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WORLD HEALTH ORGANIZATION
ORGANISATION MONOIALE DE LA SANT~
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITI'EE Nineteenth Session Manila 1-8 October 1968 Provisional agenda item 14
WPR,!RC19/6 16 August 1968 ORIGINAL: ENGLISH
INTEGRATm) PIANNING IN HEALTH: REPORT ON NON-GOVERNMENTAL ORGANIZATIONS INTERESTm) IN HEALTH, AND HEALTH PIANNING PRACTICES IN THE WESTERN PACIFIC REGION
Report by the Regional Director 1 INTRODUCTION
The Regional Committee, dUring its eighteenth session, noted the existence in countries and territories in the Western Pacific Region of many manpower and financial resources, which are not related to the usual governmentally-supported national and international organizations but which have an important bearing on the health programmes of Member countries. It recognized that as national health planning becomes increasingly recognized and practised as an important administrative function of health departments, these resources would have an even more important role to play in the health services of' countries. recommending that Member governments: "(1) in initiating and developing national health
In making
these observations, the Regional Committee adopted resolution WPR,!RC18.Rl
planning programmes, include and involve the early partiCipation and utilization of these additional resources; "(2)
involve and utilize the assistance of \'JHO in
such planning and developmental activities;
I" (3)
intono •••
WPR/RCl9/6 page 2
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"(3)
inform the Regional Director of the action
taken so that a report can be sul::mi tted to the nineteenth session of the Regional Committee." The purpose of this paper is to report on the information received
from Member governments. 2 METHOD USED
Early in March 1968, a questionnaire was sent to national and territorial health administrations requesting information on nongovernmental resources for health and on current health planning practices, including attitudes on international assistance in this field. The questionnaire described the private (or non-governmental) organization as follows: (a)
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it is self,.governing as it operates according to its o"m charter and by-laws; its activities are directed entirely or partially to the field of health; its budget is derived from individual sources (e.g., foundations, philanthropies) and/or the resources of voluntary, civic, professional, commercial/ industrial and such similar groupings in the country and! or from the outside;
(b) (c)
(d)
it is to be distinguished from the semi-official organization, which is financed partly from government funds and is responsible to a certain extent to the appropriate government agency on fiscal and/or operational matters.
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l'IESULTS
Replies were received from 23 of the 32 governments to whom the letter was addressed. Two (2) governments stated that they could not provide the information requested. Nineteen (19) of the 21 replies received (representing a 65% response from governments) contained information on both private /organizations
wPR/RC19/6 page
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organizations and health plDl'Uling practices; 2 contained no information on health planning practices. 3.1 Information on private organizations 3.1.1 Areas of activity in health The questionnaire had suggested a classification under such broad organization groupings as: (a) (b) (c) (d) (e) (f) (g) (h) voluntarJ health, voluntary social, civic, private foundations and philanthropies, religious medical and allied professional, commerce and industry, others. ~1h1ch
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As the replies were not uniform, it was considered convenient to group the 818 organizations in the 21 countries to area of activity: (a) (b) (c) Medical care (hospital, dispensary, first-aid treatment, medical research), 558 (68%); Maternal and child health (maternity, maternal and child health clinic and family planning), 96 (12%); Welfare ( child nutrition, child welfare, aged l'1elfare, rehabilitation of the crippled, l'1elfare of the handicapped, association for retarded children, wounded veterans rehabilitation, other rehabilitation associatiOns, lepers welfare, nutrition welfare, Red Cross relief, tuberculosis welfare, miscellaneous organizations for welfare and for disaster relief), 86 (10%); (d) Public health (blindness prevention, cancer control, leprosy control, mental health, parasite control, tuberculosis control. venereal diseases control, nutrition, nursing care, miscellaneous health activities), 39 (5%); / (e ) Training ••• replied, according
WPR/RC19/6 page 4 (e) Training and staff development (training organizations for physicians, nurses and other health personnel, medical and paramedical associations), 22 (3%); (f) Unclassified, 17 (2%). It will be observed The distribution of organizations according to area of activity in 21 countries or territories is shown in Annex 1. that there is a wide range in the number of organizations reported which, on the basis of the known size, population, resources and stage of development of some of the countries listed, would reflect under-reporting. In one country, information from only one state was received.
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3.1.2 Approximate annual cost of services provided Only 101 organizations (12%) reported their annual expenditure which gave an aggregate total of $9 192 600. activity showed the following: (a) (b) (c) (d) (e) Medical care Public health Welfare J:'.laternal and child health Training and staff development Although not representative of the organizations as a whole, a breakdown of the costs by
$ 4 911 600 2 423 400 1 194 200 591 700 71 700
53.4% 26.4% 13.0% 6.4%
0.8% The distribution of expenditures by country/territory is given in Annex 2. It was noted that 80 (10%) of the organizations are financed from outside of the country , although it was not established whether the others are financed from local sources only. 3.1.3 Organizations registered with and operating under governmental regulations Eighty-three (83),
The returns reveal that only 141 (17%) organizations are registered with and operating under goverrunent regulation. presumably from among those registered, submit progress reports to goverrunents; 27 of these include information on their SOurces of income and 31 give information on their assets and liabilities. / One hundred •••
WPR/RC19/6 page 5 One hundred and twenty-seven (127) private organizations (16%) submit progress reports to their own governing bodies. information on their assets and liabilities. also furnished information on their sources of income. These include One hundred and ten (110)
3.1.4 Health activities performed solely by private organizations Four (4), or 20%, of the 21 replies confirmed that certain health activities are being undertaken solely by private organizations. in which the government is not at present participating. bility for some health activities. In one
country, two foreign-supported organizations are involved in activities In one terri-
tory, certain religious and voluntary organizations have sole responsiIn another, foreign-supported In
religious denominations render medical and health care services. one country, two foreign and one local organization look after the rehabilitation of the handicapped.
3.1.5 Arrangements for mutual consultation, co-ordination and joint planning activities between the health authority and the private organizations concerned Twelve (12), or organizations. <'
63%, of the 19 replies to this question indicated
that conSUltations took place between the health authority and the private Three (3) governments (15%) did not have such an arrangement and 4 (or 22%) had no comments to make.
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3.1.6 Plans to organize an improved mechanism to ensure better collaboration in planning and executing health activities Two (2), or
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9%,
of the 21 replies expressed the view that colla-
boration between private organizations and the health authority might be improved through national health planning and by a continuing review and improvement of present arrangements, while 10 (48%) considered existing mechanisms adequate. There were no comments in the remaining
9 (43%) replies. 3.2 Health planning practices and international collaboration in health planning 3.2.1 Existence of National Development Planning Authority ,
Twelve (12) of 19 replies x
(63%) were in the affirmative; 4 (21%), /3.2.2 •••
negative; and 3 (16%), silent.
WPR/RC19/6 page 6 3.2.2 . Involvement of health auth~rity in the formulation of the present national development plan and in developing the future plan Ten (10) of the 19 replies
(53%)
indicated that opportunities for
consultation exist between the national development planning body and the health authority. either through committee meetings or consultations. Two (2) countries (10%) reported that their health authorities are not consulted. The remaining 7 (37%) were governments which did not have development planning bodies. 3.2.3 Use of certain organizational mechanisms by the health planning sector Six (6) governments (32%) reported the presence of organizational mechanisms: (a) (b) (0)
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health planning unit technical sub-committee for planning central advisory committee on planning
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one (1) government (5%) was considering the establishment of a technical sub-committee on planning. Five (5) governments (26%) were satisfied with present consultative arrangements. Three (3) (16%) did not believe this question applied to their governments. Four (4) (21%) had no comment. 3.2.4 Existence of intra-sectoral planning procedure in the absence of a formal policy on national health planning Of the 7 governments which did not report the existence of a national development planning body. 1 did not indicate any consultative mechanism being used by the health authority while the remaining
6 availed themselves of consultations and advice from special committees, institutions. etc •• in connexion with their intra-sectoral planning to promote better the organization and execution of the health authority's functions.
/3.2.5 •••
WPR/RC19/6 page 7 3.2.5 Governments' plans for requesting international assistance in the area of national health planning Ten (10)
(53%) of the 19 governments which replied plan to request
WHO assistance (with 1 government considering the possibility only). One (1) (5%) plans to approach the University of Hawaii School of Public Health. Five (5) (26%) had no immediate plans.
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Three (3) (16%) had no conunent. The forms of assistance envisaged from WHO are: (a) (b) (c) advisory services attendance at group inter-country meetings fellowships -
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COMMENTS AND CONCLUSIONS
4.1 The questionnaire touched upon areas where certain information on private organizations may not have been available to all or where health planning practices are still developing. However, countries/ territories conducting future surveys may find the inclusion of some of the information requested useful in assessing community health resources and in undertaking comprehensive planning. The frame of the questionnaire may have been responsible for some of the difficulties encountered in formulating replies. The questions attempted to secure a wide span of information and data but they may have been too briefly worded and some of the terms used may have needed definition or explanation in the context of the subject and purpose of the questionnaire. The difficulty in interpreting the results obtained issues from differences in the content and completeness of the returns received. As mentioned earlier, only 65% of the governments responded and only 12% of ~~e
private organizations provided information on their annual Many replies were brief and consequently lacked details
expenditures.
which could have been very informative. While the questionnaire endeavoured to gather information on similar subjects from countries and territories, it is hazardous to /make comparisons
WPF/RC19/6 page 8 make comparisons in depth of the results obtained. In this context
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regional averages would be meaningless in view of the wide diversity of the size, population, socio-economic development and organizational characteristics of the countries and territories concerned. Nevertheless, the information provided gives an indication of individual country/territory conditions and thereby reflects in its totality a broad view of conditions obtaining in the Region. 4.2 Allowing for the above limitations. the information received can be summarized as (a) fo11o~lS:
Private organizations interested in health The replies received from 21 countries/territories provided information on 818 such organizations. categorized into 6 groups: The general range of their activities has been arbitrarily medical care, 68%; maternal and child health, 12%: welfare, 10%; public health, training and staff deve1opnent,
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3%;
unclassified,
5%: 2%.
(b)
Approximate annual cost of services provided (see paragraph 3.1.2) Only 101 (12%) of these organizations have reported their annual expenditure which has an aggregate total of $9.19 million. The percentage distribution of expenditure in this small and certainly not representative sample gives medical care, 53.4%; public health, 26.4%; welfare, 13.0%; maternal and child health, 6.4%; training and staff developnent, 0.8%.
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(c)
Arrangements for mutual consultation, co-ordination and Joint planning activities between the health authority and the private organizations concerned (see paragraph 3.1.5) Twelve (12) countries/territories reported that there were satisfactory arrangements for mutual consUltation between private organizations and the health authorities.
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Health planning practices (see paragraph 3.2) Of the 19 governments which submitted information on this topic, 12 reported the existence of a national deve10pnent planning body, of which health was a sector in 10 countries and territories. /Whether as •••
WPR/RC19/6 page 9/10 Whether as a health sector of the national development planning authority or working independently, the health authority in the majority of cases uses special committees and other similar devices in its planning for health. (e) '-
Governments' plan3 for requesting international assistance in the area of national health planning (see paragraph 3.2.5) Governments are aware of the international assistance available for health planning and 10 of them are interested in obtaining WHO assistance in this field.
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The replies to the questionnaire would support the Regional Committee's view that resources are available from private organizations interested in health. Altho~l
the figures are not complete
and a number of countries have not reported, the large number of
aotive organizations shows a oonsiderable resource potential whioh oan be tapped and oo-ordinated with government resouroes for health work.
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WPR!RC19/6 page 11/12 ANNEX 1
DISTRIBUTION OF PRIVATE ORGANIZATIONS ACCORDING TO AREAS OF ACTIVITY IN HEALTH IN 21 COUNTRIES AND TERRITORIES IN THE WHO ~lESTERN PACIFIC REGION - 1967 Are a o f Medioal Publio Care MlUth 1 1
Aotivity Traininl! Welfare Total 1
Country or Territory MCH Brunei
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Cambodia China Fiji Gilbert and Ellioe Islands Guam Hong Kong Korea (Republio of) laos Maoao Malaysia Sabah, East Malaysia New Caledonia New Hebrides New Zealand Philippines Ryukyus
2 1
1
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1
3 1 1 2
1 2 2 2
81 1
1
8
3 6 12
1 4
3 4
489 4
6
-
8 28
578 40 4 14 6
1
3 7 2
1 1
2 2
5 1
5
5 4
9 6
9
-
1 9 11
5 6 17*
36 26
3
5
Timor** Tonga Trust Territory of the Paoific Islands Viet-Nam (Republio of) Western Samoa
3
1
2 1
-
4 5 2
9 7 27 14 818
1
25
5
3 22
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1
4 86
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96
558
39
*Voluntary organizations as listed. **Timor has no private organizations but provided information on organizational faoilities for planning.
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WPRjRC19/6 page 13
ANNUAL EXPENDITURES REPORTED BY CERTAIN PRIVATE ORGANIZATIONS IN SOME COUN'IRIES AND 'IERRITORIES IN '!HE WHO WES'IERN PACIFIC REGION I 1967 Number of Institutions Reporting Not Reportinsj ""''les
Country or territory Total
1
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I Brunei Cambodia China Fiji Gilbert and Ellice Islands Guam Hong Kong Korea (Republic of) Laos Macao Malaysia Sabah I East Malaysia New Caledonia New Hebrides New Zealand Philippines Ryukyus ;
Expenses ted (in thousand US dollars) 'C.
1 3 6 12 3 4 578 40 4 14 6 5 6 17 36 26 9 7 27 14
1 2 4 8 2 1 0 11
0 1 2 4 1
641.9 72.4 301.0 96.5 1.7 40.0
3 578 29 4
2691.9
0 14 6 5
2158.5 94.4 184.9 141.2
0 0
0 17
6
0
36 0 0 7 21 14
1671.2 203.8
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26 9 0 6 0
Tonga Trust Territory of the Pacific Islands Viet-Nam (Republic of) Western Samoa
893.2
$9192.6
818
101
717