of Uturoa and Talohae hospitals; - the formulation of health policies based on programme planning and management as well as the development of relevant legislation.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 2.6 Informatics management WHO collaboration will be requested to support local staff. lrr, formulating a telematic support system to overcome the isolation of the health administrative structures in the archipelago. 4. Organization of health ayatema bllaed on prlrNiry health care The Government plans to develop district primary health care systems in the remote and isolated Islands. A seminar on primary health care policies will be organized for students at the training Institute for the health professions in French Polynesia. 6. Public Information and education for health To increase public awareness on health and environment programmes, appropriate health education and Information materials will be prepared and disseminated. 8.2 Oral health WHO collaboration will be requested to evaluate the current training programme for dental hygiene. Oral health education activities will also be reviewed.

French Polynesia

265

French Polynesia 8.3 Accident prevention Road traffic accidents are one of the major causes of morbidity and mortality In the country. WHO collaboration is requested to further develop the national road traffic accident prevention programme. 9.1 Maternal and child health, Including family plaming The Government continues to give high priority to maternal and child health and family planning. Support will be requested to review the local psychosocial constraints on family planning. 10.1 Psychosocial and behavioural factors In the promotion of health and human development A training programme will be conducted with a view to facilitating self-education in health within each sociocultural part of the local society. 10.3 Prevention and treatment of mental and neurological disorders Attention will be given to the prevention, evaluation, Identification and management of neurological disorders in French Polynesia. 11.1 Community water supply and sanitation

266

Cooperation will be provided to assess the progress of the Internatlonal Drinking Water Supply and Sanitation Decade activities in French Polynesia. 11.5 Food safety Training of personnel In the field of modern food products Inspection technologies will be undertaken with WHO collaboration. 13.1 Immunization Emphasis will be given to the prevention and control of typhoid fever. The possibility of abandoning typhoid fever Immunization will be considered.

BUDGETARY IMPLICATIONS The Government continues to give priority to the role of public Information and education for health In ensuring the success of public health activities, and this is reflected In the large allocation for this programme. The rest of the country planning figure has been distributed to ten programmes for which WHO technical support Is requested.

Eatl.,.ted obligations

FRENCH POLYNESIA Regular budget Programme 1988-1989 1990-1991

Other sources (:>ecrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$

2. WHO's general programme development and management 2.6 Informatics management

7000

3. Health system development 3.2 Managerial process for national health development

6500

(6 500)

{100.00)

4. Organization of health systems based on primary health care

7000

5. Development of human resources for health

6500

(6 500)

{100.00)

8. Public information and education for health

13 500

22600

9100

67.41

8. General healtb.pr:.Olection and promotion 8.2 Oral4milfth

7000

French Polynesia

287

268

Eltlrnated obligations

FRENCH POLYNESIA Regular budget Programme 1988-1989 199G-1991 Increase (Decrease) %

Other aources 1988-1989 1990-1991 Source of funds

US$ 8.3 Accident prevention

US$ 7000

US$

9. Protection and promotion of the heaHh of specific population groups 9. 1 Maternal and child health, including family planning 9.5 Health of the elderly

11 500 6500

7000

(4 500) (6 500)

( 39.13) (100.00)

1o. Protection and promotion of mental heaHh 10. 1 Psychosocial and behavioural factors in the promotion of health and human development 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological disorders

7000

6500

(6 500)

(100.00)

7000

Eatlmated obligations

FRENCH POLYNESIA Regular budget Programme 1988-1989 US$ 11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.5 Food safety

Other sources (Decrease) %

199G-1991 US$

Increase US$

1988-1989 US$

199G-1991 US$

Source of funds

6500

7000 7000

500 7000

7.69

13. Disease prevention and control 13. 1 Immunization 13.9 Leprosy 13.11 Sexually transmitted diseases 13.16 Cancer 13.17 Cardiovascular diseases

7000

2 800

6500 6500 6500

(6 500) (6 500) (6 500)

(100.00) (100.00) (100.00)

French Polynesia

269

270 Estimated obligations

FRENCH POLYNESIA Regular budget Programme 1988-1989 199o-1991 Increase (Decrease) %

Other sources 1988-1989 1990-1991 Source of funds

US$ 13. 18 Other noncommunicable

US$

disease prevention and control activities

6500

(6 500)

(100.00)

-TOTAL- FRENCH POLYNESIA 83 500

-92800

-9100 10.90 --

-2800

GUAM NATIONAL HEALTH DEVELOPMENT SITUATION The health of the pe.ople can be measured through the economy of a nation. Guam has been steadily growing In terms of both Its economy and its population. A healthy economy directly affects the health of the people since health and social services are generally readily accessible and this is evidently happening In Guam. Guam is committed to achieving its health objectives for 1990 and beyond with priority in the areas of preventive health services, health promotion and health protection. To ana in these objectives, It plans to Implement an aggressive educational programme for the prevention and control of AIDS and other communicable diseases. re-evaluate requirements for food safety and institutional sanitation, and place more emphasis on staff development and personnel and human resource management. There has been a steady Improvement of the health status as shown by the continued downtrend of mortality. The infant mortality rate decreased by 23%, while two of the ten leading causes of deaths, cancer and diabetes mellitus, decreased by 14% and 27%, respectively. The leading cause of death is still diseases of the heart. Collaborative activities with WHO need to be maintained In order to continue efforts to achieve the Improved health status of Guam through assisted programmes on human services development, general health protection and promotion, and disease prevention and control. programmes are included under General Health Protection and Promotion and Disease Prevention and Control. 5. Development of human resources for health Continued collaboration Is expected in the development and upgrading of health manpower. Technical support through WHO fellowships and consultancies will be aimed at Improving the skills of existing health personnel to upgrade the level of health systems and services. Priority areas are primary health care and support services such as nursing, biomedical equipment and repair, management and disposal of toxic laboratory waste, environmental health and medical records organization systems.

8.4 Tobacco

or health

Tobacco use is becoming one of the most feared causes of cancer. Guam does not have any programme In this area. WHO technical support to help develop a tobacco or health programme Is therefore required.

13.13 AIDS An urgent need for WHO technical support In programme and policy development and AIDS Infection control has been Identified.

BUDGETARY IMPLICATIONS White the major emphasis of WHO collaboration will continue to be on health manpower development, the need for WHO collaboration In general health protection and promotion and disease prevention and control Is recognized and the budgetary allocation covers these programme areas. Areas or needs that are not budgeted may be covered through the Intercountry programme or other sources.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 WHO collaboratlon.has·foct:Jsed predominantly on health manpower development In the past. Forthistiiennial programme budget period, two other

Guam

271

272

Estimated obligations

GUAM Regular budget Programme 1988-1989 1990-1991 Increase (Decrease) 1988-1989 Other sources 1990-1991 Source of funds

US$ 5. Development of human resources for heaHh 8. General heaHh protection and promotion 8.4 Tobacco or health

US$

83500

76900

{6 600)

{7.90)

7000

13. Disease prevention and control 13.13 AIDS

7000

-TOTAL-GUAM 83500

- 90 900

-. 7400 8.86

-- -

HONG KONG NATIONAL HEALTH DEVELOPMENT SITUATION The health policies and development strategy of the Government, which are laid down in the White Paper on the 'Future development of medical and health services in Hong Kong' are tbased on the need to safeguard and promote the general public health of the co":Jmunity as a ~~?'e, and to ensure the adequate provision of personal and med1~1 healt_h facll~1es for the ~ople, including that large section of the community wh1ch rel1es on subsidized medical attention. In pursuance of these objectives, the Government's medical planning policy aims to provide a balanced dev_elopm~n! and provision of pro":Jotive, curative and rehabilitative services withtn the limits of the resources available. In the ongoing Medical Development Programme for the decade 1986-1995, a total of four new major hospitals with an average capacity of 1500

and children. Immunization programmes are carried out against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and rub9!ia. Under the comprehensive observation scheme, children are assessed at c;iif!erent ages to detect early developmental abnormalities, .a~ referred to spec1allst care or the child assessment service for further examination. Resulting from continuous efforts for the prevention and surveillance

of communicable diseases, dreaded diseases such as smallpox and plague are non-existent, while indigenous malaria and poliomyelitis, diphtheria and other communicable diseases are no longer a threat. Because of Its international position, Hong Kong Is vulnerable to the Introduction and spread of communicable diseases, Including AIDS. In November 1984 an Advisory Commtttee on AIDS, consisting of medical experts from the Medi~al and Health Department and the two universities, was established to monitor the global development of AIDS_ The first AIDS case In the territory was reported in February 1985 and, following this, the Government started a surveillance programme on AIDS to monitor the spread of the disease in Hong Kong. Under this programme, certain high risk groups, Including haemophil lacs, intravenous drug addicts and sexually promiscuous people, are tested for the HIV antibody. The Hong Kong Red Cross Blood Transfusion Service also started a blood screening programme in 1985 to screen donors to detect HIV positive results. Up to January 1988, ten AIDS cases had been confirmed and a total of 106 persons had been found to be seropositive for HIV antibody. Health educational activities have been stepped up to educate the public on the facts of the disease and to allay any misco~ceptlon and undue anxiety, including a 24-hour telephone service and a spectal AIDS counselling and consultative clinic service. The Central Health Education Unit also takes on other general health education programmes and publicity campaigns for the community covering topics on food hygiene, home safety, organ donation, malaria and mental health.

beds are included. The total hospital beds available should be increased to 38 000 by 1995. Tuen Mun Hospital, opening in 1988, provides medical services for the new towns in the western region of the New Territories, which record a considerable population increase. The Queen Mary Hospital extension project, completed in 1989, provides an additioR of 844 beds and some new psychiatric and paediatric facilities. Other projects include extension, improvement and building plans to upgrade existing hospital facilities, both In the public and private sectors. The number of ,general and specialist clinics is expected to increase to 77 by 1990. On the whole, the medical· and health system and delivery services are effective, accessible and, abov.e;·all, ,provided at only nominal cost to a large proportion of the general pubtic;..who need such services. The pri~ry h~lth care system has met the_re~quir..ements as advocated by WHO, and IS striVIng to meet the objective of health'<for.:all by the year 2000. The major spearbeaet6f,;pf.lmary health care is provided by the Family Health Services, which provider-CIDmprehensive health care for both mothers

Hong Kong

273

Hong Kong The Occupational Health Division provides an advisory service to the Government and the public on matters concerning the health of workers and the hygiene of workplaces. It Investigates notified occupational diseases and potential hazards reported by the factory Inspectorate and conducts surveys for monitoring possible physical, chemical and biological hazards in the work environment. The Division is also involved in the medical assessment of government clinics, compressed air workers, personnel exposed to ionizing radiation, and injured employees under the Workmen's Compensation Ordinance and the Pneumoconiosis (Compensation) Ordinance. Mental health services are provided for the mentally ill, which include the practice of community psychiatry with special emphasis on the follow-up and after-care of discharged mental patients and their reintegration into the community. The School Dental Care Service provides regular dental examinations, simple dental treatment and oral health education to primary school children. The oral health education programme is being stepped up with emphasis on preventive dental care. The Pathology Service provides clinical and public health laboratory services to government hospitals and clinics, and a consultancy service for the government-assisted sector. It also administers mortuaries and blood banks. The Virus Unit provides a central laboratory service for the diagnosis and surveillance of various viral Infections, Including AIDS, and services for screening, assessment and guidance of immunization programmes against viral infections for the community. The present health care delivery system, through its different stages of development, has provided adequate services for the people. To achieve further improvements in the future, in the midst of social, economic and political developments, and to provide greater flexibility in administration, the Government has accepted the recommendation of a firm of International consultants, to set up an Independent Hospital Authority for the better management of its medical services. Under the independent Hospital Authority, a Hospital Services Department is being established for the management of both government and subvented hospitals. A separate Health Department is also being established to take responsibility for providing

274 preventive services which are essential f~r the maintenance of good publi.c health in the community, the target date be1ng Aprll1989. The Government Will continue to fulfil its commitment for the provision of health care for the community, though under different management systems.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 5. Development of human resources for health The implementation of the national health policies has generated a corresponding need for development of human resources for health care. Local training facilities are being developed or expanded to cope with the increase in demand for both undergraduate and postgraduate training of doctors, nurses and supplementary medical grades. The develo~ment of local training facilities has focused on training to meet basic serv1ce needs or established demands in major areas of health care delivery. The development of specialized knowledge and skills is contingent upon the availability of local expertise. There is a continuous need for health care personnel to be exposed to health care services and delivery systems overaees and to learn specific skHis, which can In turn be brought back and passed on to others. WHO support Is required for the training of health personnel overseas to enable them to acquire skills and experience which are not available locally, such as health planning and management, health education, occupational health, epidemiology, communicable diseases prevention and control, laboratory techniques and Investigations. All these training requirements, In the form of fellowship programmes, are geared towards the further development of the medical and health services.

BUDGETARY IMPLICATIONS There has been no significant change In the budgetary allocation. The emphasis of WHO collaboration continues to be on the development of human resources for health.

Estimated obligations

HONG KONG Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 5. Development of human resources for heaHh TOTAL- HONG KONG

US$

122 800

132 600

9800

7.98 7.98

122 800 132 800

9800

Hong Kong

275

276

JAPAN NATIONAL HEALTH DEVELOPMENT SITUATION The health situation In Japan has continued to improve concurrently with its social and economic development. The basis for health promotion is that every Individual should be aware of his responsibility to ''promote and protect his own health by himself'. Since a framework of health services closely identified with the community is required In order to meet health needs, the National Health Promotion Movement, whose aim is comprehensive health promotion, has been in operation since 1978. The Movement has three major objectives: (1) the continuity of health examinations and guidance throughout the life cycle, from pregnancy and birth to old age; (2) the development of community health centres, in which the community participates, to provide various services, including consultation services, and of a system of health guidance based on the appointment of public health nurses to municipalities; (3) the enhancement of community awareness and promotion of health through, for example, the Japan Health Promotion Foundation. The basic principle governing the delivery of health care services Is that all citizens should be able, at any time and place, to receive the health care they require. Until now, efforts have focused on ensuring the availability of sufficient health care personnel and consolidating health care facilities. Emergency care, medical care for remote areas, and high-level and specialized care for such diseases as cancer and cardiovascular diseases have been promoted. At the end of 1985, there were 9608 hospitals, 78 927 general clinics and 45 540 dental clinics, showing increases of 58%, 34% and 64% respectively compared with the number in existence in 1960. There were 1236 hospital beds per 100 000 population, which Is high compared with other countries. In addition, there were 850 centres, 1175 welfare offices, 165 child guidance centres, and 284 social insurance offices. The Improvement In the health situation has been clearly reflected In a reduction in mortality rates, which has contributed greatly to the prolongation of life expectancy. In 1985, life expectancy at birth was 74.78 years for males and 80.48 years tor females; 84% of infants had a birth weight of at least 2500 grams; and the infant mortality rate was 5.5 per 1000 live births. A further consequence has been a shift in the principal causes of death from communicable diseases to chronic degenerative diseases such as malignant neoplasms and cerebra-cardiovascular diseases. The proportion of all deaths caused by degenerative diseases (i.e. cancer, cerebrovascular and heart diseases) doubled In a period of thirty years from 30.4% In 1952 to 61.7% in 1985. In view of the growing Importance attached to , the control of these diseases, mass screening for the early detection of stomach and uterine cancer and for the prevention of diseases of the circulatory system has been intensified. To support rural health measures, the facilities of rural screening centres have also been strengthened. The change In vital statistics and the low birth rate has resulted In a rapid increase in real terms and percentages of the elderly population. It is estimated that, within the coming 35 years, the elderly, defined as those over 65, will constitute approximately 22% of the entire population as compared with the current figure of 10.2% in 1985. The change has also contributed to the increase in medical expenditure. The per capita medical expenditure in 1985 was 132 300 yen as compared with 100 230 yen in 1980 and 24 100 yen in 1970. In the light of such changes, it is considered that greater attention should be given to the appropriate allocation of resources and to health manpower development to meet the changing role of health professionals.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 5. Development of human resources for health In order to achieve the goals of national health development policies and strategies for the year 2000, It will be necessary to expand and Improve programmes for the training of health personnel within the framework of

available local facilities, and also to utilize as much as possible opportunities for their training abroad

BUDGETARY IMPLICATIONS The main emphasis of WHO collaboration with Japan continues to be on the development of human resources for health.

Japan

277

278

Estimated obligations

JAPAN Regular budget Programme 1988-1989 1990-1991

Other sources 1988-1989 1990-1991

Increase (Decrease) US$ %

Source of funds

US$ 5. Development of human resources for health

US$

95000 95 000

95 000

- TOTAL-JAPAN 95 000

- - - -

- -

KIRIBATI NATIONAL HEALTH DEVELOPMENT SITUATION The basis for health programming in Kiribati is the National Health and Family Planning Services System Plan, which Is strongly oriented towards primary health care. The first plan covers the period 1981-1986 and the current plan, which is basically an extension, covers the period 1987-1991. The Ministry had felt a need for such a plan as It considered that the government health services were not meeting the needs of the people. In designing the plan, the Government hoped that all health-related programmes could be integrated. It stressed that communities should be involved at all stages; that the country's resources should be utilized to establish self-sufficiency; and that the communities' cultural and religious beliefs and traditional practices should be respected at all times. Implementation of the plan has been regularly evaluated since 1981. The following problems were identified as constraints when the latest plan was formulated: (i) Development constraints - Many communities are not yet fully motivated to participate in their health care. - Community leaders still:lack the "know-how'' in organizing community participation. - Many communities lack the appropriate facilities for water and sanitation. - Local resources for rural development on water, sanitation and nutrition are not adequate. - The supportive infrastructures are still not well established In regard to capital equipment and materials. - Funds are still lacking for a major project on the redevelopment of the only referral hospital with its specialized departments. - The sheer Isolation of the communities creates communication problems for the proper supervision of programmes within the Islands and between islands.

(ii) Administrative problems and Issues - Many health personnel still lack the "know-how'' to Implement. the newly-introduced primary health care approach. - Many health personnel have not been exposed to modem changes in medical technologies. - Community personnel resources have still not been deployed to participate competently in the health care of the communities. - Proper and mutual collaboration between organizations concerned in health-related programmes has not been well established. The health plan is being Implemented In components as follows: Component 1 - Development of community participation through: (a) community education for the members of vHiage welfare groups on health-related matters; (b) community surveys to guide the village welfare groups on problem identification and solution and Implementation of priority activities;

Kiribati

278

Kiribati (c) material supplies to accommodate the needs of village welfare groups through the rural development procedures (community-village welfare group-Island council-Government-Ministry-Development Coordination Committee-Cabinet-Ministry-island council-community). Component 2 - Maintenance and development of supportive services and infrastructures through: (a) development of health manpower; (b) development of the public Information and health education services; (c) promotion of nutrition; (d) development of oral health services; (e) maintaining and improving the maternal and child health/family planning services; (f) maintaining and improving the noncommunicable diseases services, including mental health care; (g) promotion of environmental health; (h) development and improvement of diagnostic, therapeutic and rehabilitative services; (i) maintenance and Improvement of the essential drugs and vaccines services; groups; (b) local courses on primary health care; (c) on-the-job training/supervision; (d) primary health care research (four villages);

280

(e) primary health care workshops at Island level for village welfare

(f) logistic support. The plan is designed to bring 85%-90% of the population under the umbrella of health for all by 1991.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 WHO and other external support will be directed towards achieving these objectives. The budget proposals for 1990-1991 have been prepared with a view to maximizing the input which WHO can make to achieve the alms of the Health Plan. 3.1 Heahh situation and trend •••eaament The Ministry has developed a Health Information Centre, which Is provid ing a data bank for monitoring and evaluating the various components of the plan. To support this work, WHO provided the Ministry with a microcomputer configuration In 1986. Training of staff In the use of computers and the provision of adequate software are areas which require attention. 3.2 Managerial proce.. for national heahh development The time is opportune to develop the management skills of health staff, particularly at district level. It Is noted that the managerial network system Is operating successfully In other Island countries and Kiribati would like to participate. It is proposed to arrange courses in management and supervision. It Is hoped that some support can also be provided through the UNDP/WHO project.

mpromotion of traditional medicine; (k) maintenance and improvement of disease control and prevention. Component 3 -The gradual development and orientation of health care delivery to that of a primary health care-based one through: (a) technical collaboration from WHO and other external sources;

There is also a need to review and modernize registry procedures. 3.4 HeaHh legislation As a preliminary to an overall review of the Health Act the Government wishes to upgrade health laws and regulations. The Act has o~ly been modified slightly from colonial times and is therefore in serious need of updating. 4. Organization of health systems based on primary health care Primary health care remains the linch-pin of the Health Plan. For this reason, the Government Is anxious that the full-time post of Public Health Administrator should be retained until the objectives of the Plan have been achieved. At district level, supplies and equipment continue to be provided for health centres and dispensaries; motor cycles, in particular are required to enable the health staff to move around the islands. It is proposed to continue the series of community workshops to further explain the concepts of primary health care to the communities and enlist their participation. 5. Development of human resources for heaHh Regular reviews of health manpower needs are being undertaken. Manpower training Is still a priority area at each level of management and is likely to remain so for some time. 6. Public Information and education for heaHh Health education is a priority area. The programme has been greatly supported by WHO technical collaboration but the Government is now anxious to train a senior officer who would have complete technical and administrative responsibility for the programme, such as a health education specialist with an MPH health education. It Is planned to undertake special studies on: (I) production of health education material ; (ii) provision of health education services: and (iii) research into health education needs. 8.1 Nutrition The major prOblem remains the difficulty In recruiting a trained national nutritionist. A fellowship was provided in 1988-1989 budget, but the selected

candidate withdrew. It may now be more practical to send a person, possibly a nurse, for training in dietetics as an Interim measure until the nutritionist Is selected. It Is proposed to follow up the nutrition survey which was completed In 1987 and also to analyse the nutritional value of local plants. An interesting home garden project was initiated some years ago and is being continued. 8.2 Oral health The main constraint Is the unavailability of a senior national staff to manage the programme. It Is proposed to send a national to undertake a full dental course In Australia. Special attention will be given to the selection of a suitable well-qualified candidate who will have good prospects of completing the course. In the meantime, the services will be managed by an expatriate dental officer. Dental therapists and dental assistants will still have to be trained overseas. It is planned to conduct a survey to evaluate the oral health programme. 9.1 Maternal and child h•Hh, Including family planning The Government is most anxious to develop a famUy health programme covering maternal and child health/family planning and adolescent health and Is hopeful that UNFPA and WHO will support the expanded programme. Tha programme will be aimed at mothers, children under the age of five, and adolescents, especially teenage glr1s. 10.2 Prevention end control of elcoholend drug ebuae The Government suspects that alcoholism could be a problem In Kiribati. In addition, it is considered to be a contributory factor to many ~the road accidents which occur. A more detal ed Investigation of the problem IS necessary.

malar

10.3 disorders

Prevention end treatment of mental end neurologlcel

The central hospital has a separate psychiatric ward for the treatment of mental conditions. Specialized training as well as access to appropriate references are needed for the nurses attached to the ward.

Kiribati

281

Kiribati 11.1 CommunHy water supply and sanitation The Government has set a target to provide 90% of the population with safe drinking water and good sanitation facilities by 1991. The techniques for making ferro-cement tanks and water sealed latrines have been well taught. However, materials are needed for constructing tanks and latrines. 11.4 Control of environmental health hazards Pollution of the Tarawa lagoon has been a major concern for some time, tor which technical support has been provided by WHO. The Government is developing measures to control the pollution, including the purchase of equipment and conducting of workshops as a follow-up to WHO collaboration. 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care The laboratory has reasonably well-trained staff, as a result of an extended programme of training. Its main needs are supplies and equipment, including books to maintain the standard of the laboratory. 12.2 Essential drugs and vaccines The Pharmacy has now a good pool of suitably qualified staff. In order to maintain this pool, staff will continue to be sent for short periods of training. Supplies are no longer a problem, except perhaps expendable equipment and books. 12.4 Traditional medicine It is proposed to conduct a seminar to create awareness among doctors and medical assistants on traditional medicine as practised in Kiribati. 13.2 Disease vector control The environmental health programme stresses safe drinking water, proper disposal of human and domestic wastes, proper pest control and

282 development of proper living conditions. Flies, mosquitos and rats are a problem in parts of Kiribati. It is proposed to distribute materials for controlling pests and to conduct workshops for educating communities on proper hygienic measures. 13.13 AIDS Although no cases of AIDS have yet been diagnosed, the Government is anticipating support from the Global Programme on AIDS in developing a suitable prevention programme. 13.18 Other noncommunicable disease prevention and control activities Suitable educational material for the prevention and control of diabetes has been developed at the Diabetes Centre in Suva. The Government would like to utilize much of this material and produce It locally.

BUDGETARY IMPLICATIONS Health manpower training continues to be a priority area. The inclusion of long-term fellowships to prepare local staff to manage the programmes accounts for the significant budgetary increases shown under development of human resources for health, public information and education for health and oral health. New areas for WHO collaboration Include health situation and trend assessment, managerial process for national health development, health legislation, prevention and control of alcohol and drug abuse, control of environmental health hazards, disease vector control and other noncommunicable disease prevention and control activities. The budgetary provision for community water supply and sanitation has been reduced so that provisions can be made for environmental pollution. The essential drugs and vaccines programme shows a major budgetary decrease since the need for support in staff training has already been met In previous bienniums.

Estimated obligations

KIRIBATI Regular budget Programme 1988-1989 199G-1991

Other sources (Decrease) %

Increase US$

1988-1989

199G-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development 3.4 Health legislation

US$

11 700

16200 7000

16 200 7000

4. Organization of health systems based on primary health care 227600 216 200 (11 400) ( 5.01)

5. Development of human resources for health 51 300 81 100

29800

58.09

6. Public Information and education for health 80000 98300 18300 22.88

B. General health protection and promotion 8. 1 Nutrition 37700 32 200 ( 5 500) ( 14.59)

Kiribati

283

284

Estimated obligations

KIRIBATI Regular budget Programme 1988-1989 US$ 8.2 Oral health 16200

Other sources (Decrease) % 211.11

1990-1991 US$ 50400

Increase US$ 34200

1988-1989 US$

1990-1991 US$

Source of funds

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning

106 000

10. Protection and promotion of mental health 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological disorders

7000

16000

4000

(12 000)

( 75.00)

11. Promotion of environmental health 11. 1 Community water supply and sanitation

51 BOO

38400

(13 400)

( 25.87)

Estimated obligations

KIRIBATI Regular budget Programme 1988-1989 1990-1991 Increase (Decrease) %

Other sources 1988-1989 1990-1991 Source of funds

US$ 11.4 Control of environmental health hazards 11.5 Food safety 3200

US$ 24600

US$ 24600 ( 3 200)

US$

(100.00)

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines 12.4 Traditional medicine

23000 71 200 4500

16 400 19 100 4000

( 6 600) (52 100) ( 500)

( 28.70} ( 73.17) (11.11)

13. Disease prevention and control 13.2 Disease vector control 8 BOO 8 BOO

Kiribati

285

286

Estimated obligations

KIRIBATI Regular budget Programme 1988-1989 1990-1991

Other sources tDecrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 13.18 Other noncommunicable disease prevention and control activities

US$

4600 582 500 640 000

4600

- TOTAL- KIRIBATI 57 500 9.87 106 000

- -

LAO PEOPLE'S DEMOCRATIC REPUBLIC NATIONAL HEALTH DEVELOPMENT SITUATION The priorities of the Second Five-Year Plan (1986-1990) remain largely In line with those of the First Plan (1981-1985). The main focus ri the economy continues to be the agricultural sector, and particularly the production of paddy. In the field of Industry, the Government is giving priority to agro-industrial processing requiring less than two years' maturity to meet the needs of both the growing internal market for dally consumption goods a111d of external markets for foreign exchange earnings. Improvements a-e also being Introduced In both transport and telecommunications to increase exchanges with rural areas. Finally, reforms are being undertaken In the fielcs of education and health aimed at, Inter alia, providing suitable skilled l:tbour for the implementation of the above activities. The Government has reiterated early this year Its firm commitment to Improve and expand delivery of health care. During the last decade, there has been an increase In the number of health facilities and personnel Medical care is now provided by 4 central, 16 provincial and 111 district hospitals and by 706 commune dispensaries. In addition about 6000 villages have simple first aid posts. The objectives of the Ministry of Health are to redt£e the risk of epidemics and to Implement disease control programmes against malaria, acute respiratory Infections, diarrhoeal diseases, children·~ lmmunlzable diseases, etc. Considerable progress has been made In he water and sanitation programme and in the expansion of quality of health care for every citizen of the country. The above objectives are to be gradually achieved through the development of a network of hygiene and epidemiological services for disease surveillance and control, Including water and sanitation. Progranmes continue to improve the case management of acute d iseases such as malaria diarrhoeas, acute respiratory lnfectlohs, etc., together with ctvonic endemi~ diseases (tuberculosis and leprosy) . Attention is given to the st-engthening of services for the provision of essential drugs, development of health resources, Increasing use of traditional medicine and further Improvement of community participation through health education and involvement of local popular groups. Constraints on effective health service development include shortages of qualified personnel, weak supervisory mechanisms, unavailability or Irregular supply of essential drugs and other supplies, a poorly developed health information system, lack of effect ive managerial capabilities, lack of coordination and insufficient allocation of resources for the health sector.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 Specific priority areas have been Identified which will have a positive. Impact in resolving health development Issues, In support of the national strategy for health for all. Care has also been taken not to dilute scarca•WHO resources in too many programme areas. During the Fourth Party Congress held in 1986 and the Second Congress of Public Health held In March 1987,, emphasis was laid on the moSt appropriate and effective use and management of international resources. Both the technical and political commitments at the national level emphasize the need to minimize risks of epidemics and to Improve the quality and coverage of communicable disease control programmes. Priority wilt also be accorded to dealing effectively With the problems related to shortage of qualified health personnel.

3.1 Health situation and trend assessment This programme will further promote and support the development of existing health information and epidemiological surveillance activities. This will include strengthening of national capability in the collection, analysis and use of health Information for Identification of major health problems. Essential Information and data for the monitoring and evaluation of the national health-for-all-strategies will be further developed. With the use of these

Lao People's Democratic Republic

287

Lao People's Democratic Republic Indicators, the health-for-all monitoring process will be levels. prom~ed

288 at various Support wUI be provided for the development of district health systems In order to Improve the quality, and expand the coverage, of health care as well as provide support and guidance to commune health posts and traditional birth attendants. Repair and maintenance of biomedical equipment will also be included to a limited extent. It is expected that considerable support will continue to be provided through 1990 by UNICEF, UNDP and other nongovernmental organizations. 5. Development of human resources for health Even though WHO collaboration In training prog~ammes dates ~ck to 1971, there still remain several Issues and problems wh1ch require continued

Collaboration will be required to Improve health Information support for health services development, enhance capabilities to develop and produce appropriate health indicators, and improve the patient record systems at various health facilities. In order to obtain complete, reliable and regular Information, "sentinel districts" will be established In six provinces to monitor disease incidence and the impact of other activities. The present vertical programmes, which compile data on individual programmes, will be gradually integrated In the overall health Information system. Much more emphasis will be given to training programmes, development of standardized classifications and nomenclatures, the use of Information collected at various levels and feedback of synthesized data. The overall thrust of the programme is to support the managerial process for national health development and Its priority support for the health-for-all strategies. 4. Organization of health systems based on primary health care In spite of progress In the development and expansion of health Infrastructure, training programmes and the Increasing use of appropriate technology, coverage of the essential elements of primary health care in the six provinces remains Inadequate. In those districts where coverage is considered adequate, concern has been expressed about the quality of health care, and the efficiency and availability of basic logistics to support field health personnel. Based on demographic, social and other factors, emphasis will be placed on the rural areas, vulnerable groups (mothers and children), ethnic minorities and the remote areas. In 1984, eleven districts in six provinces were Identified for the organization of primary health care activities. In 1986, expansion of activities was considered In another four districts bringing the total to 22 districts. The programme will play an Important role in achieving the national health-for-all strategies as well as monitoring and evaluation. At the national meeting in December 1987, considerable support was given to the provincial health administrations In evaluating the health-for-all strategies.

national efforts backed by international resources. There Is a general shortage of skilled health personnel and maldistrlbutlon of existing staff. The Government has laid emphasis on planning, training and deploying the types and numbers of health personnel needed, who will be provided with the necessary logistic, technical and supervisory support. Efforts will also be made to ensure that health personnel are utilized optimally for effective implementation of the health-for-all strategies. Programmes for the training of trainers will continue to provide for health personnel of other provinces; provincial training courses will continue. Particular emphasis is being placed on health management In the University of Medical Sciences and other training Institutions In and outside the capital. The contractual services agreement with Technoexport for the teaching programme of the School of Medicine Is under constant review and efforts are being made to gradually phase It out. However, the Ministry of Health has faced difficulties In finding suitable teachers and the phasing-out process is not progressing as planned. During the next decade, nursing education will be further expanded and provincial teaching institutions, including the regional schools for medical assistants, will be upgraded In terms of manpower and training materials. The programme will continue to keep the curricula and teaching programmes In line with the Identified needs of the country. Training will give more emphasis to community-based nursing care; a demonstration zone will be Identified for each institution for field training. Training materials, Including audio-visual aids,

will be further developed and Improved In their relevance to learning objectives. The administrative, managerial and supervisory skills of nursing personnel will receive special attention. 6. Public Information and education for health Health education activities are progressing slowly and the need for specialized trained personnel at the central level Is acutely felt. The use of existing mass media for health education Is still limited and the schgo! health programme needs to be further developed. Involvement of community organizations is crucial for the programme. WHO support will be geared towards the development of planning and programming capabilities at the central level and in two or three provincial capitals. 8.1 Nutrition

At present, 25 districts, 78 communes and 1136 villages In the six provinces are undertaking maternal and child health activities of varying quality. Maternal and child health services are also being offered at nurseries and kindergartens In the provinces. It Is estimated that the access rate to these services In Vientiane Municipality Is about 56%. The home-based mothers' record was Introduced In 1987 In five communes of Vientiane Municipality. Training of traditional birth attendants started in 1984; about 580 had been trained by the end of 1987. It is essential that the central maternal and child health services are strengthened and made more operational. WHO collaboration will be required to support national personnel in the expansion of the services to other parts of the country. 11.1 CommunHy water aupply and Anltatlon

Although the nutrition programme forms part of the maternal and child health activities, nutritional surveillance coverage of children and mothers is poor. More emphasis needs to be given to a multisectoral approach involving the Ministry of Education (kindergartens), the Lao Women's Association, the Ministry of Agriculture, curative services for children and obstetric consultations in order to improve the nutritional status of children and pregnant and lactating mothers. 8.2 Oral health Although the existing infrastructure is inadequate, progress has been made in Vientiane Municipality and a few of the large towns. The programme will support fluoridation of water In VIentiane and promote preventive activities against dental caries and periodontal diseases, particularly In school children. Health education will be directed towards Improvement of oral hygiene and reduction of sucrose consumption. 8.1 Maternal and child health, Including family planning Currently, efforts are being concentrated In six provinces. Attention will be given to the expansion of activities to districts in other provinces In a phased manner. Expansion of maternal and child health services Is Important as they support the.lmmunlzation and diarrhoeal disease control programmes.

This programme is considered Important In Improving the quality of life and reducing transmission of disease and frequency of water-borne disease outbreaks. Its main thrust will be on providing technical support to the expansion and improvement of national programmes on community water supply and sanitation, including training and use of appropriate technology. Institutional development will be an Important part of the activities. The national programme has received substantial support In the past from UNDP. UNICEF continues to provide technical support. It Is expected that the services of the United Nations volunteers will continue to be made available. Substantial collaboration Is expected from the WHO Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) . 12.1 Clinical, laboratory and radiological technology for health aystem• baaed on primary health care WHO collaboration Is expected to focus on the development of essential and simple diagnostic methods and other techniques to support disease surveillance and control programmes. Local production of diagnostic reagents such as for dengue fever will be further Improved.

Lao People's Democratic Republic

289

Lao People's Democratic Republic 12.2 Essential drugs and vaccines While draft guidelines have been prepared for essential drugs needed at various types of health facilities, further support Is needed for this essential · element of primary health care, with particular emphasis on the development and implementation of a feasible system of selection. procurement, stockage, distribution and use. Support will be provided to boost the local production of some essential drugs In existing pharmaceutical facilities as well as the development of a satisfactory network for distribution. The Japanese Government and certain other donors also support the programme. Training of local personnel In drug supply management, Including Inventory maintenance, will be given more attention. 12.4 Traditional medicine The programme will promote and support the Integration of traditional medicine practices in overall medical care. Useful and effective practices will be identified in close consultation with monks, herbalists, etc. Local studies on medicinal plants will be supported and training programmes organized at provincial level. The programme will operate in close collaboration with the Pharmaceutical Research Centre and the Institute of Science and Technology. UNICEF support is expected to continue. 12.5 Rehllblllbltion Community-based services have now been extended to several provincial capitals and districts. Local production of low-cost prosthetics Is in progress. The programme also Includes disabilities other than locomotor handicaps. Support to the programme Is also being provided by a French nongovernmental organization, "Handlcape Internationals", while ESCAP has proposed collaboration In the training programme. WHO support is being gradually phased out after several years. 13.1 Immunization Although this programme has been given priority and received support at the highest government level, immunization coverage remains very low. Constraints Include a shortage of trained personnel, poor health and road

290 Infrastructure, logistical problems related to the cold chain and vaccine distri bution, low population density, lack of health education, etc. The programme Is still not well integrated Into ongoing maternal and chUd health and other health care activities. The Government has now embarked on an Intensive accelerated programme on a mobile basis. However, inadequate health infrastructure and other problems are likely to adversely affect sustainability of the programme. Logistical support is being provided by UNICEF and is expected to continue. WHO should continue to provide technical backstopping. 13.2 Disease vector control Dengue fever/dengue haemorrhagic fever and shock syndromes continue to be a major concern of the health administration because of their epidemic potential and high case fatality rates, particularly In children. The programme will provide much needed support to reduce mosquito density by a series of measures involving the communities. Vector control activities that communities can carry out by themselves will be further developed. Use of permethrin-impregnated nets will be further promoted. 13.3 Malaria The programme has been suffering from various problems related to manpower, financial resources, logistics, etc. The epidemiological situation Is a source of concern, particularly In certain areas during seasons of high transmission. WHO collaboration wHI be needed to reduce or prevent outbreaks and to lower malaria endemicity In selected areas. The programme needs to be carefully Implemented and gradually extended In the context of the primary health care strategies. An improved and effective health Information system and a rational but simple epidemiological approach will be the guiding principles In selecting appropriate prevention and control measures and providing optimal coverage of well defined priority areas and target population groups. The key to malaria control Is the availability of adequate and appropriately trained manpower. It Is crucial, therefore, that the control programme should continue to develop managerial and epidemiological expertise and capabilities at the central level. The training programme will not only develop different categories of personnel in specific fields but also train

other health workers In the practical aspects of malaria management and control. It Is expected that additional resources will be made available by UNICEF and a nongovernmental organization. 13.4 Parasitic diseases

The programme Is to be closely linked to the programmes on Immunization, provision of essential drugs, organization of health systems based on primary health care, and development of human resources for health. UNICEF support Is expected to be available. 13.8 Tuberculosis

This programme will provide technical support for the surveillance and control of Schistosoma mekongi in Khong Island in the southern part of the country. The programme will also include Opistorchis viverrini infection. It is expected that coordination with the Mekong Secretariat will be strengthened in this field. 13.6 Diarrhoeal diseases It is becoming increasingly clear that diarrhoeal disease cont rol needs to be integrated and implemented through ongoing medical care at the health facilities and maternal and child health services. There is an urgent need to promote wider and more extensive use of oral rehydration therapy. The programme will continue to emphasize early treatment of acute diarrhoeas with oral rehydration therapy, educate mothers on appropriate feeding of children during diarrhoeal episodes, encourage breast-feeding, and provide health education In food, personal hygiene and use of safe water. Training programmes will continue and will be combined or linked with other training activities such as maternal and child health, Immunization, acute respiratory Infections, etc. It Is expected that UNICEF will continue to provide oral rehydration salts and to support training activities. Input from a nongovernmental organization Is expected to continue. 13.7 Acute respiratory Infections This programme requires considerable technical and logistical support tor its development. AAI ranks second after malaria In terms of morbidity and mortality. The main thrust wlll be on the Implementation of the programme, based on standard case management through existing health facilities. A simple method will be used to identify the child with acute respiratory Infections and to distinguish between mild, moderate and severe forms. Experience gained In the Champhone District of Savannakhet Province will be used In expanding the programme.

Tuberculosis control activities are not well developed outside the capital. The programme suffers from a number of constraints, Including Insufficient administrative support, Inadequate planning and management, lack of trained manpower and shortage of drugs and other supplies. WHO collaboration will be needed for the strengthening of programme management, expansion and supervision of activities In selected provinces and districts, and training of various categories of health workers In case-finding by direct microscopy and in providing an effective treatment regimen. 13.9 Leprosy The main thrust of this programme will be on ear1y case-finding and treatment to reduce prevalence. Incidence and development of deformities. A second priority Is the phased expansion of the programme to areas of known high endemicity followed by an ln-{jepth review of leprosy patients In order to differentiate between the majority of burnt-out cases and those that are still active. Institutionalized treatment will be limited to management of lepra reactions and deformities. Further expansion of multldrug therapy and bacteriological diagnostic services will receive emphasis. 13.14 Other communicable disease prevention and control activities Epidemiological surveillance of dengue fever/dengue haemorrhaglc fever and dengue shock syndrome, Japanese encephalitis and hepatitis B Is generally weak because of the shortage of trained manpower and Inadequate laboratory facilities. However, It Is noted that detection of antibody-positive reactors of HBV Infections, dengue fever/dengue haemorrhaglc fever and even of AI DS has improved with the Introduction of newer laboratory techniques and diagnostic methods.

Lao People's Democratic Republic

291

Lao People's Democratic Republic The Government will concentrate WHO resources mainly In the strengthening of surveillance, laboratory diagnosis, vector control, case management and preventive and control strategies for dengue fever/dengue haemorrhagic fever. Certain activities related to hepatitis 8, Japanese encephalitis and AIDS could also be included in this programme. 13.15 Blindness and deafness Although reliable Information is not available, It Is clear that a large number of blindness cases are preventable or curable, being caused mainly by infections, unoperated cataract or nutritional disorders. The objective of the programme is to reduce avoidable and curable blindness through simple, cost-effective primary eye care. Emphasis will be placed on training, health education and coordination with maternal and child health programmes.

292 the national strategy for health for all. The major part of the country planning figure has therefore been allocated to disease prevention and control, the organizatio n of health systems based on primary healt h care and the development of human resources for health. The expansion of programme activities from the central level to the provinces accounts for the budgetary Increases in programmes such as maternal and child health, essential drugs and vaccines, vector biology and control, parasitic diseases, acute respiratory Infections, and leprosy. The oral health programme also shows a significant budgetary Increase In view of the priority given to fluoridation of water In Vientiane. Although community water supply and sanitation, cl inical, laboratory and radiological technology for health systems based on primary health care, and the expanded programme on Immunization are considered priority areas, budgetary provisions for these programmes have been red uced In view of the availability of extrabudgetary resources. The phasing out of the WHO technical officer post accounts for the reduction under the rehabilitation programme. Under health situation and trend assessment and health Information support, major collaborative requirements are expected to be met In 1988-1989.

BUDGETARY IMPLICATIONS The programme budget proposals reflect the priority areas identified by the Government to achieve the health development objectives in support of

Estimated obligations

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme 1988-1989 US$

Regular budget 1990-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Vientiane, Laos

100 100

75600

( 24 500)

( 24.48)

331 300

357 000

25 700

7.76

4. Organization of health systems based on primary health care 228 500 220 700 ( 7 800) ( 3.41)

5. Development of human resources for health 219 500 254 800 35 300 16.08 408 700

6. Public information and education for health 41 000 39000 ( 2 000) ( 4.88)

8. General health protection,and promotl0n 8. 1 Nutrition 25000 33800 8800 35.20

Lao People's Democratic Republic

293

294

Estlnated obligations

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme 1988-1989 US$ 8.2 Oral health 20000

Regular budget 1990-1991 US$ 69400

Other sources (Decrease) % 247.00

Increase US$ 49400

1988-1989 US$

1990-1991 US$

Source of funds

9. Protection and promotion of the heaHh of specific population groups 9. 1 Maternal and child health, including family planning

32700

106 900

74 200

226.91

6400 36700

10. Protection and promotion of mental heaHh 10.3 Prevention and treatment of mental and neurological disorders

20900

( 20 900)

:100.00)

11. Promotion of environmental heaHh 11. 1 Community water supply and sanitation

59000

35 700

( 23 300)

39.49)

80400

Estimated obligations

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme 1988-1989

Regular budget 199G-1991 Increase %

Other sources (Decrease) 1988-1989 199G-1991 Source of funds

US$ 12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines 12.4 Traditional medicine 12.5 Rehabilitation

US$

46500 32000 17400 109 500

39800 58500 33100 33200

( 6 700) 26500 15 700 ( 76 300)

( 14.41) 82.81 90.23 ( 69.68) 4700

13. Disease prevention and control 13.1 Immunization 13.2 Disease vector control 13.3 Malaria 13.4 Parasitic diseases 122 700 16000 223 400 13 500 110 300 28 700 216 300 37100 (12400) 12 700 ( 7 100) 23600 ( 10.11) 79.38 ( 3.18) 174.81

Lao People's Democratic Republic

295

296

EltlrMted obligations

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme

Regular budget

Other sources (Decrease) %

1988-1989 US$

1990-1991 US$ 33400 49800 31 000 43600

Increase US$ 13 400 28800 7500 20100

1988-1989 US$

1990-1991 US$

Source of funds

13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy 13. 14 Other communicable disease prevention and control activities 13.15 Blindness and deafness

20000 21 000 23500 23500

67.00 137.14 31.91 85.53

40000 11 000 20000

32000 28600

( 8 000) 17 600 ( 20 000)

( 20.00) 160.00 (100.00) 23400

14. Health Information support TOTAL- LAO PEOPLE'S DEMOCRATIC REPUBLIC

1 818 000

1 968 300

150 300

8.27 -

560 300

MACAO NATIONAL HEALTH DEVELOPMENT SITUATION The Department of Health Services was governed in 1984 by Statutory Law 44/79/M, whose general ruling was that ''the network of assistance should function as a perfectly integrated system, peripheral health development being an extension of the departments of the Central Hospital Conde de S. Januarlo, which would give the necessary support". This hospital-centred health policy was modified by the health directives issued by the Government at the beginning of 1985, establishing a subsystem for primary health care that would receive priority, without however compromising hospital activities. The aim is a health system in line with modern concepts, in which priority is given to the primary care subsystem, thereby achieving a more equitable distribution of the resources available. The unreliability of demographic data, together with the incomplete registration of births and deaths and an absence of morbidity statistics, make it difficult to give a precise description of the general health situation. It is, however, considered to be excellent. Communicable disease control has been Intensified. Nearly all schoolchildren were inoculated under the expanded programme on immunization or at maternal and child health consultations in health centres. In 1986, 100% of infants under one year of age were immunized against tuberculosis, 80% against diphtheria, pertussis and tetanus, and 82% against poliomyelitis, while 88% of Infants under two years of age were immunized against measles. An extensive campaign has been conducted against tuberculosis - the main health problem; detection procedures and treatment are free of charge. Antimosquito measures have been intensified, mainly along the border and in the urban and rural areas. The main communicable diseases in 1986 were, In number of cases: pulmonary tuberculosis (420), infectious hepatitis (138), measles (1 04), typhoid fever (15), mumps (10), varicella (19) and German measles (7). The leading causes of death In 1986 were: other forms of chronic lschaemic heart disease (95), acute but ill-defined cerebrovascular disease {74), chronic pulmonary heart disease (57), malignant neoplasm of tra_ chea, bronchi and lungs (48) , malignant neoplasm of liver and Intrahepatic bile ducts (45), senility without mention of psychosis (44) , intracerebral haemorrhage (42), emphysema (39), pulmonary tuberculosis (34), essential hypertension (32) and heart failure (32). The progress of health development can be assessed from . the following: - The population of Macao Is well served by a supply of treat~ water, piped to the home; the same Is true of the Islands, except for a few localities where drinking-water Is however available within less than 15 minutes' walk. - Disposal of sewage and wastes Is stHI Inadequate, although It has improved considerably during the last two years.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 5. Development of human resources for heaHh WHO collaboration will be required to support continuing education of health workers to ensure smooth functioning of the health services.

BUDGETARY IMPLICATIONS The Government continues to give priority to the development of human resources for health.

Macao

297

298

Estimated obligations

MACAO Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$

5. Development of human resources for health TOTAL- MACAO 61 500

66400

4900

7.97

- 81 500

-88400

7.97

4900 --

MALAYSIA NATIONAL HEALTH DEVELOPMENT SITUATION During the Fifth Malaysia Plan period (1986-1990), the Government's efforts to raise the overall living standards in the country have included the implementation of health programmes covering promotive, preventive, curative and rehabilitative services. Emphasis has been placed on the provision of health services to rural areas in order to attain a more equitable distribution of health services and the upgrading and refurbishing of existing health care delivery centres and institutions. There has been a tremendous improvement in the health status of the population due to concerted and conscious efforts by the Government In the implementation of Its health programmes In line with the WHO goal of health for all by the year 2000. The infant mortality rate has declined rapidly from 26.79 per 1000 live births In 1979 to 15.50 per 1000 live births In 1986, while the toddler mortality rate, which was 2.4 per 1000 children aged 1-4 In 1979, declined to 1.16 per 1000 children In 1986. Life expectancy at birth for males Increased from 67.1 years in 1979 to 68.5 years in 1986 while that of females was 73.7 years in 1986 as compared with 72.2 years In 1979. During the Fifth Plan period, emphasis in health development will be on preventive care and on fostering greater Involvement of the community In health care. Based on the primary health care approach, which is aimed at Improving the health status among different population groups and areas, efforts will be made to Improve intersectoral and interagency coordination and collaboration In health and health-related activities. Identification and provision of health facilities as part of a comprehensive set of programmes to develop smaller k:Jentlfied townships will be emphasized. The National Health Plan is expected to consolidate health care resources in order to ensure optimum utilization and cost effectiveness. The existing health care infrastructure throughout the country has continued to be expanded and strengthened through a comprehensive health care system. This has included the provision of basic health care services from the first point of contact at rural clinics to the general hospital in each state and the General Hospital in Kuala Lumpur, which is the highest tertiary care level. Increased accessibility by the population to primary health care has continued to be augmented by mobile health services. The Government has continued to build new hospitals during the Fifth Plan period to meet the target of two acute beds per thousand population. Nine new hospitals were completed, thereby increasing the number of acute care beds from 23 700 in 1980 to 26 200 in 1985. In view of the tight financial situation, the development of new hospitals was unable to meet the population increase, resulting in a marginal improvement in the bed population ratio. The total outpatient attendance in 1986 was 21 148 341 and the total number of admissions 1 122 618. The Ministry of Health is particularly concerned with the quality of services provided to the public. To ensure an efficient delivery of health services to the community, the Ministry Is planning a study to monitor the capabilities of the existing specialized services In hospitals so as to upgrade quality to meet the changing technology and environment. The rural health services consist of a large package of services delivered under various health programmes, Including among others communicable disease control, Inpatient care, personal dental care, maternal and child health/family health, school health, applied nutrition, and health education. Rural health service activities are carried out at the mk:Jwlfe clinics and rural clinics level by auxiliary personnel, such as midwives and rural nurses, and at health sub-centre level by auxiliary personnel such as health nurses and medical assistants. At health centres, the services are undertaken by professional personnel such as doctors and dentists. These facilities provk:Je ambulatory care and are the first points of contact In the primary health care approach, allowing for referrals for a higher level of care based on need. Institutional care required is provided In district hospitals, large d istrict hospitals with basic specialist care, general hospitals with a wider range of specialist care and, where necessary, In the national referral centre at General Hospital, Kuala Lumpur for the highest level of specialist care. This system constitutes a hierarchy of health care within the government health care system and ensures access to all levels of health care for the population.

Malaysia

299

Malaysia In its efforts to attain the goal of health for all by the year 2000, Increasing emphasis is being given to the delivery of primary health care services to improve the health of the population in the rural areas. The preventive programmes in the rural health service provide such services as maternal and child health, immunization, nutrition and others. The two-tier system of one health centre for 15 000-20 000 population and one rural clinic for 4000 rural population has provided a higher quality of care and wider population coverage. The health care coverage for Peninsular Malaysia is 95% while that for Sabah and Sarawak is about 60%. Considerable efforts have been made over the years to provide safe water supply and sanitary latrines in the rural areas in order to reduce the incidence of waterborne diseases. In 1986, 65.6% of the population were receiving safe water supply and a total of 66.5% of the rural population had proper sanitary latrines. The Health Services Financing Study, initiated in 1983 to review the total health care financing system in the country, was completed In September 1985. The main recommendations of the study were the creation of the National Health Security Fund, establishment of the National Health Council for interagency coordination among the various public health delivery agencies, development of group medical and non-medical services, and decentralization or leasing of some of the general and district hospitals. The Government will continue to work towards strengthening its capability in drug production and quality control of drugs, drug registration and control procedures as well as acquiring advanced technology in supply management and hospital pharmacy management for pharmacists. A recent development in the national drug policy is the commencement of drug registration in November 1985. In the practice of hospital pharmacy, the role of the pharmacy service in the health centres, total parenteral nutrition and assorted therapeutic drug legislation to ensure proper handling, rational prescribing and goods dispensing will continue to be given due attention. Monitoring of narcotic and psychotropic drugs for illicit use is also being given priority. Biomedical research, aimed at Improving the diagnosis, management, and prevention of parasitic and infectious diseases, and community health problems, will continue to be expanded in accordance with national health goals.

300 Planning and management of health manpower are central to the effective delivery of health services. Appropriate training programmes have been d eveloped to meet the demand for health personnel. Apart from established training activities, the Government will give priority to postgraduate training for medical officers and post -basic training for auxii iary staff, particularly In certain specialities such as anaesthesia, paediatrics, orthopaedics, ophthalmol ogy, radiology and pathology. The doctor/population ratio has improved from 1:3388 In 1984 to 1:2986 In 1986. The long-term objective Is 1:2200 by the year 1990.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The principal objective of WHO collaboration is to help the Government to promote, coordinate and support Its efforts in implementin~ the national strategy of health for all by the year 2000, through the strengthening of national capability to solve national health development problems. Special attention will be given to underprivileged areas where health Indicators are still well below the national averages. The most Important component of WHO collaboration will still be d evelopment of human resources for health through fellowships and training activities in the country.

3.2 Managerial process tor n11tlon111 heaHh development This programme is intended to Improve the national capacity for developing and operating health systems, particularly In making effective use of the managerial process for national health development. Particular emphasis will be given to improving the managerial capacity of the operational level of the health system. Training activities will be promoted and supported to improve the organizational and decision-making capability of senior public health officials.

3.3 HeaHh systems research and development Health systems research will be carried out as part of the managerial process for health development and will be used for the generation of the knowledge and action required to improve the planning, organization and operation of the health systems. The Government will continue to identify and mobilize expertise in support of national health systems activities, particularly with regard to the latest development In data research.

4. Organization of health aystems based on primary health care In Malaysia, the district health system Infrastructure, comprising a network of health care facilities, Including a health district office, a hospital at first-referral level, has served the community with health-related services. In this light, efforts are being made to enhance managerial skills with the aim of ensuring the systematic development and operation of new hospitals which will be built under the Fifth Malaysia Plan.

8.2 Oral health The Government Is Improving the dental programme through training of dental manpower.

9.1 Maternal and child health, Including family planning The Government will Implement a plan of action for reduction of maternal and infant mortality and the risk approach strategy will continue to be given emphasis, especially in areas of high mortality.

5. Development of human resources for health The Government has established a system of continuing education to stimulate and intensity its efforts to improve health personnel management. All health personnel are given the opportunity to upgrade their technical and managerial competence and performance th rough training. The main emphasis will be for improving training of health workers such as medical officers, health inspectors, occupational therapists, physiotherapists, public health engineers and on ensuring the Increased relevance of such training to national health priorities. In this context, special reference Is made to continuing medical education. Efforts will be made to encourage major improvements in education (including improved teacher training) and the mechanisms for regulating training programmes so as to meet the new expanded roles of all categories of staff.

9.4 Workers' health The Government is giving attention to health problems of working populations who are affected by specific occupational health hazards, especially those who are working In agriculture, small-scale industries, construction and mining. The training of health personnel directly Involved In the detection of this problem will continue.

10.3 Prevention and treatment of mental and neurological disorders The Government will continue to give emphasis to specialist care for the mentally and neurologically Ill, to the Incorporation of a mental healtn component in primary health care, and the development of community support systems which permit patients (even If they suffer chronic impalnnent) to live a socially and economically productive life. Training of health staff In mental health will continue. Collaboration Is required In respect of the Inclusion of community mental health In the public health nursing training programme.

8. Public Information and education for health Increased efforts will be.made to prepare all categories of health and health-related workers for health education and public information tasks through the development and testing of Intensive, short, practical training programmes, with emphasis on skills in effective communication. Educational workshops will support the development of national mechanisms and procedures to Increase coordination between health workers as well as community groups of the mass-media by developing the shared understanding of problems, issues and roles. The Government will be setting up the Health Education and Communication Centre (HECC), which is due to be completed by end of 1989, for the purpose of planning, development and production of supportive media for health education. The centre will facilitate the Implementation of programmes and activities pertaining to public information and education for health. The Poison Control and Information Centre will also be set up as a referral centre for polson control and polson information.

11. 1 Community water aupply and unltatlon The Government has given considerable Impetus to the Improvement of community water supply and sanitation. Levels of coverage and standards of drinking water supply and sanitation have Improved. The Government Is also assessing and implementing projects to address environmental problems involving pollution of the human environment as a result of rapid Industrial development. The training programmes aiming at institutional and human resource development in the field of environmental health will continue.

Malaysia

301

Malaysia 11.5 Food safety The Government Is concerned with environmental health problems such as Illness due to contaminated food. The effects produced by the Ingestion of food contaminated by undesirable levels of chemicals (e.g. additives, pesticides, heavy metals, drug residues) are potentially dangerous because of their possible long-term Impact on human health.

302 13.2 Disease vector control Collaboration Is required In the prevention and control of vector-borne diseases through the development of comprehensive strategies for vector and pest control. Particular attention will be given to personnel training, use of appropriate technology, and community involvement to Increase self-reliance. This will promote the concept of vector control through primary health care Involving public Information, health education, the relevant and Increased use of technologies and community participation.

12.1 Clinical, laboratory and radiological technology for health systems baaed on primary health care The Government will promote the selection, development, adaptation, use and assessment of clinical, laboratory and radiological technologies appropriate for national health systems and institutions, taking Into account cost-effectiveness, affordability and social acceptability.

13.3 Malaria WHO collaboration Is needed In the monitoring of malarial drug resistance in Kelantan.

13.7 Acute respiratory Infections 12.2 Essential drugs and vaccines Collaboration with WHO will be required for middle-level management training so as to strengthen national capacity for the implementation of national drug policies to ensure quantification of needs, procurement, production, regular distribution and improve rationality in the use of drugs and vaccines. Educational workshops wHI be organized to promote the programme for the prevention and control of acute respiratory Infections.

13.8 Tuberculosis The tuberculosis control programme Is Integrated with the basic health services. The training of health workers In the technical and management aspects of the control programme needs to be further emphasized.

12.3 Drug and vaccine quality, safety and efficacy a~ trai~ing activities o.n all as~cts of national drug use, Including drug

The Government is seeking WHO collaboration to support education

reg1strat1on and regulation, quality control and dissemination of validated information.

13.9 Leprosy The Government Is strengthening national capabilities for planning, management, implementation and evaluation of the Integrated leprosy control programme. WHO collaboration Is needed to evaluate the efficacy of the multiple drug therapy regimen and Its Implementation In the leprosy control programme.

12.4 Traditional medicine The Government is in the process of evaluating the role of traditional medicine in the country. The registration of traditional medicine is expected to begin In 1991 and the training ·of health personnel related to this process Is required.

13.13 AIDS WHO support Is needed for the development and Implementation of the national AIDS prevention and control programme, with emphasis on epidemiological assessment, surveillance, laboratory capability and education of health care workers at all levels. Adequate training of medical and health personnel is necessary.

12.5 Rehabilitation WHO collaboration Is needed in the training of personnel In rehabilitative medicine.

13.17 Cardlovascullir diseases The Government will continue to monitor and evaluate the different approaches to the cardiovascular disease prevention and control programme.

Budgetary Increases are also shown under the programmes on public Information and education for health, community water supply and sanitation and clinical, laboratory and radiological technology for health systems based on primary health care. Budgetary decreases are shown under the managerial process for national health development and disease vector control In view of substantial support to these programmes In the previous biennium. For organization of health systems based on primary health care, although requests under this programme show a sharp decrease, this does not mean a loss of Interest In primary health care by the Government. Several requests for primary health care components are made under different headings.

14. Health Information support WHO collaboration Is needed In strengthening and modernizing the Universiti Sains Malaysia medical library so that health Information becomes readily available and easily accessible.

BUDGETARY IMPLICATIONS The high priority given to the development of human resources for health accounts for the significant budgetary increase for this programme.

Malaysia

303

304

Estimated obligations

MALAYSIA Regular budget Programme 1988-1989 1990.1991 Increase (Decrease) 1988-1989 Other sources 199o-1991 Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Kuala Lumpur, Malaysia 3.3 Health systems research and development 3.4 Health legislation

US$

"' (100.00)

US$

700

(

700)

75400

39600

( 35 800)

( 47.48)

382 700

436 100

53 400

13.95

32500 7400

17 700

(14800) ( 7 400)

( 45.54) (100.00)

4. Organization of health systems based on primary health care

275500

40300

(235 200)

( 85.37)

5. Development of human resources for health 131 400 288700 157 300 119.71

Estimated obligations

MALAYSIA Regular budget Programme 1988-1989 1990-1991 Increase (Decrease) 1988-1989 Other sources 1990-1991 Source of funds

US$

8. Public information and education for heaHh 8. General heaHh protection and promotion 8.2 Oral health

48100

122 100

74000

153.85

17700

18 400

700

3.95

9. Protection and promotion of the heaHh of specific population groups 9. 1 Maternal and child health, including family planning 9.4 Workers' health

17 200 16200 27 200

17 200 11 000 67.90

10. Protection and promotion of mental heaHh 10.2 Prevention and control of alcohol and drug abuse

15500

(15500)

(100.00)

Malaysia

305

306

Estimated obligations

MALAYSIA Regular budget Programme 1988-1989 US$ 10.3 Prevention and treatment of mental and neurological disorders

Other sources (Decrease) %

199()...1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

9000

11. Promotion of environmental health 11. 1 Community water supply and sanitation

44500

60000 127 400 ( 40.63)

DP FS

11.5 Food safety

38400

22 800

(15 600)

68400 19400

141 400 39200

73000 19 800

106.73 102.06

19 800

36200

16400

82.83

Estimated obligations

MALAYSIA Regular budget Programme 1988-1989 US$ 1990-1991 US$ Increase US% (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

12.4 Traditional medicine 12.5 Rehabilitation

13000

14600 3900

1 600 3900

12.31

13. Disease prevention and control 13.2 Disease vector control 13.3 Malaria 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy 13.13 AIDS 13. 15 Blindness and deafness 13. 17 Cardiovascular diseases 14 800 25400 11 100 7000 7 800 7000 26700 66200 49700 8000 ( 16 500) 8000 ( 11100) 7000 ( 7 000) ( 18 400) 26700 10 000 ( 47.30) ( 72.44) (100.00) ( 24.92) 17200

11·000

7000

Malaysia

307

308

Estimated obligations

MALAYSIA Regular budget Programme 1988-1989 US$ 14. HeaHh information support TOTAL- MALAYSIA 5000 1 284 800 1990-1991 US$ Increase US$ (Decrease) 1988-1989 US$ Other sources 1990-1991 US$ Source of funds

9100 1 441 200

4100 156 800

82.00

-12.19 214 800

- -

NEW CALEDONIA NATIONAL HEALTH DEVELOPMENT SITUATION Because of New Caledonia's large area and low population density, extensive health facilities are necessary. The territory comprises 25 medical districts, headed by one or more physicians and other medical and auxiliary health personnel. It is at this level that primary health care Is provided . These facilities also provide the basis for preventive and health educational activities. Over the past few years, a considerable effort has been made to implement these activities In order to achieve the goal of health for all by the year 2000. Within this framework, a number of activities have been carried out partly with the active support of WHO. The programme budget for 1988-1989 Includes the training of qualified personnel , with a view to decentralizing the preventive and health care activities. The training of these personnel should span a period of several years and the proposals aim to continue and maintain the fellowships allocated in the programme budget t 988-1989.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 5. Development of human resources for health Continued support will be required for the training of health manpower, such as midwives and laboratory technicians, in order to further strengthen the health system.

BUDGETARY IMPLICATIONS The Government continues to give high priority to the development of human resources for health.

New Caledonia

309

310

Estimated obligations

NEW CALEDONIA Regular budget Programme 1988-1989 199Q-1991

Other sources (Decrease) %

Increase US$

1988-1989

199Q-1991

Source of funds

US$ 5. Development of human

US$

resources for health TOTAL- NEW CALEDONIA

66200 ~-

72000 -

5 800

8.76

8.76 -

- -

66200

72 000

5 800

- -

NEW ZEALAND NATIONAL HEALTH DEVELOPMENT SITUATION The Government of New Zealand has accepted WHO's goal of health for all by the year 2000 and has adopted strategies which will give priority to primary health care, health promotion and health protection. Within the changing structure of the health services, particular attention is being given to the health of the Tangata Whenua (Maori), the elderly, child health and mental health. Common themes which characterize these strategies, and which will continue to play a significant role in the direction of the health services In 1990-1991, are planning and management. New Zealand 's health services are the responsibility of a variety of publ!c, private and voluntary agencies. For the past decade, there have been continuing efforts to Integrate and coordinate the health care activities of the three sectors; legislation was enacted in December 1983 to allow for the voluntary and evolutionary establishment of area health boards. The legislation seeks to Involve to a greater extent both the providers and consumers of health care in the planning and development of a region 's health services. Since 1984, the health of Maori people has been one of the priorities of the health service. Maori people now wish to participate in all decisions that affect their well-being. In the spirit of primary health care, they now argue that the Treaty of Waitangi, signed in 1840, should become the foundation of good health for all In Aotearoa (New Zealand) . The guiding philosophy of the legislation stresses the concept of ''total health", which embraces not on~yothe treatment and curative aspects of health care, but also health promotion and disease prevention. In a practical sense, the.se !unctions, t?gether with the additional functions specified In the leg1~~t1on, wm ~ Integrated through the amalgamation, over time, of the activities of hospital boards·anc:k et·district offices of the Department of Health. . In New Zealand, as In mest(other developed countries, there has been tmle.real Wowth in heatth ,r.eso.urces ~lnce the mid-1970s. As a result, emphasis on f1nanc1al management bas-gmwn.and will continue to grow as the country works towards Improving the cost-efficiency of its health services. The population-based funding formula, which was Introduced from 1 April 1983, Is designed to ensure that the total funds available for allocation to the hospital sector are "managed" in a way that most accurately reflects the composition and health needs of the population it serves. National management strategies to redistribute funds and to reorganize the administration of health services have a significant impact on management and planning at the local level. As these strategies unfold over the next decade, skilled and effective planning and decision-making at the local level will assume increasing Importance as central policy decisfoo& are interpreted at the operational level. Efforts In the service plannlhO area are aimed at providing a service-based policy framework within which local planning may proceed. Widespread upgrading of geriatric facilities is at present under way. Obstetric and paediatric services are also being targeted for expansion. Planning guidelines for specialized services such as renal dialysis, ~eonatal services, card iac surgery and neurosurgery are gradualfy being Implemented. In 1984, 5.24% of the total workforce was employed In the' health industry. Recent constraints on public health expenditure mean that growth rates in health workforce have been controlled. To address these problems, the Department of Health has since 1974 substantially developed its health manpower planning functions. With comprehensive descriptions of the existing health manpower in most major health-re~ated occupational groups now complied, the Department Is encourag1ng such groups to become actively involved In planning their own health manpower, and t o Improve their awareness of cross-occupational relationships. Health manpower planning and management were assisted by the responsible for determining and promulgating uniform co~ditlons of employment and personnel policies for the health workforce. With the establlsh~ent In 1984 of the Health Service Personnel Commissfon which was

New zealand

311

New Zealand proposed dissolution of the Commission in April 1988, responsibility for pay and c.onditions of service will be transferred to the management of the health services. The effectiveness of planning and management techniques is dependent, in part, on the reliability and accuracy of the information on which they are based. In recent years, concerted and Increasing efforts have been made to Improve both the quantity and quality of Information available for the planning and management of health services. This applies to Information gathered on an ongoing basis and to ad hoc studies. Steps are to be taken to develop information policies which coordinate activities involving all sectors providing health services. Basic minimum data sets and performance indicators are being developed for planning and management in service areas. These will be structured for ease and economy In gathering and analysis and for use at the local, regional and national level.

312

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 5. Development of human resources for health The Government is proposing to utilize WHO collaboration to promote health manpower training. Fellowships will be requested for study In areas of health care which have a high priority for development In New Zealand.

BUDGETARY IMPLICATIONS As In 1988-1989, the full budgetary allocation Is being devoted to the development of human resources for health.

Estimated obligations

NEW ZEALAND Regular budget Programme 1988-1989 199o-1991

Other sources {Decrease) % 1988-1989 199o-1991

Increase

Source of funds

US$ 5. Development of human resources for health 55000

US$ 59000 --

US$ 4000

US$

7.27

- TOTAL- NEW ZEALAND 55 000

-4000 7.27

---

- -

59 000 - -

New Zealand

313

314

PAPUA NEW GUINEA NATIONAL HEALTH DEVELOPMENT SITUATION The health status of the people as measured by the crude death rate and Infant, child and maternal mortality rates as well as life expectancy is expected to gradually Improve. As In the past, communicable diseases and problems related to pregnancy continue to be the major health problems. Though a reduction In the incidence rates of immunizable diseases is expected, it will be tempered by the constraints of a zero-growth health budget and lack of transport, which Is critical in maintaining outreach services. Other noncommunicable disease problems of a chronic and degenerative nature and social behaviour problems are increasing and will require appropriate strategies to deal with them. In the past, substantial improvements in health status have been achieved through the provision of expanded health services. However, further gains will only be possible through life-style changes in dealing with new disease problems and through acceptance by the community and individuals of greater responsibility for their own health. The economic situation is similar to that of many other developing countries: economic growth has slowed owing to the wide variation In commodity prices, which provide a major source of the country's revenues, and the Increasing debt burden. It Is expected that the economic outlook will improve slightly despite the instability of commodity prices. Because of continued population growth, however (the birth rate was estimated to be 3.5% in 1987), the Government is unable to keep pace with demands for Increased services. As a result, it is emphasizing expansion of the economic sector and no growth in the social services sector, which includes health. The available resources for health services on a per capita basis in real terms is expected to decrease. The Government continues to base its health policies and strategies on the attainment of health for all by the year 2000. These basic principles and strategies for health development are laid out in the 1986-1990 National Health Plan. A major new emphasis will also be directed to the secondary health services in support of primary health care. In contrast to the primary health services, tte hospital facilities of the country are aged. Following two major hospital stL<1ies in 1987, the secondary health services sector will be developed by: - ~ ubstantial capital Investment In the redevelopment of hospital facilities; - lnproved management skills of hospital personnel; - development of hospital managerial systems such as cost Inventory and information systems;-

accountin~.

-Improved maintenance systems for maintaining the capital investment In hospital "acUities and equipment. Th3 major policy initiative of 1990-1991 will be the development of a third five-y3ar National Health Plan covering the period 1991-1995. During 1990, the I 986-1990 National Health Plan will be evaluated to assess the progress achieved, to determine the priority health problems facing the country, and to deta-mine the priorities and plans for addressing those problems for the next five ye.ars. The new Plan will be completed during 1990.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 WHO collaboration will focus on the following major efforts for achieving tealth for all: - increasing health services coverage by expanding the number of base level t"lealth workers through new training programmes; - c eveloplng the management skills of health staff at all levels; - e<panding primary health care outreach services rather than facilities;

- improving the effectiven.ess and efficiency of those health resources which are available. 3.1 Health situation and trend assessment

of out-of-country fellowships will be for long-term study and utillzed for personnel actually Involved In the management and provision of rural and secondary health services. 6. Public information and education for health

Continued collaboration will focus on wider use and analysis of data from the existing health information system at all levels of the health system for management of health programmes. Much of this effort will focus on further strengthening of the regional epidemiological units as they work with the provinces to undertake health situation and trend assessment activities. 3.2 Managerial process for national health development

Continued support Is required to promote organized community action In primary health care, training of various categories of health workers (including health ed ucation specialists) , and research and development on appropriate media support for the health education programmes. Information and education materials need to be developed for all health programme areas. 8.1 Nutrition

Collaborative activities will continue to emphasize development and health systems research. The areas of management to be further developed are policy formulation , planning, monitoring and evaluation, supervision, budgeting, quality assessment, and effective and efficient management of health resources. This will be carried out at the national , regional and provincial levels. 3.3 Health systems research and development

National and provincial (district) nutrition pro grammes will be implemented in the light of the national policy review and strengthening of nutritional surveillance. Attention will continue to be given to the Inclusion of nutrition as part of the primary health care and maternal and child health programmes, so as to make nutritional advice and care available to all the population. 8.2 Oral health

National capabilities In health systems research will be further enhanced so that findings can be used for policy-making decisions and improving the organization, management, and efficiency and effectiveness of the health system. 4. Organization of health systems based on primary health care Continued support will be needed for research and development to further promote community Involvement In the adoption of the primary health care approach. The demonstration of positive experiences in provinces will be shared with other provinces in order to promote Information exchange and technical cooperation. 5. Development of human resources for health

Education of the public on the need for and basic means of personal oral hygiene will be expanded. Efforts to promote the prevention of dental diseases will be continued. Support Is needed for a national survey of oral health needs and review of oral health programmes. 9.1 Maternal and child health, Including family planning With support from extrabudgetary funds, the programme will continue to collaborate in the strengthening of maternal and child health and family planning activities through improvement of the maternal and child health information system, assessment of training needs and better supervision. 9.4 Workers' health

Continued cooperation is required for the training of national staff in post-basic training. Increased emphasis will be placed on the use of local training institutions. Capabilities to conduct post-basic and In-service training on a wider scale in specific technical areas will be strengthened. The majority Papua New Guinea

Technical support will be required for the identification of the major health and safety problems of workers in agro-lndustries, mineral mining and processing operations and other medium- to small-scale industries. Continued 315

Papua New Guinea support will be provided fort he development of technical guidelines and training of health personnel involved In workers and occupational healtn

316 12.1 Clinical, laboratory and radiological technology for health aystems based on primary health care National public health laboratory services will be further developed to provide essential support to the disease prevention and control programmes, particularly those relating to malaria, leprosy and tuberculosis. The technical and operational aspects of rural laboratory diagnostic services will continue to be strengthened. 13.1 Immunization Continued technical support will be necessary to reduce mortality and morbid ity due to tuberculosis, pertussis, diphtheria, tetanus, measles and poliomyel itis. Surveillance of the cold chain for vaccine storage and transport will be Intensified. As the year 1990 approaches, there will be increased monitoring of the actual immunization coverage through programme reviews and coverage surveys. 13.3 Malaria Continued support Is expected for the planning, Implementation and evaluation of a countrywide Integrated malaria control programme and rural laboratory d iagnostic services. Malaria control activities will take Into consideration and be adapted to provincial realities and specific problems. Research and development Is expected to continue In malaria control activities, with emphasis on promotion and strengthening of district/health centres based on primary health care programmes, with malaria control as an entry point. Studies on appropriate technology (e.g. Impregnated mosquito nets) for use at community level will also continue to be supported. 13.6 Diarrhoeal dl...aa. Efforts will continue to reduce mortality from diarrhoea through the use of oral rehydration therapy. This will be Implemented through extensive training and Increased emphasis on health education and community participation. Studies will be conducted on causative agents and prevention.

9.5 Health of the elderly A better understanding Is needed of the problems and needs of this increasing segment of the population. Much of this effort will focus on having technical expertise available to follow up earlier findings and lJ train health workers to recognize and address the social, mental and healtt- needs of the elderly. 10.3 Prevention and treatment of mental and neurological disorders Continued collaboration Is required in the development of a programme to Improve management of psychiatric problems end promotion of mental health by strengthening the capability of provincial heath services to increase the knowledge and skills of general health workers and promote community participation. This will be achieved through the dEVelopment of teaching modules together with the training of personnel in production of such teaching material. Key persons will be trained In the use of such materials and their regular Inclusion In the In-service, pre-service and heath education programmes. 11.1 Community water aupply and unltatlon Efforts will focus on community participation In the funding, construction and maintenance of community water supply cn::t sanitation systems, Improving programme planning and management at provincial and national levels, health education and the Introduction and use of appropriate technology. 11.5 Food ufety National staff will continue to be trained In food scfety and the implementation of related legislation.

13.7 Acute respiratory Infections A national review will be conducted of management of acute respiratory infections at the peripheral level. Research will be undertaken on the management of acute respiratory infections through maternal and child health services and also on appropriate technology for prevention of acute respiratory infections.

13.15 Blindness and deafness Activities for the detection of deafness will be developed and strengthened. Collaborative efforts will also address prevention activities and provision of essential care for those with some degree of hearing impairment.

BUDGETARY IMPLICATIONS Reflecting the national priorities, collaboration in health situation and trend assessment, managerial process for national health development, organization of health systems based on primary health care, development of human resources for health, health education, and community water supply and sanitation will continue to receive the major part of the country planning figure. New government priorities are reflected in the inclusion of new programmes for health systems research and development, health of the elderly, and blindness and deafness, and a significant Increase in clinical, laboratory and radiological technology for health systems based on primary health care, due to the proposed inclusion of a Technical Officer post, which will ensure integration of health laboratory services wtth disease prevention and control programmes. The major decrease in the malaria programme Is attributable to the termination of one long-term staff post. This reflects the priority given to integrating the coordination of the various disease prevention and control programmes. Extrabudgetary support is expected for the programmes on maternal and child health, alcohol and drug abuse, leprosy, tuberculosis and AIDS.

13.8 Tuberculosis Continued support in implementing the short-course chemotherapy protocols nationwide will be expected from extrabudgetary sources. The rural laboratory diagnostic services will support Improved diagnostic and treatment procedures for tuberculosis cases, concurrently with the leprosy control programme.

13.9 Leprosy With a view to nationwide Implementation of multidrug therapy, WHO will be requested to collaborate in the technical and operational aspects in order to accelerate control activities. This will be done in conjunction with the tuberculosis control programme and with extrabudgetary support.

13.13 AIDS With support from extrabudgetary funds, technical collaboration will be needed in preventing the spread of HIV Infection, with emphasis on the screening of blood donations to ensure safe blood supplies, health education, and cooperation in the conduct of serosurveys for monitoring purposes. Further collaboration will be needed for the review of programme activities and the national plan of action for AIDS control.

Papua New Guinea

317

318

Estimated obligations

PAPUA NEW GUINEA Regular budget Programme 1988-1989 199o-1991

Other sources (Decrease) % 1988-1989 199o-1991

Increase US$

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Port Moresby, Papua New Guinea 3.3 Health systems research and development

US$

213 900

175 400

( 38 500)

( 18.00)

231 900

200 600

( 31 300)

( 13.50)

412 100

437 000

24900

6.04

11 000

4. Organization of health systems based on primary health care

371 800

364 800

( 7 000)

( 1.88)

20400

5. Development of human resources for health 320 400 457600 137 200 42.82

8. Public information and education for health 176 900 185700 8800 4.97

Estimated obligations

PAPUA NEW GUINEA Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 8. General heaHh protection and promotion B. 1 Nutrition 8.2 Oral health 52 700 30 700

US$

22200 21 700

( 30 500) ( 9 000)

( 57.87) ( 29.32)

9. Protection and promotion of the heaHh of specHic population groups 9. 1 Maternal and child health, including family planning 9.4 Workers' health 9500 25 700 16200 170.53

318 500

9.5 Health of the elderly 10. Protection and.promotion of mental heaHh 10.2 Prevention£BIHiJ!IJDntrol of alcohol and dr.ug·ltbuse

95000

48200

( 48 200)

(100.00)

Papua New Guinea

31"9.

320

Estimated. obligations

PAPUA NEW GUINEA Regular budget Programme 1988-1989 US$ 10.3 Prevention and treatment of mental and neurological disorders

Other aources (Decrease) %

1990.1991 US$

Increase US$

1988-1989 US$

1990.1991 US$

Source of funds

18 700

11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.5 Food safety

356 800 5000

316100 9 200

( 40 700) 4200

( 11.41) 84.00

7800

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care

214 200

13. Disease prevention and control 13. 1 Immunization 13.2 Disease vector control

79600

89600

10 000

12.56 4 100 FS

Estimated obligations

PAPUA NEW GUINEA Regular budget Programme Other sources (Decrease} %

1988-1989 US$

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

13.3 Malaria 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.15 Blindness and deafness

360300 79600 37600

198 400 92 700 14500

(161 900) 13 100 ( 23 100)

( 44.93) 16.46 ( 61.44)

4700

25600 11 800 2 787 000 2 961 900 11 800

- TOTAL- PAPUA NEW GUINEA

174 900

8.28

381100

Papua New Guinea

321

322

PHILIPPINES NATIONAL HEALTH DEVELOPMENT SITUATION The Government, pursuant to the global objective of health for all by the year 2000, has embarked on the development of primary health care delivery schemes In partnership with the private sector and the communities as a strategy for all the programmes of the Department of Health. lr consonance with the strategy, targets have been set for the various health prat.Jrammes and efforts have been Initiated for the expansion and reorientation of the health system. As of December 1986, 244 883 out of a total of 375 889 baf"angay health workers were active In the implementation of primary health care. In addition, the ranking of barangays Initiated In primary health care showed that 32.62% and 29.92% were at the third and fourth levels of development. The reorganization of the Department of Health under Executive Ord€1' 11 9 ensures the Integration of the curative and preventive services to provide better support to primary health care and strengthen the referral system. Programmes and projects have focused on health problems stemming from the p revalence of communicable and noncom municable d iseases, p oor envi ro nmental sanitation, high population growth rate and malnutrition, with special emphasis on the following proQrammes: maternal and child health, tuberculosis, schistosomiasis, malana and diarrhoeal diseases control. Under the National Health Plan for 1987-1992, the following policies and strategies will be adopted. (1) Health development programmes will be focused on the following Impact programmes: comprehensive maternal and child health, control of diarrhoeal diseases, tuberculosis, malaria and schistosomiasis, to improve the health status. To provide support to the effective implementation of the various health programmes, functional support programmes such as planning and community health service will also be developed and strengthened. (2) The Integration of hospital and field health services will continue to be developed and pursued to expand coverage, Improve referral, planning and management of programmes/projects, and ensure maximum effo3ctiveness. (3) Priority In the development of health Infrastructure/facilities will be given to peripheral health facilities In order to Improve health service delivery. (4) Development and greater reliance on resources indigenous in the communities, Including technology, will be continuously promoted. (5) Intra- and intersectoral collaboration in health and nutrition services delivery will be strengthened. (6) Promotion of family planning as a component of comprehensive maternal and child health to reduce Infant and maternal morbidity and mortality levels as well as to promote family well-being will be strengthened. (7) Institutional capability building will be pursued and manpower development, In particular, will be strengthened and Intensified In support of the partnership and self-reliant direction of primary health care. Specific targets to be achieved by the end of 1991 are as follows: (1) reduction of the Infant mortality rate from 52.81 infant deaths per 1000 live births In 1988 to 49.01 infant deaths per 1000 live births; (2) reduction of the crude death rate from 7.5 deaths population In 1988 to 7.1 deaths per 1000 population; per 1000

(3) reduction of the crude birth rate from 30.8 per 1000 population in 1988 to 29.2 per 1000 population; (4) reduction of the population growth rate from 2.34% in 1988 to 2.21%; (5) reduction of the prevalence of severe and mcxlerate malnutrition _ In children below 7 years from 18% to 14%; and

{6) Increase In accessibility to safe drinking water supply from 75% of the total population In 1988 to 81% of the total population.

Institutionalization of primary health care, the coming biennium will see some developments In the organization of health systems based on primary health care. Future efforts will focus on Improving the institutional capability of the health system by strengthening the district level, with emphasis on studies to ensure more effective and efficient implementation of health programmes and projects, training and supervision, and the referral system. Collaboration will be needed for evaluation and monitoring as well as managerial support to primary health care activities.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 The main thrust of WHO collaboration for the period 1990-1991 will be on programmes and projects directed towards solving persistent health problems, and promoting community health and sanitation through inter- and lntrasectoral cooperation and coordination and community participation. Priority will also be given to the strengthening of health institutional capability and the development of human resources for health.

5. Development of human resources for heahh Continuous support will be required for the National Teacher Training Centre, In order to upgrade its training programmes for various levels of health personnel, and for the training programmes of the College of Public Health, University of the Philippines. This will be done by providing Information on new trends and technology for the health personnel of different fields.

3.1 Heahh situation and trend assessment Health systems development requires, among others. sound, reliable and timely information, and the managerial capability to utilize such Information for effective and efficient delivery of health services. Much work on these lines is now being done. A health information system master plan was d rawn up in 1987 and the upgrading of mid-level managerial capabilities has been started. It is therefore expected that more and more activities along the lines of institutional capacity building will be widely undertaken in the future. Continued collaboration In promoting the use and further development

8. Public Information and education tor heahh Public health education continues to be an Important component of health programmes. Strategies for Increasing the public's awareness of their responsibilities tor the attainment of health will continue to be developed In consonance with recent developments In the system. WHO will be requested to collaborate In public Information and education for health as part of the health delivery system. Health education will be Intensified by provision of Information, education and communication materials and dissemination of Information through various communication channels. Multlsectoral cooperation at the commu nity level will be strengthened through training and reorientation of barangay health workers, public health workers. civic organizations. schools, etc.

of the national health Information system will be needed. Based on existing circumstances and an Initial assessment of progress In this area, techn ical support will be required to promote the systematic generation, collection and utilization of timely, accurate and reliable Information for the use of both managers and lmplementors, and the public.

3.2 Managerial process for national heahh development Cooperation In further Improving the managerial capabilities of responsible health officials Is expected to continue, partlcular1y In activities concerned with intersectoral planning and implementation of health-for-all strategies. 4. Organization of heahh systems based on primary heahh care It Is anticipated that with the Government's Intensive efforts towards building Institutional capability, and as a result of efforts In the past towards the Philippines

8.1 Nutrition Collaboration will be sought In Improving nutrition conditions through Implementation of comprehensive programmes, Intra- and lntercoordlnatlon with related agencies, Intensification of disease surveillance, and research on human behaviour and hygiene practices of the community.

323

Philippines 8.2 Oral health Support will be needed for the education and research components of oral health and for the provision of modern technology and Information pertaining to oral health.

324 agencies, and active community participation through the primary health care approach to Improve the living conditions of the community. An evaluation of the achievements of the International Drinking Water Supply and Sanitation Decade Programme will be conducted.

11.5 Food safety 9.1 Maternal and child health, Including family planning WHO will be requested to collaborate In Improvement of the Institutional set-up and provision of the necessary equipment, further development of the risk approach and assessment of appropriate technology for maternal and child care at community level. Support will be required for the national programme to ensure food safety through provision of standards, a laboratory network for regional and provincial levels, and the application of modern technology through Intra- and intersectoral coordination and cooperation.

9.4 Workers' health Support will be required for the evaluation of national policies and programmes, development of appropriate technologies for prevention of occupational diseases, and promotion of workers' health through appropriate coordination and cooperation with industrial estates.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care It is anticipated that, with progress In the upgrading of health facilities in the country, there will be an Increased demand for equipment maintenance services. Technicians will need to be trained and the Department's pool of engineers will have to be updated on current trends In technology. WHO will be requested to collaborate In providing Information and new technologies for the determination of standards for appropriate clinical and diagnostic procedures and to offer technical cooperation, whenever needed, for new developments.

10.1 Psychosocial and behavioural factors In the promotion of health and human development Guidelines for the Incorporation of psychoiD_Qical knowledge and skills In training curricula of health personnel in connection with programmes for disease prevention and control will be Implemented. Further collaboration will be sought in upgrading institutions and modern treatment technology.

12.2 Essential drugs and vacclnn Cooperation will continue to focus on the implementation of national drug policies to ensure quantification of needs, procurement, production distribution and management of essential drugs and vaccines, Including t~ assurance of regular supplies to the grassroots level.

10.2 Prevention and control of alcohol and drug abuse Collaboration will be requested in evaluating the Implementation of national programmes, and developing technologies for the prevention and management of alcohol and drug abuse problems. Support will also be needed for the collection and dissemination of new information from neighbouring countries.

12.3 Drug and vaccine quality, Nfety and efficacy Cooperative activities wHI aim at monitoring and maintaining the quality safety and efficacy of drugs and vaccines. '

11.1 Community water supply and sanitation 12.4 Traditional medicine Activities will focus mainly on the use of appropriate technology, local resources, strengthening and Improving the operation and maintenance of existing facilities, staff development, promotion of coordination among related Collaboration will be sought In promotional activities for the Incorporation of useful traditional practices In the health systems. Studies and

research on traditional medicine plants and treatment will be pursued. Further support will be provided in the area of technology transfer among countries through exchange of Information.

13.7 Acute rnplratory Infections The national acute respiratory Infections programme Is In the Initial stage of development. It Is anticipated that there will be further expansion of programme coverage, which carries with It the need for training responsible personnel on various aspects of the programme, a series of social preparation activities, programme evaluation and logistics support.

12.5 Rehabilitation Efforts to develop the national rehabilitation programme and eventually institutionalize this activity at various levels of the health care system will continue.

13.8 Tuberculosis This is one of the five Impact programmes of the Department of Health. Continued support will be needed for Implementation of the programme, which will expand Its coverage with mass drug treatment. Support will also be provided for training, research, monitoring and evaluation.

13.1 Immunization Continued support will be required to increase coverage-, Improve the quality of vaccines reaching the communities and strengthen the surveillance of target diseases. Monitoring and evaluation of the programme will also be supported. Immunization programme material will be integrated Into the curriculum of training institutions for medical and health personnel.

13.9 Leprosy Support will be provided for prevention and treatment activities as well as monitoring and evaluation of the national programme.

13.3 Malaria Efforts will continue to reorient the malaria programme as an Integral part of primary health care and an intensified control programme will be carried out by rural health units in the country.

13.15 Blindness and deafness WHO will be requested to collaborate In prevention of blindness activities and In studies and research to Improve Implementation through the existing health system.

13.4 ParasHic dlseasn Collaboration will be sought In the schistosomiasis control programme through regular assessment, evaluation and wider application of new drugs. At the same time, strehgthenlng of environmental sanitation and personal hygiene programmes In endemic areas will be emphasized and close coordination will be assured with national Irrigation authorities.

13.18 Cancer Cancer control will be strengthened through provision of advanced methodology In the cancer registry, treatment techniques and promotion of preventive measures.

13.8 Diarrhoeal diseases The national control programme will expand Its c::>verage and strengthen Its linkage wlth.envlronmental sanitation and personal hygiene. The emphasis of WHO cooperation will be on monitoring and evaluation while efforts will be made to Integrate .diarrhoeal disease control training programmes with the curricula of teaching institutions for medical and health personnel and community health education.

13.17 Cardiovascular dlseaaea It Is anticipated that, with the development and Implementation of a national cardiovascular diseases control programme, there will be an expansion of coverage, hence, further demand for trained personnel, supplies and technical know-how.

Philippines

325

Philippines Collaboration will be requested for Implementation of the nationwide control programme, training of personnel, and monitoring and evaluation of the programme.

326 situation and trend assessment, managerial process for national health development, development of human resources for health and clinical, laboratory and radiological technology for health systems based on primary health care. In the area of disease prevention and control, major increases are shown under acute respiratory Infections and cardiovascular diseases to allow for expansion of programme coverage. On the other hand, the budgetary provision for organization of health systems based on primary health care has been reduced since primary health care Is expected to be considerably developed by 1988-1989. Future activities will therefore focus on the improvement of the system, which will require less external support. The community water supply and sanitation programme shows a significant decrease as a result of the completion in 1988 of the assignment of a WHO long-term staff. The maternal and child health, including family planning programme will remain a priority programme, but the budgetary reduction shown is due to significant advances made in this field and to the availability of other funding sources.

BUDGETARY IMPLICATIONS The National Health Plan for 1987-1992 adopted policies and strategies to address the great demands placed on the health institution faced with the perennial problem of scarce and inequitably distributed resources. Health programmes were prioritized and implemented in the context of primary health care. The Government has made some headway in the implementation of priority programmes, mainly as a result of realignment and improved/efficient -utilization and management of resources. As a result, there has been some shift in the allocation of resources. The priority given to strengthening of health institutional capability and manpower development is reflected in the Increased allocations for health

Estimated obligations

PHILIPPINES Regular budget Programme 1988-1989 US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office located in Manila, Philippine~

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

65500

99400

33 900

51.76

15 000

44200

29200

194.67

1 500

208400

230000

21 600

10.36

4. Organization of health systems based on primary health care

229 000

138 000

( 91 000)

( 39.74)

5. Development of human resources for health 189900 220 800 30900 16.27

6. Public Information and education for health 47500 55200 7700 16.21

8. General health protection and promotion 8. 1 Nutrition

15 000

17700

2700

18.00

Philippines

327

328 Estimated obligations

PHILIPPINES Regular budget Programme 198S..1989 US$ 8.2 Oral health 25000

Other sources (Decrease) % 19.20

1990-1991 US$ 29800

Increase US$ 4800

198S..1989 US$

1990-1991 US%

Source of funds

9. Protection and promotion of the health of specific population groups 9.1 Maternal and child health, including family planning 9.4 Workers' health

104 000

91 600 13 BOO

(12400) 13 800

( 11.92)

10. Protection and promotion of mental health 10.1 Psychosocial and behavioural factors in the promotion of health and human development 10.2 Prevention and control of alcohol and drug abuse

7300

8800

1 500

20.55

6500

7000

500

7.69

Estimated obligations

PHILIPPINES Regular budget Programme 1988-1989 US$ 11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.4 Control of environmental health hazards 11.5 Food safety

Other sources (Decrease) %

199G-1991 US$

Increase US$

1988-1989 US$

199G-1991 US$

Source of funds

114 600

83 500

(31100)

( 27.14)

20000

1 600 26100 30900 4800 18.39

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary.hea'lth care 12.2 Essential drugs and•.vacoines 12.3 Drug and vaccine::quality., safety and effica,cy

65000 26 000

91 600 30900

26600 4900

40.92 18.85

22000

25400

3400

15.45

Philippines

329

330 Estimated obligations

PHILIPPINES Regular budget Programme 1988-1989 US$ 12.4 Traditional medicine 12.5 Rehabilitation 10000

Other sources (Decrease) %

1990-1991 US$ 11 000 9400

Increase US$ 1 000 9400

1988-1989 US$

1990-1991 US$

Source of funds

10.00

13. Disease prevention and control 13. 1 Immunization 13.2 Disease vector control 13.3 Malaria 67 300 79300 12 000 17.83 40000 44200 4200 10.50 69700 14000 48100 71 000 80700

FS FS FS FT

13.4 Parasitic diseases 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy

34500 51 000 40000 172 000 10000

42000 54 700 55200 188 800 11 000

7 500 3 700 15 200 16 800 1 000

21 .74 7.25 38.00 9.77 10.00

40700 839 800

FS FS ST

68600

Estimated obligations

PHILIPPINES Regular budget Programme Other aources (Decrease) %

1988-1989 US$

199G-1991 US$

Increase US$

1988-1989 US$

199G-1991 US$

Source of funda

13. 10 Zoonoses 13. 15 Blindness and deafness 13.16 Cancer 13.17 Cardiovascular diseases

10 000 6500 34 700 92400 1 735 200 7 800 39400 112 600 1 874 000

( 10 000) 1 300 4 700 20200 138 800

(100.00) 20.00 13.54 21.86 8.00 4500 VD 20000

-TOTAL- PHILIPPINES

1 280 200

Philippines

331

332

REPUBLIC OF BELAU NATIONAL HEALTH DEVELOPMENT SITUATION When Belau became a republic In 1981, the "Oibiil Era Kelulau" (OEK) -the national congress -adopted a joint resolution in support of primary health care as one of the effective tools for reaching the goal of health for all by the year 2000. The national health organizational set-up, Including programmes, goals, objectives and evaluation measures, has been established. In the Five-Year Plan, it is stated that the community leaders conference to be held this year will include health system development as a top priority In the development of various states or communities. At this time the Community Health Centre Board exists and is in full operation. A Sub-Area Council for Health also exists. These boards function as autonomous health planning bodies. The Community Health Centre project was implemented one year ago. This programme is community-oriented, providing as its primary target primary health care services to the underserved population. The renovation of the present hospital buildings is almost complete. Plans for a new 80-bed hospital are completed but additional funding is still sought. Because of lack of qualified management personnel, a bid was put out for contracting outside agencies to assist in the areas of administration and fiscal management. The child nutrition programme still exists and all public schools provide hot lunch to students five days a week. The Old Age Programme also provides a hot lunch programme to senior citizens five days a week. In the sanitation and environmental health area, the Chief Sanitarian retired last November. At present a staff/consultant has been recruited with

U.S. Environmental Protection Agency funds and will be In Belau for one year to assist in the office.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The main thrust of WHO collaboration for 1990-1991 continues to be on the training of health personnel.

3.2 Managerial process for national heaHh development For three years now the country has participated In training In management and administration In support of health-for-all strategies. The three workshops conducted In the past three years, focusing on supervision/management skills development, have been received well by the people. WHO cooperation should be continued and should focus on other topics, Including drug service systems, etc.

4. Organization of heaHh systems based on primary heaHh care The Belau Community Action Agency has been active In providing for health-related matters such as: - first aid and home care to parents; - physical examination for pre-school children; - cardiopulmonary resuscitation to swimming Instructors; - preventive care for otitis media;

Conaid~recj_part of the Trust Territory of the Pacific Islands at the time the proposed 1990-1991 regional programme budget was prepared.

- safe drinking water and sanitation.

Such activities as those cited above receive assistance from the Bureau of Health Services. This year steps are being taken to Involve community leaders actively In their own health concerns and welfare. A first workshop is being held for all state governors, which, It Is hoped, will propose concrete measures to overcome the dependent attitude and passive role of communities and promote their self-reliance. This is an area requiring more collaborative efforts with WHO in planning and conducting workshops and community-based programmes In primary health care.

The medical officers training school started in Pohnpel one year ago. There are five young people attending this school. Fifteen young people are nearing the end of their 18-month health assistants training. Eight are recruited from those states In Belau for which there are no resident health assistants. After graduation In June 1988, the eight health assistants will be deployed to their state of recruitment. The other seven will staff the mental health and psychiatric wards at the hospital under the supervision of existing staff. WHO collaboration Is required for the training of health personnel In various disciplines in order to strengthen national capability In reaching the goal of health for all by the year 2000.

5. Development of human resources for health When the National Government retirement plan took effect in November 1987, services were affected by the loss of personnel without available r.eplacement. In the field of dentistry, for example, there are no local people tra1ned to replace the three dental officers due to retire in 1988 and 1989. The problem is the same in other areas such as pharmacy, where there Is no person readily identified in school to replace the pharmacist who is due to retire. Although there are young people studying In medical schools and nursing schools, there is no guarantee that graduates will return to work In Belau. Past experience shows that those who are trained In the United States usually stay there and do not come back. It is more cost-effective to send people already recruited into the government system as "on-the-job trainees" and have them go out for formal training in specific fields, as in the 1986-1987 ~ealth Inspector course and ~he 1988-1989 radiography course. This approach IS seen to be the most effectiVe way of guaranteeing that personnel are trained and kept within the health service system.

12.2 Essential drugs and vaccines As part of the regional effort between the Micronesia jurisdictions, the Department of Interior and the United States Public Health Services to Improve the flow of procurement of supplies and drugs, a telex system has been implemented to facilitate the order of pharmaceuticals. However, the shortage of essential drugs and supplies continues to exist due to funding constraints. WHO technical support in this area Is required.

BUDGETARY IMPLICATIONS As In the previous two years, the major portion of the country planning figure is being allocated to development of human resources for health.

Republic of Belau

333

334

Estimated obligations

REPUBLIC OF BElAU Regular budget Programme 1988-1989 199G-1991

Other sources (Decrease) 1988-1989 199o-1991

Increase

Source of funds

US$ 3. Health system development 3.2 Managerial process for national health development

US$

6500

7000

500

7.69

4. Organization of health systems based on primary health care

7000

5. Development of human resources for health

80500

96100

15 600

19.38

6. Public information and education for health &.General health protection and promotion 8.2 Oral health

6500

( 6 500)

(100.00)

6500

( 6 500)

(100.00)

:Estimated obligations

REPUBLIC OF BELAU Regular budget Programme 1988-1989 1990-1991 Increase (Decrease) 1988-1989 Other sources 1990-1991 Source of funds

US$ 9. Protection and promotion of the health of specific population groups 9.1 Maternal and child health, including family planning

US$

110 300

40200

12. Diagnostic, therapeutic and rehabilitative technology 12.2 Essential drugs and vaccines 6500 9900 3400 52.31

13. Disease prevention and control 13.18 Other noncommunicable disease prevention and control activities

6500

( 6 500)

(100.00)

TOTAL- REPUBLIC OF BELAU 113 000 120 000

6.19 110 300

7000

-40200

Republic of Belau

335

336

REPUBLIC OF KOREA NATIONAL HEALTH DEVELOPMENT SITUATION The Government has adopted a national policy and strategy for health for all by the year 2000 In parallel with the National Economic and Social Development Plan. The successful Implementation of the National Economic and Social Development Plan has Improved the quality of health services and decreased the incidence rate of the major communicable diseases. The medical Insurance programme Introduced by the Government In 1977 covered 50.6% of the total population in 1987. The medical Insurance expansion programme shows that all the residents in 134 counties will be beneficiaries of community medical Insurance from 1988 and all the residents in cities from 1989. The Improved standard of living and welfare has extended the average life expectancy from 62.7 years for males and 69.1 years for females In 1980 to 65.8 years for males and 72.2 years for females in 1987. However, many problems remain to be solved. First, the rapid growth of medical demands has increased the financial burden on the people, causing insolvency in the medical Insurance and hampering the development of the system itself. Second, many people In the relatively low income brackets, such as the urban self-employed, have been unable to benefit from medical insurance. !hey have to pay medical fees that are higher than those charged under medical Insurance. Third, there have been many kinds of accidents such as traffic accidents and workmen's accidents. Environmental pollution has affected the health of the people. Moreover, the Government Is still obliged to limit Its budgetary allocation to the health and welfare sector In Its development plan to 3.3% of the total general account budget of the Central Government in 1987. Under these circumstances, cooperation with WHO is considered very important. Activities proposed In the health programmes are briefly described below. To enhance the efficiency of the health education system, various kinds of health education materials will be developed. More emphasis will be placed on the preventive services. The incidence of the major communicable diseases has continued to decrease through the successful operation of the disease prevention programme, advances In chemotherapy, the promotion of public health and improvements in the standard of living. Great efforts will be made to prevent AIDS. Water quality will be regularly monitored at least twice a year and more efforts will be made to enhance sanitation standards. In the area of mental health, appropriate facilities and regional hospitals will be established and operated in cooperation with health centres in 13 provincial governments. The maternal and child health programme will be strengthened, particular attention being given to perinatal care and health care services for pre-school children. Natural population increase rate will be reduced to 1% by 1993 and 0% by 2023. To achieve this goal, the average number of child births per mother should be decreased to 1.9 by 1990.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

5. Development of human resources for health The programme of human resources for health provided through the National Teacher Training Centre (NTIC) at Seoul National University College of Medicine will be continued with WHO support. NTIC will organize workshops on curriculum development, simulated patient training and medical college admission tests. Support will also be needed to train staff In various aspects of educational technology. 6. Public Information and education for health The development of coordinated public information and health education programmes will be given emphasis. Various kinds of health education materials will be developed. Support will be required for training In health education and methods of utilizing mass media. 8.1 Nutrition

1990-1991 WHO collaboration In 1990-1991 will focus mainly on: (1) further strengthening of the national health informaticn system; (2) strengthening of the health care delivery system, including expansion of the health insurance system;

(3) development of human resources for health; and (4) technical support in control of environmental health hazards.

3.1 Health situation and trend assessment The national health information system will be further srrengthened. Methods will be developed to collect and computerize health information. Support will be requested for a study tour on health information 3ystems and on national medical expenditure, measuring and usage technique-s.

WHO collaboration wUI be required to strengthen national capability In developing a nutrition policy based on primary health care, through the training of health and related workers. 8.2 Oral health Support will be required for a workshop on the development of oral health programmes, which will contribute to the formulation of preventive dental care policies. 8.4 Tobacco or health Smoking control programmes will be initiated. Collaboration will be requested for a seminar on developing a tobacco-or-health programme. 9.1 Maternal and child health, Including family planning The ante-natal care of pregnant women and delivery care assistance as well as infant care will be strengthened. Collaboration will be required for training in maternal and child health.

3.4 Health legislation Efforts will continue to improve the enforcement of health legislation and regulations, particularly those related to the national strategi3s for health for all bytheyear2000. Support will be required for training middle~evel officials in management techniques to implement health legislation. 4. Organization of health systems based on primary health care In order to expand the health insurance system, the provision of medical personnel and facilities in rural areas needs to be strengthened. Strengthening of the health care delivery system is urgent and will be implemented through research and development activities. Collaboration will be requested in supporting local training at the School of Public Health and In carrying out a pilot project on the cistrlct health system.

Republic of Korea

337

Republic of Korea 9.2 Adolescent health WHO collaboration will be required in Identifying the health needs of young people. Educational methods will be developed. Support will be required for a study on adolescents' sexual activities and related problems.

338 substances, solid waste management, Indoor pollution control, development of acid rain prediction model, etc. A study on health risk assessment of ambient air pollution will be carried out. WHO support will also be required for a seminar on disposal and recycling of solid wastes.

11.5 Food safety 9.5 Health of the elderly Support will be required to promote the health and welfare of the elder1y and to study appropriate welfare programmes for the e:der1y. Collaboration will be required In Improving food safety standards In the country.

10.2 Prevention and control of alcohol and drug abuse Support will be required in developing methods for the prevention and , control of alcohol and drug abuse.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Support will be required for training In radiological technology and expanding the radiation protection programme.

11.1 Community water supply and sanitation Training of staff on the development of drinking water quality standards and management of community water supply systems will continue.

12.3 Drug and vaccine quality, safety and efficacy National capability in drug quality assurance and regulatory control will be strengthened through training of staff In advanced techniques of good laboratory and clinical practices and supply practice techniques.

11.2 Environmental health In rural and urban development and housing Collaboration will be required to evaluate environmental policies and to study environmental education techniques and improvement of the institutional basis for environmental administration.

12.4 Traditional medicine Collaboration will be required for research and studies on traditional medicine and Its proper utilization.

13.1 Immunization The immunization programme will continue to be developed. Support will be required for a seminar on expansion of the immunization project.

11.4 Control of environmental health hazards Continued technical collaboration will be needed in the fields of air pollution, water pollution and solid waste management. This will be complemented by oyerseas tr~ining of staff in such areas as monitoring of foodstuff contam1nat1on by residual pollutants, environmental investment and Its benefit analysis, lake water quality control techniques, construction and management of hazardous waste landfill, control of toxic and hazardous

13.8 Tuberculosis Support will be required to Improve tuberculosis control through prevention, ear1ier case-finding and treatment services.

13.9 Leprosy Programmes for provision of appropriate services for treatment of registered patients will be promoted with WHO support.

13.16 Cancer Cooperation In the cancer control programme and cancer cytology training is needed.

13.11 Sexually transmitted diseases Collaboration will be required to develop techniques of laboratory diagnosis of sexually transmitted diseases.

BUDGETARY IMPLICATIONS The budgetary Increases shown under health situation and trend assessment and organization of health systems based on primary health care are due to increased requirements for training. Under the programme for control of environmental health hazards, Increased technical support is required for various components of the programme. Provisions have also been included for new programmes such as tobacco or health, adolescent health, research and development in the field of vaccines and AIDS. While health manpower training continues to be given priority, the budgetary provision for the programme for development of human resources for health shows a decrease since training requirements have been included under other programmes.

13.12 Research and development In the field of vaccines Support will be required to develop techniques of vaccine purification, analysis and production.

13.13 AIDS Research on the establishment of a treatment system for AIDS patients and to strengthening of AIDS test capacity will require collaboration.

Republic of Korea

339

340

Estimated obligations

REPUBLIC OF KOREA Regular budget Programme 1988-1989 199G-1991

Other sources (Decrease) 1988-1989 199G-1991

Increase

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Seoul, Korea 3.4 Health legislation 4. Organization of health systems based on primary health care 5. Development of human resources for health

US$

25000

75600

50 600

202.40

309900 19200

342 400 9200

32500 (10000)

10.49 ( 52.08)

333 600

364 200

30600

9.17

155 300

80 500

( 74 800)

( 48.16)

6. Public information and education for health 32 700 10 400 ( 22 300) ( 68.20)

Estimated obligations

REPUBLIC OF KOREA Regular budget Programme 1988-1989 1990-1991 Increase (Decrease) 1988-1989 Other sources 1990-1991 Source of funds

US$ 8. General heahh protection and promotion 8. 1 Nutrition 8.2 Oral health 8.4 Tobacco or health 25 200 6500

US$

10 400 16300 16 300

(14800)

( 58.73) 150.77

9800 16300

8. Protection and promotion of the heahh of specific population groups 9. 1 Maternal and child health, including family planning 9.2 Adolescent health 9. 5 Health of the elderly 16600

6300

7200 20600

7200 4000 24.10

Republic of Korea

341

342

Estimated obligations

REPUBLIC OF KOREA Regular budget Programme 1988-1989 US$ 10. Protection and promotion of mental health 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological disorders

Other 10urces (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

2900

10 400

7 500

258.62

18 300

( 18 300)

(100.00)

11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.2 Environmental health in rural and urban development and housing 11.4 Control of environmental health hazards 11.5 Food safety

10 000

14100

4100

41.00

81 700

71 100

( 10 600)

( 12.97)

313 300 32600

393 200 10 400

79900 ( 22 200)

25.50 (68.10)

Estimated obligations

REPUBLIC OF KOREA Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991 US$

Source of funds

US$ 12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.3 Drug and vaccine quality, safety and efficacy 12.4 Traditional medicine 12.5 Rehabilitation 15 900

US$

9300

25 700

16300 27000

( 9 400) 27000 (15900)

( 36.58)

(100.00)

13. Disease prevention and control 13.1 Immunization 13.4 Parasitic diseases 13.6 Diarrhoeal diseases 18000 7400 9400 21 100 3100 ( 7 400) ( 9 400) 17.22 {100.00) (100.00)

Republic of Korea

343

344

Estimated obligations

REPUBLIC OF KOREA Regular budget Programme Other sources (Decrease) % 8.62

1988-1989 US$

1990-1991 US$ 6300 7 200

Increase US$ 500 7 200

1988-1989 US$

1990-1991 US$

Source of funds

13.8 Tuberculosis 13.9 Leprosy 13. 11 Sexually transmitted diseases 13.12 Research and development in the field of vaccines 13.13 AIDS 13.14 Other communicable disease prevention and control activities 13. 16 Cancer

5 800

5200

5 200

38400 13 000

38400 13000

20000 8600 25 800

( 20 000) 17 200

(100.00) 200.00

47800

- TOTAL- REPUBUC OF KOREA

1 493 800

1 828 200

134 800

9.01

47800

- -

REPUBLIC OF THE MARSHALL ISLANDS . . . . . _ __ _- - : - - -_ NATIONAL HEALTH DEVELOPMENT SITUATION The health delivery system of the Marshall Islands consists of two hospitals In two otthe islands and dispensaries on each of the remaining Islands. The hospitals provide a full range of primary, secondary and some tertiary services, Including both preventive and curative care. The dispensaries provide only primary care because of the lack of more qualified manp<J~Ne r and the necessary infrastructure. The centre of health care is the hospital, which contains outpatient departments, inpatient rooms, public health clinics, dental clinics, and health admi~ist~ative offices. Services at the new hospital in Majuro and the smaller hospital 1n Ebeye are available to residents representing 59% of the total population. The remaining 4 1% of the population in the other islands must depend on dispensaries for their primary care services and travel to the hospitals for more sophisticated care. The access to the hospitals is via field trip ships, which visit the islands every two to four months. In the event of a medical emergency these ships may be diverted from their route to evacuate patients. ' Recently, however, travel to and from the outer Islands during medical ev~cuation has been improved by the opening of 17 airstrips In the outer islands, wh1ch are now being used regularly by the air11ne of the Marshall Islands. . Re~ident~ w~o can reac~ the hospitals in two hours to one-day travel t1me are said to hve 1n Intermediate areas. Examples are people in Laura a village at the southern edge of Majuro atoll. These people have access to th~ir own dispensary and the hospital.

-------l

Dispensaries are manned by either health assistants or "medexes". Health assistants are residents of the islands which they serve. They have been given basic training to enable them to provide diagnosis and treatment of common diseases. Their training Includes emphasis on public health, sanitation, and health education services. "Medexes" are a higher level of health personnel. They are either former graduate nurses or experienced health assistants trained in a two-year course by the University of Hawaii School of Medicine. In their capacity, they serve In the hospital as physjcian extenders and in the outer islands as supervisors of other health assistants. Finally, the outer island dispensaries operate under a medical director In Majuro, who generally oversees the needs for medicines and supplies. The Medical Director also provides training and technical assistance, medical advice on emergencies and other direct health care services through on-site visits.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The main thrust of WHO collaboration for 1990-1991 continues to be on the training of health personnel.

3.1 Health situation and trend asHnment The Ministry of Health has progressed and Is progressing toward a more organized and powerful health Information system. In March 1987 a well organized and effective health Information system workshop was supported by WHO. The Ministry is currently developing a computerized health Information system for vital records, immunizations, and medical records summary reports. WHO Is requested to collaborate In the evaluation of the automated health Information sy~tem and Its progress. Support Is also required for training In health Information and med1cal records management and in the International Classification of Diseases - Ninth Revision cooing.

1 Considered part of the Trust Territory of the Pacific Islands at the time the proposed 1990-1991 regional programme budget was prepared.

Republic of the Marshall Islands

345

Republic of the Marshall Islands 4. Organization of health systems based on primary health care In 1983, the Five-Year Comprehensive Health Plan for the Marshall Islands endorsed primary health care as the best long-term strategy for the Improvement of the health status of the population. In 1985, the Task Force on Health made 20 recommendations with a direct impact on primary health care. Substantial progress on some of these recommendations has already been made. Technical collaboration Is needed to assess the progress of primary health care and to make further recommendations on future strategies. In addition, the Ministry conducts reorientation courses on primary health care for health assistants serving the outer islands.

346

area, training in maternal and child health programme management will be required.

10.3 Prevention and treatment of mental and neurological disorders With increasing urbanization, westernization and what can almost be termed cultural collapse, substantial stress exists in the social environment, especially in the urban centres. In addition to the treatment of classic neurological disorders, mental health workers find themselves Increasingly dealing with problems related to substance abuse, crowding and urban life-styles. Additional training in these areas of mental health counselling Is requested in the 1990-1991 programme budget.

5. Development of human resources for health To decrease dependence, more Indigenous people need to be trained in highly responsible and upper level management positions in the health field.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Currently, there is only one Indigenous medical laboratory technician working in the Ministry of Health. This person can be expected to retire In less than ten years from the commencement of this programme of collaboration. It is necessary to begin preparing more people In the area of medical laboratory technology to avoid the necessity of hiring an expatriate In the not so distant future.

6. Public information and education for health In every substantial document evaluating the health system In the Marshall Islands, In recent history, the need for much more health education among the general population has been cited. It has been and is viewed as an important and necessary part of any effort to achieve effective primary health care. Health education Is a very labour-intensive undertaking. The current Health Education Department is very understaffed and In need of more trained personnel. To begin remedying this situation, the Ministry of Health requests collaboration for training of health educators to become proficient In training front -line primary health care workers.

13.1 Immunization The Immunization programme continues to be a high priority and, to this end, training for an immunization programme staff member Is requested In 1990 or 1991. The intent of this training would be an overview of overall immunization programme management.

8.2 Oral health Oral health is a very important but often neglected aspect of primary health care. The Ministry of Health primarily utilizes dental nurses in dental programmes. These dental nurses need periodic continuing education.

BUDGETARY IMPLICATIONS The high priority given to training of health personnel accounts for the Increased budgetary allocations for public Information and education for health clinical, laboratory and radiological technology for health systems based o~ primary health care, and prevention and treatment of mental and neurological disorders. The decrease shown under development of human resources for health Is due to the reallocation of fellowships to the specific programme areas. Organization of health systems based on primary health care, while continuing

e.1

Maternal and child health, including family planning

With the high rate of fertility, and the large number of children, maternal and child health services are extremely important. To improve services in this

to be a high priority, likewise shows a budgetary decrease since primary health care activities have been Integrated In other programme areas such as public Information and education for health.

The importance given to strengthening the health Information system Is reflected In the increased budgetary allocation for the health situation and trend assessment programme.

Republic of the Marshall Islands

347

348

Estimated obligations

REPUBLIC OF THE MARSHALL ISLANDS Programme 1988-1989

Regular budget 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment

US$

6500

32100

25 600

393.85

4. Organization of health systems based on primary health care 36600 27500 ( 9 100) ( 24.86)

5. Development of human resources for health 108 200 72 000 (36 200) ( 33.46)

8. Public information and education for health 8. General health protection and promotion 8.2 Oral health 19500

19 700

23000

3500

17.95

Estimated obligations

REPUBLIC OF THE MARSHALL ISLANDS Programme 1988-1989 US$ 9. Protection and promotion of the heahh of specific population groups 9. 1 Maternal and child health, including family planning 10. Protection and promotion of mental heahh 10.3 Prevention and treatment of mental and neurological disorders

Regular budget 1990-1991 US$ Increase US$ (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

4200

69600

10 800

10 BOO

12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary:health care

16400

16 400

Republic of the Marshall Islands

349

350

Estimated obligations

REPUBLIC OF THE MARSHALL ISLANDS Programme 1988-1989

Regular budget 1990-1991 Increase (Decrease) 1988-1989

Other sources 1990-1991 Source of funds

US$ 13. Disease prevention and control 13. 1 Immunization

US$

4200 -

- 22.89 69 600

TOTAL- REPUBLIC OF THE MARSHALL ISLANDS

170 800

209 900

39 100

SAMOA NATIONAL HEALTH DEVELOPMENT SITUATION Samoa's health development strategy continues to be adapted to the National Economic Development Plan. The present Sixth National Development Plan covers the years 1988-1990. As indicated by a slight rise in the GOP, a reduced rate of inflation and an increase in the availability of local goods and services, Samoa's economy has improved slightly over the last two years. This has, however, not permitted any expansion of activities In developmental projects as the Government's strict domestic economic policies have not yet been relaxed . Similarly, while the cost of living has Increased, local salaries and wages have not kept pace with this Increase. In real terms then, there has been a decrease in funds to perform the same service. It Is the cooperation of WHO, In addition to the Government's health budget, which allows the current health programmes to continue to operate and these are essential If such services are to expand. In spite of these economic constraints, the Ministry of Health has made progress In several areas such as health Information systems, maternal and child health, and Immunization. It is estimated that the Introduction of a computerized health information system will significantly Increase both the validity and reliability of health statistics. The coverage of antenatal cases increased by 10% from 1985 to 1986 with no additional resources or increases in personnel. The Immunization programme continues to increase its coverage; in 1986, 92% of all children were immunized against the six childhood diseases. On the whole, the 1986 health statistics are similar to the ones for 1985 and indicate a stable health situation.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 Primary health care will be the focus of WHO collaboration in 1990-1 991. Managerial process for national health development will also play an important role, and a long-term WHO staff member is proposed for this programme in Samoa during this biennium. 3.1 Health situation and trend assessment At the end of 1989, computerization of the health Information system will be nearing completion . During 1990-1991, the next stage In the development of this programme will be to Increase the Department's ability to formulate an accurate health situation and to analyse scientifically health data. The focus of activities will be on strengthening the medical records system of the national hospital, as this Is a major provider of health Information data, and formalizing a close collaboration between the staff of the medical records In the national hospital and of the health Information unit of the Health Department. Community participation will be emphasized for the collection of health data on events In which the health staff are only peripherally Involved. Efforts will also be made to Improve intersectoral cooperation for health data collection, In particular closer liaison with the government statistician.

3.2 Managerial process for national health development This important activity will continue, with emphasis on managerial training as well as a review of management practices for middle-level managers at the district level and in the central health administration. To strengthen this programme, WHO will be requested to provide a health administrator who will collaborate with national staff In managerial training activities and will closely monitor progress of programme implementation.

Samoa

351

Samoa 3.4 Health legislation Health legislation In many cases goes back to the time of the former administration and Is In need of formal review, especially to bring It in line with health-for-all goals and objectives. 4. Organization of health systems based on primary health care Continued collaboration In this Important programme will be required to further strengthen the primary health care approach in the entire health infrastructure. By the end of the 1988-1989 biennium, community nursing officers will have been deployed around the country. Efforts will focus on supporting these health workers in their new role as coordinators of health services in various districts. More effective means of cooperation with women's committees will be explored, In particular, to counteract the growing tendency for members of the community not to attend women's committees meetings. Community participation will be further encouraged by stressing self-help concepts. The role of the community nursing officers will be further emphasized as the pivotal element for intersectoral cooperation at the grassroot levels. 5. Development of human resources for health By the end of 1989, the Government will have Introduced once again a bond system, which should give a greater guarantee that overseas trained health workers will return to the country to participate In health development. With the Intense out-migration of the more active population, It Is not surprising also that the health field is suffering from this phenomenon. In view of the high turnover of health personnel, further basic and post-basic training of health workers is even more essential. Although the Government is relying heavily on bilateral aid for overseas academic training, WHO's continued support for human resources development In the health field will be required. 8. Public Information and education for health Public health Information and education will continue to be prominent in all health programmes. With WHO cooperation, health education and the production of health Information materials will continue to strengthen programme efforts, especially In the face of increasing public health concerns such as AIDS and various noncommunicable diseases. 8.2 Oral health

352

Development and promotion of oral hygiene, with special emphasis on the prevention of dental decay and periodontal disease in the community, will continue. Over the last biennium, WHO support has been given In the area of dental nurse training and continued support will be needed to complete this training and promote dental services In the community, especially at the district level. The quality of dental care also needs to be guaranteed through the provision of post-graduate training opportunities for senior dental personnel. 8.4 Tobacco or health Health information and education on the deleterious effects of tobacco will be promoted as a new programme. National workshops for health workers and the general public will be organized. 9.1 Maternal and child hNtth, Including fllmlly planning With 48% of the current population estimated to be under the age of 15, there will still be a considerable need for an Increase In these services, especially when these children reach child-bearing age. With support from UNFPA and UNICEF, programme activities will be encouraged based on the primary health care approach. 10.1 Psychosocial and behavioural factor. In the promotion of health and human development During the last biennium, this programme aimed at analysing and documenting the psychological and behavioural consequences of socioeconomic change In the community. At the end of the previous biennium a clear picture had evolved of the need for further WHO collaboration In this field . During the 1990-1991 biennium lntersectoral cooperation will be promoted to address increasing social problems In the community. Health education efforts will concentrate on promoting a healthy psychosocial environment. A continuous effective liaison with nongovernmental organizations working In this field will be the cornerstone of the Health Department's involvement in this project.

10.2 Prevention and control of alcohol•nd drug abuse This new programme will address Increasing social problems caused by the abuse of both alcohol and drugs. With WHO support, national alcohol and drug policies will be established, education programmes developed, and the prevention and management of alcohol and drug abuse problems promoted.

introduction of hepatitis vaccine some time In early 1989, continued collaboration will be needed to maintain the present high level of coverage.

13.4 Parasitic diseases With WHO and Government collaboration, the main parasitic disease, filariasis, has been brought under control. However, a mass survey performed In 1987 still showed an incidence of filarial carriers of 2.9% of the population. In order to achieve the goal of complete eradication of this disease, continued support for a yearly treatment with single dose mass drug administration will be needed. Additionally, surveillance will continue for other vector-borne diseases, especially dengue fever.

11.1 Community water supply and sanitation Training of assistant health Inspectors will continue. The curriculum of this course will be reviewed regularly to ensure that the assistant health inspectors' role responds to the needs of the community. The focus of the activities will be on further development of sanitation, and also on promotion of community participation, especially along the lines of self-help activities. Starting with this biennium, the Department of Health will take over the management of the assistant health inspector training programme.

13.6 Diarrhoeal diseases 1 nnovative ways of community participation will be explored to promote oral rehydration salt therapy as a self-help approach to diarrhoeal disease control.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care The continued need for Improved quality control in diagnostic and treatment services will be addressed with WHO collaboration. Efforts to Improve radiological technology will focus on the Introduction of ultrasonics as a diagnostic tool. The local laboratory assistants training programme will get under way during this biennium. To keep up with recent advances In various specialist fields, support will be needed for a variety of post-graduate training courses for medical officers.

13.8 Tuberculosis For many years, WHO has cooperated In fighting this disease and prolonged efforts have ensured a steady reduction In Its Incidence. However, there Is still a need for continuing efforts at contact tracing and case management as well as strengthening the Department's capacity to regularly follow up cases after their discharge from treatment.

13.13 AIDS This new special programme will focus on Improving diagnostic capabilities, developing a protocol for management of AIDS patients and promoting intense health education, both for the general public and special target groups.

12.2 Essential drugs and vaccines Support continues to be needed in the areas of selection, procurement (bulk purchasing), storage and distribution of essential drugs, vaccines and pharmaceuticals. Additional emphasis will be placed on managerial training for senior and middle-level managers of the pharmaceutical section.

13.14 Other communicable disease prevention •nd control activities Through WHO collaboration, hepatitis B vaccine will be available for use In the Immunization programme by the beginning of 1989. By then also the nationwide survey to assess the incidence of hepatitis 8 in the population will

13.1 Immunization Thanks to the combined etforts of WHO, UNICEF and the Government, this is one of the most successful programmes In the health field. With the

Samoa

353

Samoa have been completed. WHO support will be required to collaborate further In the surveillance and prevention of hepatitis B. In addition, efforts will focus on organizing a rational and appropriate sexually transmitted diseases programme.

354 more and more prominent and have become a major public health concern. Continuous WHO support In the areas of monitoring, control and, most Important, health education, directed at enhancing public awareness and participation through healthy living practices, will be required.

13.17 Cardiovascular diseases Cardiov~scular dis~ses have em~rged as a leading cause of mortality. In 1986, congestNe heart failure ranked f1rst, cerebrovascular disease ranked third ~nd acute myocardi~llnfarction ra':lked sixth among all causes of mortality. Continued WHO support 1n the prevention and control of these diseases will be needed, especially since a growing percentage of the population is reaching the 60 plus age group.

BUDGETARY IMPLICATIONS The managerial process for national health development shows a significant budgetary Increase as a result of the Government's request for long-term technical support In health administration. For the programme on organization of health systems based on primary health care, continued support is required for strengthening the primary health care approach, In particular the role of community nursing officers. Two programmes show significant budgetary reductions. In the case of development of human resources for health, the reduction Is In line with the policy of reducing the budget allocation to this programme and the distribution of fellowships to the other programmes. In the community water supply and sanitation programme, the proposed discontinuation of the post of sanitarian accounts for the budgetary reduction.

13.18 Other noncommunicable disease prevention and control activities The incidence of rheumatic heart disease increased by 37% between 1985 and 1986. WHO has collaborated In the last biennium In streamlining the rheumatic heart disease programme but further efforts will be needed for Its prevention and control. Other diseases, especially diabetes, are becoming

Estimated obligations

SAMOA Regular budget Programme 1988-1989 199D-1991

Other sources (Decrease) %

Increase US$

1988-1989

199D-1991

Source of funds

US$

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Apia, Samoa 3.4 Health legislation

5000

5 900

900

18.00

5000

155 200

150 200

3 004.00

222 600

239600 5 700

17000 5 700

7.64

4. Organization of health systems based on primary health care

297 600

490 900

193 300

64.95

5. Development of human resources for health 484200 140 400 (343 800) ( 71.00)

6. Public information and education for health

8000

6000

( 2 000)

( 25.00)

Samoa

355

356 Estimated obligations

SAMOA Regular budget Programme 1988-1989 US$ 8. General heaHh protection and promotion 8.2 Oral health 8.4 Tobacco or health 5000 36100 2300 31 100 2300 622.00

Other sources (Decrease) %

199o-1991 US$

Increase US$

1988-1989 US$

199o-1991 US$

Source of funds

9. Protection and promotion of the heaHh of specific population groups 9. 1 Maternal and child health, including family planning

1 800

10. Protection and promotion of mental heaHh 10. 1 Psychosocial and behavioural factors in the promotion of health and human development

6000

7400

1 400

23.33

Estimated obligations

SAMOA Regular budget Programme 1988-1989 US$ 10.2 Prevention and control of alcohol and drug abuse

Other sources (Decrease) %

1990.1991 US$

Increase US$

1988-1989 US$

1990.1991 US$

Source of funds

2 300

2300

11. Promotion of environmental health 11. 1 Community water supply and sanitation

215 800

164 500

(51 300)

( 23.77)

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vacCines

10 000 10 000

28400 40000

18 400 30000

184.00 300.00

13. Disease prevention and·-contrdl 13.1 Immunization

10 000

11 900

1 900

19.00

Samoa

357

358

Estimated ·Jbligations

SAMOA Regular budget Programme 1988-1989 1990-1991

Other sources (Decreue) %

Increase US$ 18000 2 300 ( 1 200) 16300

1988-1989

1990-1991

Source of funds

US$

JS$

US$

13.4 Parasitic diseases 13.6 Diarrhoeal diseases . . 13.8 Tuberculosis 13.13 AIDS 13. 14 Other communicable disease prevention and control activities 13.17 Cardiovascular diseases 13.18 Other noncommunicable disease prevention and control activities TOTAL- SAMOA

12 000

lOOOO 2 300

150.00

7 200

6000 16300

( 16.6:")

7 800 5 000

9300 5 700

1 500 700

19.23 14.00

5000

5 800

800 --

16.00

-7.28 1 800

- --

1 316 200

1 4"2 000

95800

- -

SINGAPORE NATIONAL HEALTH DEVELOPMENT SITUATION The general health status of the people has remained satisfactory. In 1986, the estimated population was 2.59 million, reflecting a growth of 1.1% over the previous year. The crude birth rate was 15.2 per 1000 population while the crude death rate was 5.0 per 1000 population. The average life expectancy at birth is currently 71 years and the Infant mortality rate has continued to remain fairly stable at 9.1 per 1000 live-births. There have been no major outbreaks of communicable diseases. This is evidence that Singaporeans enjoy a high standard of health. The country has a dual system of public and private health care. The Government administers the public system of health care. It provides 30% of the family practice in terms of attendances and 80% of the hospital services in terms of admissions. The Government encourages the development of the private sector. The public health services are heavily subsidized. The Government subsidy for outpatient care Is about 50% while that for hospital care Is approximately 60%. In 1984, Singapore introduced a compulsory savings scheme for health care. The scheme, known as the Medisave Scheme, has been well received. In 1986, It was further liberalized. Payment of the full hospital bill Incurred In government hospitals from the Medisave Accounts was permitted. In addition, the scheme was extended to cover the private hospitals. Account holders can use their savings to pay for hospital expenses incurred by grandparents who are Singapore citizens or permanent residents. The Ministry of Health Is responsible for the national health development strategies and plans. It comprises eight Divisions, viz, Planning and Development, Personnel and Administration, Finance and Computer Services, Hospitals, Primary Health, Support Services, Dental and Nursing Administration. The Ministry's policies and plans are embodied In a National Health Plan, the objectives of which are: (a) to encourage Singaporeans to stay well. This will be done through Increased emphasis on preventive medicine and education, and the health financing system; and (b) to raise the standard of medical practice to provide for the needs of the population. The development strategy Is as follows: (1) Dental health. The Ministry provides preventive services and curative care- in dental clinics In hospitals, outpatient clinics and primary schools. The plan is to shift from curative to preventive dentistry. Greater emphasis wi" be given to dental health education, and to Improving and extending the dental services to cover pre-school, primary and secondary school populations. A good school dental service will result In the long-term dental health of the general population. The Ministry will also place emphasis on the development of the specialized dental services, but will only maintain a presence In outpatient dental services to provide for the young, elderly and Indigent. (2) Primary health. At present, the Ministry of Health provides maternal and child health, school health, training and health education and outpatient curative servk;es and health services for the elderly through a network of 39 outpatient clinics. Most of these are single or tw(Hjoctor clinics, which are not cost-effective because of high overheads. Others have lost their population base because of the population shift to the new housing estates. The Ministry plans to consolidate the 39 outpatient clinics Into 16 polyclinics, which will provide the full range of maternal and child health, curative outpatient services, school health services, training and health services, and health services for the elderly. Of the 39 existing outpatient clinics, 6 will be retained. Ten polyclinics will be built in the new housing estates.

Singapore

359

Singapore Environmental health services are of a high standard. However, as the society becomes more affluent and health-conscious, public expectations have also become higher. The rising expectations, together with the tight labour sh?rtage, will pose a strain on the Government In maintaining or upgrading the eXIsting environmental health standards unless the Government continues with the lnt~oduction ~f more advanced technologies and the upgrading of professtonal experttse. At the end of 1987, there were 2939 registered doctors, 654 registered and practising dentists and 9299 qualified and practising nurses.

360

11.2 Environmental heaHh In rural and urban development and housing With WHO support, one officer will be sent for the post-graduate course In environmental engineering and one for the course In solid waste management. This upgrading of knowledge and expertise, which Is not available locally, Is essential for the Improvement and upgrading of existing sewerage systems and treatment, as well as the design and management of new treatment facilities to achieve better performance and standards. The training attachment on solid wastes management will expose public health inspectors to the latest methods used In advanced countries and their application to the local context.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 As Singapore is aiming at becoming a regional centre of excellence and as the country enjoys a high standard of health, the main emphasis of the programme of cooperation with WHO during 1990-1991 will be the development of human resources for health in a few selected fields where local expertise is not yet available.

11.5 Food safety WHO collaboration will be required for the training of an officer In food technology/food science, particularly on techniques In food science, which Is essential for Improving and upgrading the standards and system. As a result of the demand for services In trace analysis of carcinogenic and toxic compounds in food, there Is a need to develop expertise In sample preparation and advanced instrumental techniques.

3.1 HeaHh aHuetlon end trend assessment WHO collaboration will be required for the training of medical epidemiologists.

5. Development of human resources for heaHh Health manpower development continues to be the main priority for WHO collaboration. Emphasis will be on the training of nursing personnel In nursing education and nursing administration.

12.1 Clinical, laboratory and radiological technology for hMHh systems based on primary heeHh care To enforce non-ionizing radiation (NIR) safety, there Is a need to send an officer for training. The training will emphasize NIR safety and ?haracterlzatlon, intensity-level measurement, equipment handling, and Interpretation of measurements In terms of biological effect.

9.5 HeaHh of the elderly Support will be requested for the training of nursing and auxiliary staff In providing health services for the elderly.

12.4 TradHiol'llll medicine Pharmaceutical staff are trained In western medicine and hence have very little knowledge of traditional medicine, other than what Is available In the reference books. A sizeable proportion of the population still believe In the use of traditional medicines for treatment of diseases. China and Japan which have a wide variety of traditional medicines, have well-developed cont~ol systems. !here Is a need to study their systems and adapt relevant control measures tnto the local system.

10.2 Prevention and control of alcohol and drug abuse One of the support staff will require training In dope testing of urine samples.

13.2 Dlaeaae vector control The Ministry would like WHO to collaborate in training an officer In the latest techniques and approaches used by advanced countrie.; in vector control. The knowledge gained will enable the Ministry to review and further improve Its existing methods of vector control and surveillance. 13.13 AIDS Support is requested in training a nurse who would be involved in nursing AIDS patients.

BUDGETARY IMPLICATIONS The emphasis given to training of health manpower accounts for the large allocation to the programme for development of human resources for health and other programmes such as promotion of environmental health and health of the elderly. On the other hand. a significant decrease Is shown under clinical. laboratory and radiological technology for health systems based on primary health care. In view of the expected completion In 1988-1989 of one long-term fellowship in radiography.

Singapore

381

362

Estimated obligations

SINGAPORE Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase

1988-1989

1990-1991

Source of funds

uss 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located in Singsapore

US$

5 500

5500

180 800

202 800

22000

12.17

5. Development of human resources for health 9. Protection and promotion of the health of specific population groups 9.5 Health of the elderly 25100 25100 274 600 255 800 ( 18 800)

( 6.85)

Estimated obligations

SINGAPORE Regular budget Programme 1988-1989 US$ 10. Protection and promotion of mental health 10.2 Prevention and control of alcohol and drug abuse

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

5 800

11. Promotion of environmental health 11.2 Environmental health in rural and urban development and housing 11.4 Control of environmental health hazards 11.5 Food safety

15 400

26600

11 200

72.73

14 700 31 400

(14 700) 31 400

(100.00)

Singapore

363

364

Estimated obligations

SINGAPORE Regular budget Programme 1988-1989 US$ 12. Diagnostic, therapeutic and ,. rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.4 Traditional medicine

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

45 500

19200 9 700

(26 300) 9 700

( 57.80)

13. Disease prevention and control 13.2 Disease vector control 13. 11 Sexually transmitted diseases 13.13 AIDS 13. 16 Cancer 13. 17 Cardiovascular diseases

8 300

8300

8600 9900 8100 8600 556 300 600 100

( 8 600) 9900 ( 8 100) ( 8 600)

(100.00)

(100.00) (100.00)

-TOTAL- SINGAPORE 43 800 7.87

- -

SOLOMON ISLANDS NATIONAL HEALTH DEVELOPMENT SITUATION The Government sector Is dedicated to the goal of health for all by the year 2000. Within the framework of this objective under t he national development plan, several projects have been identified to ensure that certain goals are reached. Basically, there are no major changes in the Government's policies and objectives, which follow closely those adopted in the 1988-1989 biennium. The development of primary health care through the district health services and services related to family health, improvement of rural water supply and sanitation, and control of malaria play a leading role in national development. Strengthening these health sectors is considered essential to achieve a more equitable distribution of health resources and attain a reasonable level of health for all citizens permitting them to lead a socially and economically productive life. To ensure progress along these lines, the development of health Informatics Is considered essential to strengthen operational research and training, and planning of future health programmes. Nongovernmental organizations are participating in health activities but the pace of their involvement is considered slow. To improve this, the Government plans to provide fellowships for nongovernmental organizations during the period as well as other activities Involving such organizations. Community involvement and the use of appropriate technology are considered important and will be facilitated through workshops at the district and community level. As regards devolution, there has been a change in status in a number of health activities, responsibility tor some of which is being handed back by the provinces to the central government. The natural situation of this country with its widely scattered islands and varied epidemiological situations makes a steadily progressive improvement of the health situation difficult to achieve. It is considered that, despite the setbacks in malaria control during the previous period, achievements made during 1988-1989 will be consolidated during the 1990-1991 biennium. The emphasis during the biennium will again be on prevention, training of adequately equipped health manpower, and the integration of preventive and curative programmes, particularly at the community level. While a ne~ natl~nal hospttal was foreseen during the last biennium, the development of th1s proJ_ect has not progressed and funding, positioning and d esign are bemg reconsidered. The common health problems are those related mainly to communicable diseases, although the number of accidents is grad~lly increasing while in the urban areas some of the diseases of affluence are be1ng seen in certain small groups. Malaria remains the most serious health problem and, despite successes with the malaria control programme, there were 72 000 cases reported In 1987. The introduction of permethrin-lmpregnated bed nets In highly endemic areas has resulted In a reduction of cases In children and appears to be an example of successfully applied appropriate technology In primary health care. It is expected that there will be further case reductions In 1988, despite the administrative and social problems currently affecting the control programme. The rehabilitation of rural water supplies and sanitation following cyclone Namu has progressed well with support from WHO and UNDP and the Australian and New Zealand Governments. Further progress, not only In reconstruction but also In buUdlng and maintaining an appropriate system, wlll require increased Inputs from WHO and other aid organizations for several years to come. Improvements In training and In the reporting systems for tuberculosis and leprosy have brought a greater awareness of the problem of tuberculosis and its treatment with multidrug therapy. The joint collaboration of WHO and the New Zealand Leprosy Trust Board In these problems Is appreciated and will be needed this biennium through fellowships and training provided under primary health care. Development of the immunization/diarrhoeal disease/acute respiratory Infection programmes have progressed well In conjunction with the family health and maternal and child health programmes supported by WHO, UNFPA and Save the Chldren's Fund (Australia). Collaboration with FAO and SPC has resulted In some progress with a plan for a national nutrition survey, and nutritional programmes aimed at increasing general knowledge of nutrition have been developed. There is

Solomon Islands

365

Solomon Islands expected to be a further need for collaboration in assessment of nutritional status and design of nutrition education programmes this biennium. The construction of a new training and research centre was completed In 1988 and opened the way for the formulation of better training programmes for health workers with emphasis on primary health care. The opportunity now presents Itself for regional training courses and research, particularly In malaria and vector-borne diseases, with emphasis on operational problem-solving and primary health care-oriented programmes.

366 appropriate to future progress. In addition, all operational research needs will be reviewed. Workshops will be held to achieve this. 4. Organization of health systems baaed on primary health care The main thrust of primary health care will be on evaluation of the effectiveness of activities established at the periphery and their effect on the health of the nation. At this stage It should be possible to see the Impact of the concepts of primary health care, In particular In the major disease control programmes. In addition, an assessment will be needed to ascertain that promotional activities are up to date and clearly understood by the community. Training of village health workers and health volunteers will continue throughout the period and the community will be Involved in hands-on learning of appropriate technology.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 The main emphasis of WHO collaboration in 1990-1991 will be on the continued development of a sound health system infrastructure related to the Government's health programmes, with particular reference to the establishment of the principles of primary health care and self-reliance. In view of the varied progress in different fields and programmes and the anticipated development of the health statistics unit, the Government Intends to place more emphasis on evaluation of all programmes to determine actual progress and future needs. The Ministry of Health and Medical Services intends that the evaluation will extend to all sectors and to all levels of health care in the community. The results will be carefully evaluated at district and central levels and the Health Plan and operational plans will be modified so that well-defined health projects can be carried out with community participation. 3.1 Health sltUIItlon and trend assessment Collaboration will be requested in the review and development of the Ministry of Health's statistics unit and the epidemiological evaluation of health programmes, particularly the health improvement programmes and those linked with primary health care and malaria control. Technical support in updating of the Health Plan is requested. WHO support in the provision of an epidemiologist has strengthened the capability of the health planning unit. 3.3 Health systems research and development Support will be needed for the Ministry of Health and Medical Services to assess progress with the Health Plan and to make the relevant changes

Development of human resources for health

The upgrading and training of staff are continuous activities. At present there are manpower deficiencies In most un'lts of the Ministry and It is unlikely that, with the currently available fellowships from all sources and the present attrition rate, manpower will be adequate before 1995. The emphasis on training is reflected not only In the health manpower programme but also In specific programmes. Most courses Identified reflect the emphasis being placed on the encouragement of community health practices; emphasis In training must strike a balance between primary health care and clinical specialization. Fellowships outside the country are supplemented by workshops, courses and refresher training for nurses and other medical staff. Auxiliary workers and other health personnel will also attend programmes sponsored by WHO from extrabudgetary sources and the Intercountry programme budget. Community-based rehabilitation programmes are being planned for a joint venture between the Ministry, the physiotherapy department of the Central Hospital, and the Disabled Society. This will require skilled broadly trained physiotherapists. 6. Public Information and education for health The need to actively pursue health education and health promotional activities is well recognized by the Ministry, which has placed great emphasis on this programme during the past few years. WHO will be requested to actively

participate with the Ministry in training health educators and in developing health education programmes In the schools and the community. As health education forms an integral part of ali health programmes, WHO support for the development of promotional activities related to these programmes will be required. A considerable input is proposed in these programmes by UNFPA and UNICEF. 8.1 Nutrition The Ministry intends to extend its promotional activities during the period. WHO will be requested to support these activities in conjunction with other interested agencies such as UNICEF and SPC. A national nutritional survey feasibility study will be conducted by the Government in conjunction with WHO, UNICEF and SPC In late 1988. 8.2 Oral health The oral health programme has been considerably expanded throughout the country and requires the expertise of trained and skilled professionals as well as generalists who have sufficient knowledge to provide adequate emergency care. Preventive dentistry Is one of the main themes of the Ministry. Oral health promotional programmes will be carried out In schools throughout the country. Training of nurses in emergency care will be undertaken during the period through a series of workshops throughout the country. WHO will be requested to support the postgraduate training of technicians and therapists and the specialized studies of a dentist in oral health and to provide technical collaboration to assess the needs and feasibility of local training of auxiliary dental personnel. 9.1 Maternal and child health, Including family planning The country has a high population growth rate. The general health protection and promotion programme places emphasis on women and children to ensure that they are not relegated to a disadvantaged role In the course of development and, more Importantly, that they share equal benefits from the positive impact of overall socioeconomic development. Special emphasis Is placed on maternal and child -health and nutrition. Cooperation In both these

areas is being sought from SPC, UNICEF and UNFPA. Collaboration between WHO and these agencies is considered invaluable. 9.4 Workers' health Due to the increase In Industrial accidents and those related to Industry and the effects of certain Industrial practices on health, fellowships for training in this field are sought. 11.1 Community water supply and unitatlon The water supply and sanitation programme is one of the most extensive and important programmes In the health sector and will require trained personnel for some time to come. The Ministry has considered for some time setting up an assistant health inspector training scheme in conjunction with WHO. Trained sanitary engineers and health Inspectors will be required for such undertakings and also for the conduct and maintenance of the present programme. WHO support will be requested in training and in conducting local workshops, particularly those associated with evaluatJon of progress, rehabilitation of water supplies and sanitation and maintenance by the community. Furthermore, the Government considers that a full-time engineer should be present to collaborate in rural water supply and sanitation projects. 12.1 Clinical, laboratory and r~~dlologlcal technology for health syatems based on primary health care Because of the geographical distribution of the Island provinces, It Is necessary to develop certain resources In many places. The need for diagnostic laboratories and X-ray units In all provinces necessitates the provision of skilled manpower, which at present Is well below quota. 12.2 Essential drugs and vaccines There is a need to rationalize drug procurement and utilization for which technical collaboration is requested. Continued UNICEF support In the supply of essential drugs and vaccines Is expected. The Government also lacks qualified pharmacists and pharmacy assistants. During the period, WHO

Solomon Islands

367

Solomon Islands support In the provision of training fellowships and in workshops to enhance the refresher training of locally trained pharmacy assistants will be required.

368

BUDGETARY IMPLICATIONS The budgetary tables reflect the role of WHO In promoting and establishing the concepts of primary health care In the management of health problems. Other major areas of activity are the development of evaluation systems for ongoing programmes and for Interim assessment and adjustment of the health plan. Manpower development still plays a big role and the WHO regular budget contributes through a wide range of activities and fields to ensure that manpower problems are resolved . The budget reflects the high level of concern for adequate malaria control and development of self-help, and for reconstruction and maintenance of the rural water supply and sanitation facilities. In the light of the above, significant budget Increases are to be seen under organization of health systems based on primary health care and community water supply and sanitation. The anti-malaria programme continues to be given the highest prlortty, but a budgetary reduction Is shown since the programme has received a substantial contribution from the Japanese Government. Continuation of UNFPA funding Is expected for maternal and chid health, including family planning.

13.3 Malaria Malaria is considered the single most important health problem affecting the community and as a result Is accorded great Importance In the order of programme priority. The recent change In approach and the Involvement of more people In the community In controlling the disease have been successful and It is consider-ed that any gains should not be lost. The approach to control through concepts of primary health care and community involvement will be continued and extended through the use of additional methods. Continued collaboration is requested in the form of technical staff and fellowships in management and evaluation techniques, recent advances in vector control and Interpersonal relationshi ps in community health programmes. The epidemiological aspects will be closely coordinated with the health situation and trend assessment programme. Further training support will be requested from the intercountry programme, particularly with the completion of the new training and research centre and the programming of regional courses.

Estimated obligations

SOLOMON ISLANDS Regular budget Programme 1988-1989 199o-1991

Other sources (Decrease) %

Increase US$

1988-1989

199o-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development

US$

169 300

136 900

( 32 400)

(19.14)

13 900

(13900)

(100.00)

3.3 Health systems research and development

10 800

4. Organization of health systems based on primary health care

254 600

289 900

35 300

13.86

5. Development of human resources for health 157 300 167 400 10 100 6.42

6. Public information -and education for health

32900

27800

( 5 100)

( 15.50)

Solomon Islands

369

370

Estimated obligations

SOLOMON ISLANDS Regular budget Programme 1988-1989 1990-1991

Other aources (Decrease) % 1988-1989 1990-1991

Increase US$

Source of funds

US$ 8. General health protection and promotion 8. 1 Nutrition 8.2 Oral health 8.3 Accident prevention 10 000 40 800 8100

US$

US%

17 200 74600

7 200 33 800 ( 8 100)

72.00 82.84 (100.00)

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning 9.4 Workers' health 27200 27 200

372600

1o. Protection and promotion of mental health 10.3 Prevention and treatment of mental and neurological disorders

6800

( 6 800)

{100.00)

Estimated obligations

SOLOMON ISLANDS Regular budget Programme 1988-1989 US$ 11. Promotion of environmental health 11. 1 Community water supply and sanitation

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

88 700

170 500

81 800

92.22

304500

12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines

49600 47100

51 700 53600

2 100 6500

4.23 13.80

13. Disease prevention and control 13.3 Malaria 202 600 162 400 ( 40 200) (19.84) 100 900

-TOTAL- SOLOMON ISLANDS 1 081 700 1 190 000 108 300 10.01 778 000

Solomon Islands

371

372

TONGA NATIONAL HEALTH DEVELOPMENT SITUATION . The ~overnment has continued to provide, on a priority basis, the best possible medical and health care to as many people as possible within the limits of available resources through a network of hospitals, health centres, health clinics with health professionals as well as auxiliary and voluntary health workers, particularly in previously underserved, remote and Inaccessible areas. Home visits by various categories of health workers, primarily from health centres and health clinics, have augmented this outreach capability significantly. . The n~twor~ and extensions described above, together with the Increasing participation of nongovernmental organizations, particularly since the begin~ing of the F~h ~ive-Year National Development Plan (1986-1990), as well a~ v1llage orgamzat1ons (e.g. health committees, water committees), compnse the present Infrastructure on which the Ministry of Health depends In furthering Its aim of continually Improving the health status and social welfare of the people. This Infrastructure has enabled appropriate health and medical services to. become Increasingly accessible to more people, especially to groups at nsk, at practically all levels of the delivery system. The main thrusts of primary health care are reflected In the National Development Plan 1986-1990, and include the following: - institutionalization and sustenance of primary health care; -.development of health programmes/projects which support community-based health projects/activities to ensure continuing active community participation; - improvement of the welfare and health status of the population by strengthening health programmes and the reduction of communicable and noncommunicable disease morbidity and mortality rates; - more equitable distribution of health care facilities and services; and - collaboration with and provision of appropriate support wherever possible to nongovernmental organizations which are active In the health field . Health status is relatively sat isfactory when compared, for example, with that In other developing countries. A substantial improvement In the health status of all segments of the population has been brought about by the various service and field health units of the Ministry of Health In close collaboration with the private sector, and by the communities themselves through the primary health care approach. It has be'en reinforced by the continued improvement and expansion of the health and medical services, and the consequent Increase in population coverage. Safe drinking-water Is available at 15 minutes' walking distance to approximately 95% of the population. Some 80% of expectant mothers attend prenatal clinics. However, only about 60% of confinements are attended by trained personnel. Similarly about 60%-80% of children up to one year are seen by trained health workers. Coverage for the six lmmunizable diseases is more than 80%. Facilities. ~nd staff for treatment of acute common Illnesses or injuries, and for the prov1s1on of essential drugs, are available to at least 80% of the population within one hour's walking distance. While the gains made from 1980 to 1987 are encouraging the still unmet needs and emerging new requirements of a mobile population, characte_rlzed by a changing life-style and growing modernization, are no less challenging. . ~romoting .and sustai~ing t~e awareness of the population in general and pnority population groups 1n particular and ensuring the continuing support

of policy-makers, planners, and different development sectors as well as nongovernmental organizations for the various projects making up the national health programme call for an organization of effort and management of resources different from the past. For Instance, mobilizing the communities to continually support and participate In planning and managing their health programmes has a better chance of being institutionalized If district health systems are well functioning, If supportive, supervisory financial management and administrative and technical capabilities at various centres have been properly developed and are sustained, and If other resources crucial to the successful implementation of programmes are available at all times. However, resources, as a rule, are scarce. Likewise, orienting or re-orienting the health system towards primary health care will require a continually suppOrtive leadership as well as fully committed, well-motivated and properly trained peripheral workers, supervisors, trainers and programme managers, among others.

To Improve the efficiency and effectiveness of selected health management areas, a workshop on health systems research is planned, with WHO collaboration. 3.4 Health legislation Additional support will be required In assessing the status of Implementation of nursing legislation formulated In 1988-1989 as well as In reviewing and formulating legislation on medical and health care and in consolidating the above legislation Into a draft National Health Act.

4. Organization of health systems baaed on primary health care Cooperation in this area will continue to concentrate on detailed programming, monitoring and evaluation required In further Improving health systems based on primary health care as well as In further strengthening health centres to make them more efficient and effective. Ukewlse, more efforts will be exerted in improving the Implementation of the operational health plan, further development of village health workers, and strengthening of administrative and management capability In various fields, partlcularty In health planning and health administration.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME

1990-1991 Barring unforeseen circumstances (e.g. the Introduction of HIV/AIDS, worsening of hepatitis B and related viral infections), the health situation will continue to Improve during 1988-1989 and probably beyond. However, achieving the objectives through the major thrusts of primary health care planned for 1986-1990 will require an expansion of the programme of cooperation between the Government and WHO In a number of areas. WHO 's collaboration will remain mainly technical In nature and will be based on the principles of partnership, consultation, respect and efforts toward self-reliance. 3.1 Health situation and trend assessment Continued WHO support. will be needed In further developing the national health information system; especially in refining the minimum basic data set (MBDS) developed during 1988-1989 and the use of health and related Indicators. The improvement of administration and management of medical records also requires WHO collaboration. 3.3 Health aystema.reaearch and development This area is considerecf.essential to the generation of new knowledge crucial to the successful pursuit bf the objectives of the:health.tor-all strategies. Tonga

5. Development of human resources for health The development of human resources for health will continue to be the major area of collaboration In conjunction with further Infrastructure development. WHO's continued technical support to the nursing school Is requested. Cooperation will continue In the training and orientation to primary health care of health workers, I.e. health officers, public health nurses, clinical nurses, and dental chairside assistants, most of whom will be operating In district and rural areas. In addition, WHO support will continue to be required for overseas training of health staff In various fields In order to upgrade the quality of health and related services and strengthen national capability to train various categories of health workers locally. &. Public Information and education for health

The technical and operational capability of the Health Education Section of the Ministry of Health In general health education as well as In the AIDS prevention and control programme will be further improved.

373

Tonga

374 8. 1 Nutrition 9.4 Workers' health Technlcal collaboration In this new programme will be required for Identifying occupat ional health problems, formulating policies and developing suitable programmes for the prevention of occupational diseases based on primary health care, and training selected programme personnel.

A national workshop will be convened for selected participants from the government departments concerned and nongovernmental organizations to consider the findings and recommendations of the 1986 national nutrition survey and small special studies related to diabetes and hypertensive disorders. This activity Is expected to lead to adoption of a national nutrition programme.

8.2 Oral health Continued support will be needed for expanding the school dental health programme to the other island groups as well as for training of staff in dental care.

10.2 Prevention and control of alcohol and drug abuse Collaboration in this area will enable the Government to conduct studies to show the relationship between alcohol consumption and social/behavioural changes, assess the extent of alcohol-related problems, formulate suitable policies and programmes as well as train health care and social welfare workers.·

8.3 Accident prevention 11.1 Community water supply and sanitation Support In this new area is required particularly for conducting a multisectoral and interdisciplinary workshop on traffic accidents prevention and control. Continued collaboration In community water supply and sanitation technology will consist mainly of technical and management support for project operation, policy formulation and programme planning, especially In finding suitable alternative measures and schemes for strengthening the management of village water supply, and training of staff.

8.4 Tobacco or heallth This new programme Is very Important for further protection and promotion of general health. Collaboration is needed In the area of public information and education on smoking and related diseases as well as In conducting studies on how to strengthen and expand the country's smoking control programme.

12.1 Clinical, laboratory and radiological technology for health 1yatems baaed on primary hMith Cllre Continued collaboration will be necessary to Improve and further develop laboratory services at health centres and health clinics, for efficient control of communicable and noncommunicable diseases. Training on essential laboratory techniques for staff at peripheral areas will be conducted. WHO collaboration will also be required for upgrading of radiological services and for strengthening in-country radiological management capability.

9. 1 Mater11111 and child health, Including family planning To further Improve policy and programme coordination in maternal and child health/family planning, cooperation is required In the conduct of a workshop with participation from the various government agencies concerned and nongovernmental organizations, including youth and women's groups. With UNFPA support, WHO will continue to collaborate with the Government in strengthening community Involvement in the maternal and child health/family planning programme.

12.5 Rehabilitation WHO collaboration In the development of community-based rehabilitation services will continue.

13.1 Immunization A follow-up review and evaluation of the immunization programme will

a national workshop and overseas training of selected personnel on educational and preventive measures against AIDS.

be conducted with a view to completely eradicating certain lmmunizable diseases.

13.15 Blindness and deafne11 Continued support Is required In determining, through an epidemiological survey, the prevalence and causes of blindness.

13.2 Disease vector control Cooperation will be required for the training of public health inspectors In vector control as well as for equipping the new vector control unit.

13.16 Cancer Continued support is needed for organizing and conducting public information and education on cancer Itself, smoking and other factors related to cancer.

13.6 Diarrhoeal diseases Training in the administration of oral rehydration therapy will be conducted with WHO support.

13.17 Cardiovascular dlseaMI Cooperation will continue to be required for assessing the extent of the problem as well as in organizing suitable Intervention programmes, conducting health systems research on risk factors associated with cardl01/8scliar and other noncommunicable diseases and overseas training of staff.

13.7 Acute respiratory Infections Continued collaboration will be requested In reviewing the surveillance system, training peripheral workers In the management of cases, and identifying high-risk groups.

BUDGETARY IMPLICATIONS 13.8 Tuberculosis Support is needed to strengthen the national tuberculosis control programme based on the primary health care approach and to introduce the standard treatment regimen to peripheral workers. A significant budgetary Increase Is shown under the organization of health systems based on primary health care, which continues to be given high priority. The emphasis on short-term rather than long-term fellowships has resulted in reduced budgetary requirements for health situation and trend assessment and clinical, laboratory and radiological technology for health systems based on primary health care.

13.11 Sexually transmitted diseases Technical competence in the diagnosis, treatment and management of sexually transmitted diseases as well as in the development and use of simple management protocols for patients and contacts will be further strengthened.

13.13 AIDS Collaboration is required in this new area for the strengthening and expansion of the national prevention and control programme; mainly -through

Tonga

375

376

Estimated obligations

TONGA Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.3 Health systems research and development 3.4 Health legislation 19500

US$

34500

20 400

( 14 100)

( 40.87)

16400 21 000

16400 1 500 7.69

4. Organization of health systems based on primary health care 222 500 248 900 26400 11.87

5. Development of human resources for health 293 900 304 300 10400 3.54

8. Public Information and education for health 31 900 29400 ( 2 500) ( 7.84)

Estimated obligations

TONGA Regular budget Programme 1988-1989 199G-1991

Other .ources (Decrease) %

Increase US$

1988-1989

199G-1991

Source of funds

US$

8. General health protection and promotion 8. 1 Nutrition 8.2 Oral health 8.3 Accident prevention 8.4 Tobacco or health 13 100 18000 3400 31 700 3400 5 700 ( 9 700) 13 700 3 400 5 700 ( 74.05) 76.11

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning 9.4 Workers' health

3400 10400

3400 10 400

360 800

167 700

Tonga

377

378

Estimated obligations

TONGA Regular budget Programme 1988-1989 US$ 10. Protection and promotion of mental heahh 10.2 Prevention and control of alcohol and drug abuse

Other sources (Decrease) %

199G-1991 US$

Increase US$

1988-1989 US$

199G-1991 US$

Source of funds

3 000 5 700 2 700 90.00

11. Promotion of environmental heahh 11. 1 Community water supply and sanitation

201 100

206100

5000

2.49

12. Diagnostic, therapeutic and rehabilitative technology 12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.5 Rehabilitation

203200 3000

181 500 3400

( 21 700) 400

( 10.68) 13.33

13. Disease prevention and control 13.1 Immunization 3400 3400

Eatlmated obligations

TONGA Regular budget Programme Other sources (Decrease) %

1988-1989 US$

1990-1991 US$ 3400 3400

Increase US$ 2400 3 400

1988-1989 US$

1990-1991 US$

Source of funds

13.2 Disease vector control 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.11 Sexually transmitted diseases 13.13 AIDS 13.15 Blindness and deafness 13.16 Cancer 13.17 Cardiovascular diseases

1 000

240.00

3 500

3400 3400

(

100) 3400

( 2.86)

3500

3400 39500

( 100) 39500 100 ( 2 600)

( 2.86)

1 000 6000 21 100

1 100 3400 20500

10.00 ( 43.33)

(

600)

( 2;·64) 8:28 --

6800

VD 167 700

TOTAL-TONGA

1 079 800

1180 000

100 200

367 600

Tonga

379

380

Estimated obligations

TUVALU Regular budget Programme 1988-1989 199o-1991 Increase (Decrease) 1988-1989 Other sources 199o-1991 Source of funds

US$ 4. Organization of health systems based on primary health care

US$

2000

( 2 000)

(100.00)

20 700

1 000

5. Development of human resources for health 9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning

29000

(29 000)

(100.00)

13 700

11. Promotion of environmental health 11. 1 Community water supply and sanitation

2000 --

( 2 000) (33 000)

(100.00)

-(100.00) 34400 1000

TOTAL- TUVALU

33000 --

- -

VANUATU NATIONAL HEALTH DEVELOPMENT SITUATION The principal objective outlined in the Second National Development Plan for 1987-1991 is to attain better health for all by the year 2000 through the application of primary health care strategies, defined by the first national workshop on primary health care as ''the road leading to a good healthy and happy life through total development within the community, worting together in a spirit of awareness and self-reliance ... ". The Plan, which identifies the principal causes of attenda1ce at health units during 1985, shows that the major public health problems are skin infections, respiratory infections and malaria. Chest infections anj malaria are the major causes of hospitalization, exceeded only by the number of admissions for delivery by expectant mothers. The Statistical and Epidemiological Report for 1985 showed that the annual growth rate was maintained at 3.36% and that average life expectancy at birth t-ed improved tremendously over the past few years and was estimated at 61.1 years for males and 59.3 years for females. The incidence rate per 1000 populatic·n for malaria was put at 183 while the case rate for scabies and skin infections 'Was 487. The prevalence rate for leprosy was lower than 1984 and was estimated at 0.1 per thousand in the previous year. The same is true for tuberculosis, v.hich showed an incidence rate of 1.25 per thousand for 1985 compared with 2.1 in 1984. Childhood diseases such as pertussis and measles attained a C83e rate of 9.6 and 51.1 per 1000 inhabitants in 1985, as compared with 1.8 and 12.0 in 1984. The underlying cause oUhe major health problems appea-s to be poor living conditions. Data on attendance at health institutions would improve overall if there were better·housing, water supply, sanitation and e1vironmental conditions in the rural areas. However, these improvements are rot perceived to be the sole responsibility of the Health Department as they ar3 included in the portfolio of other government departments, thus requrlng greater collaboration in attaining the Plan's objective of health for ail in the first place. Improvements in the delivery of health services rank second in order of the priorities that face the Government. The problems relating to the delivery of health services as identified by the Second Plan are grouped under four different categories: planning and management, manpower, infrastructure, and community lnvolvem~.nt. A detailed health plan has not yet been prepared and this Is hampenng the decision-making process of the Health Department. Manpower problems are numerous, ranging from the non-availability of Ni-Vanuatu professional staff to problems related to attracting and retraining staff for rural and isolated areas. Lack of adequate career structures and severe financial constraints impede improvements in this domain. The general condition of hospitals and other health service buildings damaged In recent cyclones is of concern to the Health Department. The level of commitment by communities to primary health care is generally unknown. These problems have also been aggravated by tne recent natural disasters and the general economic situation prevailing in the wor1dt today. Unfortunately, Vanuatu has experienced major disasters in the form of three cyclones: two cyclones hit the northern area of the archipelago early In 1985 and a third powerful cyclone "Uma" hit the central and southern Islands of Vanuatu In February 1987. As a consequence, the country Is facing major difficulties. The status of the local economy affected by these disasters and the general economic situation globally have had a serious Impact on the nation's health care system. The health of the economy Is closely linked with the health of the people. A higher level of socioeconomic development correlates with higher Incomes, resulting in the ability to provide better government services in general and ultimately a healthier population. The stringent fiscal measures applied to Government Department expenditure have affected the Implementation of health projects to some extent, as employment of new staff Is totally restricted: for example, graduates of the 1985-1987 nurses course are not yet employed. The Second Plan has identified six programmes to be Implemented during the Plan period. These programmes relate to: planning and administration; community and rural health services; hospital services; general services, including primary health care support services; health manpower development and training; and research.

Vanuatu

381

Vanuatu These programmes aim at administering the health services In an efficient and cost effective manner. Each programme has a number of activities that are to be Implemented by the Government, either relying on its own resources or through collaboration with bilateral or International programmes, among which the WHO collaborative programme forms a cornerstone of national health policy.

382 4. Organization of health eystems based on primary health care Emphasis of collaborative activities will be on the evaluation of primary health care activities undertaken since 1985 and on advising on future development and on the conduct of research and developmental projects at the district level. Workshops for primary health care coordinators and a course for training of trainers In primary health care to be conducted in conjunction with the School of Nursing will be organized. 5. Development of human resources for health

PROPOSED WHO COLlABORATIVE HEALTH PROGRAMME

1990-1991 Collaboration with WHO is intended to develop national capability in solving the country's health development problems. This Includes the development of appropriate knowledge and skills which could be used in the formulation of a collaborative programme to improve the efficiency and effectiveness of the Health Department, develop capabilities In health system planning and management of the health services as well as expand and strengthen the delivery of primary health care programmes. During the implementation of the proposed programme, special emphasis will be placed on three priority areas: -malaria, which at present Is the major public health problem; -development of human resources for health, because of the shortage or complete lack of qualified local health personnel; - expansion and strengthening of the delivery of primary health care programmes, particularly in the outer islands. 3.1 Health eltuatlon and trend assessment The Health Statistics Unit of the Health Department will be strengthened and In-service traini~g will be provided to statistical clerks, to provide a better feedback and monitoring system. 3.2 Managerial process for national health development Collaboration Is required in planning and conducting an in-service training course for administrative/fiscal staff, and In management training of a senior staff member of the National Health Office. Health manpower will continue to be developed in accordance with needs. Training activities within and outside the country will continue to require WHO support. Emphasis of collaboration will be on reviewing nursing staff needs (e.g. nurses, nurse practitioners, nurse aides, etc.) and training since this category will continue to form the backbone of the nation's health services In the foreseeable future. 6. Public Information and education for health With the availability of a core staff of trained health education coordinators throughout the country, support will be required for on-the-job training and local production of audiovisual aids, etc. Support Is also expected for health education under the Global Programme on AIDS. 8.2 Oral health It Is proposed to conduct a national dental survey to provide the base line data on oral health and to continue with the district level oral health workshops with WHO collaboration. An additional dentist needs to be trained to assist in the delivery of an adequate oral health programme. 9.1 Maternal end child health, Including family planning The Maternal and Child Health Unit of the Health Department has been strengthened by previous WHO collaboration in the form of a long-term fellowship and with UNFPA funding in expanding ante-natal, post-natal care as well as care during delivery, breast-feeding and family planning.

Further collaboration during the 1989-1992 cycle Is envisaged from UNFPA, with the assignment of a United Nations volunteer (public health nurse), and from Save the ChNdren Fund to strengthen the supervisory capabilities of the Unit and to conduct in-service training courses.

13.3 Malara. Malaria remains the main health problem. In view of prevailing operational constraints and limited resources, the malaria control programme will be developed making full use of existing health systems based on primary health care. In this context, efforts will focus on the development of pilot projects in areas with varying epidemiology and ecology, through which an optimal mix of available control measures, Including drug distribution systems, will be determined for wide application.

11.1 Community water supply •nd sanitation With the completion of the International Drinking Water Supply and Sanitation Decade and of activities In the water sector, WHO collaboration will be directed towards improving and strengthening the Environmental Health Unit of the Department In the delivery and Implementation of the sanitation sector activities of the Decade plan. Consideration will be given to providing technical Inputs Into the Vila urban sewerage plan if the results of studies now being conducted indicate the feasibility and urgency of implementing this plan.

13.8 Tuberculosis WHO will be requested to cooperate with the Health Department in strengthening the delivery of a programme that deals with tuberculosis and leprosy. Additional input from the Intercountry programme on tuberculosis and leprosy will also be requested.

11.5 Food safety There is a need to strengthen the national nutrition policy by providing adequately trained personnel to ensure the safety of food.

13.13 AIDS With the collaboration of the Global Programme on AIDS, the Healtm, Department has developed a short-term plan for the prevention and control of this disease. Based on the progress of Implementation In the first two years of the programme, further collaboration between WHO and the Government is envisaged for the development of a long-term programme on AIDS.

12.1 CllniCIII, .. bcntory •nd radiological technology for health systems baud on primary health care The strengthening and upgrading of technical capabilities of laboratory staff through the organization of In-service training courses are considered important. Collaboration will be required to strengthen the present core laboratory staff In the building of viable laboratory diagnostic facilities for the country. Technical expertise to the laboratory will also be requested through the Global Programme on AIDS.

BUDGETARY IMPLICATIONS The significant Increases under the programmes on organization of health systems based on primary health care and malaria reflect the Importance given by Government to the strengthening and expansion of the primary health care network In the country and the need to address a major endemic disease during the Second National Development Plan. Further efforts to Improve health planning and management account for the budgetary Increase shown under the programme for managerial process for national health development. The emphasis given to training of national health staff, partlcular1y nursing staff, is reflected In the increased budgetary allocation for the development of human resources for health.

12.2 Essent.. l drugs and vaccines Support will be required for the formulation of a national drug policy, quantification of needs, and management of procurement, storage and distribution of essential drugs and vaccines, to ensure a regular supply at the peripheral level.

Vanuatu

383

Vanuatu

384

The significant decrease shown under the health situ~tion and trend assessment programme Is due to the Government's decision In 1988-1989 not to proceed with its original request for a long-term epidemiologist. Other major decreases occur under the programmes on health legislation, oral health and

control of environmental health hazards, where It Is expected that WHO Inputs as well as Inputs from other sources In the previous biennium will have contributed to Improving national capabilities as well as identifying other funding sources.

Estimated obligations

VANUATU Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$ 3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development 3.4 Health legislation

US$

122 200

18100

{104100)

( 85.19)

11 800 13 000

35100

23300 (13000)

197.46 (100.00)

4. Organization of health systems based on primary health care 174 BOO 230 500 55 700 31.86

5. Development of human resources for health 205 200 301 300 96100 46.83

6. Public Information and education for health 8. General health protection and promotion 8. 1 Nutrition 5000 ( 5 000) {100.00) 15 200 9400 ( 5 800) ( 38.16)

Vanuatu

385

386

Eatlmated obligations

VANUATU Regular budget Programme 1988-1989 US$ 8.2 Oral health

Other sources (Decrease) %

199G-1991 US$ 40200

Increase US$ ( 16 300)

1988-1989 US$

199o-1991 US$

Source of funds

56500

( 28.85)

9. Protection and promotion of the heaHh of specific population groups 9.1 Maternal and child health, including family planning

5000

( 5 000)

{100.00)

193300

1o. Protection and promotion of mental heaHh 10.2 Prevention and control of alcohol and drug abuse

2000

( 2 000)

{100.00)

11. Promotion of environmental heaHh 11. 1 Community water supply and sanitation 11.4 Control of environmental health hazards

201 600

210 000

8400

4.17

11 500

13000

{13000)

{100.00)

Estimated obligations

VANUATU Regular budget Programme 1988-1989 US$ 11.5 Food safety 3000

Other sources (Decrease) %

1990...1991 US$ 3400

Increase US$ 400

1988-1989 US$

1990...1991 US$

Source of funds

13.33

12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines

38300 12 300

36000 12 200

( 2 300)

( 6.01) ( 0.81)

(

100)

13. Disease prevention and control 13.3 Malaria 13.8 Tuberculosis 181 200 19500 4000 254 200 19600 73 000 100 40.29 0.51 (100.00)

14. Health information support TOTAL-VANUATU

( 4 000)

-1 083 800 1 170 000 86400 --

- 7.97 --

204 800

Vanuatu

387

388

VIETNAM NATIONAL HEALTH DEVELOPMENT SITUATION The status of health development has considerably improved during the last few years of the present decade. In line with tha development of the economy In the Third Five-Year plan 1986-1990, the two main thrusts of the health services, namely, development of primary health care and strengthening of the quality of health care, have made considerable progress in a number of areas, particularly the following: (1) In spite of the constraints, especially those caused by recurring natural calamities, good results were achieved In the prevention and control of epidemics by elimination of a large number of foci and the overall decrease In mortality. In general, epidemic outbreaks have been controlled, morbidity and mortality rates for plague, pertussis, poliomyelitis, cholera, measles, c;! iphtherla and tetanus as well as a number of diseases such as tuberculosis, leprosy and trachoma have declined. (2) There has been a reduction In the population growth rate as a result of efforts by the health services. There are variations among the provinces but the results are encouraging. (3) Traditional medicine, including acupuncture, has been extensively used In case treatment at all levels, particularly the grassroots. The Institute of Traditional Medicine In Hanoi was designated as a WHO collaborating centre, which speaks highly of the level of achievement obtained in this important field . (4) Training of staff has been actively pursued in line with the development of the health network and taking into consideration a well-planned strategy of manpower development, mainly at peripheral level. Almost all communal health centres throughout the country have been staffed with an additional 1-3 assistant doctors. Training of health staff has been reoriented towards a more community-oriented approach in consonance with the development of primary health care. However, the health services are still encountering a number of serious problems. (1) The prevalence of some Infectious diseases is still high; the decrease In prevalence of a number of diseases is still not stable; a number of diseases, particularly malaria, still pose problems. (2) The population growth rate Is still considered high in relation to the target set for 1990 of 1. 7% per annum. Activities in the area of maternal and child health/family planning need to be intensified. (3) Much remains to be done In the area of environmental protection. High concentration of population In urban areas poses a serious problem of water and air pollution as well as deficiencies in refuse and garbage disposal. The same can be said for sewage and other required facilities. Workers, both industrial and agricultural, need protection from the health hazards posed by their specific working environments. There Is a need for nutrition surveys and health edUcation activities directed towards the most vulnerable groups among the population. Low living standards combined with deficient health education programmes are other factors contributing to the deterioration In the health status which need to be corrected. (4) The shortage of basic resources and lack of teaching facilities, particularly in the basic health network, are seriously hampering the development of normal health activities and the promotion of quality health care. In the face of these challenges, the health system has identified two main thrusts for the period 1988-1992: - strengthening primary health care activities; and - Improving the quality of all aspects of the health services.

In this context, the Important tasks facing the health services during the period 1988-1992, and particularly 1990-1991 , can be described as follows:

by immunization. Improvement, both quantitative and qualitative, in the production of vaccines is expected to continue during this period at local level. Leprosy Is expected to be totally controlled In two provinces by 1990 and each province Is expected to have one or two districts free of the disease. Attention will be given to the control of parasitic diseases through the provision of antl-helminthics and by Improving coverage for filariasis detection at various centres throughout the country.

(1) The health services, taking Into consideration past achievements and current constraints, will make optimal use of all available resources, both from the national budget and International assistance, and will strengthen and Increase the quality of the basic health network, e.g . communes, cooperatives, production brigades, districts and Intercommunal polyclinics. Careful attention will be given to the stabilization of the peripheral network, to Increasing professional and technical quality focusing on primary health care, to the provision of essential drugs and basic equipment to the lower and Intermediate health units, both from local production and from external assistance, to preventing downgrading of health establishments by procuring appropriate budgetary provisions from national and communal resources, to strengthening self-sufficiency In the production of d rugs from local medicinal plants for treatment of common diseases, to developing a model health system for the district level according to the district model of economic development, and to strengthening the quality of treatment provided at district level to alleviate the pressure on higher levels of care. The statistics network will be further developed and strengthened to ensure the quality of data collection with a view to carrying out a proper evaluation of the imp:ementation phases concerned, according to the indicators adopted. Intercommunal polyclinics and laboratories will provide wider coverage to Increase the quality of health care.

(3) Improvement of t he quality of medical examinations and treatment in hospitals and polyclinics will be promoted and outpatient care will be further developed. Training and refresher training for all categories of health staff will focus on primary health care. More specialized training will be provided to assistant doctors assigned to district hospitals and intercommunal polyclinics.

(4) In collaboration with other agencies such as the Ministry of Education, Information agencies, etc., promotional activities on health protection and health care will be further developed. Training of health staff, especially at district and commune levels, will also receive special emphasis. Workers' health will continue to receive attention. Special consideration will continue to be given to the use of traditional medicine In both prevention and treatment. Acute respiratory Infections will receive particular attention because of their impact on both morbidity and mortality among Infants. This programme Is expected to continue its expansion to the peripheral levels but at a more rapid pace. Cancer and cardiovascular diseases programmes will receive support for early detection, diagnosis and treatment both at provincial and peripheral levels. Rehabilitation will focus mainly on methodology and techniques to provide aid to patients suffering from the sequelae of cardiovascular diseases and occupational hazards. In collaboration with UNFPA, continued support Is envisaged for a comprehensive programme on maternal and child health. WHO support is required for the protection of chlldren against rheumatic fever and Its sequelae. A comprehensive oral health programme will continue to be developed with emphasis on prevention of caries and health education in conjunction with the Ministry of Education.

(2) As a result of activities carried out by the basic health network and the support received from higher levels, the following programme areas are expected to show improvement: environmental protection, nutrition surveys and Improvement In food safety, prevention and control of epidemic outbreaks, particularly Infectious diseases among children such as poliomyelitis, tetanus, encephalitis, tuberculosis, diarrhoeal diseases, strengthening of vigilance in the case of AIDS and a stricter control of sexually transmitted diseases and hepatitis B. Diseases such as tuberculosis, trachoma and especially malaria should show a steady decline. Morbidity and mortality rates should be reduced. Immunization targets have been well established as well as the expected reduction in morbidity and mortality for the six diseases preventable

VietNam

389

VietNam Health of the elder1y activities will be integrated within the primary health care programme. Activities will focus on the development of the gerontology centre and training. The prevention and treatment of mental and neurological disorders programme will be expanded. (5) National drug production will be further strengthened. Consideration will also be given to the provision of necessary medical equipment for peripheral health units such as instruments for communal health centres, intercommunal polyclinics and some equipment for district hospitals. This will include reagents and consumables to ensure routine analysis. Imports will be restricted to items which are necessary to get the Plan under way and which cannot be supplied at national level. In the light of the above, the following areas of collaboration are proposed during the period 1990-1991.

390 3.1 Health situation and trend assessment In order to better serve the health planning and evaluation process, support will be required to strengthen the health statistics network, particular1y with respect to basic equipment and methodology for data collection, Improve the analysis of data, and ensure the normal operation of the computer centre in the Ministry of Health.

3.2 Managerial process for national health development Support will be required for the strengthening of planning activities, including annual updating of the health services five-year plan from_central to peripheral levels, development of the programme of cooperation with WHO In matters of management, and Integration of the various cooperation programmes in order to improve efficiency.

PROPOSED WHO COLLABORATIVE HEALTH PROGRAMME 1990-1991 The collaborative activities will strongly support two main thrusts envisaged in the five-year plan for health 1988·1992: (a) strengthening primary health care activities; and (b) improving the quality of all aspects of health services. WHO will also collaborate in the improvement of health planning and evaluation through the development of a health statistics network, management training, health systems and the adoption of a relevant health legislation system. Development of human resources for health will be aimed at improving the quality of medical and auxiliary health personnel training in order to produce more appropriate community-oriented health professionals. Strong collaboration will continue in priority programme areas such as malaria, maternal and child health, family planning, clinical, laboratory and radiological technology for health systems based on primary health care, self-reliance in the production of essential drugs and vaccines and their quality, safety and efficacy. Special attention will also be given to disease vector control, immunization, blindness and deafness and oral health.

3.3 Health systems research and development Support Is required to Improve the organization of the health services from central to peripheral levels and to acquire experience In those organizational structures which will be more appropriate for national needs and priorities.

3.4 Health legislation WHO collaboration is required to develop an appropriate !1ealth legislation system in order to support the mandate given to the health authorities at the different levels of the system to preserve and maintain the health status through enforcement of needed laws. Experience will be gained from other neighbouring developing countries and through further training of local health and related authorities.

4. Organization of health systems based on primary health care WHO, together with UNICEF and other International organizations, has supported the development and strengthening ofthe country's grassroot health organization. It has cooperated actively in strengthening capabilities in the planning, monitoring and management of primary health care activities and has

given material support to Intercommunal polyclinics and laboratories and to 200 commune health centres. Continued support will be needed for the development of Infrastructure, Improvement of transport facilities for the referral of patients, training of staff, and development of research areas for further expansion to Inaccessible rural areas.

Collaborative activities are expected to focus on consolidation and reinforcement In the above areas and their extension to rural areas in the context of primary health care.

9. 1 Maternal and child health, Including family planning Support will be required for the control of acute rheumatic fever affecting children and its prevention. Activities are expected to involve other centres besides the Institute for the Protection of Mother and Newborn.

5. Development of human resources for health WHO has supported the strengthening of medical faculties and colleges of the Ministry of Health as well as a number of provincial medical colleges and technical colleges, and more recently seven new medical technical colleges for the training of lower level medical staff (district and commune) oriented towards primary health care. Continued collaboration Is required to re-equip some medical schools in the provinces and the health development centre, together with the Australian International Development Assistance Bureau (AI DAB), and to further develop training activities Inside and outside the country and the Region with a view to exchange of experiences.

9.4 Workers' health Collaboration Is expected to continue with more emphasis on protection of workers exposed to chemicals and on the important field of agriculture where the majority of the labour force works.

9.5 Health of the elderly Activities to improve the health care of the elderly are being gradually Integrated into primary health care.

6. Public Information and education for health Support will be required for the training of staff directly involved In primary health care activities and for the preparation of health education materials.

10.3 Prevention and treatment of mental and neurological disorders Collaboration Is required for the upgrading of staff capabilities through training programmes at home and abroad on organization, management and treatment as well as for the provision of specific drugs for mental patients.

8.1 Nutrition Activities for the improvement of the nutritional status of the population, particularly through training, will continue. UNICEF and the World Food Programme are also collaborating with this programme.

12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Support will be required for the further strengthening of clinical, diagnostic and therapeutic technologies for health services at various levels, including Intercommunal laboratories, biochemistry and haematology sections of upper level hospitals, training In maintenance and repair of medical equipment, and local production of Instruments.

8.2 Oral health The extensive support provided by WHO to this programme in the past has greatly contributed to its rapid development, including the formulation of a national strategy and plan of action for operative dentistry, training in appropriate dental care Jor :school children, preventive dentistry, oral health planning, support for the upgrading of dental clinics and training of dental auxiliaries, among others.

12.2 Essential drugs and vaccines Self-reliance will be promoted through the training of cadres in the management of drug distribution. Appropriate technologies will be developed

VietNam

391

VietNam for the production of traditional remedies from local raw materials. Support will also be required for the procurement of raw materials for local processing of drugs.

392 13.2 Disease vector control Further support is required for the training of quarantine services staff In vector surveillance and logistics. Courses need to be organized for mobile teams In the operation, maintenance and utilization of spraying equipment.

12.3 Drug and vaccine quality, safety and efficacy The quality control of drugs and vaccines will be further developed and reagents and technical equipment for these purposes will be standardized. Support will continue to be provided to the Institute of Drug Control and Standard Chemicals In Hanoi and Ho Chi Minh City, the vaccines control centre, a number of provincial drug control units and local training activities. Training in this discipline in appropriate countries is also envisaged.

13.3 Malaria Further collaboration Is required to develop and strengthen the already acquired technical capabilities of field staff through training to be provided at provincial level with respect to vector control techniques, resistance of the vector to DDT and pollution of the environment by insecticides. Appropriate coverage in terms of drugs, pesticides and equipment is also required.

12.4 Traditional medicine Basic equipment Is required for the production of traditional drugs using local raw materials to meet the needs of the expanding primary health care activities. New experiences In this field will be obtained through training programmes in neighbouring countries with experience in traditional medicine utilization.

13.4 Parasitic diseases Support Is required for the further development of technical expertise on filariasis epidemiology and control and detection at various centres of the network, evaluation of the effectiveness of new drugs and treatment schemes, and provision of anti-helminthics.

12.5 Rehabilitation Training in methodology and techniques for rehabilitation, particularly in the areas of occupational diseases and vascular diseases, will continue to be developed. Training courses will be organized for technicians from provincial hospitals.

13.6 Diarrhoeal diseases WHO collaboration Is expected to continue. There Is a need to apply advanced techniques for diarrhoeal disease prevention and treatment and epidemiological surveillance in provinces where appropriate conditions exist and to consolidate programme development during the biennium in the fields of management of diarrhoeal diseases and related activities. UNICEF support in this field is expected to continue.

13.1 Immunization Collaboration will be required in the expansion of the Immunization programme to the communes during 1990-1991. Support will be necessary for training activities, particularly in cold chain maintenance, and for provision of drugs, vaccines and cold chain equipment. There Is a need to upgrade the quality of vaccines currently produced and to study the feasibility of producing new vaccines. There is also a need to study the possibilities of local production of new vaccines, and to seek support for the strengthening of the cold chain, including training in cold chain maintenance and repair as well as exchange of experiences in neighbouring countries.

13.7 Acute respiratory Infections There Is a need for appropriate follow up and strengthening of activities undertaken in previous years In such areas as training and procurement of drugs, reagents and basic equipment. Further expansion and Integration with primary health care are envisaged. Although strong support Is expected from the Swedish International Development Agency and UNICEF, WHO collaboration is nevertheless required.

13.8 Tuberculosis Support will be-;needed for the strengthening of diagnosis and laboratory facilities at the Tuberculosis Institute and hospitals and for the training of staff through fellowships and local training activities. This programme Is strongly supported by The Netherlands. 13.13 AIDS Information on preventing the Introduction and spread of this disease In the country is necessary. Diagnostic test-kits are required.

be organized at provincial level on diagnostic techniques, education on prevention, and early diagnosis. 13.17 Cardiovascular diseases Collaboration Is needed to upgrade the Bach Mal Hospital as a support centre for Improving diagnostic procedures at the peripheral levels of the health network. 14. HeaHh Information support Health publications are required for dissemination to health workers. Exchange of Information with neighbouring countries will provide a broader perspective for future development.

Other communicable disease prevention and control actlvHies 13.14 Thanks to the growing effectiveness of primary health care in dealing with these diseases at peripheral level, the workload of the upper referral levels will diminish, making It possible to reduce the budgetary requirement. Nevertheless, continued support Is required for upgrading capabilities In the application of advanced techniques for the prevention and treatment of some certain prevalent diseases such as dengue haemorrhaglc fever, hepatitis, etc. Increased emphasis has been given to the strengthening of managerial and technical capabilities In vaccine production and development to cope with epidemics of dengue haemorrhaglc fever, Japanese encephalitis, viral hepatitis, etc. WHO collaboration will be required with respect to training, equipment of basic laboratory facilities, and reagents for the study of new vaccines at the National Institute of Hygiene and Epidemiology. 13.15 Blindness and deafness It is important to achieve the target of active trachoma reduction In order to prevent blindness and reduce morbidity. Requirements are for training courses, raw materials for drugs and Instrument sets for cataract operations. 13.16 Cancer The Cancer Institute requires support In terms of equipment and reagents for the detection and diagnosis of this disease. Training courses will

BUDGETARY IMPLICATIONS There are slgnlflcant Increases in the programmes on blindness and deafness, health Information support and more modest Increases In malaria, prevention and treatment of mental and neurological disorders, clinical!, laboratory and radiological technology for health systems based on primary health care, and essential drugs and vaccines In order to better support the accelerated development of priority areas. Two programmes considered of high priority are not Included. These are community water supply and sanitation and environmental health In rural and urban development and housing, which are strongly supported by UNICEF for the period 1988-1991. There Is a decrease In contributions requested for programmes such as oral health, health of the elderly, Immunization, diarrhoeal diseases, and tuberculosis due to assurances of future support from other sources and to the fact that these programmes are becoming self-sustaining or Integrated Into the basic health network. Three new programme areas have been Included, e.g. health systems research and development, health legislation, and AIDS. The first two are In response to the expected development of health systems based on primary health care and the third to the potential threat posed by this disease.

VietNam

393

394

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 1990-1991

Other sources (Decrease) %

Increase US$

1988-1989

1990-1991

Source of funds

US$

3. Health system development 3. 1 Health situation and trend assessment 3.2 Managerial process for national health development Costs of WHO Representative's Office, located In Hanoi, Viet Nam

50000

55 600

5 600

11.20

20000

22 200

2 200

11.00

336 700

393 500

56 800

16.87

3.3 Health systems research and development 3.4 Health legislation

16 700 16 700

4. Organization of heaHh systems based on primary heaHh care 867 000 900 000 33 000 3.81

5. Development of human resources for heaHh 700 000 722 300 22300 3.19 137 000 73300

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 US$ 6. Public Information and education for health 8. General health protection and promotion 8. 1 Nutrition 8.2 Oral health 20000 200 000 16 700 111 100 ( 3 300) ( 88 900) ( 16.50) ( 44.45)

Other sources (Decrease) %

199o-1991 US$

Increase US$

1988-1989 US$

199o-1991 US$

Source of funds

50000

55600

5 600

11.20

9. Protection and promotion of the health of specific population groups 9. 1 Maternal and child health, including family planning 9.4 Workers' health

50000 80000 80000

55600 88900 33 300

5600 8900 ( 46 700)

11.20 11.13 ( 58.38)

2 876 800

1 444 900

9.5 Health of the elderly

VietNam

395

396

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 US$ 10. Protection and promotion of mental health 10.3 Prevention and treatment of mental and neurological disorders

Other sources (Decrease) %

1990-1991 US$

Increase US$

1988-1989 US$

1990-1991 US$

Source of funds

55 000

88900

33 900

61.64

11. Promotion of environmental health 11. 1 Community water supply and sanitation 11.2 Environmental health in rural and urban development and housing 11.4 Control of environmental health hazards

39 800

( 39 BOO)

(100.00)

26100

(26100)

(100.00)

304 500

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 US$ 12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 12.2 Essential drugs and vaccines 12.3 Drug and vaccine quality, safety and efficacy 12.4 Traditional medicine 12.5 Rehabilitation 13. Disease prevention and control 13.1 Immunization 13.2 Disease vector control 13.3 Malaria VietNam 250 000 200 000 400 000 211 100 222 200 500 000 ( 38 900) 22 200 100 000 ( 15.56) 11.10 25.00 397

Other sources (Decrease) % 1988-1989 US$ 199G-1991 US$

199G-1991 US$

Increase US$

Source of funds

320 000 500 000

389 000 555 600

69000 55600

21.56 11.12

18600 9 700

w w

140 000 55 000 50 000

111 100 77 800 50 000

( 28 900) 22 800

( 20.64) 41.45

66200

398

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 199o-1991

Other sources (Decrease) % 11.20 ( 38.22) 11.20 ( 44.40) 27100 48600 1988-1989 199o-1991

Increase US$ 5600 ( 34 400) 5600 ( 44 400)

Source of funds

US$ 13.4 Parasitic diseases 13.6 Diarrhoeal diseases 13.7 Acute respiratory infections 13.8 Tuberculosis 13.9 Leprosy 13.13 AIDS 13. 14 Other communicable disease prevention and control activities 13.15 Blindness and deafness 13.16 Cancer 13.17 Cardiovascular diseases 50000 90 000 50 000 100 000

US$ 55600 55 600 55600 55600

US$

33 300

125 000 80000 50000 30000

133 300 166 700 55 600 33300

8300 86 700 5 600 3300

6.64 108.38 11 .20 11 .00

127900 41 000

w ST

Estimated obligations

VIETNAM Regular budget Programme 1988-1989 US$ 14. Health information support TOTAL- VIET NAM 1990-1991 US$ Increase US$ 40600 314 500 (Decrease) %

Other sources 1988-1989 US$ 1990-1991 US$ Source of funds

15 000 5 079 600

55 600 5 394100

270.67 6.19 3 730 700 1 444 900

VietNam

399

400

ANNEX3 REGIONAL AND INTERCOUNTRY ACTIVITIES

401

402

REGIONAL AND INTERCOUNTRY ACTIVITIES RE(2ULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMME

Man-years/morths

Estimated obligations

1988-1989

199G-1991

1988-1989 US$

199G-1991 US$

1988-1989

199G-1991

1988-1989 US$

1990-1991 US$

Governing bodies

1.3

Regional Committee

393 000

-2. WHO's general programme development and management

2.1 2.2 2.3 2.4

Executive management Regional Director's development programme General programme development External coordination for health and social development Health-for-all strategy coordination

8/00

8:oo

423500 903 ~000

440 000 922 000 1 582 800

40/00

4o:oo 10."00

1 463 400

10/00 8/00

305 400 571 600

317 500 1 062 500

2.5

a:oo

Regional and intercountry activities

403

Regional and intercountry activities

404

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months 1988-1989 199o-1991

·PROGRAMME

Man-years/months 1988-1989 199o-1991

Estimated obligations 1988-1989 199o-1991

Source of funds.

US$ 2.6

US$ 652 200

US$

Informatics management

20/00

26/00

332 400

-86/00

-92/00 3 999 400 4 977 000

- -

-3.

Health system development 3.1

Health situation and trend assessment Managerial process for national health development Health systems research and development Health legislation

18/00 6/00

10/00 4/00

1 050 600 401 400

750 BOO 297 500

1/00

162 400 3600 162 400 33 900

VI 110 500

3.2

AS DP VK ST

3.3

142 500

132 BOO 14000

46600

3.4

-24/00

-14/00 1 594 500 1 195 100

1/00

-408900 110 500

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMME

Man-years/months

Estimated obligations

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$ 1 686 100

1988-1989

1990-1991

1988-1989 US$ 288 200 79700 1 044 100

1990-1991 US$ 196 000 1 000 000

Organization of health systems based on primary health care

22/00

18/00

1 517 500

ST VD

-22/00 -5.

-18/00 1 517 500 1 686 100

-1 412 000 1 196 000 --

-28/00 1 533 600 1 346 700

-6/00

Development of human resources for health

24/00

2/00

51 100 57 500 52 700

18 BOO

AS ST VD

-24/00

-28/00 1 533 600 1 346 700

-6/00 -512 300 576 000

-2/00 161 300 18 BOO

-6.

-8/00

-2500

Public information and education for health Research promotion and development, including research on health-promoting behaviour

8/00

-4/00

- 4/00 654 200 736 500

-149 600

Regional and intercountry activities

405

Regional and intercountry activities

406

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMM E

Man-years/months

Estimated obligations

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

General health protection and promotion 8.1 8.2 8.3 8.4

Nutrition Oral health Accident prevention Tobacco or health

6/00 4/00

420 400 274 600 52 000

473 200 244 500 45 000 130 000

-747 000 892 700

10/00

10/00 --

-9.

Protection and promotion of the health of specific population groups 9.1

Maternal and child health, including family planning Workers' health Health of the elderly

4/00

248 300

286 500

8/00 21/00

6/00 20/00

71 900 1 021 600

64000 827 900

AS FP

9.4 9.5

98000 143 000 --

58 000 132 400 120 400

ST 891 900

-489 300 476 900 29/00

1 213 900

4/00 --

4/00

26/00

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMME

Man-years/months

Estimated obligations

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

10. Protection and promotion of mental health 10.1

Psychosocial and behavioural factors in the promotion of health and human development Prevention and control of alcohol and drug abuse Prevention and treatment of mental and neurological disorders

4/00

194 800

195 500

10.2

63000

48000

19100

ST VP

10.3

51 000

93 000

16 800

-4/00

-4/00 308 800 336 500

- --

-35900

-11. Promotion of environmental health 11.1

Community water supply and sanitation

8/00

740 100

353 000

Regional and intercountry activities

407

Regional and intercountry activities

408

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMME

Man-years/months

Estimated obligations

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$

11.2

Environmental health in rural and urban development and housing Food safety

1 452 100

2 348 100 2 700 ST

11.5

-8/00

-8/00 2 192 200 2 701 100

- --

- 2 700

12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Essential drugs and vaccines

- -

4/00 4/00

267 800 378 800

318 500 364 100 342 800 26100 64 700 102 4.00 211 100

12.2

DP FB ST VD

12.3 12.4

Drug and vaccine quality, safety and efficacy Traditional medicine

11 000 4/00 4/00 261 100

48100 292 700

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source of funds

PROGRAMME

Man-years/months

Estimated obligations

1988-1989

1990.1991

1988-1989 US$

1990.1991 US$ 73 500

1988-1989

1990.1991

1988-1989 US$

1990.1991 US$

12.5

Rehabilitation

57 500

-12/00

976 200 1 096 900

-536000 211 100

12/00 --

-13. Disease prevention and control 13.1 13.2 13.3 13.4 13.5

Immunization Disease vector control Malaria Parasitic diseases Tropical disease research Diarrhoeal diseases Acute respiratory infections

4/00 4/00 4/00 4/00

381 800 230 300 738 000 190 300

334 100 215 500 792 500 207 500

2/00

698100 17 400 8100 8400

VI VD VM ST FA FB

137 100 4/00 4/00 319 400

176 500 300 800

2/00 1/00 2/00 2/00

81 100 46400 467 700 12 500 28600

13.6

13.7

2/00

4/00

217 600

254 200

AS VD

Regional and intercountry activities

409

Regional and intercountry activities

410

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months 1988-1989 199Q-1991

PROGRAMME

Man-years/months 1988-1989 199Q-1991

Estimated obligations 1988-1989 199Q-1991

Source of funds

US$ 13.8 13.9 Tuberculosis Leprosy 79900 2/00 81 100

US$ 100 000 200 700 14 000 2/00 1/00

US$ 98600 94900 1 144 100 56 800 1 200 965 000

US$ AS ST 800 000 ST VL

13.11 Sexually transmitted diseases 13.13 AIDS 13.14 Other communicable disease prevention and control activities 13.15 Blindness and deafness 13.16 Cancer 13.17 Cardiovascular diseases 13.18 Other noncommunicable disease prevention and control activities 4/00

UF FX 500 000 ST VD ST

12/00

653 600 53 000 78 000 214 200

607 500 79000 144 000 34000

647 000 256 600 51 500

382 000

300 000

4/00

19000 3 393 300

200 500

-38/00

-42/00 3 660 800

-12/00

- 5 066 000 1 600 000

REGIONAL AND INTERCOUNTRY ACTIVITIES REGULAR BUDGET OTHER SOURCES Man-years/months Estimated obligations Source 1990-1991 of funds US$ ST

PROGRAMME

Man-years/months

Estimated obligations

1988-1989

1990-1991

1988-1989 US$

1990-1991 US$ 647 900

1988-1989

1990-1991

1988-1989 US$ 1 200

14. Health information support

24/00

592 000

-15. Support services 15.1 15.2

- 318 300 333 800 2/00

Personnel General administration and services Budget and finance Equipment and supplies for Member States

16/00

2/00

19 700

24000

104/00 42/00

104/00 40/00

2 43· 4 300 493 900

2 849 700 540 500 4/00 6/00

1 151 100 47900

800 000 82200

AS AS AS

15.3 15.4

12/00

14/00

222 700

255 100

3/00

54800 --

-174/00

- 174/00 3 469 200 3 979 100

9/00

8/00

1 273 500

906 200

- Total-Regional and intercountry

- 442/00 22 372 500 24 702 300

-36/00 10 263 500 4 934 500

442/00

57/00

Regional and intercountry activities

411

412

ANNEX4 SUMMARY OF INTERCOUNTRY ACTIVITIES- 1990/1991

413

414

SUMMARY OF INTERCOUNTRY ACTIVITIES- 1990/1991 2.2 Regional Director's development programme health-for-all leadership will be organized in Manila in 1990, to be followed up by national meetings to be held in selected countries in 1991.

As in previous years, the funds provided under this heading will be used to finance collaborative programmes with governments which could not be foreseen when the programme budget proposals were being developed, and also to provide seed money to enable genuinely innovative programmes or other important activities to commence, Including those that are likely to attract substantial extrabudgetary funding.

2.6

Informatics management

2.3

General programme,development

Provision is made for continuation of an intercountry project to improve the managerial and technical skills of WHO staff In order to provide better support to countries in their efforts to implement health-for-all strategies. Emphasis will be given to (a) briefing and orientation and (b) technical and management training, including language and communications training and computer training. The project includes provisions for a programme manager, consultants and individual and group.training activities.

The project on health informatics support will be the principal instrume nt for implementing the informatics management programme in support of Member States. The objectives are: (a) to strengthen and develop national policies and strategies for health informatics applications; (b) to strengthen the basic infrastructure necessary for utilization of informatics technology; (c) to develop and test efficient and effective informatics technology applications to health system management; and {d) to improve access to and use of international data bases and other informatics/telematics resources. The project provides for consultants who will coordinate activities on national health informatics policies and strategies in selected countries. A meeting of national focal points in informatics will be convened in 1990, to be followed up by national workshops in 1991 . Research for the development of a model primary health care management information system will also be supported.

2.5

Health-for-all strategy coordination

3.1

Health situation and trend assessment

To strengthen health-for-all leadership capabilities of national staff, a project for health -for-all leadership development has been included. Collaboration under this project will relate to (a) improving managerial and communication skills of national staff; (b) enhancing the training capabilities of national institutions for health-for-all leadership through communications development; (c) in-depth orientation on health-for-all policies/strategies and on WHO's programme of cooperation with Member States; (d) support to monitoring and evaluation of health-for-all strategies. The project includes provision for a Technical Officer who will be responsible for programme development and management. Fellowships for management and communication skills training are provided for. A regional colloquium on

Provision is made for the continuation of an intercountry team on epidemiological surveillance and disease control in the South Pacific, with an epidemiologist and a technical officer stationed in the South Pacific. The project aims to: (a) promote the development of epidemiological and related services; (b) promote improvement of the quality of epidemiological surveillance and of control services against priority diseases such as immunizable diseases, diarrhoeas, acute respiratory infections, filariasis, arboviruses, sexually transmitted diseases and noncommunicable diseases; (c) support training in epidemiology, including the control of diseases; and (d) support coordination of international aspects of disease control. In addition

Summary of intercountry activities- 1990/1991

415

Summary of intercountry activities- 1990/1991

416

to technical support provided by the team, the project includes provisions for local costs to support national courses on epidemiological surveillance for countries or areas in the South Pacific, as well as other countries or areas in the Region, and supplies and equipment for strengthening surveillance. An intercountry project on health information systems development has also been included, which aims to develop capabilities in Member States in the collection, analysis and use of health information for identification of priority health and management problems, and their trends, to support health systems management. Collaboration will be provided through consultants and support of national workshops on health/medical records/minimum basic data sets in selected countries.

3.4

Health legislation

A new project has been included which will supP.ort .countries i~ the revision of existing legislation or development of new leg1slat1on to prov1de a sound legal basis for health-for-all policies and strategies.

Organization of health systems based on primary health care

3.2

Managerial process for national health development

Provision is made for continuation of an intercountry project to support countries or areas in the development of their managerial process for national health development. In 1990-1991, collaboration under the project will be provided in strengthening of health development networks to support management training, the strengthening of health sector financial planning mechanisms, and in national training for district level management, financial management and participative decision-making. A workshop on health sector financial planning will be held in 1991. Technical support to the regional programme will be provided through a Technical Officer.

Provision is made for the continuation of a project for the development of health systems based on primary health care, using a team consisting of a medical officer, a scientist and two statisticians. The project has the following objectives: (a) to expand population coverage with systems based on primary health care through the strengthening of district health systems in support of peripheral primary health care units; (b) to implement/strengthen mechanisms for effective community participation and intersectoral collaboration for health development; (c) to strengthen managerial and research capability to monitor, evaluate and reformulate health systems development programmes; (d) to promote technical cooperation among countries in formulating, implementing, monitoring and evaluating health systems development programmes. Provision is made for the continuation of a project on hospital management, design and maintenance, aimed at developing national self-reliance in the planning, design, management and maintenance of health facilities. A technical officer will be available to collaborate with countries or areas in training and other activities related to the planning, design and management of health facilities. Consultants will be provided for maintenance and repair of biomedical equipment and for hospital planning, management and maintenance. National workshops in hospital management and maintenance and research in planning of district hospitals will be supported.

3.3

Health systems research and development

The intercountry activities include provision for continuation of a project on health systems research and development. Aiming to promote and support the development of national capabilities to plan, implement and use health systems research as part of the managerial process for national health development, the project will provide technical support to countries in strengthening networks and collaborating centres for health systems research training, exchange of information and conduct of priority research. A workshop on health systems research will be convened in 1991.

Development of human resources for health

Provision is made for the support of health personnel and faculty development through fellowships for individual training and study tours and for participation in various educational meetings.

The programme also includes an intercountry project concerning health manpower development for the twenty-first century, which aims to develop national capabilities in order to: (a) ensure rational, efficient and effective utilization of available human resources for health by formulating country-specific policies and plans on the basis of long-term needs and objectives; (b) implement community-based, competence-based and problem-based education of human resources development for health in support of health-for-all strategies through primary health care, by widening the scope of the national teacher training centres (NTTC) from a purely "educational" orientation towards the concept of human resources development for health; (c) evaluate relevance and effectiveness of educational and training activities in support of health-for-all strategies through primary health care by assessing health personnel performance standards; (d) ensure continuous professional staff development of training institutions in educational planning and technology. Collaboration under this project will be provided mainly through support of national and regional training programmes and through consultants as well as fellowships, supplies and equipment in different areas to help countries achieve the above objectives. Efforts will be made to collect and disseminate information on the health manpower situation in the Region. A meeting of national fellowship officers will be convened in 1990 to review current practices in the selection, placement, utilization and evaluation of WHO-supported fellowships aimed at relevance and the achievement of health for all. A new project for strengthening nursing service and education in the South Pacific has been included under this programme. The project aims to strengthen national capabilities in nursing in the South Pacific: (a) to improve the health status and quality of human life through the provision of relevant and effective primary, secondary and tertiary nursing services in all settings of health care, including homes, communities, schools, health centres, clinics and hospitals; (b) to specifically reduce maternal, infant and child mortality and morbidity, and to promote the physical and psychosocial welfare of the total population through the allocation of the required nursing resources to primary health care, giving attention to health promotion, health maintenance and disease prevention; (c) to study and to take effective measures to strengthen nursing leadership which will effectively participate in planning of health services and will manage the countries' health resources for priority services at all levels of the health care system. Technical support under the project will be

provided mainly through a Nurse Educator/Administrator based in Suva, Fiji. Consultants for national training of nursing system managers and for strengthening nurse practitioner/community nurse programmes will also be provided.

Public information and education for health

Provision is made for continuation of a project for strengthening training in health education. The project includes provisions for consultants in the area of health education services, school health education and health behavioural research. National workshops for strengthening national capabilities in health education will also be supported. Provision has also been made for continued support in the development and implementation of communication and public information strategies to promote healthful life-styles and to strengthen advocacy for health. Support will be provided in the design and production of educational and publicity materials, the conduct of national workshops for improving technical capabilities-in' media production and the dissemination and exchange of information on health related issues.

Research promotion and development, including research on health-promoting behaviour

To promote research related to health, provision is made for the continuation of a project on research promotion and development, which includes provisions to cover the work of the Western Pacific Advisory Committee on Health Research, the award of research grants and research training grants to individuals and to institutions for the carrying out of specific research activities. The WHO Regional Centre for Research and Training in Tropical Diseases, based in Kuala Lumpur, will continue its biomedical research and training activities in order to develop improved control methods for the major communicable diseases, especially parasitic diseases, prevailing in the Region. The project includes provisions for a scientist (research), consultants in biomedical research and research training activities, research training grants and local costs to support group training activities.

Summary of intercountry activities- 1990/1991

417

Summary of intercountry activities- 1990/1991

418

8.1

Nutrition

8.4

Tobacco or health

Provision is made for the continuation of a project aimed at developing national capabilities in countries or areas of the Western Pacific Region in order to: (a) promote and support improvement of the nutritional status of all sectors of the population ; (b) significantly reduce the incidence of specific nutritional deficiencies; and (c) study and take effecttve measures to correct causative nutritional factors of noncommunicable diseases, especially cardiovascular diseases, cancer and metabolic diseases. Support will be provided through a medical nutritionist, consultants, national workshops to develop nutrition programmes, research grants, and provision of technical and educational materials. A regional seminar on nutrition education in training institutions will be convened in 1991.

Provision is made for a new project on tobacco or health. The project will promote legislative action to restrict the use of tobacco, support education of the public with emphasis on the inclusion of health education in the school curriculum at primary and secondary levels, train health workers at all levels explaining In the hazards of tobacco use, and support surveys of tobacco use. Support will be provided through consultants for the development of national programmes and legislation, the provision of educational materials, and the support of national workshops and research on tobacco trends. A regional working group on tobacco or health will be convened in 1990.

9.1

Maternal and child health, including family planning

8.2

Oral health

Provision is made for the continuation of a project on oral health which aims: (a) to promote the development of appropriate infrastructure and organization which will result in increasing effectiveness in the operation of oral health programmes and in full coverage of population; (b) to promote,and to collaborate with national counterparts in, the development and implementation of preventive activities in order that the level of dental caries and periodontal disease can be reduced and controlled; (c) to promote the training of appropriate manpower and the utilization of appropriate technology for oral health programmes. Support will be provided through consultants on fluoridation and defluoridation problems, training and utilization of dental auxiliaries and promotion and development of appropriate preventive activities, and the provision of supplies and equipment. Support will also be provided to countries undertaking national dental surveys and the evaluation of programmes.

An intercountry project on the strengthening of maternal and child health/family planning is included, with the following objectives: (a) to strengthen the family health services at all levels of the health care delivery system, in the context of primary health care. particularly those for women of child-bearing age, infants, young children and adolescents; (b) to develop national tnanpower capability in order to reduce maternal, perinatal , infant and child hood mortality and morbidity; (c) to improve the physical and psychosocial development of children and adolescents and the health of the reproductive age group. Collaboration will be provided In strengthening national programmes for population coverage with maternal and child health care, and in promoting research on causes of maternal death, perinatal morbidity and mortal ity. A regional workshop on evaluation and monitoring of maternal and child health/family planning programmes will be organized in 1991 . A request will be made to UNFPA for continued support of the intercountry family health project to enable it to continue to cooperate with countries or areas in the field of maternal and child health/family planning.

8.3

Accident prevention

Provision is made for the continuation of an intercountry project aimed at promoting the development of national road traffic accident prevention programmes. Support will be provided to countries or areas for the development of national programmes, including national workshops in selected countries.

9.4

Workers' health

Provision is made for continuation of an intercountry project aimed at promoting the development of occupational health services integrated Into the general health systems and the improvement of working conditions, particularly

for workers in small-scale industries and in agriculture. The project includes provisions for consultants for strengthening national workers' health programmes, local costs for national seminars and training courses, and support for the promotion and strengthening of research in workers' health.

10.3

Prevention and treatment of mental and neurological disorders

9.5

Health of the elderly

An intercountry project will continue which will aim at improving the well-being and quality of life of the aged through the provision of community-based health services. To extend technical support to countries, consultants will be provided for the development of geriatric services in countries and for promotion of geriatric and gerontology education. A meeting on training in geriatrics and gerontology will be convened in 1990. Studies and research on priority problems of the elderly will be supported.

A project on the promotion of mental health/neurosciences is included, aimed at promoting policies and programmes on mental and neurological disorders within the framework of national mental health programmes. The project includes provisions for consultants to support the development of mental health policies and programmes and local costs for meetings of national coordinating groups. The 4th meeting ofthe Regional Coordinating Committee on Mental Health will be convened in 1990.

11.2

Environmental health in rural and urban development and housing

10.1

Psychosocial and behavioural factors in the promotion of health and human development

An intercountry project is included which aims to promote health and human development, taking into account psychosocial factors. Technical support will be provided for national efforts to promote healthy psychosocial development and for training health workers and planners in psychosocial aspects of health.

10.2

Prevention and control of alcohol and drug abuse

This programme includes an intercountry project on prevention and control of alcohol and drug dependence, which aims to reduce the problems related to alcohol and drug abuse in the Region and to incorporate policies and programmes for the prevention and management of alcohol and drug abuse into national health strategies. The project includes provisions for consultants who will support the strengthening of national programmes as well as national training activities. Research on the development of prevention and control methods for drug abuse and alcohol-related problems will be supported.

The Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) will continue to cooperate in activities aimed at: (a) promoting and facilitating collaboration between environmental institutions and personnel of WHO Member States within WPRO; (b) supporting Member States in the development of self-reliant institutions, planning capabilities in the field of environmental planning and human health, environmental health policies and environmental manpower; (c) promoting the exchange of environmental information oriented to human health and well-being; (d) promoting the identification and adaptation of appropriate technology in the field of environmental health control and engineering; and (e) providing a recognized and visible regional focal point for promotion of environmental planning and protection. Collaboration will be provided through technical support for the following: the development of national policies and plans for environmental health; the provision of technological and administrative expertise in various fields, such as control of air, land and water pollution, industrial and solid wastes management, hygiene of housing, food safety, and environmental impact studies; the development of environmental health and resource protection manpower; information services; and environmental management programme development. The project includes provision for a director, three environmental engineers, an environmental systems engineer, a sanitary engineer and a food hygiene and

Summary of intercountry activities- 1990/1991

419

Summary of intercountry activities- 1990/1991 safety officer. Provision is also made for consultants in various specialized fields, support for training courses, information consolidation and processing, and applied studies. In addition, the Centre will organize the following training activities during the biennium: a regional seminar on integrated planning for environmental health, a regional workshop on chemical accidents and model legislation for chemical safety and hazardous wastes, a regional seminar on foodborne diseases, and a regional seminar on community water supply and sanitation. With the completion of the International Drinking Water Supply and Sanitation Decade in 1990, support for post-Decade activities will also be provided through the Centre.

420

provided in the area of formulation, procurement, distribution, inventory control and information for the rational use of drugs. An intercountry project for the South Pacific countries or areas is also included. Collaboration will be provided with respect to technical and administrative management of drugs, including distribution to the periphery, the exchange of information on drugs among governments concerned, and training of personnel in the field of drug management.

12.3

Drug and vaccine quality, safety and efficacy

12.1

Clinical, laboratory and radiological technology for health systems based on primary health care

The programme includes an intercountry project on health laboratory technology, aimed at developing or strengthening national health laboratory services in order to meet the diagnostic, case management and monitoring needs of curative and preventive medicine, using economical and effective techniques, with particular emphasis on support for primary health care. Through consultants, collaboration will be provided in promoting standardization of laboratory procedures and the establishment of a network for antibiotic susceptibility testing. A regional workshop on quality assurance for blood transfusion and blood screening tests will be organized in 1990. An intercountry project on radiation health has also been included which will provide support in the development of national basic radiological services, and the training of radiological personnel. The local promotion and production of basic radiological systems will also be supported.

The intercountry project aims to monitor and maintain the quality, safety and efficacy of pharmaceutical products needed by the health system. The project provides for consultants to cooperate in national programmes for drug quality assurance, drug monitoring and drug information. A workshop on drug information exchange will be organized in 1990. National workshops on drug quality assurance will be supported.

12.4 Traditional medicine The intercountry project aims to promote and support the incorporatio and integration of traditional medicine practices into the general health system, particularly in primary health care. Support will be provided for traditional medicine studies, the training of health workers, and exchange of information on traditional medicine. The project includes provisions for a medical officer, consultants, local costs to support national workshops, and research grants. A regional working group on herbal medicine will be convened in 1990.

12.2

Essential drugs and vaccines

12.5

Rehabilitation

Provision is made for the continuation of a project on essential drugs, vaccines and biological products, which aims to ensure the availability of essential drugs and vaccines of adequate quality at an affordable cost. Activities will be directed towards the development of drug policies that will ensure optimum utilization of finance and manpower. Technical support will be

The intercountry project on community-based rehabilitation aims to promote and support the development of community-based rehabilitation services and appropriate rehabilitative technology. Support will be provided to governments with respect to: planning and management of community-based rehabilitation programmes; promoting intersectoral coordination in the

development of community-based rehabilitation services; training of national staff; and exchange of information. A working group on planning and management of community-based rehabilitation will be convened in 1990.

13.3

Malaria

13.1

Immunization

The intercountry programme provides for continuation of a team comprising a medical officer, technical officer and field development officer, who will cooperate with countries or areas in national training activities and in the review and evaluation of national immunization programmes. The services of this team are shared with the diarrhoeal diseases control programme (see page 422). The objectives of the project are: (a) to reduce morbidity and mortality from diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis by further strengthening the delivery of immunization services within the context of comprehensive health services; (b) to promote regional self-reliance in terms of vaccine quality control and production; (c) to further develop cold chain systems, including their management, maintenance and repair; (d) to promote evaluation on the cost effectiveness of the national programmes; (e) to continue to develop efficient surveillance system for EPI target diseases. The project also includes provisions for consultants for the conduct of programme reviews, the supply of training materials and cold chain equipment, local costs to support national training activities, and research grants for cold chain equipment testing.

The programme provides for the continuation of the regional antimalaria team, consisting of a scientist and parasitologist based in Kuala Lumpur, who will: (a) provide technical expertise in support of national malaria control programmes as required, with emphasis on the projects in Malaysia, the Philippines and countries in the Indochina peninsula and the south-west Pacific; (b) cooperate in regional and national malaria training programmes; and (c) promote field research activities. Provision for continuation of a malaria training project has also been included. The project will provide training in malariology for professional and senior technical health personnel in the Region and in particular: (a) will organize, and cooperate in the organization of, group educational activities for malaria at regional and national levels; (b) will provide fellowships/grants to malaria workers on an ad hoc basis, as and when required. The project includes provisions for consultants, fellowships, supplies and equipment and local costs to support national workshops for malaria personnel at the central, provincial and district levels.

13.4

Parasitic diseases

13.2

Disease vector control

The programme provides for continuation of an intercountry project aimed at strengthening national vector-borne disease control programmes in the Region in order to: (a) reduce the abundance of mosquitos, other insect vectors and rodents of public health importance; and (b) minimize disease transmission of filariasis, dengue haemorrhagic fever, malaria, Japanese encephalitis and other vector-borne diseases. The project will provide support for strengthening community-based vector control operations and national training and field activities on vector control.

Provision is made for the continuation of a project which aims to strengthen support to national programmes for the control and surveillance of ma:jor endemic parasitic infections in the Region, and in particular: (a) to prevent and progressively control some of the major human parasitic diseases such as schistosomiasis, filariasis, clonorchiasis, paragonimiasis and protozoal and helminthic infections; (b) to sustain the gains achieved by chemotherapy through improved hygiene and sanitation, alteration of the environment and control of intermediate hosts, within the context of primary health care. The project provides for a parasitologist, supported by consultants, who will collaborate with countries where infections are endemic in the planning, implementation and assessment of national control programmes. National training activities will also be supported.

Summary of intercountry activities- 1990/1991

421

Summary of intercountry activities- 1990/1991

422

13.6

Diarrhoeal diseases control

This intercountry project aims: (a) to reduce mortality and malnutrition related to diarrhoea, particularly in children under 5 years of age; (b) to reduce morbidity from acute diarrhoea by promoting feeding practices, food hygiene, environmental sanitation and disease surveillance (the promotion of research will also be essential to identify appropriate control measures); (c) to promote national self-reliance in the implementation of the control programme on diarrhoeal diseases, using the primary health care approach. This project shares with the immunization project (see page 421) the provision for a team comprising a medical officer, a technical officer and a field development officer who will support countries or areas in diarrhoeal disease control activities, in addition to activities of the immunization programme. The project also includes provisions for consultants, supply of training materials and emergency supplies of oral rehydration salts, and local costs to support national training activities.

control. The project includes provisions for consultants in the areas of programme evaluation, BCG vaccination assessment, and BCG production. Support will also be provided for national training activities and improvement of laboratory services. Continued support will be given to the WHO/Japan International Tuberculosis Course.

13.9

Leprosy

13.7

Acute respiratory infections

Provision has been made for the continuation of a project which aims at reducing mortality from severe cases of acute respiratory infections, particularly pneumonia in children by introducing prevention and control measures at the community level with emphasis on proper case management. Collaboration will be provided mainly through a medical officer and consultants who will cooperate in the planning, development and evaluation of acute respiratory infection programmes at country level. Support will also be provided to national training and health education activities. A workshop for national programme managers will be organized in 1991.

Provision is made for the continuation of a project aimed at providing collaboration in the following areas: (a) the development of effective leprosy control programmes in specified countries or areas of the Region; (b) the planning, implementation and evaluation of WHO-recommended multid~ug therapy; (c) the training programme for health workers; (d) health educatton activities related to leprosy control to ensure complete treatment and community awareness and participation in programme delivery. The project provides for a medical officer who will provide cooperation in the development of effective leprosy programmes throughout the Region. Support will also be provided for national training activities and for strengthening of laboratory services.

13.11 Sexually transmitted diseases An intercountry project on control of sexually transmitted diseases has been included, which will provide support to countries, through consultants, in strengthening national control programmes on sexually transmitted diseases and in strengthening epidemiological surveillance, particularly laboratory support.

13.8

Tuberculosis control

Provision has been . made for continuation of a project which will provide support to countries or areas in the following: (a) the planning, implementation and evaluation of national tuberculosis control programmes; (b) the training of health workers in tuberculosis control; (c) the training of trainers, programme managers and senior health officers of Member States in the effective management of tuberculosis control programmes; (d) the integration of tuberculosis control programmes through the primary health care approach, especially at the district level; (e) the production of quality BCG vaccine for use within the Region; (f) health systems research on tuberculosis

13.14 Other communicable disease prevention and control activities The programme includes an intercountry project on the development of new programmes on communicable diseases, with the following objectives: (a) to prevent or control bacterial, viral, rickettsial and mycotic diseases for which separate programmes do not exist but which are of public health importance; (b) to promote training in the surveillance and control of these diseases; (c) to provide prompt and effective collaboration when an alarming incidence of these diseases occurs. Provision has been made for consultants who will cooperate with countries in activities relating to dengue fever/dengue

haemorrhagic fever, viral hepatitis, Japanese encephalitis and haemorrhagic fever with renal syndrome. Research activities for the development of Japanese encephalitis and haemorrhagic fever with renal syndrome vaccines will be supported.

cardiovascular diseases with diabetes mellitus control and prevention where both are major health problems; (c) supporting exchange of information, knowledge and coordination among WHO collaborating centres and other research institutions.

13.15 Blindness and deafness Provision has been made for an intercountry project which aims: (a) to reduce avoidable and curable blindness, promote eye health and make adequate eye care available to all, especially underserved rural and urban communities; (b) to decrease the Incidence and consequences of hearing impairment, especially in its profound and severe forms. The project provides for consultants who will cooperate with countries or areas in developing blindness information systems and applied research and in the assessment of the extent and causes of deafness, development of primary prevention programmes and promotion of health education activities. Support will also be provided for national training activities, research on ophthalmology and deafness epidemiology and for studies on specific problems in blindness and deafness.

13.18 Other noncommunicable disease prevention and control activities Provision has been made for an intercountry project on metabolic diseases, especially diabetes mellitus, which will provide support for the development of community control programmes, integrated into the existing primary health care system, and the development of educational materials on other noncommunicable disease prevention and control activities. Local costs to support national workshops will also be provided.

14.

Health information support

13.16 Cancer An intercountry project on cancer control will continue and will cover: (a) development of primary prevention activities for liver cancer, lung cancer and mouth cancer; (b) development of appropriate technologies for cancer control and management; (c) continuing support for training of health personnel; and (d) promotion of cancer pain control programmes at the country level. The project includes provisions for consultants and local costs to support national workshops on cancer prevention and control. A regional seminar on cancer epidemiology and control will be organized in 1990.

The programme includes a project with a prov1s1on for the dissemination of books, documents and other teaching materials to public health workers and teaching institutions. Provision has also been made for support of a regional biomedical information project with the following objectives: (a) to strengthen and develop national capacities in biomedical and health literature resources and services through institutional strengthening and training, particularly in information processing technology of key staff in developing Member States; (b) to develop and test efficient and effective procedures for information selection and extraction, storage and retrieval and for information dissemination; and (c) to improve access to national and regional health and biomedical literature and to facilitate the production of regional medical indices of journals and fugitive literature. The project provides for consultants on library and information science and local costs to support national workshops on library networking and resource sharing. A regional meeting of focal points for biomedical information will be held in 1991 .

13.17 Cardiovascular diseases Provision has been made for the continuation of an intercountry project for prevention and control of cardiovascular diseases, which will focus on: (a) promoting preventive activities emphasizing nutrition, physical activity and non-smoking; (b) promoting integration of prevention and control activities for

Summary of intercountry activities- 1990/1991

423

424

ANNEX 5 CLASSIFIED LIST OF PROGRAMMES FOR THE PERIOD OF THE EIGHTH GENERAL PROGRAMME OF WORK

425

426

CLASSIFIED LIST OF PROGRAMMES FOR THE PERIOD OF THE EIGHTH GENERAL PROGRAMME OF WORK A. 1. DIRECTION, COORDINATION AND MANAGEMENT Governing bodies 1.1 1.2 1.3

B. 3.

HEALTH SYSTEM INFRASTRUCTURE Health system development 3. 1 3.2 3.3 3.4 Health situation and trend assessment Managerial process for national health development Health systems research and development Health legislation

World Health Assembly Executive Board Regional committees

WHO's general programme development and manageme,t 4. 2.1 2.2

Organization of health systems based on primary health care Development of human resources for health Public information and education for health HEALTH SCIENCE AND TECHNOLOGY

2.3 2.4 2.5 2.6

Executive management 1 Director-General's and Regional Directors' Development Programme General programme developmenr2 External coordination for health and social developme1t3 Health-for-all strategy coordination Informatics management

5. 6. C.

7. 1ncludes Director-General's office, Regional Directors' offices, officES of Assistant Directors-General with Headquarters Programme Committee secretariat, offic~ of the Legal Counsel, and Internal Audit. 2 1ncludes Directors of Programme Management in regional offices, t•e Managerial Process for WHO's Programme Development, and Staff Development and Traini 1g. 3 1ncludes collaboration within the United Nations system, with other orgoanizations and with multilateral and bilateral programmes, and emergency preparedness and rranagement. 1

Research promotion and development, including research on health-promoting behaviour General health protection and promotion 8. 1 8.2 Nutrition Oral health

Classified list of programmes

427

Classified list of programmes 8.3 8.4 Accident prevention Tobacco or health 12.2 Essential drugs and vaccines 12.3 Drug and vacci. ne quality, safety and efficacy 12.4 Traditional medicine 12.5 Rehabilitation

428

Protection and promotion of the heahh of specific population groups 9.1 9.2 9.3 9.4 9.5 Maternal and child health, including family planning Adolescent health Human reproduction research Workers' health Health of the elderly

13. Disease prevention and control 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13. 12 13.13 13.14 13. 15 13.16 13.17 13.18 Immunization Disease vector control Malaria Parasitic diseases Tropical disease research Diarrhoeal diseases Acute respiratory infections Tuberculosis Leprosy Zoonoses Sexually transmitted diseases Research and development in the field of vaccines AIDS 1 Other communicable disease prevention and control activities2 Blindness and deafness Cancer Cardiovascular diseases Other noncommunicable disease prevention and control activities

10. Protection and promotion of mental health 10. 1 Psychosocial and behavioural factors in the promotion of health and human development 10.2 Prevention and control of alcohol and drug abuse 10.3 Prevention and treatment of mental and neurological d isorders

11. Promotion of environmental health 11.1 11.2 11.3 11.4 11.5 Community water supply and sanitation Environmental health in rural and urban development and housing Health risk assessment of potentially toxic chemicals Control of environmental health hazards Food safety

12. Diagnostic, therapeutic and rehabilitative technology 12.1 Clinical, laboratory and radiological technology for health systems based on primary health care

1 The acronym AIDS stands for acquired immunodeficiency syndrome. The term is used to represent the entire spectrum of health problems associated with infection with the human immunodeficiency virus (HIV) and related retroviruses. 2

1ncluding smallpox post-eradication surveillance.

PROGRAMMESUPPORT

14. Health information support 1 15. Support services

15.1 15.2 15.3 15.4

Personnel General administration and services Budget and finance Equipment and supplies for Member States

1ncludes WHO's publications and documents and health literature services_

Classified list of programmes

429

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Technical Documents

Дата принятия 31 декабря 1988 г.

Источник Всемирная организация здравоохранения