Organisation mondiale de la santé (OMS) · Technical Documents

Proposed programme budget estimates for the financial period, 1984-1985

31 décembre 1982 Organisation mondiale de la santé

Texte intégral

WPR/RC33/3

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Thirty-third session Manila, 20-24 September 1982

PROPOSED PROGRAMME BUDGET ESTIMATES FOR THE FINANCIAL PERIOD 1984-1985

The Regional Director has the honour to present to the Regional Committee for the Western Pacific the proposed programme budget estimates for the financial period 1984-1985.

Manila, July 1982

ABBREVIATIONS

The following abbreviations are used in this document: ASEAN FAO ILO TCDC UNDP UNEP UNFPA UNICEF U~AID

WPACMR

Association of South-East Asian Nations Food and Agriculture Organization of the United Nations International Labour Organisation Technical cooperation among developing countries United Nations Development Programme United Nations Environment Programme United Nations Fund for Population Activities United Nations Children's Fund United States Agency for International Development Western Pacific Advisory Committee on Medical Research

CONTENTS

Explanatory notes .......................................... .

Regional Director's programme statement ••••••••••••••••••••• SUMMARIES Summary of regional health programme: estimated obligations by source of funds Summary by programme and source of funds •••••• Summary by programme and organizational level •••••• Regular budget 1982-1983 and 1984-1985 by appropriation section with percentages of the total PROGRAMME ANALYSES 1. Direction, coordination and management 1.1.0

vii xiii

1 2

5 8

Governing bodies 1.1.3

Regional Committee

12 13 •••••••••.•••••••••••• •.••••• 14 15 16 20

1. 2. 0

WHO's general programme development and management 1. 2.1 1. 2. 2 1. 2. 3 1. 2.4 Executive management ................................................... .

Regional Director's development programme

General programme development •.•....•.•..•....•.•.•....•••••.

External coordination for health and social development

Health system infrastructure 2.3.0 Health sys tern development . . . . • . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . • • . . . . . . . . . . . . . . . . . . . .

23 24 27

2.3.1 2.3.2 2.3.3 2.3.4

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

30 33 ]_]_]_

2.4.0 2.5.0 2.6.0 3.

Organization of health systems based on pr1mary health care ••••••••• Health manpower ...•.......•....... ~~......... . .....•.

Public information and education for health

••••••••

35 38 43

Health sc1ence and technology - health promotion and care

3.7.0 3.8.0

Research promotion and development General health protection and promotion

47 50

3.8.1 3.8.2 3.8.3 3.9.0

Nutrition Oral health Accident prevention

51 55 58 61 62 66 69 72 73 76 79 82 83 86 89 91

Protection and promotion of the health of specific population groups

3.9.1 Maternal and child health, including family planning 3.9.3 Workers' health ••.•••• 3.9.4 Health of the elderly 3.10.0 Protection and promotion of mental health

3.10.1 3.10.2 3.10.3 3.11.0

Psychosocial 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 0 •••••••••••••••••••••••••••••••••••••••••••••••••

Promotion of environmental health

3.11.1 3.ll.2 3.11.3 3.11.4

Community water supply and sanitation ••••••••.••••••••••••••••• Environmental health in rural and urban development and housing Control of environmental health hazards ••••••••• Food safety o o o o o o o o o o o e o • o o • o • • • • o o o o o et

3.12.0

Diagnostic, therapeutic and rehabilitative technology

94 95 99 102 105 108

3.12.1 3.12.2 3.12.3 3.12.4 3.12.5 4. Health sc~ence

Clinical, laboratory and radiologic! technology for health systems based on primary health care •••••• • •••••••••••••••••• Essential drugs and vaccines •••••• • ••••••• Drug and vaccine quality, safety and efficacy ••••••••••••••• Traditional medicine •••••••••••• • ••••••••••••••••• Rehabilitation •••e••••• ~~··········· •••••••••••••••••• and technology - disease prevention and control

4.13.0

Disease prevention and control •••••••••••••••••••••••••••••••••••••••••••••••••••••

111 112 116 119 123 125 128 131 134 137 139 142 144 147 150 153

4.13.1 4.13.2 4.13.3 4.13.4 4.13.6 4.13.7 4.13.8 4.13.9 4.13.10 4.13.11 4.13.13 4.13.14 4.13.15 4.13.16 4.13.17 5.

Immunization

e • • • • • • • • • • • o.

Disease vector control Malaria ..•........ Parasitic diseases •••••• Diarrhoeal diseases Acute respiratory infections Tuberculosis ••••••• Leprosy •••••• Zoonoses •••••• •••••••o •••-"'••••••e•••••••••

Sexually transmitted diseases . . . . . . . . . . .

. ..

••••••••••••••••••••

Other communicable disease prevention and control activities •••••••••••••• B1 i nd ness ........ . ......•. ., ................................... . Cancer •••••••• • •••••••• Cardiovascular diseases Other noncommunicable disease prevention and control activities

Programme support

5.14.0 5.15.0

Health information support Support services ••••••••••

156 158 ct ••••••••••••

5.15.1 5.15.2 5.15.3 5.15.4

Personnel General administration and services Budget and finance ••••••••••••••••• Equipment and supplies for Member States ••••••••••••••

159 161 163 165 v

INFORMATION ANNEXES Summary of country and intercountry activities • 0 •••••••••• 0 •• 0 ••••••••••••• 0 •••••••••••••••••••

169 173

ANNEX I ANNEX II ANNEX III

Regional Committee and Regional Office Country or area programmes ..... Intercountry programme ........ II!

•••••••••••••••••••••••••••••••

•••••••••••

* •••••••••••••••••••••••••••••••••••••••••••••••••

177 359

e •••••••••••••••••••••••••••••••••••••••••••••••••

EXPLANATORY NOTES

In compliance with resolution WHA30.23 (development of programme budgeting and management of WHO's resources at country level) adopted by the Thirtieth World Health Assembly, 1 the proposed programme budget estimates presented by the Regional Director include the original provisions for the biennium 1982-1983 and requirements for the biennium 1984-1985. The Regional Committee will need particularly to examine the requirements for the biennium 1984-1985. 2. The programme budget of WHO is based on the classified list of programmes of the Seventh General Programme of Work covering a specific period (1984-1989 inclusive), which was adopted by the World Health Assembly in May 1982.2 The classification reflects a generalized model of support to national health systems, organized in such a way as to facilitate the development and operation of health systems based on primary health care aimed at achieving health for all by the year 2000. Four broad interlinked categories form the Appropriation Sections which are broken down into "programme summaries" and "programmes". The programme budget estimates are presented by "programme". 3. Regional programme statements (pages 11 to 166) present the medium-term (1984-1989) objectives, targets and plans of action for each programme, together with programme activities for the period covered by the biennial programme budget, 1984-1985. Each statement is supported by a summary budgetary table. 4. Country programme statements for each country or area (pages 177 to 355) describe national development strategies for achieving health for all by the year 2000, the main directions for WHO support 1984-1989, and WHO support foreseen for 1984-1985. They are supported by planning figures, broken down by programme. For the intercountry programme, a budgetary table is preceded by a statement under each programme heading (pages 359 to 375). 5. The budgetary estimates for the Regional Office are shown on page 173. The estimates for personnel costs are based on appropriate averages applicable to posts in the professional and general services categories. The estimated obligations for programme 5.15.2, General Administration and Services, include provisions for common services from the regular budget and other sources.

lWHo Handbook of Resolutions and Decisions, Vol. II, 4th ed., 1981, page 136. 2see resolution WHA35.25.

vii

viii 6. The estimates for regional advisers, related secretarial assistance and duty travel, are included the intercountry programme under the appropriate technical programme. ~n

7. The estimates for WHO Programme Coordinators and their offices, duty travel and common services are shown under the country in which the office is located, under the programme heading Managerial Process for National Health Development. If a WHO programme coordinator is responsible for more than one country or area, the estimates are distributed over the countries or areas concerned. 8. As in previous biennia, provision is made for a Regional Director's development programme. The funds will be used to finance collaborative programmes with governments which could not be foreseen when the programme budget estimates were developed and to provide seed money to enable genuinely innovative programmes or activities to commence, including those likely to attract substantial extrabudgetary funding. 9. The symbols that have been adopted expected to be financed: ~n

this document to indicate the sources from which activities are

AS - Special Account for Servicing r,osts DP - United Nations Development Programme - Indicative planning figures FB - Associate Experts other than United Nations Development Programme FP - United Nations Fund for Population Activities RB - WHO regular budget ST - Sasakawa Health Trust Fund VB - Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (Prevention of blindness) VC - Voluntary Fund for Health Promotion - Special Account for the Cholera Programme VD Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (Other)

VG - Voluntary Fund for Health Promotion - Special Account for Medical Research (Specified) - Other than human reproduction VI - Voluntary Fund for Health Promotion - Special Account for the Expanded Programme on Immunization VK - Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (DANIDA) VL - Voluntary Fund for Health Promotion - Special Account for the Leprosy Programme VV - Voluntary Fund for Health Promotion - Special Assistance to Democratic Kampuchea, Lao People's Democratic Republic, and Socialist Republic of Viet Nam

CLASSIFIED LIST OF PROGRAMMES

DIRECTION, COORDINATION AND MANAGEMENT 1.1.0 Governing Bodies 1.1.1 1.1.2 1.1. 3

World Health Assembly Executive Board Regional Committees

1.2.0

WHO's General Programme Development and Management 1. 2.1 1. 2. 2

Executive Managementl Regional Director's Development Programme

lincludes Regional Director's office.

1.2.3 1.2.4 2.

General Programme Developmentl External Coordination for Health and Social Development2

HEALTH SYSTEM INFRASTRUCTURE 2.3.0 Health System Development 2.3.1 2.3.2 2.3.3 2.3.4 2.4.0 2.5.0 2.6.0 Health Situation and Trend Assessment Managerial Process for National Health Development Health Systems Research Health Legislation

Organization of Health Systems based on Primary Health Care Health Manpower Public Information and Education for Health

HEALTH SCIENCE AND TECHNOLOGY - HEALTH PROMOTION AND CARE 3.7.0 3.8.0 Research Promotion and Development General Health Protection and Promotion 3.8.1 3.8.2 3.8.3 Nutrition Oral Health Accident Prevention

lincludes Director of Programme Management, the Managerial Process for WHO's Programme Development, WHO Information System and Staff Development and Training. 2Includes collaboration within the United Nations system, with multilateral and bilateral programmes, and emergency relief operations. other organizations and with

3.9.0

Protection and Promotion of the Health of Specific Population Groups 3.9.1 3.9.2 3.9.3 3.9.4 Maternal and Child Health, including Family Planning Human Reproduction Research Workers' Health Health of the Elderly

3.10.0

Protection and Promotion of Mental Health 3.10.1 3.10.2 3.10.3 Psychosocial 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

3.ll.O

Promotion of Environmental Health 3.11.1 3.ll.2 3.11.3 3.11.4 Community Water Supply and Sanitation Environmental Health in Rural and Urban Development and Housing Control of Environmental Health Hazards Food Safety

3.12.0

Diagnostic, Therapeutic and Rehabilitative Technology 3.12.1 3.12.2 3.12.3 3.12.4 3.12.5 Clinical, Laboratory and Radiological Technology for Health Systems based on Primary Health Care Essential Drugs and Vaccines Drug and Vaccine Quality, Safety and Efficacy Traditional Medicine Rehabilitation

HEALTH SCIENCE AND TECHNOLOGY - DISEASE PREVENTION AND CONTROL 4.13.0 Disease Prevention and Control 4.13.1 4.13.2 4.13.3 Immunization Disease Vector Control Malaria

Xl.l.

4.13.4 4.13.5 4.13.6 4.13.7 4.13.8 4.13.9 4.13.10 4.13.11 4.13.12 4.13.13 4.13.14 4.13.15 1+.13.16 4.13.17 5.

Parasitic Diseases Tropical Disease Research Diarrhoeal Diseases Acute Respiratory Infections Tuberculosis Leprosy Zoonoses Sexually Transmitted Diseases Smallpox Eradication Surveillance Other Communicable Disease Prevention and Control Activities Blindness Cancer Cardiovascular Diseases Other Noncommunicable Disease Prevention and Control Activities

PROGRAMME SUPPORT 5.14.0 5.15.0 Health Information Supportl Support Services 5.15.1 5.15.2 5.15.3 5.15.4 Personnel General Administration and Services Budget and Finance Equipment and Supplies for Member States

lHealth services.

information

support

includes

WHO's

publications

and

documents

and

health

literature

REGIONAL DIRECTOR'S PROGRAMME STATEMENT

1. In developing the proposed programme budget estimates for the biennium 1984-1985, the unique role of WHO as the international health partner of every Member State, in its efforts to obtain a level of health for all citizens by the year 2000 that will permit them to lead a socialiy and economically productive life, has been kept constantly in mind. Every Member State of the Western Pacific Region has committed itself to that goal and WHO has a special responsibility to support each one in coordinating its health work and in mobilizing and rationalizing resources for health. To that end, countries or areas of the Western Pacific Region were asked, in early 1980, to provide WHO with drafts of Lheir national policies and strategies for "health for all". From the information submitted by each one a regional strategy was developed, the current version of which was adopted by the Regional Committee at its thirty-second session in 1981.1 Information derived from the national strategies and the Regional Strategy was submitted to the Director-General to form an integral part of a Global Strategy and thus the basis of the Seventh General Programme of Work covering a specific period 0984-1989 inclusive). Using the Seventh General Programme of Work and its programme classification as the basis, regional medium-term programmes for the period 1984-1989 and the programme budget for the first biennium, 1984-1985, of the six-year period evolved concurrently. It is that programme budget which is now being presented to the Regional Committee. It constitutes a small, but potentially significant, part of WHO's unique role in countries, providing an opportunity to put at the disposal of Member States the entire range of WHO capabilities, which include the promotion of technical cooperation among countries and the transfer of technology, information and resources for health.

2. In developing the medium-term programmes and the programme budget estimates during 1981 and 1982, efforts were made to evaluate the activities of WHO's current programme of cooperation with countries, taking into account the principles of relevance, progress, efficiency, effectiveness anJ impact, and to consider how WHO's resources might be better and more flexibly applied; particularly in support of a sound health system infrastructure, one of the principles of Alma-Ata,2 3. In turn, the activities of the programme of cooperation now under consideration, developed on the basis of the Seventh General Programme of Work, will be monitored and evaluated in relation to development activities, programme delivery and health status, using the indicators proposed in the Global and Regional Strategies for Health for All by the Year 2000.

lsee resolution WPR/RC32.R5, Handbook of Resolutions and Decisions of the WHO Regional Committee for the Western Pacific, Vol. II, 3rd ed., 1982, page 3. 2neclaration of Alma-Ata. Series No. 1). Alma-Ata 1978, Primary Health Care, WHO, Geneva, 1978 ("Health for All" X~~~

x~v

4. During the biennium 1984-1985, most of WHO 1 s cooperation wi 11 be provided through the country programme. However, an intercountry programme, diminished in terms of activities, has been maintained because of the heterogenous nature of the Western Pacific Region, which in some instances makes the intercountry programme a more effective and efficient means of providing cooperation in the right place and at the right time. Provision is made for the organization of courses, workshops and seminars; for the continuation of such intercountry teams as those for epidemiological surveillance and disease control, the development of health systems based on primary health care, health facilities planning, design, management and maintenance, nutrition, immunization, malaria, diarrhoeal diseases, acute respiratory infections, tuberculosis and leprosy; for an International Drinking-Water Supply and Sanitation Decade team; and for continuation of the Regional Centre for Research and Training in Tropical Diseases and the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies. 5. Taking into account the expressed objectives of individual Member States, the Regional Strategy for Health for All by the Year 2000 gives, as the overall societal image by that time: a socially and economically productive population which has a longer life expectancy; low rates of infant and maternal mortality; fewer disabled persons; and adequate shelter, education and means of livelihood. Such an image will be derived from (1) a well nourished population; (2) safe drinking water available to all; (3) the sanitary disposal of human and animal waste; (4) reduction of environmental pollution and hazards to a minimum; (5) prevention and control of communicable diseases to an extent where they cease to be a major problem; ( 6) reduction in the number of cases of chronic disease; ( 7) psychosocial well-being and lifestyles conducive to health; (8) elimination of pockets of ill health; (9) regulation of fertility to ensure better health and social well-being; and (10) access for all to appropriate health care. 6. Thus, the medium-term programmes for the period covered by the Seventh General Programme of Work (1984-1989), and the programme activities for the first biennium of that period (1984-1985) are aimed at the ultimate fulfilment of the above-mentioned objectives. 7. It is interesting to note that, in accordance with government requests, the highest proportion of resources is allocated to health manpower, with disease prevention and control, organization of health systems based on primary health care and health system development next in order of importance. 8. WHO's general programme development and management includes the offices of the Regional Director, the Director, Programme Management, and the WHO Programme Coordinators, as well as activities for the

effective application of the managerial process for WHO's programme development, the WHO management information sys tern to support the process, and the training of relevant staff. It also includes external coordination for health and social development. 9. The regional medium-term programmes formulated on the basis of the Seventh General Programme of Work will be reviewed periodically so as to provide more effective guidance in the preparation of programme budget proposals. The evaluation components of all programmes of cooperation with Member States will be emphasized, and improvements in the different aspects of management will be introduced as staff gain more experience. The management information system will be continuously evaluated, and its information processing capability gradually enhanced. One element of the Global and Regional Strategies on which the information system will focus is the indicators for monitoring and evaluation. WHO staff at all levels, and national staff as appropriate, will be given training or orientation to enable them to participate effectively in the managerial process. Collaborative arrangements made with other United Nations agencies, intergovernmental organizations and nongovernmental organizations in official relations with WHO, as well as coordination with extrabudgetary funding agencies, will aim at promoting intersectoral action in support of "health for all". 10. The building up of the health system infrastructure for the integrated delivery of health care to the entire population is a continuous and dynamic process of adjustment which must take into consideration, at different points in time, the changing health situation, as well as the overall socioeconomic situation. Considerable efforts have been exerted in developing health systems based on primary health care, and these are expected to be vigorously pursued. Health system development aims at strengthening national mechanisms and capabilities to: improve disease reporting procedures and the collection of important epidemiological information, as well as training in epidemiology; collect and analyse information on the health situation, including trends; utilize the information obtained to make the necessary interventions, in the form of policies, programmes and projects, with the necessary budgetary support, and subsequently to implement and evaluate them; conduct research on optimal ways of organizing the health system for integrated programme delivery to all communities, with priority given to the most underserved areas; and enact the legislation necessary to introduce the changes necessary in order to use the primary health care approach to attaining the goal of "health for all". ll. The organization of health systems based on primary health care will enable the population as a whole to enjoy the benefits of the essential elements of primary health care, through the effective operation of the health system at peripheral, intermediate and central levels. Active community participation in health development will be fostered, as will the development of mechanisms for such part~c~pation; technical and administrative support at various levels of the health system will be enhanced, particularly at the periphery and at immediate referral level; effective coordination will be XV

XV~

promoted, among the components of the health sector, and between the health and health-related sectors; and health technology, appropriate to conditions prevailing within the community, will be developed and used. Research and development activities will be promoted, through "learning by doing". 12. The promotion of policies and programmes to meet the requirements of the health system for manpower appropriate to "health for all" priorities, in the context of primary health care, will be of primary concern. Activities will focus on the development of middle level health personnel and trainers of personnel to work at the periphery, as well as primary health care workers. Attention will also be given to the reorientation of existing health manpower. Support will be provided for the'development of new categories of health manpower, as the situation warrants, and for the necessary restructuring of curricula. Formation of health personnel tvill also include institutional strengthening, continued support for the application of the educational process, and identification of needs for educational material. 13. To formulate an appropriate managerial process for health manpower development, coordination between producers and users will be strengthened; and health manpower policies and plans, as well as national systems for training in the managerial process for national health development, will be promoted and developed. The planning of continuing education programmes will be emphasized. Support will be provided for the development of national mechanisms to irnprove the integration of fellowships in health manpower plans. 14. As active community involvement is essential to primary health care, public information and education for health to promote a healthful lifestyle and community self-reliance in health, acqu~res added significance. Cooperation in developing and strengthening public information and health education policies and programmes will be actively pursued. Emphasis will be placed on developing the community's capability to undertake group action in support of health and development, through the strengthening of existing or newly formed community organizations. The process initiated to involve news reporters and radio broadcasters will continue, and national capability to provide media support for health prograinmes will be strengthened. Health education will be included in the curricula of primary and secondary schools and teacher training institutions. WHO will continue to collaborate in the training of health workers, particularly those at the periphery, in health education and the community approach. The application of behavioural research in health, health education and public information will be encouraged.

15. The long-term objective in research promotion and development is to support Member States 1.n achieving sufficient self-reliance to enable them to carry out the health research activities most relevant to the solution of their major health problems. The importance is recognized of: (1) developing the necessary mechanisms at country level to relate research activities to national health development goals; and (2) strengthening national capability and the necessary infrastructure for carrying out research which has as its specific objective the solution of a particular health problem. The WHO Regional Centre for Research and Training in Tropical Diseases, Institute for Medical Research, Kuala Lumpur, will continue to function as an instrument in promoting basic and field research and training in tropical diseases. 16. Nutrition, oral health and accident prevention compr1.se the &eneral health protection and promotion programme. Undernutrition is, and is likely to remain, one of the main contributory causes of the high rate of infant and young child mortality in the Region. Attention, with regard to nutrition, will focus primarily on the promotion of national food and nutrition policies, as components of overall integrated economic development. Action-oriented research activities will be supported, with the aim of solving specific local nutritional problems and reducing the incidence of nutritional deficiencies. The training in nutrition of various categories of health worker, including primary health care workers, will be supported, and activities in relation to infant and young child feeding, in particular breast-feeding, will be encouraged. The achievement of oral health depends to a large extent upon effective preventive activities and the promotion of health education among schoolchildren and their parents. The deployment of well-trained dentists and dental therapists is accordingly called for. Collaboration will be extended in strengthening dental training and improving curricula and teaching resources, including training guides for primary health care workers. Activities in the area of accident prevention will focus on research into road traffic accidents, particularly in relatlun Lu human factors and behavioural aspects, and the development of preventive measures. Intersectoral collaboration will be emphasized. 17. Protection and promotion of the health of specific population groups encompasses the health problems of women of child-bearing age, children, workers and the elderly. Maternal and child health is an essential component of primary health care. Protection of the health of mothers and children is vital, because of the special biological and physiological needs, inherent in the process of human growth, that must be met to ensure the survival and healthy growth of the child. Among women of reproductive age, pregnancy-related complications are common causes of death and morbidity, together with infection, poor nutrition, and lack of fertility regulation. With support from UNFPA, cooperation will be provided in strengthening the maternal and child health component of the health care delivery system. It will also be extended in training, including teacher training. The risk approach will be promoted as a national managerial process for the more effective health care of mothers and children. xvii

xviii

Some centres for teacher training will be strengthened. The WHO Special Programme of Research, Development and Research Training in Human Reproduction will continue to provide support to collaborative research activities in the Region and to the strengthening of national research capability.

18. In the area of workers' health, support will be provided for national planning, particularly in relation to occupational hazards and work-related sickness, involving rural workers and those employed in small-scale industry. Strengthening of the occupational health services and coordination of their work with the safety and health inspectorates are essential; collaboration will be provided in this context to support planning and implementation and to train key staff. In close consultation with the International Labour Organisation, cooperation will be extended in the preparation of guidelines and the organization of training activities, to improve the skills of employers' and workers' organizations in preventive health care.

19. Care of the elderly, who are increasing in number, will constitute an important component of health care delivery. WHO will collaborate 1n research activities, particularly epidemiological and sociological studies on the nature and magnitude of health problems among the aged; operational research for application of the knowledge gained in field practice; development of teaching curricula for the training of all categories of health worker; and the adaptation and evaluation of self-help care manuals for the elderly themselves, or their families. 20. Erosion of the traditional psychosocial support s ystem, as a result of rapid social change, is reducing the ability of individual s , families and connnunities to cope with disea s e and disability and impeding them in fulfilling their other s ocial roles. Such psychosocial problems, in addition to problems related to drug and alcohol abuse, have placed an additional burden on already over-extended mental health progrannnes, which too often lack sufficient resources and technology to d e al with them. Protection and promotion of mental health will emphasize the strengthening of institutes in the Region, with a view to their eventua l designati on as WHO Collaborating Centres, through which technology f o r the prevention and treatment of mental and neurological disorders will be developed, operational res e arch activities carried out and teacher tra1n1ng organized. Na tional coordinating mechanisms will be established consisting of multidisciplinary groups which will develop strategies and plans for mental health programmes which will emphasize th e integration of mental health activities in primary he a lth care as opposed to the present practice o f institutiona lized care.

21. Promo tion of environmental health will continue to be an important component of primary health care in the strategy for ach ievi ng the goal of health for all by the year 2000. The tempo of cooperation with Member States in the provision of community water supplies and sanitati on is expected to increas e

significantly as the International Drinking-Water Supply and Sanitation Decade unfolds, giving priority to underserved rural and peri-urban populations and ·placing emphasis on affordable, self-reliant and easily maintained systems. Health education to ensure a measure of community responsibility for water and sanitation schemes will receive attention. Control of environmental health hazards through the development of means of protection against degradation from pollutants and toxic wastes will continue to be a major function of the Western Pacific Regional Centre for Promotion of Environmental Planning and Applied Studies (PEPAS), which will focus attention on the monitoring and scientific evaluation of such adverse influences on the environment.

12. The promotion of food safety has also become an increasingly urgent need, particularly in overcrowded urban areas. WHO will actively support national educational programmes to raise the level of awareness and knowledge with respect to hygienic food handling and the dangers of biological and chemical contamination. PEPAS will continue to supply expertise and resources to support the monitoring and control of foodborne disease. 23. Environmental health in relation to rural and urban development and housing is the subject of increasing concern, as cities continue to expand and more attention 1.s given to the environmental consequences of planned change in rural habitats. Technical cooperation will be provided by PEPAS in the scientific analysis of important developments in this field and their application to urban renewal and rural housing development. 24. Primary health care cannot achieve its full potential for health promotion without the support of diagnostic, therapeutic and rehabilitative technology appropriate to the circumstances of each country. The modern management of laboratory services and their adequate decentralization to the periphery will receive special attention. The modernization of diagnostic imaging and laboratory methods represents a major thrust to make essential examinations available at the lower levels of care and to improve their quality through the selection and provision of suitable equipment, the standardization of techniques and the continued training of staff. 25. The escalation of drug costs, resulting in shortages of essential drugs, will be actively combated by encouraging the establishment of joint purchasing and supply schemes, efforts to promote good manufacturing practices and quality assurance programmes, and rationalization of national lists of approved drugs. Likewise, the quality, safety and efficacy of vaccines and biological products will be continuously promoted, through WHO support for the establishment and improvement of laboratories and plant, the training of personnel, and the adoption of recognized international standards.

Xl.X

26. The contribution of traditional medicine to basic health care is attracting great interest. WHO will support national policies aimed at training the various categories of health worker, including traditional practitioners, so that appropriate traditional methods of healing, especially those associated with the use of indigenous herbal plants, may be integrated with primary health care. Studies of the botanical, pharmacological and therapeutic properties of the most commonly used plants will be encouraged and efforts will be made to support the propagation, standardization and manufacture of the most useful drugs. Further research and training in acupuncture will also be encouraged. 27. Finally, the International Year of Disabled Persons has heightened regional and national awareness of the rights, needs and potential contribution of the handicapped to a remarkable degree. A comprehensive long-term regional programme, incorporating guidelines for national action, has been prepared by a regional working group. The adoption, by all governments, of a community-based rehabilitation programme closely linked to primary health care will be promoted. Training of key national staff to provide the necessary cadre of experts for programme management and training within the countries, and the development of low-cost appropriate technology, will be the main components of the WHO programme, which will be supported by the establishment of WHO Collaborating Centres and a regional information exchange programme. 28. Disease prevention and control, including communicable and noncommunicable diseases, is a programme of high priority. Continued support is provided for the immunization and diarrhoeal disease control programmes, both of which are now more closely integrated into primary health care. In view of the high mortality and morbidity from acute respiratory infections in many countries or areas, increasing attention is focused on expanding the network of acute respiratory infection units and undertaking operational research studies in this field. Activities in the context of the tuberculosis and leprosy control programmes will continue at about the same level. Both programmes will emphasize the training of staff in management and planning. In the few countries where malaria remains a major public health problem, cooperation in the national programmes will continue. As a consequence of the greater importance being given in most countries or areas to the prevention and control of chronic diseases, in particular cardiovascular disease, cancer and diabetes mellitus, various activities will be undertaken, including epidemiological studies, operational research, health education and training. 29. Implementation of the Strategy to achieve "health for all" implies a judicious choice of effective and efficient approaches and procedures. For this it is necessary to know what health and health-related technology and methodology is available, as well as what is required and what are the implications of applying a particular approach or procedure in a given country context. Biomedical and health services research areas also need to be identified for the further development and

management of health programmes. The health information support programme therefore aims to enhance national and regional capability 1n biomedical information system development, through institution strengthening and the training of key national staff, and to facilitate scientific and technological information exchange, through technical cooperation among countries or areas of the Region and through access to international data bases. 30. Staff of the support services - personnel, budget and finance, conference and office services and supplies - are available, on request, to provide cooperation to Member States in the areas of their specialization.

Regional Director

XX1

SUMMARIES

SUMMARY OF REGIONAL HEALTH PROGRAMME:

ESTIMATED OBLIGATIONS BY SOURCE OF FUNDS

Estimated obligations 1982-1983 1984-1985 US$ 46 125 000

us$ Regular budget Other sources~

39 070 000

Voluntary Fund for Health Promotion United Nations Development Programme United Nations Fund for Population Activities Associate Experts other than United Nations Development Programme •.............•................••.........

3 554 000 6 764 900 4 736 300 43 200 2 644 500 740 800 18 483 700 57 553 700 =:::::=::::::;:::::::;:;:::===

170 000 3 751 600 2 014 400

Sasakawa Health Trust Fund

........................... Sub-total - Other sources Total

Special Account for Servicing Costs

809 600 6 745 600 52 870 600

==========

SUMMARY BY PROGRAMME AND SOURCE OF FUNDS

Estimated obligations PROGRAMME Regular budget US$ 1.1.0 Governing bodie·s 1.1.3 1.2.0 Regional comnittee 280 000 280 000 346 000 346 000 66 000 1982-1983 Extrabudgetary sources US$ Total US$ Regular budget US$ 1984-1985 Possible extrabudgetary sources US$ Total US$ Increase/ (Decrease) Regular budget US$

WHO's general programme development and management 1.2 .1 1.2 .2 1.2 .3 1.2.4 Executive management Regional Director's development programme General programme development External coordination for health and social development 334 900 775 300 1 834 300 268 200 3 212 700 163 000 163 000 334 900 775 300 l 997 300 268 200 3 375 700 420 000 922 500 2 235 600 341 800 3 919 900 200 000 200 000 420 000 922 500 2 435 600 341 800 4 119 900 85 100 147 200 401 300 73 600 707 200

2.3.0

Health system development 2.3.1 2.3.2 2.3.3 2.3.4 Health situation and trend assessment Managerial process for national health development Health systems research Health legislation 1 357 900 3 223 278 20 (. 880 600 800 000 300 168 600 90 199 9 467 000 300 200 100 1 526 500 3 313 478 29 5 347 600 100 200 400 746 800 4 046 376 26 5 195 200 100 000 100 170 000 60 000 230 000 1 284 000 916 800 4 106 376 26 5 425 200 100 000 100 (611 100) 822 97 6 314 600 300 000 800

2.4.0 2.5.0 2.6.0 3.7 .o 3.8.0

Organization of health systems based an primary health care He a 1th manpower Public information nnd education for health Research promotion and development General health protection and promotion 3.8.1 3.8.2 3.8.3 Nutrition Oral health Accident prevention

4 690 600 6 435 500 663 900 885 600

1 311 200 3 393 100 37 200 111 000

6 001 800 l l 828 600

5 455 100 8 840 100 997 400 1 038 900

6 739 100 8 840 100 . 997 400 1 038 900

764 500 404 600 333 500 153 300

701 100 996 600

709 407 32 1 148

400 200 200 600

8 900 25 600 34 500

718 432 32 1 183

300 800 000 100

529 805 116 1 451

600 500 000 100

529 805 116 1 451

600 500 000 100

(179 398 .84 302

800) 300 000 500

Estimated obligations PROGRAMHE Regular budget US$

1982-1983 Extrabudgetary sources US$

1984-1985 Total US$

Regular budget

Possible extra budgetary_ sources US$

Total US$

Increase/ (Decrease) Regular budget US$

us$

3.9.0

Protection and promotion of the health of specific population groups 3.9.1 3.9.3 3.9 .4 Maternal and child health, including family planning Workers' health Health of the elderly 266 223 20 509 000 600 000 600 4 797 266 23 5 086 200 700 000 900 5 063 490 43 5 596 200 300 000 500 422 142 151 716 600 500 500 600 2 011+ 400 292 800 2 307 200 2 437 435 151 3 023 000 300 500 800 156 (81 131 207 600 100) 500 000

----

3.10.0

Protection and promotion of mental health 3.10.1 3.10.2 3.10 .3 Psychosocial 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

213 800 129 400 267 500 610 700 42 900 42 900

213 800 172 300 267 500 653 600

213 100 35 500 174 400 423 000

(700) (93 900) (93 100) (187 700)

3 .11.0

Promotion of environmental health 3.11.1 3.11 2 3 .11.3 3 .11.4 Community water supply and sanitation Environmental health in rural and urban development and housing Control of environmental health hazards Food safety 1 322 600 1 099 600 580 200 160 100 3 162 500 473 500 45 000 2 655 100 2 136 600 3 459 200 1 099 600 1 053 700 205 100 5 817 600 1 554 500

922 000

2 476 500

231 900 360 700 (161 800) 43 000 473 800

1 460 300 418 400 203 100 3 636 300 40 000 962 000

1 460 300 458 400 203 100 4 598 300

3.12.0

Diagnostic, therapeutic and rehabilitative technology 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care Essential drugs and vaccines Drugs and vaccine quality, safety and efficacy Traditional medicine Rehabilitation

3.12.2 3.12.3 3.12.4 3.12 .5

523 000 272 400 560 50 278 1 684 600 000 000 000

235 800 569 100 312 900 180 000 1 297 800

758 800 841 500 873 230 278 2 981 500 000 000 800

1 050 500 678 200 332 194 67 2 322 300 000 000 000

33 000 583 800 180 000 796 800

1 083 500 1 262 000 332 374 67 3 118 300 000 000 800

527 500 405 800 (228 144 (211 638 300) 000 000) 000 3

Estimated obligations 1982-1983 Regular budget US$ 4.13.0 Disease prevention and control 4.13.1 4.13.2 4 .13.3 4.13 .4 4.13.6 4.13. 7 4.13.8 4.13 .9 4.13.10 4.13.11 4.13.13 4.13.14 4.13.15 4.13.16 4.13.17 Innnunization Disease vector control Malaria Parasitic disease Diarrhoeal diseases Acute respiratory infections Tuberculosis Leprosv Zoonoses Sexually transmitted diseases Other communicable disease prevent ion and control activities Blindness Cancer Cardiovascular diseases Other noncommunicable disease prevention and control activities 641 286 1 697 339 175 342 641 79 40 121 459 76 212 3118 700 600 600 400 800 100 700 200 900 700 400 200 000 100 36 24 557 290 255 172 271 914 20 6 100 300 500 000 100 200 000 700 000 100 677 310 2 2 55 629 430 514 912 993 60 127 680 280 254 348 800 900 100 400 900 300 700 900 900 800 200 900 500 100 661 466 1 781 317 415 363 736 112 68 17 822 213 386 4 71 600 200 600 500 200 500 800 100 000 500 600 000 000 900 156 000 Extrabudgetary sources US$ Total US$ Regular budget US$ 1984-1985 Possible extrabudgetary sources US$ Total US$ Increase/ (Decrease) Regular budget US$

PROGIW1ME

11 000 145 000

661 477 1 926 317 415 363 736 112 68 17 822 213 386 471

600 200 600 500 200 500 800 100 000 500 600 000 000 900

19 179 84 ( 21 239 21 95 32 27 (104 363 136 174 123

900 600 000 900) 400 400 100 900 100 200) 200 800 000 800

220 800 204 700 42 500 21 000 3 036 000 208 000

38 000 5 500 400 534 000

59 000 8 536 400 742 000

96 500 6 930 000

96 soo 7 086 000 762 900

58 500 1 429 600 228 900

5.14.0 5.15.0

Health information support Support services 5 .15 .1 5.15.2 5.15.3 5.15 .4 Personnel General administration and services Budget and finance Equipment and supplies for Member States TOTAL

762 900 -----

300 400 1 9 52 000 474 400 144 800 2 871 600 39 070 000

15 400 563 600 34 300 26 600 639 900 18 483 700

315 800 2 515 600 508 700 171 ~~oo 3 511 500 57 553 700

373 800 2 895 900 618 900 202 000 4 090 600 46 125 000

19 600 710 000 46 000 34 000 809 600 6 745 600

393 400 3 605 900 664 900 236 000 4 900 200 52 870 600

73 400 943 900 144 500 57 200 1 219 000 7 055 000

==========

========::::=

==========

=========

==========

=========

SUMMARY BY PROGRAMME AND ORGANIZATIONAL LEVEL

Estimated obligations PROGRAMME Regular budget US$ 1.1.0 Governing bodies Regional Country or area Intercountry 1982-1983 Extrabudgetary sources US$ Total US$ Regular budget US$ 1984-1985 Possible cxtrabudgetary sources US$ Total US$ Increase/ (Decrease) Regular budget US$

........................... ···················· ....................... Total

280 000

346 000

66 000

280 000

346 000

66 000

1.2 .o

WHO's general progrnmme development and management Regional Country or area Intercountry

........................... .................... ....................... Total

1 646 800 1 565 900 3 212 700 163 000 163 000

1 646 800 1 728 900 3 375 700

2 131 300 1 788 600 3 919 900 200 000 200 000

2 131 300 1 988 600 4 119 900

484 500 222 700 707 200

2.3.0

Health system development Regional Country or area Intercountry

.......................... ................... ··········· ........... Total

148 400 3 292 100 1 439 800 4 880 300

99 600 367 500 467 100

148 400 3 391 700 1 807 300 5 347 400

177 500 4 035 200 982 400 5 195 100

170 000 60 000 230 000

177 500 4 205 200 1 042 400 5 425 100

29 100 743 100 (45 7 400) 314 800

2.4.0

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

.......................... ................... ...................... Total

3 027 400 1 663 200 4 690 600

455 400 855 800 1 311 200

3 482 800 2 519 000 6 001 800

3 866 200 1 588 900 5 455 100

331 000 953 000 1 284 000

4 197 200 2 541 900 6 739 100

838 800 (74 300) 764 500

2.5.0

Health manpower Regional Country or area Intercountry

.......................... ................... ...................... Total

7 381 200 1 054 300 8 435 500

3 214 100 179 000 3 393 100

10 595 300 1 233 300 11 828 600

7 713 600 1 126 500 8 840 100

332 400 72 200 404 600 5

Estimated obligations 1982-1983 Regular budget Extrabudgetary sources Total Regular budget 1984-1985 Possible extra budgetary sources US$ Total Increase/ (Decrease) Regular budget

PROGRAMME

US$ 2.6.0 Pub 1 ic information and education for health Regional Country or area Intercountry

US$

........................... .................... ....................... Total

155 700 175 600 332 600 663 900

37 200 37 200

155 700 175 600 369 800 701 100

191 200 513 100 293 100 997 400

35 500 337 500 (39 500) 333 500

3.7.0

Research promotion and development Regional Country or area Intercountry ~

. ......................... ....... ··········· .. ....................... Total 885 600 885 600 111 000 111 000 996 600 996 600

200 000 838 900 1 038 900

200 000 (46 700) 153 300

3.8.0

Genera 1 health protection and promotion Regional Country or area Intercountry

........................... .................... ......... ······ ........ Total

458 200 690 400 l 148 600

25 600 8 900 34 500

483 800 699 300 l 183 100

783 000 668 100 l 451 100

783 000 668 100 1 451 100

324 800 (22 300) 302 500

3.9.0

Protection and promotion of the health of specific population groups Regional Country or area Intercountry

··········· ................ ......... ··········· ....................... Tot a 1

369 800 139 800 509 600

140 100 946 BOO

4 509 900 1 086 600 5 596 500

455 500 261 100 716 600

2 307 200 2 307 200

2 762 700 261 100 3 023 800

85 700 121 300 207 000

5 086 900

3.10.0

Protection and promotion of mental health Regional Country or area Intercountry

.····· ...................... .................... Total

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

389 400 221 300 610 700

42 900 42 900

389 400 264 200 653 600

159 500 263 500 423 000

(229 900) 42 200 (187 700)

~---

Estimated obligations PROGRAMME Regular budget US$ 3 .11.0 Promotion of environmental health Regional Country or area Intercountry 1982-1983 Extrabudgetary sources US$ Total US$ Regular budget US$ 1984-1985 Possible extrabudgetary sources US$ Increase/ (Decrease) Regular budget US$

Total US$

........................... .................... ....................... Total

1 657 900 1 504 600

2 105 100 550 000 2 655 100

3 763 000 2 054 600 5 817 600

1 492 000 2 144 300 3 636 300

792 000 170 000 962 000

2 284 000 2 314 300 4 598 300

(165 900) 639 700 473 800

3 162 500

3.12.0

Diagnostic, therapeutic and rehabilitative technology Regional Country or area Intercountry

........................... .................... ....................... Total

1 383 400

300 600 l 684 000

579 700 718 100 1 297 800

1 963 100 1 018 700 2 981 800

1 869 000 453 000 2 322 000

33 000 763 800 796 800

l 902 000 l 216 800 3 ll8 800

485 600 152 400 638 000

4.13 .0

Disease prevention and control Regional Country or area Intercountry

........................... .................... Total

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

2 139 900 3 360 500 5 500 400

1 216 000 1 820 000 3 036 000

3 355 900 5 180 500 8 536 400

2 950 000 3 980 000 6 930 000

145 000 11 000 156 000

3 095 000 3 991 000 7 086 000

810 100 619 500 1 429 600

5.14.0

Health information support Regional Country or area Intercountry

............... ··········· ................... ...................... Total

454 000 70 000 10 000 534 000

208 000 208 000

454 000 278 000 10 000 742 000

568 300 100 000 94 600 762 900

114 300 30 000 84 600 228 900

5.15.0

Support services Regional Country or area Intercountry Total Regional Country or area Intercountry 5 556 500 20 344 900 13 168 600 39 070 000 639 900 12 043 600 5 800 200 6 196 400 32 388 500 18 968 800 57 553 700 7 504 900 24 137 100 14 483 000 46 125 000 809 600 3 778 200 2 157 800 6 745 600 8 314 500 27 915 300 16 640 800 52 870 600 c:=====-===

.······················ .... ···················· ....................... Total

2 871 600

639 900

3 511 500

4 090 600

809 600

4 900 200

1 219 000

2 871 600

639 900

3 511 500

4 090 600

809 600

4 900 200

1 219 000 1 948 400 3 792 200 1 314 400 7 055 000 ~~:===::====

==========

=======:::==

18 483 700

======-==·=

x==========

=========

REGULAR BUDGET 1982-1983 AND 1984-1985 BY APPROPRIATION SECTION WITH PERCENTAGES OF THE TOTAL

Estimated obligations Appropriation Section 1982-1983 us$ 1.

Percentages 1982-1983 1984-1985

1984-1985 US$ 4 265 900 20 487 700 9 587 900 6 930 000 4 853 500 46 125 000

Direction, coordination and management Health system infras true ture Health science and Health science and Programme support

••••••••••••

IIJ

•••

••••••••••

3 492 700 18 670 300 8 001 000 5 500 400 3 405 600 39 070 000

8.94 47.79 20.48 14.08 8.71 100.00

9.25 44.42 20.79 15.02 10.52 100.00

2. 3. 4. 5.

..................................... technology - health promotion and care ........ technology - disease prevention and control .... ................................................ Total

==========

======

PROGRAMME ANALYSES

1.1.0

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.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional 280 000

US$

US$ 280 000

US$ 346 000

US$

US$ 346 000

us$ 66 000

••

••••••••

Country or area Intercountry

... ...... Total 280 000 280 000 346 000 346 000 66 000

=======

=========

=======

=========

=======

======

12 1.1.3 REGIONAL COMMITTEE

1. The functions of the Regional Corrnnittee are defined in Article 50 of the WHO Constitution. The estimates cover expenses directly identifiable with the holding of a regular session in 1984 and again in 1985. Provision is also made for the organization of meetings of the two Sub-Corrnnittees of the Regional Committee the Sub-Committee on the General Prograrrnne of Work and the Sub-Corrnnittee on Technical Cooperation among Developing Countries. Through these sub-corrnnittees the Regional Corrnnittee 1s intensifying its involvement in the work of the Organization. 2. In addition to the direct costs of holding the above-mentioned sessions and meetings, preparation for and servicing of the Regional Corrnnittee and its sub-corrnnittees are integral parts of many other prograrrnnes.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) betwee·n 1982-1983 and 1984-1985

Total US$

Regular budget US$

Regional

........... ... Total

280 000

346 000

66 000

Country or area Intercountry

...... 280 000 280 000 346 000 346 000

=======

=========

========

=======

=========

66 000

=======

======

1.2.0 Objective

WHO'S GENERAL PROGRAMME DEVELOPMENT AND MANAGEMENT

To develop and manage the Organization's relation to those of other bodies to that end.

programme effectively;

coordinating its activities

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$

US$ 1 646 800

US$ 2 131 300

US$ 484 500

........... Country or area ... Intercountry ...... Regional Total

1 646 800

1 565 900 3 212 700

163 000 163 000

1 728 900 3 375 700

1 788 600 3 919 900

200 000 200 000

1 988 600 4 119 900

222 700 707 200

=========

=======

=========

=======

=========

=======

14 1.2.1 EXECUTIVE MANAGEMENT

1. The Regional Director acts as technical and administrative head of the regional office, subject to the overall authority of the Director-General. 2. Within the general programme of work and the policies established by the World 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, 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. 3. The Regional Director ensures coordination of WHO regional and country programmes and keeps Director-General informed of major developments affecting the health situation of the Region. the

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$ 420 000

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 334 900

Total US$ 420 000

Regular budget US$ 85 100

........... Country or area ... Regional Intercountry

334 900

...... Total 334 900 334 900 420 000 420 000 85 100

=======

=========

=======

=========

=======

======

1.2.2

REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

The funds provided under this heading will be used for financing 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.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Regional Total

775 300 775 300

922 500 922 500

147 200 147 200 =======

=======

=========

=======

=========

=======

16 1.2.3 GENERAL PROGRAMME DEVELOPMENT

Medium-Term Programme for 1984-1989 Objectives 1. To ensure that managerial processes are effectively applied for health development, in an integrated manner, in the formulation and implementation of programmes of cooperation with countries or areas of the Region; to ensure that appropriate information system methodology, as well as modern data and text processing technology, are used to develop and establish a dynamic information system to support managerial information requirements in relation to WHO's collaborative and coordinative activities; to enable WHO to provide support in 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. Targets 2. By the end of (1) 1989~

all regional medium-term programmes will be updated as necessary;

implemented, monitored,

reviewed,

evaluated,

and

(2)

biennial programme budgets will be formulated which express respective two-year portions of the medium-term programmes; all projects in operation by 1984, and those formulated during the period of the Seventh General Programme of Work covering a specific period (1984-1989 inclusive), will have adequate evaluation components; managerial methods will be continuously improved;

(3)

(4)

(5)

a dynamic, effective and efficient information sys tern will be operating in the Region to support the management of WHO's programmes of cooperation at regional and country levels in the context of "health for all" monitoring functions; WHO staff at all levels, and national staff as appropriate, will have been given briefing, orientation and training to enable them to participate actively and effectively in the managerial processes in order to support countries or areas in implementing their strategies for "health for all".

(6)

Plan of Action 3. By mid-1982, medium-term programmes had been formulated for the areas considered relevant to the regional situation. Through the process of periodic reviews (at least once a year by the Regional Programme Committee) these medium-term programmes will be updated. 4. At the time of formulation of the biennial programme budgets governments, with support from WHO Programme Coordinators and Country Liaison Officers, will use the medium-term programmes in the development of proposals to WHO. Implementation of the programme management information system will continue. 5. To strengthen evaluation it will be necessary to formulate programmes more precisely and review them periodically. As more experience 1s gained in developing and applying the managerial processes improvements will be introduced. 6. The Regional Focal Group on the Information Sys terns Programme, which is an internal mechanism established to advise and provide guidance in the development of the regional information system, will continue to function as the articulator of the requirements of users of information. 7. The information system evaluation will be further procedures will be improved. to support programme planning, budgeting, refined, based on the needs of the users, monitoring and control, and and updating and maintenance

8. Procedures will be established for extracting relevant information from available sources and presenting it in a manner which satisfies management requirements. To guarantee interprograrnme compatibility, formats and procedures for identifying, generating, processing, storing and updating needed information will be standardized.

9. Training in information system activities will be continued and collaboration with other technical and management training programmes will be promoted to energize the use of information. 10. Information processing capability will be enhanced through the acquisition or upgrading of computer and word processing equipment. 11. Information analysis capability will be developed as a direct support to senior management. 12. Staff, including national staff as appropriate, will be briefed and rebriefed on WHO's policies and strategies as they evolve aml develop. 13. Training in the managerial processes and the relevant managerial skills, for national health development as well as WHO's programme development, will be conducted for WHO staff and national staff through activities ranging from short orientation sessions to workshops of two or more weeks' duration. 14. The ability of staff to collaborative activities with activities. work effectively and harmoniously in multidisciplinary teams and in other agencies will be fostered through training programmes and other

15. The technical knowledge and skills of WHO staff will be constantly updated through short courses, study leave and refresher training. The knowledge of WHO administrative procedures and mechanisms required by WHO staff will be updated continuously. Conversion training for staff whose programmes require new skills and approaches will be arranged. Programme Activitie,,~ for 1984-1985 16. Programme and project reviews will be held once a year; programme management information will be updated every year; meetings of WHO Programme Coordinators will be held periodically; meetings of the Regional Health Development Group will be held regularly; procedures will be updated periodically; and staff meetings will be held regularly. 17. Mechanisms for implementing the programme management information system will be reviewed, revised and tested, and revised guidelines established; an information system for monitoring the operation of WHO collaborative and coordinative activities will be established; and WHO staff will be trained in the preparation and use of the WHO information system.

18. Workshops on the managerial processes for national health development and relevant managerial skills, as well as on WHO's policies and strategies, will be held in selected countries; short workshops for WHO staff on educational methods and techniques, such as the training of trainers, will be organized; administrative update courses for WHO secretaries will be undertaken; and study leave, refresher training and conversion training will be arranged.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$ 1 369 500

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 1 043 700

Total US$ 1 369 500

Regular budget US$ 325 800

........... Country or area ... Intercountry ...... Regional Total

1 043 700

790 600 1 834 300

163 000 163 000 =======

953 600 1 997 300

866 100 2 235 600

200 000 200 000

1 066 100 2 435 600

75 500 401 300

=========

=======

=========

=======

1.2.4

EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT

Medium-Term Prograwae for 1984-1989 Objectives 1. To strengthen collaboration with the United Nations, other agencies within the United Nations system and international governmental and nongovernmental organizations in official relations with WHO;

to participate actively in interagency coordination mechanisms; to provide support to countries or areas in the coordination of national programmes contributing to comprehensive socioeconomic development and the principles and goals of the New International Economic Order; to ensure the association of WHO with multilateral development programmes, funds and organizations 1n the Region; to monitor its participation in resultant activities; to promote, enhance and coordinate collaboration with all other sources of support for health work being carried out in developing countries or areas. Targets 2. By the end of (1) 1989~

mechanisms will have been strengthened for effective coordination in the planning of external cooperation for health and in the implementation of specific activities and projects; procedures will have been improved at regional level for more effective coordination with the United Nations and other organizations and institutions of the United Nations system and with bilateral and multilateral agencies.

(2)

Plan of Action 3. A situational regional levels. analysis will be undertaken of existing coordination arrangements at country and

4. The development of mechanisms will be promoted, where necessary, coordination of extrabudgetary resources for health programmes.

1n order

to achieve effective

5. Sources of external cooperation which may be available for health programmes will be identified and information on WHO programmes and priorities will be disseminated for the purpose of securing maximum participation from such sources. 6. Joint programming missions with other United Nations agencies, or with bilateral and multilateral donors, will be promoted and conducted, to identify possible areas of technical cooperation with Member States. 7. Joint activities will be banks, for example the World health-related projects. further developed with international banking institutions and regional Bank and the Asian Development Bank, aimed at furthering large-scale

8. Collaboration '-'!ill be intensified with regional governmental oganizations such as ASEAN and also with nongovernmental organizations concerned with health. Programme Activities for 1984-1985 9. WHO will continue programming missions. to promote interagency collaboration through joint consultations and joint

10. Nongovernmental organizations will be encouraged to participate in the implementation of national strategies for health development. To that end, information on the health-related activities of relevant nongovernmental organizations will be collected, in order to promote a dialogue between governments and national nongovernmental organizations and establish mechanisms for cooperative action.

11. Collaboration between United Nations agencies and multilateral and bilateral donor agencies will be stimulated in order to attract funds that can be mobilized for health development activities, particularly in the developing and least developed countries.

1.2 .4

EXTERNAL COORDINATION FOR HEALTH AND SOCIAL DEVELOPMENT

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$ 341 800

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 268 200

Total US$ 341 800

Regular budget US$ 73 600

........... ... Total

268 200

Country or area Intercountry

...... 268 200 268 200 341 800 341 800

=======

=========

=======

=========

73 600 ======

=======

2.3.0 Objective

HEALTH SYSTEM DEVELOPMENT

To support countries or areas of the Region in the progressive development of their health systems based on primary health care, through strengthening their ability to assess the situation with regard to health, as well as health trends, and to apply this information through an integrated managerial process, which will include the use of health systems research and the required development of health legislation.

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$ 177 500 4 035 200 982 400 5 195 100

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 148 400

Total US$ 177 500

Regular budget US$ 29 100 743 100 (457 400) 314 800

........... ... ...... Total

148 400 3 292 100 1 439 800

Country or area Intercountry

99 600 367 500 467 100 =======

3 391 700 1 807 300

170 000 60 000 230 000 =======

4 205 200 1 042 400 5 425 100

4 880 300

=========

5 347 400

=========

=======

2.3.1

HEALTH SITUATION AND TREND ASSESSMENT

Medium-Term Prograwme for 1984-1989 Objective 1. To develop national capability in~ (1) collecting, analyzing and synthesizing health statistical data, in order to identify major health problems and the factors involved; and (2) undertaking analyses of health trends, as well as projections, in order to monitor progress towards the goal of health for all by the year 2000; and to strengthen the development of epidemiological and related services.

Targets 2. By the end of (1) 1989~

in all countries or areas, national capability in the analysis and synthesis of health situation and trend assessment will have been enhanced to serve as a basis for the long-term, medium-term and short-term development and management of health programmes and subprogrammes; most countries or areas will have established mechanisms for epidemiological surveillance; a data base, with health and related socioeconomic indicators, will have been established at regional level to monitor implementation of the health for all strategy. Included in the data base will be. data on the epidemiological surveillance of communicable and noncommunicable diseases and of environmental hazards. A framework will have been developed for the periodic analysis and synthesis of the data.

(2) (3)

Plan of Action 3. WHO will cooperate in strengthening national capability to develop information support relevant to health development programmes and subprogrammes, particularly capability to monitor progress towards health for all by the year 2000 and to generate relevant information for assessment of the health situation and of the progress achieved in health development. Analytical capability in statistical data processing and epidemiological techniques will be developed. Ability to undertake trend analyses and

health projections will be promoted and information will be disseminated on forecasting and projection techniques and experience ~n their usage. The development and strengthening of the epidemiological surveillance component of all disease control programmes, in coordination with other communicable disease prevention and control activities, will be promoted. Simple and inexpensive technology will be developed, such as the lay reporting of health information for the generation of minimum essential health information and for the standardization and classification of health problems, health services activities and procedures. 4. The technical cooperation among developing countries approach in furthering collaboration among countries will be applied. Support will continue to be provided at national and regional levels for the application of statistical and mathematical methodology, particularly in the design of studies and in the processing and analysis of data. Training in health statistics and information will be promoted. Progranwe Activities for 1984-1985 5. Training will be undertaken in the development of health indicators and projections towards the year 2000, in modern analytical statistical techniques and in epidemiological surveillance systems. Cooperation will be provided, to strengthen national epidemiological services and laboratory support, by improving diagnostic facilities and promoting the use of WHO Collaborating Centres, and to promote research activities to develop, for example, simpler diagnostic methods and more effective intervention measures.

2.3.1

HEALTH SITUATION AND TREND ASSESSMENT

1982-1983 Estimated obligations Regular budget US$ 148 400 456 300 753 200 l 357 900 ========~

1984-1985 Estimated obligations Regular budget US$ 177 500 286 500 282 800 746 800 =======

Increase(Decrease) between 1982-1983 and 1984-1985

I Regional

Extrabudgetary sources US$

Total US$ 148 400

Possible extrabudgetary sources US$

Total US$ 177 500

Regular budget US$ 29 100 (169 800) (470 400) (611 100)

........... Country or area ... Intercountry ...... Total

99 600 b9 000 168 600

555 900 822 200 1 526 500

170 000

456 500 282 800

=======

=========

-------

170 000

916 800

=======

2.3.2

MANAGERIAL PROCESS FOR NATIONAL HEALTH DEVELOPMENT

Medium-Term Programme for 1984-1989 Objective 1. To develop or strengthen, ~n the context of the health situation and trend assessment, the formulation of national health policy, broad programming, programme budgeting, detailed programming, implementation, evaluation, and reprogramming; and to contribute to the further improvement, utilization and development of information support. Targets 2. By the end of 1989: (1) all countries or areas of the Region will have formulated health policies according to defined priorities; most countries or areas will have formulated programmes and budgets in relation to national priorities, will have assessed manpower requirements, and will have prepared plans to meet those requirements; all countries or areas will .have improved the operational effectiveness programmes, through the application of appropriate management techniques; of their health

(2)

(3)

(4)

all countries or areas will have introduced monitoring and evaluation and the continuous feedback of information, to provide a basis for the assessment of progress and the modification of plans and programmes; most countries or areas will have developed intersectoral planning and management; methods and mechanisms for decentralized and

(5)

(6)

most countries or areas will have developed mechanisms for institutional support for planning and management, which will include educational and training institutes;

(7)

WHO will have an effective mechanism in operation for the exchange of information, experience and expertise through a regional network of national institutions, which will be closely linked with those in other Regions for the purpose of technical cooperation, in collaboration with the health manpower programme;

3. By the end of 1985, WHO staff in the Region will have received the necessary orientation and training to provide support in the application of the managerial process for health development. Plan of Action 4. Promotion of the managerial process for national health development will be carried out by providing information on the various processes involved, and on their application 1n Member States, to the Regional Committee and its subcommittees, meetings of ministers of health and of other socioeconomic sectors, and meetings of professional health personnel. Relevant material and documents will be published and distributed. 5. Cooperation will be directed towards strengthening national managerial processes at all levels, through the assessment of existing processes and related infrastructure; and development, as necessary, of appropriate processes and related infrastructure, such as planning units in. ministries of health, national health development networks, and health advisory councils. it will be further directed towards improving managerial capabilities through the training of trainers and the development of learning materials. Intercountry mechanisms will be established to mobilize the resources of countries or areas in terms of knowledge, skills, technology and facilities, which participating countries will share for their mutual benefit. Intercountry networks will play an important role in training and research. 6. Guiding principles for the application of managerial processes will be further tested, with the aim of adapting them to the specific needs and practices of individual countries and developing national guidelines. 7. Training programmes will be organized for WHO staff.

8. Contributions may be expected from the programmes for organization of the health systems based on primary health care, health manpower, health systems research, health situation and trend assessment, health legislation and the staff development and training component of general programme development.

9. In addition to funds from the regular budget, support may be expected extrabudgetary sources. Close collaboration will be maintained with UNICEF. Programme Activities for 1984-1985

from

UNDP

and

other

10. Promotional activities will continue. Cooperation will be provided in training, through the training of trainers at national level, intercountry exchanges of experience, and the production of learning materials; review and monitoring of the application of managerial processes for national health development; establishment of national and regional health development networks; and research and development, which will include studies on resource allocation, decentralization of planning and management, and information systems support. 11. WHO staff will be trained in the managerial processes at workshops in selected countries which will include national staff.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary

lncrease(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget us$

sources US$

........... Country or area ... Regional Intercountry

2 697 800 525 800 3 223 600 90 000 90 000

2 697 800 615 800 3 313 600

3 414 600 631 600 4 046 200 60 000 60 000

3 414 600 691 600 4 106 200

716 800 105 800 822 600

...... Total

---------

-----------

=========

=======

=========

=======

2.3.3

HEALTH SYSTEMS RESEARCH

Medium-Term Programme for 1984-1989 Objective

1. To promote the development of national capability to plan and implement national health systems research programmes, as part of the process of organizing health systems based on primary health care, the results of which will be used to provide more efficient, effective and equitable health care at the community level. Targets 2. By the end of (1) 1989~

half the countries or areas of the Region will have developed national capability to carry out health systems research and commenced to implement programmes within the framework of national health development activities, especially with respect to pr1mary health care and the development of the necessary manpower; six institutions will have been strengthened and designated as WHO Collaborating Centres, as part of the regional development network; an effective operation. system for the exchange of information on health systems research will be in

(2)

(3)

Plan of Action 3. Cooperation will be extended in the development of national health systems research programmes. The designation of focal institutions or groups, the identification of research priorities and specific research activities, the orientation of users of health systems research, the development of inventories of health systems research and resources, and the establishment of network arrangements among institutions within individual countries, will be encouraged. A core of national health staff, trained in health systems research methodology, will be developed. Institutions engaged in health systems research will be strengthened. Within the limits of funds to be made available, national studies on very high priority subjects will be supported.

4. The regional information system will be continuously updated and improved. Collaboration will be maintained with other WHO programmes, particularly with those on the managerial process for national health development' the organization of health systems based on primary health care' health situation and trend assessment, health manpower, and research promotion and development. 5. The programme will continue to draw guidance from the Sub-Committee on Health Services Research of the Western Pacific Advisory Committee on Medical Research, as well as from the recommendations defining research needs of meetings at national and regional levels. 6. The programme will be evaluated with regard to: (1) the establishment of health systems research programmes or infrastructures as integral parts of the managerial process; (2) the number of countries conducting, or having conducted, health systems research in high priority areas; (3) the development of a core of trained staff; and (4) the designation of six WHO Collaborating Centres. Programme Activities for 1984-1985 7. National programmes and activities in health systems research will be developed through technical visits to countries and consultation with national focal points. 8. Manpower development plans will be formulated, an inventory of institutions for training in health systems research established and updated continuously, health services research integrated in the curricula of training institutions, core groups of trainers developed, and training carried out in the evaluation of research. 9. Institutions will be strengthened for designation as WHO Collaborating Centres for health sys terns research and collaborative working arrangements among them facilitated. 10. Specific health systems research studies will be formulated and carried out. 11. A health systems research information system will be developed and biomedical information system. integrated into the regional

2.3.3

HEALTH SYSTEMS RESEARCH

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budge.t US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Total US$

Regular budget

us$

Regional

........... Country or area ... Intercountry ...... Total

118 000 160 800 278 800 199 300 199 300

118 000 360 100 478 100

308 100 68 000 376 100

190 100 (92 800)

=======

=========

97 300

=======

======

2.3.3

HEALTH SYSTEMS RESEARCH

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budge.t US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Total US$

Regular budget

us$

Regional

........... Country or area ... Intercountry ...... Total

118 000 160 800 278 800 199 300 199 300

118 000 360 100 478 100

308 100 68 000 376 100

190 100 (92 800)

=======

=========

97 300

=======

======

2.3.4 Medium-Term Programme for 1984-1989 Objective

HEALTH LEGISLATION

l. To foster and support national efforts in formulating health legislation that 1.s fully 1.n harmony with, and supportive of, national strategies for "health for all". Target 2. By the end of 1989, most of the developing countries or areas in the Region will have formulated health and related legislation needed to attain the goal of health for all by the year 2000. Plan of Action 3. Action will be taken to collect more information on health legislation and to undertake a survey on health legislation needs. Appropriate national health legislation will be developed. 4. Close cooperation will be maintained between the health legislation programme and the programmes on the managerial process for national health development, organization of health systems based on primary health care, protection and promotion of the health of specific population groups, promotion of environmental health, diagnostic, therapeutic and rehab il ita ti ve technology, and disease prevention and control. Programme Activities for 1984-1985 5. Health legislation needs will be reviewed and technical cooperation will be extended on request.

2.3.4

HEALTH LEGISLATION

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

20 000 9 200

20 000 9 200 29 200 ======

26 000

6 000

-20 000 9 200 26 000

======

=====

======

=========

26 000

======

=====

6 000

2.4.0

ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

Hedium-Term Programme for 1984-1989 Objective l. To promote the appropriate organization and effective operation of comprehensive health systems which provide the essential elements of pr~mary health care to entire populations, together with referral and specialized support when necessary, and which involve communities and health-related sectors in responsible and coordinated ways. Targets 2. By the end of (l) 1989~

most countries or areas of the Region systems, based on primary health care;

will

have

reoriented

and

strengthened

their

health

(2)

most countries or areas will have developed, and will be supporting and maintaining, functioning mechanisms for health development activities in a progressively increasing number of communities, both rural and urban, priority being given to the most under served areas, within the framework of partnership or shared responsibility among the family, the community and the health and related sectors; most countries or areas will have developed or strengthened effective intersectoral coordination mechanisms for the support of health development processes at local, intermediate and national levels; half the countries or areas will have strengthened their capabilities research and the utilization of health and related information; half the countries or areas will have training courses for health personnel; restructured the curricula ~n

(3)

(4)

health

systems

(5)

of basic

and

post-basic

(6)

in collaboration with the managerial process for national health development programme, an effective mechanism will be in operation for the exchange of information and experience, through a regional network of collaborating institutions, with strong links with other WHO Regions for technical cooperation purposes.

36 Plan of Action 3. As ministries of health are expected to be the effective prime movers in primary health care, they should be provided with sufficient support to enable them to enhance their leadership in the field of health. Cooperation will be provided in strengthening the organization and support mechanisms of the health care delivery system; training health staff in planning and management, health systems research, and community organization and participation; conducting studies on intra- and intersectoral coordination, improvement of organization, resource allocation, and field operations; strengthening selected institutions; and promoting the exchange of information, experience, and expertise through the networking process. 4. Collaboration will come from the following programmes: managerial process for national health development, health manpower, health systems research, health situation and trend assessment, and public information and education for health. 5. Support is expected from UNDP and close collaboration will be maintained with UNICEF. Other extrabudgetary resources will be sought and loan· negotiations between governments and international banks will be facilitated. Programme Activities for 1984-1985 6. The main thrust, in programmes of cooperation, will be ~n the introduction and application methods and procedures appropriate for health development at local level, with a high degree community involvement; in strengthening continuing education programmes for staff development, support primary health care; in facilitating intrasectoral and intersectoral coordination formulating the necessary procedures; and ~n facilitating the dissemination of information on experience gained. of of to and the

7. In more specific terms, collaboration will be provided in: reviewing and monitoring primary health care development; improving the planning and programming process by strengthening planning mechanisms and infrastructures, including staff training; developing capability for carrying out and supporting health systems research on priority issues; carrying out research and development activities in rural and urban areas, which address the issue of community participation and intersectoral collaboration in national health development; developing health manpower through regional and national courses for trainers of primary health care workers, senior and middle level health managers and village health workers, which will include the development of skills in health facilities design and maintenance; restructuring the curricula for the training of nurses and other allied health staff, as well as preparing faculty members; and promoting the exchange of information.

2.4.0

ORGANIZATION OF HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget

us$

...........

Country or area Intercountry

... ...... Total

3 027 400 1 663 200 4 690 600

455 400 855 800 1 311 200

3 482 800 2 519 000 6 001 800

3 866 200 1 588 900 5 455 100

331 000 953 000 1 284 000

4 197 200 2 541 900 6 739 100

838 800 04 300) 764 500

=========

=======

2. 5 • 0

HEALTH MANPOWER

Medium-Term Programme for 1984-1989 Objective 1. To promote planning for the training and deployment of the number and types of personnel Member States require and can afford; to cooperate in activities to that end; and to ensure that such personnel are socially responsible and possess the technical, scientific and managerial competence needed to develop and maintain comprehensive national health systems based on primary health care for the attainment of health for all by the year 2000. Targets 2. By the end of (1) 1989~

based on the development of explicit manpower policies, half the countries or areas of the Region will have strengthened the health manpower planning component of the managerial process for national health development. Both qualitative and quantitative requirements will have been specified, appropriate to health for all priorities in the context of primary health care. The management of fellowships will form an integral part of such planning; most countries or areas will have developed mechanisms and processes to improve coordination between producers and users of health manpower, using in particular national health development centres; using appropriate information systems, most countries or areas will have strengthened national policies and systems for the optimal deployment and utilization of health personnel, ~n particular nurses and midwives; half the countries or areas will have strengthened national capability for training health service staff in the managerial process for national health development, and for developing adequate systems for continuing education;

(2)

(3)

(4)

(5)

most countries or areas will have strengthened the capacity of educational institutions to ensure that sufficient health manpower is produced, of the right type and Ln the right quantity, to meet the requirements of the health system; half the countries or areas will have introduced appropriate training for workers, directly related to primary health care, and supported through the development or restructuring of basic training programmes or continuing education schemes; all countries or areas will have restructured their training programmes, where necessary, in order to-increase their relevance to local needs, using a task- and community-oriented approach; most countries or areas will have introduced the use of sound educational processes through, inter alia, the training of teachers and the provision of adequate educational materials.

(6)

( 7)

(8)

Plan of Action 3. The prime concern of the health manpower programme will be to promote the policies and programmes necessary to meet the manpower requirements of national health systems, appropriate to "health for all" priorLtLes, in the context of primary health care. For that purpose, cooperation will be extended in the development of activities in two separate but closely related areas; that is in relation to the managerial process for health manpower development and the formation of health personnel. 4. Managerial process for health manpower development. Methods and processes will be developed for improving coordination between the producers and users of health manpower. Plans, based on explicit health manpower development policies and the national capability to analyse and identify health manpower needs, will be initiated, implemented and monitored. They will specify qualitative and quantitative requirements and the allocation of resources. 5. Programmes will be developed for the continuing education and train them in the primary health care approach, with midwives. Measures to achieve an equitable distribution of retention within the health system, as well as studies on the worker and their effectiveness in primary health care, will be of health personnel, in order to reorient emphasis on programmes for nurses and health manpower within a country and its new roles of certain categories of health supported.

40 6. Programmes for the training of trainers will be designed, with particular emphasis on health management training in schools of public health and management training institutions. The effectiveness and efficiency of the WHO fellowship programme, as well as other educational activities, as a means of developing pools of skilled health manpower, will be monitored and improved regularly. 7. Formation of health personnel. Training institutions will be strengthened for all categories of health manpower needed in the health system. The development of new educational institutions concerned with training relevant to "health for all" based on primary health care, will be promoted. Appropriate methodology for the training of primary health care workers, based on analyses of the skills required, will be developed, applied and evaluated. Training programmes will be revised or restructured, to improve their relevance and efficiency, using competency-based curricula. The application of sound educational processes will be promoted, through training of teachers, with special emphasis on teachers of primary health care workers. Cooperation will be extended in developing and testing educational materials for all categories of health worker.

8. By its nature, the health manpower programme has to closely interact with all other programmes of the Seventh General Programme of Work covering a specific period (1984-1989 inclusive), particularly with health system development (more specifically the managerial process for national health development programme), organization of health systems based on primary health care, general health protection and promotion, protection and promotion of the health of specific population groups, promotion of environmental health, and disease prevention and control. Collaboration with other WHO Regions, particularly the South-East Asia Region, will be strengthened in matters and geographical areas of common Interest. Coordination with other United Nations agencies, as well as appropriate nongovernmental organizations, will continue to ensure efficient programme delivery. 9. The availability of additional resources will be in direct coordination mentioned in the previous paragraph. Support may be sources. relation e~pected

to the strength of the from UNDP, UNFPA and other

10. The programme will be monitored and evaluated systematically. While, ultimately, indicators will relate to the availability of categories of health worker performing specific functions and their geographical distribution, intermediate variables will be measured in direct relation to targets. For example, the number of manpower plans that have been developed with defined characteristics, or the number of training institutions with training programmes restructured in order to 1ncrease their relevance to national needs.

11. In addition to the regular mechanisms for review and evaluation, progress towards the achievement of medium-term programme targets will be reviewed biennially. Programme Activities for 1984-1985

12. Activities will primarily focus on training programmes for middle-level health personnel, and for the trainers of personnel workin6 at the periphery.

13. Managerial process for health manpower development. Cooperation will be provided in: strengthening of mechanisms for coordination, particularly between producers and users; promotion, development, review and monitoring of country health manpower policies and plans; promotion of studies and measures to achieve equitable distribution of health manpower within a country and its retention within health system; identification and strengthening of mechanisms for collecting, disseminating and updating information on the training and utilization of health workers; promotion of national systems for training 1n the managerial process for national health development (in collaboration with other programmes); planning and implementation of continuing education programmes for reorienting health personnel staff towards primary health care, as well as methods for monitoring performance standards; and strengthening of national mechanisms for the integration of fellowships in health manpower plans. Cooperation will be extended in: promotion of studies and measures for institutional strengthening and for improving the management of educational programmes in training institutions; strengthening national efforts related to the application of educational processes in the training of primary health care workers; revision of training curricula, in particular reorientation of programmes for nurses and medical assistants, to emphasize the community approach; training of teachers and educational planners or managers in order to enhance their capability to introduce innovative changes in educational management fields, which will involve the study of factors facilitating or preventing such changes; and identification of needs for educational materials at regional and national level, followed by the development and testing of those materials.

14. Formation of health personnel.

2.5.0

HEALTH MANPOWER

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

........... Country or area ... Intercountry ...... Total

7 381 200 1 054 300 8 435 500

3 214 100 179 000 3 393 100

10 595 300 1 233 300 11 828 600

7 713 600 1 126 500 8 840 100

332 400 72 200

=========

==========

=========

404 600

========

2.6.0

PUBLIC INFORMATION AND EDUCATION FOR HEALTH

Medium-Term Programme for 1984-1989 Objective

1. To foster health education and information activities which will healthy, to know how to stay healthy, to do what they can, individually manner, to maintain health, to solve health problems, and to achieve health through community self-reliance based on dynamic interaction with Targets 2. By the end of 1989: (1)

encourage people to want to be and collectively in an organized the highest attainable level of the health services.

all countries or areas of the Region will have formulated and established health education and public information policies and strategies, including planning and programming of activities and strengthening of the corresponding infrastructure at various levels within the health services; the ministries of health in all countries or areas will have ensured the support of the ministries of information, education, agriculture, environment, community development and other related sectors for coordinated 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; all countries or areas will have integrated health education and public information in major programmes within the context of primary health care, with emphasis on family health and nutrition, environmental health, immunization and disease prevention and control; all countries or areas will have determined their requirements and strengthened their institutions for the preparation of health education and public information manpower for professional leadership, and for the training of health workers in health education. They will also have developed curricula for the inclusion of health education and public information 1.n the basic training and continued education of at least two categories of health worker;

(2)

(3)

(4)

(5)

most countries or areas will have developed school health education activities and integrated them in the curricula of teacher training institutions and primary schools; and over half will have introduced health education into the curricula of secondary schools; concurrently with the development of appropriate media facilities anc! trained manpower, countries or areas will have enhanced their capabilities for strengthening conrru.unication, audiovisual and media support for health programmes; half the countries or areas will have developed or strengthened mechanisms and capabilities for behavioural research in health and health education.

(6)

(7)

Plan of Action 3. As the active and dynamic involvement of communities is a vital element in the primary health care approach, the strengthening of health education and public information support to health programmes is essential. Cooperation will be provided in developing, testing and strengthening public information and health education policies and programmes in support of health services and promoting community self-reliance in health; training health staff in health education and the community approach and preparing health education and communication specialists for professional leadership; developing or strengthening school health education in primary and secondary schools and teacher training institutions and preparing teaching/learning materials; integrating health education in the major health programmes, including the careful identification of health messages and the formulation of strategies to ensure such messages are communicated effectively; and strengthening national capability for media support to health programmes and for the application of social science research in health and health education. In the implementaion of collaborative activities, linkages will be established with the following health system development, organization of health systems based on primary health care, health manpower, research promotion and development, general health protection and promotion, promotion of environmental health and disease prevention and control. programmes~

5. In addition to specific provisions for public information and education for health, provisions for other programme areas will be used to strengthen the health education and community involvement components of those programmes.

6. Indicators will be further developed and refined to assess both the contribution of health education and its impact on community involvement in health development. Emphasis in relation to the latter, i.e. the determination of trends in the nature and P.xtent of community participation, will be placed on two distinct though interrelated features, namely: (a) the functioning of organized community groups (community organizations) in response to the health and development needs of the community; and (b) the response by individuals and families with regard to optimal utilization of the health services and adoption of a healthful lifestyle. Programme Activities for 1984-1985 7. The main emphasis will be on strengthening the health education and public information components of training programmes and of institutions for manpower development, including health education in the school system; and strengthening media support to health programmes. Behavioural research in health education will also be encouraged and supoorted. 8,

More specifically 7 cooperation will be extended in the following areas: Training. Curriculum design and training methodology will be developed for the introduction of intensive and comprehensive short-duration training programmes in health education and community involvement, to provide inservice training for health workers at the periphery and their supervisors. Support wi 11 be provided in reviewing and yes true turing training curricula for health education specialists in the context of primary health care. Group training programmes will also be supported. School health education. Group training programmes will be organized in relation to the design of curricula, the development of a teacher's guide and teaching/learning materials, and the training of teachers in school health education. Media support. This, and also facilities, will be strengthened to enhance the utilization of modern media in support of health programmes. Health education services. The health education and public information component of specific health programmes, particularly family health, environmental sanitation, immunization, control of diarrhoeal diseases, tuberculosis, leprosy and malaria, will be strengthened. Health behaviour research. Social science research in health and health education will be encouraged and well-designed research proposals, with implications for health education, will be supported. 45

2.6.0

PUBLIC INFORMATION AND EDUCATION FOR HEALTH

1982-1983 Estimated obligations Regular budget US$ Regional 155 700 175 600 332 600 663 900 37 200 37 200 Extrabudgetary sources Regular budget US$ 191 200 513 100 293 100 997 400

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 155 700 175 600 369 800 701 100

Total US$ 191 200 513 100 293 100 997 400

Regular budget US$ 35 500 337 500 (39 500) 333 500

us$

••••

•

••••

Country or area Intercountry

... Total

......

=======

======

=======

=-=======

=========

=======

3.7.0

RESEARCH PROHOTION AND DEVELOPMENT

Medium-Term Programme for 1984-1989 Objective 1. To promote health services, behavioural and biomedical research, and to coordinate the development of relevant scientific activities in this area. Targets 2. Programme activities 1989, half the countries infrastructure necessary diseases prevalent; and research. Plan of Action 3. Through the members of the Western Pacific Advisory Committee on Medical Research (WPACMR), collaboration in the development of research designs and the provision of modest financial support, WHO will stimulate countries to ~n~tiate research activities. In the development of infrastructure for research, attention will be focused on research manpower training at all levels (scientjfic, technical and managerial). Efforts will be intensified to develop national institutions so that they may be designated as WHO Collaborating Centres for research and training and thus form a regional network. 4. In order to facilitate the application of existing and emerging scientific knowledge for health development, the regional research information system will be strengthened. With. advice from WPACMR, WHO will improve the guidelines for establishing health research councils or similar bodies, which are important means of relating national health research priorities to the solution of major national health problems, through the managerial process for national health development. Periodic meetings will be held of representatives of national research councils or analogous bodies, to develop international coordination in the promotion of goal-oriented health research. will a~m at fostering national and international action so that, by the end of or areas of the Region will have: (a) the essential resources, manpower, and for carrying out research relevant to the national health situation and the (b) the necessary mechanisms to ensure efficient coordination and management of

Programme Activities for 1984-1985 5. Cooperation will be provided ~n reviewing and updating WHO's regional research policies and priorities, in consultation with members of WPACMR; designing and elaborating new research projects and promoting the application and transfer of scientific knmvledge for national health development, through the regional biomedical information system; identifying, evaluating and designating suitable institutions as WHO Collaborating Centres, in order to strengthen the multinational network of centres carrying out collaborative research and related training in priority areas; tra~n~ng manpower at all levels ~n research and organizing national training courses in research methodology; implementating research projects aimed at problem solving, utilizing both regular and extrabudgetary resources; establishing or strengthening research management mechanisms in order to relate national health research policies more closely to national health policies; developing national research programme planning methodology as part of the managerial process for national health development; and strengthening the Regional Centre for Research and Training in Tropical Diseases at the Institute for Medical Research, Kuala Lumpur, Malaysia, so that it may provide epidemiological, statistical, nutritional, entomological and immunological support to scientists working in the area of parasitic and other communicable diseases within the Region.

----~

-----------------------------------------9

3.7.0

RESEARCH PROMOTION AND DEVELOPMENT

1982-1983 Estimated obligations Regular budget US$ Regional Country Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... or area ...

200 000 885 600 885 600 111 000 111 000 996 600 996 600 838 900 1 038 900

200 000 838 900 1 038 9DO

200 000 (46 700) 153 300 =-=====

Intercountry

...... Total

=======

=========

=====·====

=========

3.8.0 Objective To support the development, health and accident prevention.

GENERAL HEALTH PROTECTION AND PROMOTION

adaptation and use of methods

for promoting proper nutrition,

oral

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

458 200 690 400 1 148 600

25 600 8 900 34 500

483 800 699 300 1 183 100

783 000 668 100 1 451 100

324 800 (22 300) 302 500

=========

======

=========

=======

3.8.1

NUTRITION

Medium-Term Programme for 1984-1989 Objective

1. To promote and support improvement of the nutritional status of all sectors of the population, especially that of mothers and children and other vulnerable groups, and to significantly reduce the incidence of specific nutritional deficiencies. Targets 2. By the end of 1989: (1)

all countries or areas of the Region will have developed the capability to enable them to food and nutrition policies and/or programmes related formulate appropriate national particularly to the health sector, as components of their overall integrated economic development plans; half the countries or areas will have developed research activities under the action-oriented research, development and training programme in nutrition, which has, as priority areas, the problems of the weaning child and pregnant and lactating mothers; all countries or areas with significant levels of specific nutritional deficiencies will have undertaken control programmes to prevent them from becoming public health problems; all countries or areas will have developed infant particular for the promotion of breastfeeding; and young child feeding programmes, in

(2)

(3)

(4)

(5)

most countries or areas will have developed the expertise and the capability, ranging from national policy make~ to village worker, to implement, with appropriate institutional support, the nutrition component of primary health care, including the development of methodology, appropriate technology, training and monitoring; most countries or areas will have developed adequate surveillance indicators for monitoring and evaluation will have been refined; systems; and appropriate

(6)

52 half the countries or areas will have built up institutional capability for training and for undertaking basic and applied research, of national and regional relevance, focused on the vulnerable groups within the population.

(7)

Plan of Action 3. Collaboration will be provided to stimulate coordinated action by the health and other sectors in defining and implementing coherent food and nutrition policies and programmes. This will include the strengthening of health care systems to enable the health sector to play a distinct role in nutrition, namely in the definition and analysis of nutrition problems, the promotion of multisectoral strategies and programmes and their implementation, and the operation of a food and nutrition surveillance system. Within the context of primary health care, this will include identification of malnutrition at the community level and control of food factors and non-food factors in coordination with other programme areas. In order to ensure the more efficient execution of health service responsibilities, special attention will be paid to developing and strengthening focal points in the ml.m.stries of health, training adequate public health nutritionists, and reorienting health policies and programmes.

4. WHO will stimulate the coordinated action of the health and other sectors in relation to nutrition; at regional and international level, 1.n collaboration with other United Nations and bilateral agencies; and at national level, through the development of national coordinating systems. 5. Efforts will be made to promote the concept of nutrition as a component of national development and primary health care, by supporting the inclusion of corresponding objectives and goals in the development strategy. Community participation will be encouraged, mainly by means of educational, income-generating and decentralized management projects. 6. The primary health care worker will focus attention on the early detection, prevention and treatment of malnutrition and endeavour to control the determinant factors. 7. At country level, efforts will focus on the development of simple, cheap and culturally acceptable methodology and techniques to combat malnutrition in the community. 8. Emphasis will be placed on infant and young child feeding, action-oriented research, development and training programmes, and promotion of nutrition surveillance, including the identification and refinement of appropriate indicators.

9. WHO will collaborate in appropriate network of national and regional centres.

research,

institutional

support and 1n the development of a

10. Contributions from various programme areas will complement nutrition activities; namely, from maternal and child health, including family planning, public information and education for health, promotion of environmental health and diarrhoeal diseases. At national level, corresponding contributions may also be expected, especially from FAO and UNICEF, and possibly other agencies. Programme Activities for 1984-1985

11. Provisions from the regular budget wi 11 be complemented by extrabudgetary resources.

12. Cooperation will be provided in the formulation of policies and programmes in nutrition in the context of overall national socioeconomic development plans, and in their implementation. National workshops will focus on specific country needs and the overall objectives of the programme, and may involve a large number of participants from different sectors. Collaboration in infant and young child feeding will relate to such act1v1t1es as the promotion of breastfeeding, national legislation on breastmilk substitutes, and maternal nutrition. Action-oriented research and other research programmes will be undertaken. Intersectoral coordination, which will form an integral part of these activities, will be promoted. This will involve other United Nations agencies, the World Food Programme, UNICEF, and FAO. Support will be maintained for national and regional training programmes. Related programmes, such as maternal and child health, including family planning, and public information and education for health, and the training of primary health care workers in nutrition, will be supported.

3.8.1

NUTRITION

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

305 600 403 800 709 400 =======

305 600 8 900 8 900 412 700 718 300

141 500 388 100 529 600

141 500 388 100 529 600 ===mmz;;;.;;:=:=

(164 100) (15 700) (179 800)

-----

========

=======

:::::::=======

=======

3.8.2 Medium-Term Programme for 1984-1989 Objective

ORAL HEALTH

1. To promote the appropriate organization and effective operation of oral health and other health programmes in order to prevent or control dental caries and periodontal disease. Targets 2. By the end of 1989; (1)

half the countries or areas of the Region will have implemented effective programmes for the prevention and control of caries and periodontal disease: (a) (b) covering 80 per cent. of the children below 15 years of age; maintaining an average level of three DMF(Teeth) or less in children aged 12 years;

(2)

half the countries or areas will have implemented oral health education activities on a wide basis for the effective reduction of dental diseases; some countries or areas will have established a resources unit for oral health training; most countries or areas will have reviewed and reoriented their undergraduate dental curricula; WHO will have prepared training guides for dentists and their supportive dental personnel; studies on periodontal disease profiles will have been carried out by most countries or areas; on the effect of health education in reducing oral/dental diseases by some; and on the use of traditional medicine in dentistry by a few.

(3) (4) (5) (6)

56 Plan of Action 3. Achievement of the targets will depend lilrgely on effective preventive work and health education among schoolchildren and their parents, which requires the deployment of well-trained dentists and dental therapists. Collaboration will therefore focus on strengthening the training of dental staff and improving curricula and teaching resources to enhance the preventive aspects of their work. Promotion of research in key areas is of significance. 4. Collaboration will be required from the progrannnes concerned with organization of health systems based on primary health care, health manpower, health systems research and public information and education for health. 5. Fluoridation of the reticulated water supply will be encouraged and, where that is not possible, the use of alternatives to fluoride that have been found effective in reducing the prevalence of caries will be actively promoted. 6. The programme will be monitored and evaluated principally by using the decayed, missing and filled tooth index (DMF) at age 12 years, the long-term goal being 3 DMF(Teeth) average. Studies in caries and periodontal disease control will add another dimension to measurement in respect of the adult community. Programme Activities for 1984-1985 7. Cooperation will be provided in reviewing dental undergraduate curricula in relation to the objective of health for all by the year 2000; preparing training guides on simple dental care for primary health care workers; evaluating research on the use of high concentration fluorides for the prevention of dental caries; and training senior dental staff in oral health management. 8. Research and development activities will include the promotion of national studies on the prevention and control of periodontal diseases through the active collaboration of the three WHO Collaborating Centres in the Region. In some countries or areas, through field training during intercountry group educational activities, preparation of a periodontal disease profile will be initiated which will show the disease patterns. Through the use of these and tested oral health education methods, programmes for the prevention of periodontal diseases will be strengthened. Dental care for pre-school age children will be actively promoted, especially where this activity is neglected. Through cooperation in national workshops, ways and means will be found of increasing the productivity and effectiveness of oral health personnel in the context of health for all by the year 2000, and the information obtained will be widely disseminated.

3.8.2

ORAL HEALTH

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

152 600 254 600 407 200

25 600

178 200 254 600

581 500 224 000 805 500

428 900 (30 600) 398 300

25 600

432 800

=======

=========

=======

3.8.3

ACCIDENT PREVENTION

Medium-Term Programme for 1984-1989 Objective

1. To promote the prevention of accidents and the care of resulting disabilities, caused by road traffic accidents. Targets 2. By the end of 1989: (1)

particularly those

all countries or areas of the Region will have developed comprehensive preventive measures to reduce morbidity and mortality from road tra1fic accidents; in half the countries or areas, studies on the magnitude and nature of road traffic accidents will have been undertaken; and, in some, studies on specific road traffic accident problems, such as those related to alcohol and drugs; in some countries or areas, multisectoral and interdisciplinary national prevention and control of road traffic accidents will have been organized; committees on the

(2)

( 3)

(4)

a WHO Collaborating Centre for the prevention and control of road traffic accidents will have been designated and a mechanism for information exchange between all such WHO Collaborating Centres and Member States will have been established; in most countries or areas, a comprehensive accidents will have been developed; care system for the victims of road traffic

(5)

(6)

in most countries or areas, educational programmes will have been introduced for the prevention of accidents in the home.

Plan of Action 3. Using an approach relating to behaviour, WHO will cooperate in measures to reduce mortality and morbidity due to road traffic accidents, in cJose collaboration with ~he motor car industry and sectors sucn as those responsible for the police, road construction, and school education. 4. The establishment of national committees, accidents, will be promoted.

consisting of authorities

concerned with

road

traffic

5. Meetings will be held to stimulate the interest of national health and related agencies and to sensitize the dec is ion makers to a coordinated, multisectoral and multidisciplinary approach to the problem. 6. In many countries, statistical information on road traffic accidents and the resulting disabilities is not accurate and of limited value. Data will be collected and analyzed and surveys carried out to assess the magnitude and nature of the problem and to develop appropriate programmes. 7. The standardization of comparison of data.

indicators

and

survey methods

will

be promoted,

permit

international

8. Systematic and selective epidemiological research will certain universities and institutes, to assess the causes and

conse~uences

be developed, with the collaboration of of road traffic accidents. on human factors and the to to

9. Cooperation will be extended in research activities, particularly behavioural aspects of road traffic accidents, and on preventive measures.

10. A WHO Collaborating Centre for the prevention of road traffic accidents will be designated, promote comprehensive studies on preventive measures and to provide the necessary information governments.

11. Multidisciplinary pilot studies will be carried out on the development of appropriate preventive measures and an evaluation of national road traffic accident policies will be undertaken. 12. National road traffic accident programmes will be developed, which will include education, community participation for the prevention of accidents and the care and rehabilitation of victims. and

Programme Activities for 1984-1985 13. Information will be collected on the nature and magnitude of road traffic accidents and resulting disabilities. Study of the behavioural factors in road traffic accidents-will be supported, as well as multidisciplinary pilot studies, as preliminary steps towards cooperation 1n the development of appropriate preventive measures. 14. Cooperation will be provided in training on the prevention and control of road traffic accidents and in stimulating the interest of national health and related agenc1es in adopting a coordinated, multisectoral and multidisciplinary approach to the problem.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$

I Total US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

Regional

........... Country or area ... Intercountry ...... Total

60 000 32 000 32 000 56 000

60 000 56 000

60 000 24 000

32 000

116 000

84 000 ======

======

==========

======

=======

=========

=======

3.9.0 Objective

PROTECTION AND PROMOTION OF THE HEALTH OF SPECIFIC POPULATION GROUPS

To support the continuous evolution and adaptation of technology and approaches aimed at protecting and promoting the health of specific population groups, particularly women of child-bearing age, children, workers and elderly people; and to investigate the best ways for the health system infrastructure to apply that technology.

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... ... 369 800 139 800 509 600 =======

Country or area Intercountry

4 140 100 946 800 5 086 900

4 509 900 1 086 600 5 596 500

455 500 261 100 716 600

2 307 200

2 762 700 261 100

85 700 121 300 207 000

...... Total

2 307 200

3 023 800

=========

=======

=========

=======

3.9.1

MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING

Medium-Term Programme for 1984-1989 Objectives 1. To strengthen the family health services at all levels of the health care delivery system, context of primary health care, particularly those for women of child-bearing age, infants, children and adolescents; ~n

the young

to develop national manpower capability in order to reduce maternal, perinatal, infant and childhood mortality and morbidity; to improve the physical and psychosocial develonment of children and adolescents and the health of the reproductive age group. Targets 2. By the end of 1989: (1) in all countries or areas, programmes for care during pregnancy, childbirth, childhood and adolescence, as well as family planning programmes, will have been strengthened or expanded. At least two thirds of births will be attended by trained health workers, which includes traditional birth attendants, and at least 80 per cent. of children will have ready access to preventive and curative care in the context of primary health care; in all countries or areas, maternal and child health/family planning programmes will be fully integrated and linked with other programmes, and incorporated in a comprehensive health care delivery system; two institutions will have been identified and strengthened as regional training centres in various aspects of maternal and child health/family planning;

(2)

( 3)

(4)

1n all countries or areas, health education programmes for families, communities and the general public, as well as for workers 1n var1ous development sectors, will have been implemented; in all countries or areas, maternal and child health/family planning training activities for health workers at all levels will have been developed or strengthened; 1n at least half the countries or areas, the risk approach will have been adopted managerial tool for improving maternal and child health and family planning services; as a

(5) ( 6) (7)

appropriate health technology, applicable to maternal and child health, will have been developed and adopted, in particular for hypertensive diseases during pregnancy, the prevention of complications in childbirth, low birth weight and perinatal problems related to infections and nutrition; national capability for biomedical and health systems research in maternal and child health/family planning will have been promoted and strengthened, particularly in developing countries or areas.

(8)

Plan of Action 3. Intersectoral development programmes will be promoted, to ensure the more closely integrated planning and implementation of programmes related to maternal and child health care, as part of national health systems and of comprehensive national plans for overall development. 4. Cooperation will be extended in developing the risk approach as a managerial process for more effective preventive, curative and rehabilitative health care for mothers and children in great need. 5. Strategies for manpower development and training will be oriented in such ways as to ensure that the training is socially relevant and addresses itself to the three main groups involved in maternal and child health care, namely: (1) families, communities and the general public; (2) workers in various development sectors, including policy-makers and planners; and (3) different categories of health worker at all levels, including primary health care workers, health auxiliaries, traditional birth attendants, and health professionals and specialists working at supervisory and referral levels. 6. Contributions may be expected from the health manpower programme and the programmes which integrate health information, appropriate technology and relevant biomedical and health systems research.

7. As well as from the regular budget, support may be expected from UNFPA. Possibilities of financial support from other sources will be explored. Collaboration and joint activities with UNICEF will be continued and further strengthened. Loan negotiations between governments and the World Bank will be facilitated. Programme Activities for 1984-1985 8. Regional training centres in maternal and child health/family planning will be designated and regular teacher training in appropriate maternal and child health care, as well as 1n modern educational methods, will be undertaken. 9. Cooperation 1n areas such as curriculum development and teacher training will national training courses, directly and through the regional training centres. 10. Risk

extended

approach studies will continu2 and experience will be exchanged at national and regional level. Cooperation will be provided in the preparation of protocols, the implementation of research activities, data analysis, the development of strategies, the control of factors contributing to risk, and programme evaluation. Priority areas for the above-mentioned activities will be the solution of problems related to perinatal care and low birth weight.

11. Training will aim at the acceptance by governments of the use of appropriate technology in perinatal care, particularly at the periphery. 12. The health and health-related problems of adolescents will be reviewed. Health services for adolescents will be promoted and strengthened through activities for the International Youth Year: Participation, Development, Peace (1985), use of a multisectoral approach, and national workshops.

13. In coordination with the nutrition programme, cooperation will be extended in relation to infant and young child feeding, and breast-feeding will be promoted. 14. Maternal and child health activities will be related to activities for the prevention and control of communicable diseases, such as immunization, and the control of diarrhoeal diseases, acute respiratory diseases, tuberculosis and parasitic diseases.

3.9.1

MATERNAL AND CHILD HEALTH, INCLUDING FAMILY PLANNING

1982-1983 Estimated obligations Regular budget US$ Regional Extra,budgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget

us$

........... Country or area ... Intercountry ...... Total

136 200 129 800 266 000

3 873 400 923 800 4 797 200

4 009 600 1 053 600 5 063 200

217 500 205 100 422 600 =======

2 014 400

2 231 900 205 100

81 300 75 300 156 600

=======

=========

2 014 400

2 437 000

=========

=======

66 3.9.3 WORKERS' HEALTH

Medium-Term Programme for 1984-1989 Objective

1. To develop integrated preventive occupational health services, including monitoring and control of the working environment, with employers. Targets

centrally and in places of work, the participation of workers and

By the end of 1989: (1)

at least half the countries or areas of the Region will have formulated coordinated basic occupational health programmes providing preventive health services for workers, including the rural work force; most countries or areas will have introduced appropriate legislation, designed to protect the health and safety of workers; all countries or areas will be hazardous working conditions; us~ng

(2)

(3)

WHO guidelines for surveillance of the health effects of

(4)

in at least half the developing countries or areas, surveillance of the occupational hazards affecting the rural work force will have been integrated into primary health care; at least half the countries or areas will have established national mechanisms for the participation of worker and employer organizations in the planning and implementation of workers' health policies and programmes; most countries or areas will have trained an adequate number of specialist staff, statutory surveillance personnel, in occupational health and safety. including

(5)

(6)

Plan of Action 3. A prerequisite of the effective prevention of work-related sickness is the establishment of national services based on legal standards for work places, machinery, equipment and materials, and health surveillance. While many countries, particularly the industrialized countries, have long since established such services, their administration is often divided between the ministry of health and the ministry of labour. Strengthening of the occupational health services of the ministry of health and coordination of its work with safety and health inspectors of the ministry of labour is essential. Collaboration will be provided in planning and implementation and in the training of key staff. 4. The provision of preventive health care to rural workers and those 1n small-scale developing industries will, in many cases, be a function of primary health care workers and appropriate modifications to their training will be needed. Guidelines and teaching material will be prepared. 5. In order to support developing countries in introducing to national needs, a review of existing legislation and the implementing statutes on occupational health and safety will Collaborating Centres for Occupational Health in appropriate of the review, the WHO Collaborating Centres will undertake chemical pesticides and the expansion of farm technology. workers' health legislation or adapting it preparation of guidelines for framing and be needed. It is anticipated that the WHO countries wi 11 accept this role. As part studies of rural work hazards arising from

6. Improving the contribution of employer and worker organizations to preventive health care will increasing at Guidelines and training projects aimed require close collaboration with ILO. understanding and promoting the planning and implementation skills of such organizations will be necessary. 7. Contributions from such programmes as the organization of health systems based on pr 1ma ry he a 1 th care, health manpower, health situation and trend assessment, public information and education for health, and health systems research, and also from nursing, may be expected. Programme Activities for 1984-1985 8. Cooperation from 1mo in national planning will include the training of key national programme management staff, technical v1s1ts for planning exercises, and consultations with governments on coordination of intersectoral health and safety policies and programmes. In close consultation with

110, guidelines will be prepared for the joint planning and implementation of preventive occupational health services by employers, \vorkers' organizations and governments. Research on rural occupational health problems will be carried out by appropriate WHO Collaborating Centres. Capability in monitoring and evaluating trends in exposure to occupational hazards will be developed. The investigation of specific workers' health problems, due to over-exposure to toxic conditions, will be supported.

1982-1983 ..

1984-1985 Estimated obligations Regular budget Possible extrabudgetary sources

Estimated obligations Extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Regular budget

Total

Regular budget

US$ Regional

US$

...........

Country or area Intercountry

... ...... Total

213 600 10 000 223 600 ========

266 700

480 300 10 000

142 500

292 800

435 300

(71 100)

(10 000) 142 500 292 800 =======

266 700

490 300

435 300 =======

(81 100)

=======

======

3.9.4

HEALTH OF THE ELDERLY

Medium-Term Programme for 1984-1989 Objective 1. To improve the well-being and quality of life of the aged, through the provision of community-based health services. Targets 2. By the end of 1989: (1) half the countries or areas of the Region will have undertaken socio-epidemiological studies to determine the nature, extent and magnitude of the health and related problems of the elderly and will have developed composite profiles of the elderly; some countries or areas will have formulated policies and developed community-based programmes for care of the aged; medical, nursing and other schools for allied health personnel will have included the teaching of geriatrics and gerontology in their programmes. Care of the elderly will be integrated into training courses for primary health care workers; post-graduate and post-basic courses in gerontology and health care of the elderly will have been developed for the training of a cadre of physicians and nurse specialists for teaching, research and consultancy services; two institutions will have been designated as WHO Collaborating Centres for the promotion of research in gerontology and health care of the elderly; national multidisciplinary advisory committees on aging and the aged will have been established in some countries or areas; all countries or areas will have developed action programmes on awareness with regard to aging and the aged.

(2) (3)

(4)

(5) (6) (7)

Plan of Action 3. National policies and programmes for care of the aged will be formulated as part of general social welfare and health plans, with particular emphasis on community-based services in accordance with the sociocultural characteristics of individual countries. 4. As research in geriatrics and gerontology is a priority for relevant programme planning, WHO will collaborate in conducting epidemiological surveys at national level for the eventual development of a regional profile of the aged. WHO Collaborating Centres will be designated to stimulate research in the areas of nutrition, social surveys, clinical geriatrics and senile dementia. 5. Ministries of health will be supported in establishing national multidisciplinary advisory committees, involving the public and private sectors. Efforts will be made to integrate health care of the elderly into primary health care, with the necessary arrangements for referral. 6. Cooperation will be extended to medical and nursing schools in teaching the knowledge, attitudes and skills essential in the provision of basic care for the aged. Additional post-graduate and post-basic courses will be developed as required. Training courses for primary health care workers will include a component on care of the elderly in the community. 7. Awareness of the needs of the aging and the aged will be promoted and current values with respect to the aged strengthened.

This programme will be mainly supported from extrabudgetary resources.

Programme Activities for 1984-1985 9. One institute will be designated as a WHO Collaborating Centre for gerontology and health care of the elderly. Cooperation will be extended in initiating the collection and processing of statistical data for future planning and implementation of health services for the aged; and 1n integrating geriatrics and gerontology in educational programmes for selected health professionals. Research in a selected high priority area in gerontology and health care of the elderly will be supported. Technical guides for professional health workers on subjects relating to health care of the elderly will be tested in selected countries or areas of the Region. Manuals for elderly people on self help, or for families caring for elderly people, will be evaluated in selected countries or areas of the Region.

-····-·

3.'l.4

HEALTH OF THE ELDERLY

1982-1983 Estimated obligations Regular budget Extrabudgetary sources Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

us$

US$

us$

US$

...........

Country or area Intercountry

... Total

20 000 23 000 20 000 23 000

20 000 23 000 43 000

95 500 56 000 151 500

75 500 56 000 131 500

...... ======

======

=======

=========

-------

72 3.10.0 Objective To reduce problems related to mental and neurological disorders, and alcohol and drug abuse, and to facilitate the incorporation of mental health knowledge and understanding in general health care and social development. PROTECTION AND PROMOTION OF MENTAL HEALTH

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

e •• e •

e •• e

Country or area Intercountry

...

389 400 221 300 610 700 42 900 42 900

389 400 264 200 653 600

159 500 263 500 423 000

(229 900) 42 200 087 700) =======

...... Total

=======

=========

=======

3.10.1

PSYCHOSOCIAL FACTORS IN THE PROMOTION OF HEALTH AND HUMAN DEVELOPMENT

Medium-Term Programme for 1984-1989 Objective 1. To promote health and human development, taking into account psychosocial factors, and to facilitate the incorporation of mental health knowledge and understanding in general health care. Targets 2. By the end of 1989: (1) all countries or areas of the Region will have initiated national programmes to protect people from the harmful social pressures generated by rapid socioeconomic change and to promote mental health, particular attention being given to children, adolescents, workers and the elderly. Such activities will be integrated into programmes for maternal and child health, school health, workers' health and care of the aged; all countries or areas will have introduced basic information and knowledge on the psychosocial aspects of health into training programmes for health workers and planners; in some countries or areas, surveys magnitude of psychosocial problems. will have been carried out to assess the nature and

(2)

(3)

Plan of Action 3. As a result of rapidly changing socioeconomic conditions, lifestyles are changing and mental pressures are increasing. Consequently, the psychosocial aspects of health have become important issues in health programmes. To stimulate the awareness and concern of health workers of all sectors, particularly health administrators, the most recent knowledge and information in this area will be disseminated.

4. Research activities will be strengthened, in order to provide the necesary information for an understanding of the psychosocial consequences of rapid social change. The effects on health of socioeconomic change are complex and a multidisciplinary approach is required for research. A network of WHO Collaborating Centres is needed, to facilitate the exchange of information and experience, particularly through technical cooperation among countries. 5. The development of comprehensive activities will be supported, through cooperation with agencies involved in environmental change, such as ministries of housing or other government agencies. 6. Training for general health workers in psychosocial knowledge and techniques will be supported, improve general health care. 7. Linkages with other programmes will be sought, health. Programme Activities for 1984-1985 to

in order to promote knowledge with regard to mental

8. Collaboration will be provided in 1n1t1ating programmes on the psychosocial aspects of health, which will include assessment of the magnitude and nature of related problems, the dissemination of knowledge to a wide range of health workers and to the public, and the training of health workers of various categories. The integration of psychosocial aspects in general health care will be promoted at national level. Support to research activities on the effects of housing conditions, family functions and child mental health, will be continued. Research activities will also focus on the development of mental health care in developing countries, primarily ways and means of providing psychiatric assistance in areas where there are no mental health specialists. The activities of the WHO Collaborating Centres in Research and Training in Mental Health will be expanded in relation to psychosocial problems.

3.10.1

PSYCHOSOCIAL FACTORS IN THE PROMOTION OF HEALTH AND HUMAN DEVELOPMENT

1982-1983 Estimated obligations Regular budget Extrabudgetary sources Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

........... Country or area ... Intercountry ...... Total

84 000 129 800 213 800

25 000 188 100 213 100 =======

25 000 188 100 213 100

(59 000) 58 300 (700)

=======

=========

========

=========

=======

======

3.10.2

PREVENTION AND CONTROL OF ALCOHOL AND DRUG ABUSE

Medium-Term Programme for 1984-1989 Objective

1. To reduce the problems related to alcohol and drug abuse and to develop national policies and programmes for the prevention and management of alcohol and drug abuse through appropriate technology. Targets 2. By the end of 1989: (1)

most countries of the Region will have ratified the international treaties on narcotic drugs; most countries or areas will be 1n a position to provide dependence-producing drugs and alcohol; a network for established; information exchange and research on information on the consumption of

(2)

(3)

alcohol

and

drug

abuse

will

have

been

(4)

in half the countries or areas, community-based programmes for the prevention and control of alcohol and drug abuse, involving various sectors, such as those concerned with education, social welfare and law enforcement, as well as the health services, will have been developed or strengthened.

Plan of Action 3. The overall situation is changing rapidly and new problems in relations to alcohol and drug abuse are arising out of socioeconomic development. Such problems vary considerably in nature and magnitude from country to country. Collaboration will thus be extended in their assessment and the monitoring of changes and trends in individual countries, as well as in the development of control programmes with multilsectoral participation, and the exchange of information between countries. Efforts will be made to sensitize policy makers and administrators to problem areas. Special mechanisms to monitor changes and trends in the drug and alcohol abuse situation will be developed.

4. Emphasis will be placed on prevention and control, using appropriate technology. Training of health workers to provide them with the necessary knowledge and information will be supported. Multidisciplinary research involving such disciplines as anthropology, behavioural sc~ence and sociology, directed towards understanding the nature of the problem and developing prevention and control methods, will be promoted. A network for information and research will be developed with the active support of the WHO Collaborating Centre for Research and Training in Drug Dependence. · 5. Control of alcohol and drug abuse calls for close collaboration with other United Nations agencies and with international and national bodies or groups. Within WHO, linkages with the programmes concerned with public information and education for health, rehabilitation and drug and vaccine quality, safety and efficacy will be indispensable to render the programme effective. Programme Activities for 1984-1985 6. Cooperation will be extended ~n obtaining comprehensive information and data on the current situation with regard to drug abuse ~n the Region; in reviewing the current status of national prevention and control programmes in drug dependence, psychotropic drug and alcohol-related health problems and in developing national programmes in those areas; in promoting research on the misuse of psychotropic drugs anrl on alcohol dependence; and U! training health workers in the prevention and treatment of alcohol and drug dependency.

3.10.2

PREVENTION AND CONTROL OF ALCOHOL AND DRUG ABUSE

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

us$ Regional

........... ... 101 400 28 000 129 400 =========

Country or area Intercountry

101 400 42 900 42 900 70 900 172 300 =======

22 500

22 500 13 000 35 500

(78 900) (15 000) (93 900)

...... Total

000

35 500

======

=========

======

3.10.3

PREVENTION AND TREATMENT OF MENTAL AND NEUROLOGICAL DISORDERS

Medium-Term Programme for 1984-1989 Objective 1. To reduce problems related to mental and neurological disorders, management, with emphasis on community-based care.

through prevention and clinical

Targets 2. By the end of 1989: (1)

most countries or areas of the Region will have compiled comprehensive information on the magnitude and nature of mental and neurological disorders;

epidemiological

(2) (3)

a majority of countries or areas will have reviewed existing and potential resources for the prevention and treatment of mental and neurological disorders; in half the countries or areas, programmes for prevention of mental retardation and care of the mentally retarded will have been established; training 1n mental health will have been strengthened for all health workers.

(5)

Plan of Action 3. The old concept of institutional care for mental disorders needs to be reoriented towards community prevention and control. Many disorders can be prevented if appropropriate measures are applied, and community treatment produces better results in many cases. Epidemiological surveys or other means of basic information gathering will be supported. The existing mental health services, including mental hospitals, will be reviewed, in terms of the quality of services provided. Programmes will be developed to meet newly emerging mental disorders.

4. Special attention will be paid to preventable disorders affecting the brain, due to infectious, parasitic, nutritional, metabolic, toxic and traumatic causes, which result in mental retardation and other forms of mental dysfunction. Research activities in priority problem areas will be promoted. Exchange of information and experience will be strengthened through WHO Collaborating Centres and other institutes. A project will be developed to test the feasibility of integrating comprehensive community-based mental health activities into primary health care in different sociocultural settings. Training courses will be organized to provide health workers with the basic knowledg~ needed to prevent and treat common mental and neurological disorders. 5. In the prevention and treatment of mental and neurological disorders, WHO will collaborate with other United Nations agencies, especially UNICEF, and nongovernmental organizations. Because there are many varying causes of these disorders and they are complex, linkages will be formed with such programmes as maternal and child health, including family planning, nutrition, organization of health systems based on primary health care and public information and education for health. Programme Activities for 1984-1985 6. Strategies for a regional programme on mental retardation will be developed, with emphasis placed on preventive measures and the organization of comprehensive community care of the mentally retarded. 7. Cooperation will continue in epidemiological studies on mental and neurological disorders. Studies will be supported to develop community-based mental health services. Training programmes will be supported and exchange of information and knowledge will be promoted. Collaboration will be extended in the review and/or formulation of mental health legislation. The mental health curricula of medical schools will be reviewed.

3.10.3

PREVENTION AND TREATMENT OF MENTAL AND NEUROLOGICAL DISORDERS

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular . budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

204 000 63 500 267 500

112 000 62 400 174 400

(92 000) (1 100) (93 100) ======

=======

=========

=======

=========

=======

3.11.0

PROMOTION OF ENVIRONMENTAL HEALTH

Objective To protect and promote human health through national, community, family and personal measures for the prevention and control of conditions and factors in the environment that adversely affect it.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional Country

us$

US$

........... or area ...

1 657 900 1 504 600

2 105 100 550 000 2 655 100

3 763 000 2 054 600 5 817 600

1 492 000 2 144 300 3 636 300

792 000 170 000 962 000

2 284 000 2 314 300 4 598 300

(165 900) 639 700 473 800 ========

Intercountry

...... Total

3 162 500

=========

3 .11.1

COMMUNITY WATER SUPPLY AND SANITATION

Medium-Term Programme for 1984-1989 Objective 1. To control disease through the promotion and development of community water supply and sanitation services, thereby leading to improvement in the quality of life. Targets 2. By the end of 1989: (1)

a majority of countries or areas in the Region will have programmes for safe drinking-water and adequate sanitation;

established national

plans and programmes;

(2) ( 3)

most countries or areas will be actively implementing those comprehensive plans and

most countries or areas will have attained their own national goals with respect to safe drinking-water supply and adequate sanitation. The remainder will have achieved improvement in service levels.

Plan of Action 3. The following approaches will be utilized: International Drinking-Water Supply and Sanitation Decade programmes will coordination with other health programmes, using a primary health care approach; be promoted in

institutional development and the administration of programmes will be strengthened; human resources will programmes; be developed to ensure support for the planning and implementation of

information exchange and communication linkages will be established and promoted in relation to the technical, administrative and public information aspects of programmes; national efforts supported. to seek external financial resources for infrastructure installation will be

Programme Activities for 1984-1985 4. Cooperation will be provided in preparing comprehensive national plans and programmes. This will include policy formulation and institutional or administrative development, as well as the collection and compilation of basic data and information. Regional and national training activities will be carried out to develop technical and administrative capabilities, particularly in respect of the operation, maintenance and repair, surveillance and monitoring of systems, community participation and health education. In coordination with international institutions, WHO will collaborate in the identification, formulation, preparation and implementation of investment projects. Cooperation will also be extended in implementing appropriate technology demonstration projects and promoting information exchange in the light of the findings; in programme monitoring and evaluation studies; and in solid waste management and insect/rodent control, in relation to community and sw{mming pool/recreational sanitation needs.

3.11.1

COMMUNITY WATER SUPPLY AND SANITATION

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

806 000 516 600 1 322 600

1 606 600 530 000 2 136 600

2 412 600 1 046 600 3 459 200

842 000 712 500 1 554 500

752 000 170 000 922 000 =======

1 594 000 882 500 2 476 500

36 000 195 900 231 900

=========

=======:=;=

=========

=======

3.11.2

ENVIRONMENTAL HEALTH IN RURAL AND URBAN DEVELOPMENT AND HOUSING

Medium-Term Programme for 1984-1989 Objective To improve health and psychosocial well-being through implementation of environmental impact assessment programmes development and housing, as they affect health status. Targets 2. By the end of 1989: (1)

the ~n

promotion, relation to

development and rural and urban

most countries or areas of the Region will have formulated national policies, strategies and regulations, to ensure that legislation, and adopted the necessary administrative environmental factors are taken into consideration in rural and urban development and housing programmes; half the countries procedures. or areas will be actively implementing environmental impact assessment

(2)

Plan of Action 3. The main emphasis will be on promoting a better understanding by all government sectors of the environmental impact on health and psychosocial well-being of economic development activities. In particular, the impact of such environmental factors as air and water quality, noise and solid waste management, on the quality of human habitats, will be taken into account. 4. WHO will promote the development of criteria and guidelines for environmental health impact assessment and management measures in housing and urban and rural development projects. Cooperation will be provided in formulating the necessary administrative regulations for the implementation of national impact assessment programmes.

5. Emphasis will be placed on the need to incorporate environmental health protection measures in economic development programmes. While dec is ion-makers are usually aware of this need, a systematic approach is necessary to develop recognition of the interrelated factors. Programme Activities for 1984-1985 6. Cooperation will be provided in collecting and disseminating data and information on environmental health factors, including health criteria. Studies will be conducted to assess environmental health factors and their impact on people's health, in relation to rural and urban development and housing. Available information will be disseminated on low-cost environmental health protection technology. National plans and programmes for environmental impact assessment procedures will be promoted, including the formulation of policies, legislation, and administrative regulations and the development of institutions. Training activities will be organized, to develop the manpower required for impact assessment. Research and demonstration activities will be undertaken in priority areas.

3.11.2

ENVIRONMENTAL HEALTH IN RURAL AND URBAN DEVELOPMENT AND HOUSING

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

136 600 963 000 1 099 600

28 500 1 431 800 1 460 300

(108 100) 468 800 360 700

=========

===========

=========

=======

3.11.3 Medium-Term Programme for 1984-1989 Objective

CONTROL OF ENVIRONMENTAL HEALTH HAZARDS

1. To reduce environmental hazards through the promotion, development, planning and implementation of control programmes. Targets 2. By the end of 1989; ( 1) most countries or areas of the Region wi 11 have formulated national policies, strategies and legislation, and adopted administrative regulations, for the control of environmental health hazards; half the countries or areas will be actively implementing prevention and control of environmental health hazards. programmes for the abatement,

(2)

Plan of Action 3. WHO will cooperate in collecting data conditions; developing and implementing national hazards; facilitating intersectoral coordination; conducting monitoring and surveillance programmes. Programme Activities for 1984-1985 4. Cooperation will be extended in the monitoring and analysis of environmental hazards and ~n data collection; disseminating data and information on pollutants (chemical, biological and physical agents) which are potentially hazardous to health; promoting national plans and programmes for the control of environmental health hazards, including the accelerated release of toxic and hazardous materials; developing and strengthening appropriate legislation for environmental management; and organ~z~ng appropriate training activities. Coordination with other international agencies will be promoted. Studies on appropriate technology for the control of pollutants will be supported. and information to assess environmental programmes for the control of environmental developing national manpower programmes; .and

3.11.3

CONTROL OF ENVIRONMENTAL HEALTH HAZARDS

1982-1983 Estimated obligations Regular budget US$ Regional -

1984-1985 Estimated obligations Regular budget US$ Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Extrabudgetary sources US$

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

580 200

473 500

1 053 700

418 400

40 000

458 400

(161 800)

580 200

473 500

1 053 700

418 400 =======

40 000

458 400 =======

(161 800)

=======

=========

======

=======

3.11.4 Medium-Term Programme for 1984-1989 Objective 1. To ensure the safety of food with a Targets 2. By the end of 1989: (1) (2) v~ew

FOOD SAFETY

to reducing food-borne morbidity.

half the countries or areas of the Region will have formulated or revised food safety policies, strategies and legislation, and adopted administrative regulations; some countries or areas will be actively implementing national food safety plans and programmes.

Plan of Action 3. WHO will cooperate in promoting the development of national food safety programmes. At country level, basic programme data will be collected and food safety problems reviewed, in order to prepare national action plans. Adoption of the following as basic approaches will be emphasized: adequate legislation and distribution and sale; powers of enforcement with respect to food production, marketing,

legislation and regulations with regard to food safety in all national sectors, with emphasis on linkages with safe water, the sanitary disposal of waste, and food hygiene; surveillance for food-borne diseases; food safety practices at all levels of production, including epidemiological control measures; sensitization of policy-makers, programme adopting adequate food safety practices. processing, storage, distribution and sale,

administrators

and

consumers

the

necessity

Programme Activities for 1984-1985 4. Cooperation will be provided in promob ng public awareness of the importance of food and personal hygiene in the prevention of food-borne diseases, through the health education of school children and food handlers in hotels, restaurants and similar establishments; promoting national plans and programmes, including the formulation of administrative regulations and procedures; assessing and improving inspection measures, laborat.ory services and epidemiological control measures; developing manpower plans and resources; organizing training activities; collecting and exchanging epidemiological information, as well as information and methods with respect to standards and codes of practice and food surveillance; and pro:noting research in identified priority areas.

3.11.4

FOOD SAFETY

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

135 100 25 000 160 100

25 000 20 000 45 000

160 100 45 000 205 100

203 100

68 000 (25 000)

203 100

=======

======

=======

=========

------

43 000

3.12.0

DIAGNOSTIC, THERAPEUTIC AND REHABILITATIVE TECHNOLOGY

Objective To promote technology and institutions. the the use, . development and adaptation of diagnostic, proper use of medicinal drugs appropriate for therapeutic and rehabilitative specific national systems and

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

Regional

........... Country or area ... Intercountry ...... Total

1 383 400 300 600

579 700 718 100

1 963 100 1 018 700

1 869 000 453 000

33 000 763 800

1 902 000 1 216 800

485 600 152 400

1 684 000

1 297 800

2 981 800

2 322 000

796 800

3 118 800

638 000

=========

==========

=========

=======

=========

=======

3.12.1

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

Medium-Term Programme for 1984-1989 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 economical and effective techniques, with particular emphasis on support for primary health care; to promote and improve the use of ionizing radiation and other imaging technologies as integral parts of health systems support for primary health care. Targets 2. By the end of 1989: (1) (2) (3) (4) (5) (6) in all countries or areas of the Region, the national health laboratory services will have been incorporated as integral parts of the national health systems; most countries or areas will have developed their intermediate and peripheral laboratories sufficiently to meet the laboratory needs of the curative and preventive health services; most countries or areas will have introduced a modern system of laboratory management; most countries or areas will have established routine quality control procedures; most countries or areas will have introduced regular refresher training for local laboratory staff; most countries or areas will have standardized simple laboratory techniques for diagnosis of the most common diseases;

96 (7)

most countries or areas will have identified, developed and have ~n operation the basic diagnostic radiological services needed for primary health care and the immediate supporting levels of the health sys.tem; most countries or areas will have trained an adequate number of radiological staff to provide basic radiodiagnostic services; most countries or areas will have established preventive maintenance facilities to minimize the unserviceability of equipment; most countries or areas exposure to radiation; will be providing high standards routines and repair

(8)

(9)

(lO)

of protection against

avoidable

(11)

at least half the countries or areas will have developed quality assurance activities to ensure accurate dosimetry, an adequate standard of imaging and low wastage of film stock; a majority of countries or areas will be providing patients with adequate access to properly controlled radiotherapy when needed.

(12)

Plan of Action 3. Inadequate development of the health laboratory services constitutes a serious problem ~n many countries of the Region. While the central laboratory is usually very well developed, intermediate and peripheral laboratories have been neglected or do not exist. An effective approach will be to create an integrated system comprising a central laboratory which supervises and controls a network of intermediate and peripheral laboratories. The refresher training of local laboratory staff, as well as the standardization of techniques, will be organized by the central laboratory. 4. WHO will encourage the development of networks of intermediate and peripheral laboratories; will develop guidelines for quality control mechanisms and new economical laboratory techniques; and will provide training and refresher training.

5. It is expected that close liaison will be maintained with other programmes of importance to the development of primary health care, such as health manpower, drug and vaccine quality, safety and efficacy, and organization of health systems based on primary health care. Close coordination will also be maintained with communicable disease prevention and control activities. 6. The main thrust of WHO's cooperation in relation to radiological technology will be directed towards the training of national staff, as far as possible within the country concerned; the design and selection of suitable equipment and its proper maintenance; and the improvement of radiation exposure and image quality in diagnosis, and the prevention of unnecessary exposure. Activities will comprise cooperation in relation to the specification and supply of basic radiologica 1 equipment; the training of key staff overseas where necessary; the organization of national training courses; the strengthening of radiation protection measures; the provision of WHO manuals and teaching material; continuation of the monitoring of safety from harmful exposure to radiation; studies of image quality by WHO Collaborating Centres; and the development of national capability for equipment maintenance and repair. 7. Contributions may be expected from the programme areas of health manpower, health systems research and organization of health systems based on primary health care. Programme Activities for 1984-1985 8. Collaboration will be provided in assessing national laboratory facilities, personnel and equipment; further developing guidelines for simple laboratory techniques for the diagnosis of the most common diseases; promoting the use of standardized laboratory procedures; training laboratory staff at all levels, with emphasis on refresher training; and, where feasible, initiating and carryi~g out operational research. 9. Collaboration will be provided ~n the continuing development of basic radiological serv~ces, as an experiment in two selected countries, and evaluation of the results; the monitoring of safety from harmful exposure to radiation; study of diagnostic image quality in selected countries, in conjunction with a WHO Collaborating Centre; training key staff of developing countries ~n selected regional centres; manpower planning for radiologists, radiographers, physicists and maintenance technicians; reviewing and monitoring the development of radiological services; and developing national maintenance and repair facilities and training courses in selected countries.

3.12.1

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

1982-1983 Estimated obligations Regular budget us$ Regional •••.•.••.•. Country or area Intercountry Total 378 200 144 800 523 000 235 800 235 800 614 000 144 800 758 800 840 000 210 500 1 050 500 Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

33 000

873 000 210 500

461 800 65 700 527 500 =======

33 000

1 083 500

=======

=========

======

=========

3.12.2

ESSENTIAL DRUGS AND VACCINES

Medium-Term Programme for 1984-1989 Objective 1. To ensure the supply of essential drugs and vaccines, at an affordable cost, by rationalizing the system of selection, procurement and distribution, and by strengthening national capability for production. Targets 2. By the end of 1989: (1)

all countries or area.s of the Region will have formulated national drug policies for the selection, supply, procurement, distribution and utilization of essential drugs and vaccines; some countries or areas, with adequate resources, will have developed the capacity to formulate and manufacture a sufficient quantity of certain essential drugs and vaccines of appropriate quality; most countries or areas will have developed essential drugs and vaccines to the periphery; satisfactory arrangements for distributing

(2)

(3)

(4)

most countries or areas will have trained a sufficient number of appropriate staff to implement the above-mentioned activities.

Plan of Action 3. Ensuring the ready availability, at an affordable price, of essential drugs, vaccines and other biologicals of adequate quality, is an important component of primary health care. In many developing countries of the Region, the supply of drugs falls short of what is required for universal availability. Related difficulties include deficiencies in planning, quality assurance and distribution systems, often compounded by a shortage of trained pharmaceutical manpower.

100 4. The main emphasis of collaborative activities will be on improving the availability of drugs of good quality at an affordable price. Educational activities will be promot£d to encourage the acceptance, by health care providers, of standard national or subregional (for example, the South Pacific) lists of essential drugs, which will substantially reduce the unnecessary purchase of expensive therapeutic agents of limited application and enable economies to be effected through bulk purchase. Efforts will be made to develop joint bulk purchase arrangements between smaller countries and to promote other suitable international cooperative supply arrangements. National expertise in the management, quality assurance and distribution of drugs and vaccines will be developed through training. 5. In some instances, WHO will collaborate in the establishment or improvement of national vaccine and biologicals production laboratories, particularly where this will increase the possibility of technical cooperation with neighbouring countries. Special attention to training in good manufacturing practices will be encouraged wherever drug and vaccine production is undertaken, particularly during the early development of national drug manufacturing capability. The strengthening of national legislation to control the use and abuse of drugs, including their production and distribution, will also be encouraged. 6. As well as support from the regular budget of WHO, extrabudgetary resources will be sought and cooperation will be provided for loan negotiations between governments and international banks for the establishment of supply systems. 7. Cooperation in the activities of this programme may also be expected from such nongovernmental organizations as the International Federation of Pharmaceutical Manufacturers Associations and the World Federation of Proprietary Medicine Manufacturers, especially in manpower training. Programme Activities for 1984-1985 8. Collaboration will be provided 1n the training of national staff, with priority given to the fundamental techniques of drug production, good manufacturing practices, and drug procurement, distribution and storage; the promotion of national and subregional schemes for drug procurement, delivery and storage, selection and revision of national/subregional lists of essential drugs, and production of drugs, vaccines and biologicals; and research and development activities related to effective drug legislation and registration and control 1n the international drug trade.

3.12.2

ESSENTIAL DRUGS AND VACCINES

1982-1983 Estimated obligations Regular budget us$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

131 600 140 800 272 400 =======

31 000 538 100 569 100 =======

162 600 678 900 841 500 =======

448 700 229 500 678 200 583 800 583 800

448 700 813 300 1 262 000

317 100 88 700 405 800

=======

=========

=======

101

102 3.12.3 DRUG AND VACCINE QUALITY, SAFETY AND EFFICACY

Medium-Term Programme for 1984-1989 Objective 1. To ensure the supply of essential drugs and vacc~nes of adequate quality, safety and efficacy, at an affordable cost, by strengthening national and subregional capability for drug quality control and by establishing an international information exchange system. Targets 2. By the end of (1) 198~;

most countries or areas of the Region will have arranged assurance for domestically produced and imported drugs;

for

a means of adequate quality

(2)

most countries or areas will be regularly collecting and evaluating the information necessary for drug quality, safety and efficacy through national or subregional information management systems; most countries or areas wi 11 have above-mentioned activities. trained the appropriate staff for implementation of the

(3)

Plan of Action 3. Two essential activities are required to support government initiatives in the field of drug quality and safety: first, the provision or strengthening of national or, if necessary, regional or subregional quality control laboratories; second, the provision of continuous and adequate information on drug safety and efficacy, from national and international sources. The establishment of WHO Collaborating Centres for drug quality assurance in the Region will provide an important mechanism for technical support ~n this respect.

4. Consideration will be given to the tra1.n1ng of personnel and to the supply of special equipment and standard laboratory reagents to facilitate the development of new quality assurance laboratories. 5. Contributions to the programme may be expected traditional medicine programmes. from the immunization, laboratory technology and

6. In addition to support from the regular budget of WHO, extrabudgetary resources will be sought and cooperation may be expected from such nongovernmental organizations as the International Federation of Pharmaceutical Manufacturers Associations and the World Federation of Proprietary Medicine Manufacturers, particularly in relation to training activities. Programme Activities for 1984-1985 7. Cooperation will be provided in training 1.n the basic techniques of drug quality control, the management of drug information, drug monitoring systems, and the utilization and preparation of drug standards; in the establishment of new quality control laboratories whose activities will include drug quality control, the management of drug information on safety and efficacy, drug monitoring, and the utilization of drug standards. Research will be undertaken on drug efficacy measures in rural areas.

103

104

3.12.3

DRUG AND VACCINE QUALITY, SAFETY AND EFFICACY

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... I

545 600 15 000 560 600

312 900

858 500 15 000

319 300 13 000 332 300

(226 300) (2 000) (228 300)

Total

312 900

873 500 =======

=======

=========

=======

3.12.4 Medium-Term Programme for 1984-1989 Objective

TRADITIONAL MEDICINE

1. To integrate traditional medical practices into the general health system, particularly into primary health care. Targets 2. By the end of 1989: (1) (2) (3) (4) (5) (6) most countries or areas of the Region will have developed and strengthened traditional medicine activities, which will be integrated or implemented in parallel with modern medical practice; regional guidelines for the use of traditional medicine will have been elaborated; the exchange of information on traditional medical practices, including research findings, will have been promoted among all interested countries; in some countries or areas, appropriate training mechanisms in traditional workers at various levels, will have been developed or strengthened; medi~ine,

for health

as far as possible, a basic range of medicinal plants and traditional remedies and methods will have been identified and tested for effectiveness and safety; some countries or areas will have developed and strengthened research activities on traditional medicine.

105

106 Plan of Action 3. WHO will collaborate in the formulation and implementation of national policies for the integration of traditional medicine into primary health care; in the development of national programmes for the training of practitioners and health workers at various levels in traditional medicine techniques; and ~n the exchange of experience and research findings. 4. As traditional medicine involves a wide field of activities, close cooperation may be expected from other WHO programmes such as the organization of health systems based on primary health care, health manpower, public information and education for health, protection and promotion of mental health, and health system development. Programme Activities for 1984-1985 5. Cooperation will be provided in activities for the training of various categories of traditional medicine practitioner, as well as primary health care workers, ~n relation to the integration of traditiona 1 medicine into primary he a 1 th care. WHO wi 11 continue to support internationa 1 training courses on acupuncture, and further cooperation will be extended for the standardization of acupuncture non:!enclature. 6. Activities for the integration or parallel development of traditional and modern medicine will be supported. Cooperation will be extended in the field of national legislation, which may be necessary for the further development of traditional medicine; in the collection and dissemination of information pertaining to traditional medicine; and in the development and strengthening of research on traditional medicine, the establishment of experimental research laboratories, and research training for several categories of worker, especially in regard to medicinal herbs and acupuncture.

3.12.4

TRADITIONAL MEDICINE

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Regional Total

50 000 180 000 50 000 180 000

50 000 180 000 230 000

194 000 180 000 194 000 180 000

194 000 180 000 374 000

144 000

======

=======

===:t::===

=======

107

108

3.12.5 Medium-Term Programme for 1984-1989 Objective

REHABILITATION

1. To promote the appropriate organization and effective operation of comprehensive health, education and social welfare systems; to provide for the rehabilitation of the disabled, based on primary health care, and to prevent impairment, disability and handicap. Targets 2. By the end of 1989: (1) most countries or areas of the Region will have formulated and implemented national plans for community-based rehabilitation services in the context of primary health care; most countries or areas will have developed or strengthened intersectoral coordination for the effective support of community-based rehabilitation serv~ces and for the prevention of impairment, disability and handicap; half the countries or areas will have developed appropriate technology resources manufacture of basic aids, prostheses and orthoses for th~ disabled; half the countries or areas will have developed and prevention of impairment, disability and handicap; half the countries or areas will have developed programmes on healthy lifestyle and basic first aid; and implemented active programmes implemented active health for the

( 2)

(3)

(4) (5)

for

the

education

(6)

half the countries or areas will have integrated training in rehabilitation into the curricula of health workers at all levels;

(7)

WHO wi 11 have in operation an effective mechanism for the exchange of information between countries, on rehabilitation programmes and useful developments 1.n technical cooperation between Member States.

Plan of Action 3. An effective approach to solution of the massive problem of disability can only be made through a community-based programme, supported by appropriate institutional and referral resources, for the diagnosis, assessment and prescription of long-term case management, and linked through intersectoral coordination with educational, occupational and social welfare agencies. Collaboration will be provided in strengthening organization, staffing and training within the health care system, in order to provide the necessary capability in primary health care workers and supervisory and referral staff; increasing cooperation between the appropriate ministries and nongovernmental organizations; improving opportunities for the equal participation of the disabled in community life; promoting national programmes for lifestyle improvement and disability prevention; and improving technological resources for the provision of aids, prostheses and equipment for the disabled. 4. Contributions will be required from such programmes as organization of health systems based on primary health care, health manpower, health of the elderly, public information and education for health, and health information and trend assessment, as well as from nursing. 5. In addition to support from the WHO regular budget extrabudgetary resources will be sought.

Programme Activities for 1984-1985 6. Collaboration will be provided 1.n the planning and programming of rehabilitation services in specific countries; the training of key national rehabilitation personnel, including programme managers and the supervisors of primary health care workers; the development of·.· curricula for multipurpose rehabilitation workers; the prepar&tion of teaching aids and the distribution of WHO manuals; the collection, selection, processing and dissemination of national and international resource materials; the preparation of guidelines for the prevention of impairment, disability and handicap. Research and development act1.v1.t1.es will be instituted to evaluate problems militating against the effective participation of the disabled in the community and to develop remedial measures. 7. Coordination between the United Nations technical contributions and avoid duplication. agencies concerned with rehabilitation will maximize

109

3.12.5

REHABILITATION

1982-1983 Estimated obligations Regular budget >·

1984-1985 Estimated obligations Regular budget Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

US$ Regional

Extrabudgetary sources US$

Total

Regular budget

US$

........... Country or area ... Intercountry ...... Total

278 000

67 000

(211 000)

278 000

67 000

( 211 000)

=======

=========

=======

======

=========

======

=======

4.13.0

DISEASE PREVENTION AND CONTROL

Objective To prevent and control major communicable and noncommunicable diseases.

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources us$ Regular budget us$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total us$

Total US$

Regular budget US$

........... Country or area ... Intercountry ...... Total

2 139 900 3 360 500

1 216 000 1 820 000 3 036 000

3 355 900 5 180 500 8 536 400

2 950 000 3 980 000 6 930 000

145 000 11 000

3 095 000 3 991 000 7 086 000

810 100 619 500 1 429 600

5 500 400

156 000 =======

=========

111

112

4.13.1

IMMUNIZATION

Medium-Term Programme for 1984-1989 Objective

1. To reduce morbidity and mortality from diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis, by providing immunization against those diseases for every child in the Region by 1989 (other selected diseases may be included when and where applicable); and by providing immunization against tetanus, as needed, for women of childbearing age. Targets 2. By 1986, all countries or areas of the Region: (1) will have developed a national immunization immunization coverage ~n children; plan and means for reliably estimating the

(2) (3)

will be employing vaccines that are known to conform with WHO requirements;

and

will have established systems for monitoring the potency of vaccines at the time of use.

3. By 1987, all countries or areas will have developed mechanisms for evaluation and will have assessed the status of their immunization programmes in relation to the national, regional and global targets established for 1990. They will be continuously revising their programmes, as needed, to be able to achieve those targets. 4. By 1989, all countries or areas will be able, with WHO's support, to plan and manage a programme to make available to every child immunization against dipththeria, pertussis, tetanus, measles, poliomyelitis and tuberculosis.

Plan of Action 5. Operations. By achie.ving its own goals, the expanded programme on immunization will contribute substantially to the broader goals of health for all by the year 2000. The programme seeks to establish immunization services which reach a high proportion of newborns and women of childbearing age. Such services are more economically and conveniently provided as components of comprehensive, preventive and curative health services, particularly the maternal and child health serv1ces. The addition of immunization services, in turn, strengthens such other services. 6. In extending the immunization services, attention will normally be given first to immunizing children, and women of childbearing age, who are already using static facilities. Next, outreach services, which are not necessarily limited to immunization, will be provided to populations that can be reached from the static facilities during regular weekly or monthly visits. Finally, based on field experience, the far more difficult problem of how to provide services to the remaining population will be addressed. 7. Training. With the training in immunization management of sen1or staff and trainers of supervisory staff nearing completion,' emphasis will shift to the implementation of national training programmes for all health staff involved in immunization programmes and to the incorporation of training materials and educational methodology into the curricula of national health manpower training institutions. Whenever feasible, training in immunization for staff at the periphery will be considered in conjunction with training for other responsibilities, emphasis being given to the control of diarrhoeal diseases in particular, and maternal and child health care in general. Training of refrigerator repair technicians will also receive increasing attention. 8. Research. Emphasis will continue to be placed on research, the results of which are expected to have a positive effect by improving the impact and efficiency of immunization programmes. The main areas for research are epidemiological studies on the target diseases and on the impact of various interventions; improvement of the potency and stability of vaccines; and further development of cold chain procedures and equipment to safeguard vaccine potency. Studies on alternative strategies for outreach services will also be undertaken.

113

114

9. Evaluation. Strategies include the further development of information systems and surveys to determine disease incidence, immunization coverage and programme efficiency. During periodic programme reviews, multidisciplinary teams will scrutinize achievements, management procedures and the techniques of the immunization and related programmes. Programme Activities for 1984-1985 10. Linkages will be strengthened with other regional programmes aimed at the reduction of childhood morbidity and mortality, such as those for the control of diarrhoeal diseases, maternal and child health and nutrition. Cooperation will be extended where vaccine quality control measures can be implemented and where cold chain equipment can be designed, tested and produced. It will also be provided 1.n strengthening the cold chain components of national immunization programmes. The exchange of information between countries or areas will be facilitated in order to promote TCDC in the development of vaccine production, procurement, supplies and delivery systems. 11. Training courses will be held for senior, middle and peripheral level personnel at intercountry and national level. 12. WHO will also activities and in programme. interregional,

cooperate in the initiation and continuation of operational research studies and facilitating the exchange of information on priority 1.ssues 1.n the immunization

13. National activ1.t1.es in relation to periodic programme evaluation and the development of immunization programme information systems will receive support.

4.13.1

IMMUNIZATION

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

••••••••••

Cl'

Country or area Intercountry

...

277 900 363 800 641 700 36 100 36 100 ========

277 900 399 900 677 800 ::::::::::::::::::::::.:::

334 500 327 100 661 600

56 600 (36 700) 19 900

...... Total

=======

========

==========

=======

======

115

116

4.13.2

DISEASE VECTOR CONTROL

Medium-Term Programme for 1984-1989 Objective 1. To reduce vectors and animal reservoirs so that they no longer constitute a threat to the health and well-being of the people, priority being given to the control of those vectors and animal reservoirs responsible for the transmission of diseases of major public health importance. Target 2. By the end of 1989, at least half the countries or areas of the Region severely affected by vector borne diseases will have acquired self-reliance for the development, implementation and evaluation of vector control strategies, involving communities in self-protection. Plan of Action 3. The main line of approach will be to gather and disseminate technical information, train staff in vector control, strengthen vector surveillance and control activities, develop applied research capability, and promote health education, use of appropriate technology arid community involvement in vector control. Governments will be encouraged to maximize their efforts and resources effectively to implement and improve national vector control programmes, and every effort will be made ~co achieve greater integration of vector control activities within existing primary health care. In addition, collaboration with other organizations, including donor agencies, will be promoted to support the programme. WHO technical collaboration will be available and group training activities will be supported.

Programme Activities for 1984-1985 4. Cooperation will be provided in the promotion of health education and community involvement 1n vector control; the development of appropriate technology, such as covers for water storage containers, mosquito-proof sleeping rooms, and mass rearing and release of larvivorous fish; the organization of national training courses; the implementation of improved vector control measures at international airports, especially in the countries or areas of the South Pacific where malaria vectors are absent; the development of control measures for vectors of subperiodic bancroftian filariasis, brugian filariasis and malaria vectors; and the implementation of improved surveillance methods for the rapid detection of dengue and Ross River viruses and their vectors. Steps will also be taken to ensure that countries or areas of the Region, especially those in the South Pacific, have adequate supplies of insecticides and spray equipment in the event of outbreaks of arboviral disease.

117

118

4.13.2

DISEASE VECTOR CONTROL

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Total

Regular budget US$

us$

Regional

........... ... 89 800 196 800 24 300 24 300 89 800 221 100 310 900 251 700 214 500 11 000

Country or area Intercountry

251 700 225 500

161 900 17 700 179 600

...... Total

286 600

466 200

11 000

477 200 =======

========

=======

======

=======

4.13.3

MALARIA

Medium-Term Programme for 1984-1989 Objective 1. To foster national and international action in the control and, where feasible, eradication of malaria, and in preventing the re-establishment of malaria in countries or areas where it has been eradicated or has never been endemic, so that malaria no longer constitutes a threat to the health and well-being of the people. Targets 2. By the end of 1989: (1) each country or area of the Region where malaria is endemic, that has established a countrywide programme for control or eradication, will have reduced the annual malaria morbidity to less than 1 per cent.; in other countries, effective measures will have been taken to reduce mortality from malaria, particularly in special groups such as children under 9 years of age and pregnant women; programmes to prevent the re-establishment of malaria will be functioning in all areas that have successfully been freed from the disease.

(2)

(3)

Plan of Action 3. Technical cooperation in national antimalaria programmes will be continued for such purposes as programme management, conducting surveys, developing recording/reporting systems, analyzing data, and developing operational plans. Attention will be given to the continuous analysis of existing operational and epidemiological methodology, and the development and application of supplementary or alternative methods and techniques to improve effectiveness.

119

120 4. Particular attention will be paid to the promotion of active community parti~ipation where this will enhance the impact of control measures by improving coverage and overcoming some of the operational constraints. 5. Group educational activities will be promoted or organized to improve and update the technical expertise of professional and technical staff of the antimalaria services, in coordination with training institutions at subregional, regional or interregional levels. Similar activities will be undertaken to promote the coordination and participation of the rural health services and other rural development agencies. 6. Applied field research on technical or operational problems will be fostered, including those related to drug resistance, to the less amenable vector species, and to any other technical or operational problems deserving national, subregional or regional priority. Promotion of malaria border and subregional meetings will continue, with a view to the coordination of antimalaria operations, the exchange of technical information 3nd operational experience, and the investigation of common technical difficulties among neighbouring countries or in the subregions. 7. Where malaria is no longer endemic, cooperation will be provided for the maintenance of an adequate vigilance organization. This will include orientation with regard to malaria for key general health services staff and the provision of information on malaria to the public and private sectors, through the dissemination of relevant documentation. Where malaria has never been endemic, cooperation will be provided for the institution of measures aimed at preventing the importation of malaria vectors, and for the provision of information on malaria, including its diagnosis and treatment, through the dissemination of documentation on the malaria risk facing international travellers. Programme Activities for 1984-1985 8. Collaboration will continue in national antimalaria control programmes, as appropriate, with promotion of the active involvement of the community. In certain countries, the antimalaria services will be reconstructed and strengthened. The Regional Antimalaria Team will cooperate in determining an appropriate stratification of areas and population into ecologically, epidemiologically and operationally homogenous zones, and in ensuring the development and implementation of realistic plans for malaria control and, where feasible, eradication.

9. Coordinated regional malaria training programmes will be developed, to facilitate the organization of appropriate national courses or workshops, related to malaria prevention and control, for various categories of health worker and other staff. 10. Support will be provided to national malaria serv1ce laboratories for the continuation and further expansion of monitoring programmes for malaria parasite drug resistance, and for the promotion of national research capability in studying other technical problems in the control of malaria. 11. Other activities will include the development and strengthening of the vigilance systems 1n countries where malaria eradication has been achieved; and the coordination of antimalaria programmes, geographically and epidemiologically, in countries with common borders, through border meetings and the exchange of technical information.

121

122

4.13.3

MALARIA

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

us$

US$

ill

••

••••••

Country or area Intercountry

... ...... Total

869 000 828 600 1 697 600

285 000 272 500

15!~

000

907 500 874 100 1 781 600

145 000

1 052 500

38 500 45 500 84 000

1 101 100

874 100 1 926 600

557 500

2 255 100

145 000

=========

=======

=========

=======

=========

======

4.1~.4

PARASITIC DISEASES

Medium-Term Programme for 1984-1989 Objective 1. To prevent and progressively control some of the major paras1t1c diseases in the Region, such as schistosomiasis, filariasis, clonorchiasis, paragonimiasis, and protozoal and helminthic infections.

Targets

2. By the end of 1989, countries or areas affected by major endemic human parasitic infections will have developed control programmes and achieved an overall reduction in incidence of 40 per cent. for schistosomiasis, 30 per cent. for intestinal parasitic infections and 25 per cent. for filariasis, compared with the incidence in 1984. Plan of Action 3. The epidemiology and human behavioural aspects of parasitic infections will be studied, to encourage the development of sound control strategies and appropriate resource allocation. Special emphasis will be placed on research in new diagnostic techniques, trials of new and effective therapeutic regimens, and promotion of health education at community level. Measures to reduce contact between man, vectors and intermediate hosts will be studied and applied, where appropriate, especially in developing countries of the Region, where parasitic disease problems are associated with rural and urban development, in particular water-related projects. 4. Collaboration will be extended in the development of skills and capabilities for the control of parasitic diseases, through the education and training of national staff at all levels. Support to the WHO Collaborating Centres for Research in Parasitic Diseases will continue. Governments which have launched· control campaigns will be encouraged to continue their programmes. 5. For all activities, contributions are expected from the programmes for disease prevention and control, particularly disease vector control, public information and education for health, nutrition, promotion of environmental health and health manpower. 6. In addition to the WHO regular budget, funds are expected from extrabudgetary sources.

123

124 Programme Activities for 1984-1985 7. Cooperation will be provided in the planning and development of national control programmes in the context of primary health care, as well as their eventual monitoring and evaluation; the education and tra1n1ng of health and scientific personnel in all aspects of paras1t1c disease; and research activities to improve present knowledge with regard to parasitic diseases, particularly in epidemiology and the bionomics of intermediate hosts, as well as the socioeconomic aspects of parasitic diseases.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

o o o o o o •

o e o •

Country or area Intercountry

... ...... Total

108 600 230 800 339 400

186 700 103 300 290 000

295 300 334 100 629 400

106 500 211 000 317 500

(2 100) (19 800)

=======

-------

(21 900) ======

=========

=======

4.13.6 Hedium-Term Programme for 1984-1989 Objective

DIARRHOEAL DISEASES

l. To reduce mortality and morbidity due to acute diarrhoeal diseases and associated ill-effects, particularly malnutrition in infants and young children.

Targets 2. By the end of (1) 1989~

all countries or areas of the Region will have the capability to plan and manage programmes for the control of diarrhoeal diseases in the context of primary health care; all countries or areas will be able to produce or have access to oral rehydration salts; all countries or areas will have established effective monitoring and evaluation systems, including surveillance systems for diarrhoeal diseases sufficiently sensitive to assess the degree of disease morbidity and mortality reduction resulting from programme implementation; all countries or areas will have established operational research on diarrhoeal diseases; effective mechanisms for coordinating

(2) (3)

(4)

(5)

research activities will have been stimulated on critical issues identified in relation to diarrhoeal diseases control.

Plan of Action 3. The wider utilization of oral rehydration therapy and efforts to improve nutritional and child health care practices will be the main strategies used in controlling mortality from diarrhoeal diseases. Reduction in morbidity will result from improvement in the environment and in water supply, sanitation and food hygiene. In the application of all the strategies, health education will play a dominant role.

125

126 4. The diarrhoeal diseases control programme should be viewed as an integral component of primary health care. It needs to be integrated in, or closely linked to, activities of related programmes such as maternal and child health, family planning, immunization, nutrition and environmental health. All countries or areas where diarrhoeal diseases represent a public health problem will develop national plans for diarrhoeal diseases control which may be separate documents or integral Farts of their national health plans. To achieve this, WHO will cooperate in training national staff in planning and management; in formulating plans; and in the identification of possible sources of funds. Conjointly with UNICEF and other interested agencies the availability of oral rehydration salts will be ensured, as required. 5. As well as training in planning and management, WHO will expand its training efforts in the areas of: (a) the clinical management of cases of diarrhoeal diseases; (b) the microbiological and epidemiological aspects of diarrhoeal diseases control; and (c) evaluation and research. Since the extension of services and the provision of skills at community level are crucial for the prevention and early treatment of diarrhoea, the major emphasis will be on the training of health workers at the periphery. The role the community itself can play in this is of paramount importance. Thus the training of village health workers will focus on ways and means of more effectively securing community participation. Material developed by WHO for various categories of health worker will be made available to training institutions for use in their courses. Attempts will be made at all levels to combine training in diarrhoeal diseases control with training in other activities related to primary health care. 6. Efforts already made by WHO to promote basic and operational research on diarrhoeal diseases will be intensified, especially in areas in which, as a result of improved management and closer monitoring, In addition to the training of research workers, the specific constraints have been identified. strengthening of existing research institutions will form an important component of the programme. 7. WHO will cooperate in monitoring and evaluating the progress made towards the expansion of services, the enrolment of community support and the reduction of morbidity and mortality due to diarrhoeal diseases; planning and conducting epidemiological surveys; strengthening surveillance sys terns; and carrying out periodic programme reviews. Programme Activities for 1984-1985 8. Cooperation will be provided in formulating and updating national control plans in all countries or areas where diarrhoeal diseases represent a problem; training in the managerial and technical aspects of diarrhoeal disease control for middle level health workers and in the implementation aspects of the programme for village level health workers; designing and producing information and educational materials; and monitoring and evaluating national diarrhoeal disease control programmes.

9. In addition, requirements for oral rehydration salts and laboratory reagents will be regularly reviewed and limited quantities will be provided. Data on programme coverage and disease morbidity and mortality will be collected, analyzed and disseminated in tabular form. Research activities will be expanded by training research workers and critically reviewing and publicizing the results of research projects that have received support from WHO.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources us$ Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

ooo~~oeoooooo

Country or area Intercountl-y

... ...... Total

25 000 150 800 175 800 =======

25 000 255 100 255 100 =======

151 500 263 700 415 200

126 500 112 900 239 400

405 900 430 900

=======

=========

=======

127

128 4.13.7 ACUTE RESPIRATORY INFECTIONS

Medium-Term Programme for 1984-1989 Objective 1. To identify interventions which can be applied to prevent and control acute respiratory infections at the community level, eventually reducing mortality and morbidity, particularly in children. Targets 2. By the end of 1989: (1) (2) the scope and magnitude of acute respiratory infections in the Region will have been defined; the effectiveness of interventions in significantly reducing mortality from acute respiratory infections in defined populations will have been demonstrated; most countries or areas of the infection control programmes. Region will have established national acute respiratory

(3)

Plan of Action 3. The strategies currently available for the control of acute respiratory infections relate to the management of acute respiratory cases, health education programmes, immunization (potent and safe vacc~nes against measles, pertussis and diphtheria are already available), the identification of individuals at high-risk, and the development of rapid laboratory techniques.

As the problem needs to be better understood before control measures can be recommended, the immediate approach will be to establi1>h acute respiratory infection units Rnd upgrade existing ones. Through active surveillance of defined populations carried out by these units, scientific conclusions will be reached regarding aetiology, prevention and control. Depending on national capabilities, nationwide control programmes will be instituted gradually, based on the experience and knowledge acquired.

5. The establishment of uniform terminology and criteria for diagnosis will permit bacteriological, virological and environmental (including behavioural) factors contributing to the incidence of acute respiratory infections to be compared. Information obtained through moni taring bacterial resistance should indicate when standardized treatment needs to be adjusted. 6. Further biomedical and operational researclt will be conducted to obtain and evaluate the appropriate technology needed for the successful development of the programme. 7. To implement the above, WHO will: establish a rational basis for the management and control of acute respiratory infections, including the controlled evaluation of the effects of vaccine, for example pneumococcal vaccine, in selected areas; promote the development and application of standardized diagnosis of various acute respiratory infection syndromes; promote a standardized infections; data recording and reporting system terminology and criteria for the

for

studies

on acute

respiratory

establish and support a network of surveillance units, based on a prototype acute respiratory infection unit, to monitor, investigate and care for acute respiratory infections in defined populations; promote training; encourage and support biomedical and operational research. Programme Activities for 1984-1985 8. Cooperation will be provided in the establishment and strengthening of acute respiratory infection units in selected developing countries or areas, with the involvement also of the more developed countries; and in training in the clinical, epidemiological and microbiological aspects of acute respiratory infections, so as to ensure that standardized terminology and criteria for diagnosis are used. The acute respiratory infection projects in the Region will be critically reviewed at a meeting of the principal investigators. Trials of the vaccines under development will be conducted. Biomedical and operational research will be further promoted and supported.

129

130

4.13.7

ACUTE RESPIRATORY INFECTIONS

1982-1983 Estimated obligations Regular budget us$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

•

•••••••••

Country or area Intercountry

... ...... Total

9 300 332 800 342 100 172 200 172 200

9 300 505 000 514 300

63 500 300 000 363 500

54 200 (32 800) 21 400

=======

=========

=======

======

4.13.8 Medium-Term Programme for 1984-1989 Objective 1. To reduce mortality due disease.

TUBERCULOSIS

tuberculosis

and

the prevalence,

incidence and

transmission of the

Targets 2. By the end of 1989 all developing countries or areas of the Region will have established: (l) (2) effective national tuberculosis control programmes as integrated components of primary health care; effective programme management systems so available to all persons who require them. that the most appropriate control methods are

Plan of Action 3. Many developing countries have already established national tuberculosis control programmes based on the standard control methods recommended by WHO. However, further integration of control activities into the general health services and as components of primary health care is necessary. 4. Programme management will be strengthened to provide strong technical and administrative support for field activities. Operational research will be conducted in order to determine how tuberculosis control activities can be effectively integrated within primary health care, and to improve case finding and treatment. 5. Operational and epidemiological evaluation of the effectiveness of control methods, particularly BCG vaccination and short-course chemotherapy, will be developed. 6. The training of health workers at various levels continues to be an important act~v1ty in maintaining the quality of service. The quality control of BCG vaccine and microscopy examination will be monitored.

131

132 7. Close cooperation will be maintained or strengthened with all programme areas that have an important bearing on the delivery of tuberculosis control activities, particularly with the immunization, leprosy control, and other communicable diseases control programmes, health systems development, and laboratory health services. 8. In addition to funds programme. from the WHO regular budget, extrabudgetary resources will be sought for the

Programme Activities for 1984-1985 9. Collaboration will be provided in the further integration of tuberculosis control activities into the general health services and as components of primary health care, through situational analyses, planning, monitoring, evaluation and the training of health workers. The management components of national programmes will be strengthened in some countries or areas. For example, it is planned to develop managerial teams at central and intermediate levels to provide technical and administrative support to the general health services and to primary health care. The training of key health workers in national programmes will continue, as well as at intermediate level and at the periphery. With the involvement of its Collaborating Centres, WHO will cooperate with governments and individual institutions in planning and implementing operational research, through the exchange of information, meetings of investigators and the exchange of research workers between countries. Individual research activities will also be supported as needed. The Regional BCG Vaccine Production Laboratory at Alabang, Philippines and other national BCG laboratories will be strengthened.

4.13.8

TUBERCULOSIS

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources us$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982~1983 and 1984-1985

Total US$

Total us$

Regular budget us$

&e!il&0$30$0.&

Country or area Intercountry

... Total

109 200 532 500 641 700

250 000 21 000 271 000 ========

359 200 553 500 912 700

147 500 589 300 736 800

38 300 56 800

o o o o a o

95 100

=======

========

=========

=======

======

133

134

4.13.9

LEPROSY

Medium-Term Programme for 1984-1989 Objective 1. To reduce morbidity from leprosy, the disease. Targets 2. By the end of 1989: (1)

its transmission and the heavy toll in disability associated with

all countries or areas of the Region where leprosy is endemic will have available managerial capabilities for planning, implementing, monitoring and evaluating leprosy control through primary health care; a majority of cases of multibacillary leprosy will be under effective treatment.

(2)

Plan of Action 3. In order to develop national leprosy control programmes and improve control services, case detection, especially early detection, treatment with chemotherapy, case-holding and contact follow-up will be strengthened, through more effective control planning, programme management and training. The managerial system will be improved at national and intermediate levels to provide technical and administrative support to the control services in the field. Health services research will be promoted to guide planning, programme management and training. 4. Significantly more effective control methods may be expected to result from increased efforts in leprosy research, such as simple tests for epidemiological assessment, more potent and cost-effective chemotherapeutic regimens, And the prevention and control of drug resistance. 5. The training of health workers at all levels will continue to receive high priority.

6. Cooperation with all programmes that have an important bearing on the delivery of leprosy control activities will be strengthened; in particular health information support, the managerial process for national healch development, health systems research, the organization of health systems based on primary health care, health manpower, public information and education for health, research prumulion and development, and tuberculosis. Collaboration will be encouraged with international, bilateral and voluntary agencies. 7. In addition to funds support of this programme. from the WHO regular budget, extrabudgetary resources may be expected 1n

Programme Activities for 1984-1985

Cooperation will be provided in the planning, implementation, monitoring and evaluation of national leprosy control programmes and the training of health workers at various levels, including training in special fields such as epidemiology and statistics, laboratory technology, physiotherapy and reconstructive surgery. Supplies and equipment may be provided to strengthen leprosy services. Additional drugs (rifampicin and clofazimine) may also be provided, for combination drug regimens. The Leprosy Training Centre, Suva, will continue to play an important role 1n training in the South Pacific. Health systems research to guide the planning and management of leprosy programmes and operational research on the field application of more effective control methods will be promoted. Research may be undertaken, in coordination with the tuberculosis programme, to improve case detection and case holding.

135

136

4.13.9

LEPROSY

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

oooooooooe&

Country or area Intercountry

...

15 200 64 000 79 200

426 700 488 000 914 700

441 900 552 000 993 900 =======

26 500 85 600 112 100

11 300 21 600 32 900

OOt:lttOO

Total

======== L-

=======

=========

=======

======

----

4.13.10 Medium-Term Programme for 1985-1989

ZOONOSES

Objective 1. To develop and strengthen the surveillance, prevention and control of the major zoonoses and related food-borne infections, or intoxications of animal origin. Targets 2. By the end of 1989: (1)

strategies and practical methods for the surveillance, prevention and control of the maJor zoonoses and related food-borne diseases, adapted to specific situations where appropriate, will have been made known to all countries or areas of the Region; half the countries or areas will have national zoonoses and related food-borne diseases. control programmes 1n respect of priority

(2)

Plan of Action 3. WHO will promote priority research investigations, the training of veterinary health personnel, and the dcoignation of WIIO Collaborating Centres. The collection and dissemination of epidemiological information on zoonoses and related food-borne infections of animal origin will be improved, in order to develop effective surveillance systems. 4. WHO will collaborate in the organization and establishment of veterinary public health services, which will include surveillance, and in the development and implementation of practical programmes to control major zoonoses such as rabies, plague, leptospirosis and brucellosis. 5. For all activities, contributions are expected from other programmes for the prevention and control of communicable disease, such as disease vector control, and from programmes for the promotion of environmental health, health information support and health manpower.

137

138

Programme Activities for 1984-1985 6. WHO will collaborate in assessing the social and economic importance of zoonoses and related food-borne infections and intoxications; teaching and training veterinary health personnel; promoting research, particularly epidemiological studies of major zoonoses and food-borne intoxications of animal origin, in order to develop appropriate control strategies; encouraging the veterinary activities in relation to human health of other international agencies; and strengthening the WHO Collaborating Centres capable of undertaking and assisting in the surveillance, prevention and control of major zoonoses and food-borne infections and intoxications.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources Regular budget

1984-1985 Estimated obligations Possible extrabudgetary sources

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

........... Country or area ... Intercountry ...... Total

40 900 20 000

50 000 18 000

9 100 18 000

40 900 ======

20 000 ======

60 900

68 000 ======

68 000

27 100

======

=========

======

4.13.11

SEXUALLY TRANSMITTED DISEASES

Medium-Term Programme for 1984-1989 Objective 1. To develop or strengthen programmes for the control of sexually transmitted diseases. Targets

2. By the end of 1989, most countries or areas will be sufficiently aware of the problems and dangers arising from the increasing prevalence of sexually transmitted diseases to have taken appropriate action to: (1) (2) (3) (4) (5) strengthen surveillance of sexually transmitted diseases by improving the reporting system and the laboratory diagnostic services; facilitate early detection and proper treatment of the majority of the cases discovered; make the majority of the population at risk conscious of the dangers of sexually transmitted diseases; conduct studies for the better management of sexually transmitted disease problems; make optimal use of the existing health infrastructure and strengthen its capability formulate and implement practical sexually transmitted disease control programmes. to

Plan of Action 3. The expanding world tourist trade, the change in lifestyle of high-risk groups, and the development of resistant strains of micro-organisms, resulting in treatment failures, have greatly increased the likelihood that sexually transmitted diseases will not only gain a strong foothold in major cities and ports but may also spread to other locations.

139

140

The main approach will be to develop and strengthen sexually transmitted disease control programmes, through the collection and dissemination of technical information; the training of staff in various aspects of control; the promotion of health education, particularly within the high-risk groups; the improvement of surveillance; the strengthening of laboratory diagnostic support; and research on the development of simpler diagnostic tools· and more effective treatment schemes, including those for resistant strains of micro-organisms. 5. WHO will collaborate in reviewing current problems and in the formulation, implementation, management and evaluation of practical control programmes. Collaboration with voluntary and nongovernmental agencies, such as the International Union Against the Venereal Diseases and the Treponematoses, will be promoted, to gain community support for the programme. Programme Activities for 1984-1985 6. Cooperation will be extended in reviewing existing control programmes and problems connected with their implementation, and formulating more practical measures if required; training personnel in the various aspects of sexually transmitted disease control; strengthening laboratory diagnostic facilities (in this respect, the use of the WHO Collaborating Centre for Venereal Diseases Serology and Bacteriology will be encouraged); exchanging technical information on sexually transmitted diseases; and promoting research on the development of simple diagnostic tests, treatment schemes and behaviour patterns.

...

4.13.11

SEXUALLY TRANSMITTED DISEASES

1982-1983 Estimated obligations Regular budget Extrabudgetary sources Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget

t---US$ Regional

us$

•

Country or area Intercountry 0 0

.. ' e 9 ~

111 700 10 000 121 700

4 100 2 000

115 800 12 000 127 800

17 500

(94 200) (10 000)

-Total 6 100

17 500

(104 200)

=======

-----

=======

======

=========

======

=======

141

142

4.13.13

OTHER COMMUNICABLE DISEASES PREVENTION AND CONTROL ACTIVITIES

Medium-Term Programme for 1984-1989 Objective 1. To prevent or control bacterial, viral and mycotic diseases exist but which are of public health importance. Target 2. By the end of 1989, most countries or areas of the Region will have established mechanisms for surveillance and vigilance in respect of communicable diseases, to ensure that they can be contained when they assume public health importance. Plan of Action 3. WHO will continue to support the strengthening of epidemiological services so that countries will be ln a better position to determine the extent and epidemiological features of the bacterial, viral and mycotic infections that have become of public health importance. Collc:borative activltles in dengue fever, dengue haemorrhagic fever, haemorrhagic fever with renal syndrome, 2tnd viral he"Patitis will continue. Further attention will be given to nosocomial infections, which are considered to be an important problem ln both developed and developing countries. Other diseases which will receive attention include Japanese encephalitis, rickettsial infect ions, streptococcal infections, meningitis and plague. 4. The main approaches will be to strengthen surveillance mechanisms; facilitate the exchange of information; train staff in diagnosis, management and control; convene scientific groups to review what is known and identify gaps in knowledge; and conduct research on the etiology, diagnosis, epidemiology and other aspects of the diseases under consideration, so that practical and effective control m~asures may be formulated. for which separate programmes do not

Programme Activities for 1984-1985 5. WHO will cooperate in identifying bacterial, viral and mycotic infections of importance and developing sound control strategies suited to local situations; facilitating the exchange of technical information on various RspP.cts of other bacterial, viral and mycotic diseases; and promoting research activities to develop, for example, simpler diagnostic methods and more effective intervention measures.

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget

19R4-19R5 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total

Regular budget

US$ Regional

US$

ooeoooooooo

Country or area Intercountry • Gl •

... 0 ••

70 000 389 400 459 400 =======

70 000 220 800 220 800 610 200 680 200

165 300 657 300 822 600

95 300 267 900 363 200 =======

Total

=======

=========

=======

143

144 4.13.14 Medium-Term Programme for 1984-1989 Objective 1. To reduce avoidable blindness, promote eye health, including underserved rural and urban communities.

BLINDNESS

and make adequate eye care available to all,

Targets 2. By the end of 1989, in all countries or areas, programmes will exist for: (1) (2) ( 3) the prevention of blindness, national blindness rates having been reduced to less than 0.5 per cent., with no more than one per cent. in any individual community; the restoration of sight to the curable blind; the provision of essential eye care and access to referral services in currently underserved communities.

Plan of Action 3. As a step in identifying priority health needs, WHO will collaborate in assessing the magnitude and determining the major causes of blindness. 4. Appropriate technology for the prevention and treatment of blindness due to the major common causes, for example, trachoma, xerophthalmia and cataract, has been identified and will be applied further at national and community levels. 5. Research will be conducted to develop and adapt community-based approaches to the delivery of essential eye care within the framework of primary health care, using community workers and workers from other sectors.

6. The WHO Collaborating Centre in the Region will be involved in research on eye health care and the development of curricula for the training of health workers at various levels. Training aids and learning materials for those workers will be prepared, tested and promoted, as well as educational material for the public on the prevention and control of major causes of blindness. 7. For All activities, other health programmes may be expected to contribule, especially those concerned with health manpower, public information and education for health and the organization of health systems based on primary health care. 8. In addition to the WHO regular budget, support from extrabudgetary sources may be expected, as well as collaboration from the Asian Foundation for the Prevention of Blindness, Helen Keller International Incorporated and nongovernmental organizations in official relations with WHO. Programme Activities for 1984-1985 9. Cooperation will be extended in surveying the magnitude and nature of the blindness problem, promoting the establishment of national committees for the prevention of blindness, and formulating suitable programmes. Existing data will be collected and analysed and activities for the prevention, treatment and rehabilitation of blindness will be planned, implemented and evaluated. Training will be provided at national level, mainly to auxiliary personnel and public health workers, and postgraduate training in community-oriented ophthalmology will be supported. 10. Operational research will be supported and, where feasible, demonstration projects established. research programme will be reviewed and monitored. The

11. Information on new techniques in treatment and intervention will be disseminated to professional national staff as well as educational materials to medical and nursing schools and to the public.

145

146

4.13.14

BLINDNESS

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

us$ Regional 0

ill

'II

Country or area Intercountry

... Total

76 200

10 000 194 700

86 200 194 700 280 900

200 000 13 000 213 000 =======

200 000 13 000 213 000

123 800 13 000 136 800

...... 76 200

204 700 =======

======

======= -···"

=========

=======

4.13.15

CANCER

Medium-Term Programme for 1984-1989 Objective 1. To prevent and control cancer. Targets 2. By the end of 1989: (1) most countries or areas of the Region will have developed appropriate national cancer control policies and programmes in the context of primary health care; most countries or areas will have introduced measures for prevention or control specific to the types of cancer prevalent.

(2)

Plan of Action 3. The development of national cancer control policies and programmes will be encouraged and cooperation extended in integrating them into the existing health systems. To that end validated information will be disseminated on cancer prevention and control and the organization of cancer services. Member States will also be encouraged to establish cancer surveillance systems, including cancer registries, community-based case finding and treatment, and prevention services for the most common forms of cancer, for which effective control measures are available. The establishment of cancer control units in ministries of health and national committees to formulate and assist in implementing cancer control policies will be promoted. 4. Research on etiology, relating to the prevention and control of cancers common in the Region, will be coordinated, supported and promoted. 5. The training of health workers, including control programmes, will be supported. research workers and administrators working in cancer

147

148

6. Coordination will be established or strengthened between all programmes having an important bearing on the cancer control programme, such as health information support, managerial process for national health development, health sys terns research, organization of health systems based on primary health care, health manpower, public information and education for health and research promotion and development. 7. In addition to the WHO regular budget, support from extrabudgetary sources may be expected and close collaboration will be maintained with the International Agency for Research on Cancer and the International Union against Cancer. Programme Activities for 1984-1985 8. Cooperation will be extended in the development of national cancer control programmes, which will include community-based cancer activities, cancer registries, and screening programmes for the early detection of cancer. Key workers will be trained in the epidemiology and control of cancer. Operational research will be promoted on the effectiveness of screening for certain types of cancer. Epidemiological studies on the etiology of nasopharyngeal carcinoma and hepatocellular carcinoma will be promoted.

4.13.15

CANCER

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

OGQGI!IGOOOOO

Country or area Intercountry

... Total

166 000 46 000 212 000

42 500

208 500 46 000

248 500 137 500 386 000 =======

248 500 137 500 386 000

82 500 91 500 174 000

OOOCIIGG

42 500

254 500

=======

======

=======

=========

=======

====::::::==

149

150 4.13.16 Medium-Term Programme for 1984-1989 Objective 1.

CARDIOVASCULAR DISEASES

To prevent and control maJor cardiovascular diseases. Targets

By the end of 1989: (1)

improved strategies and methods for the prevention of cardiovascular diseases and for reducing the risk factors prevalent in different populations will have been identified and tested; most countries or areas of the Region will have assessed the extent of their national cardiovascular disease problems and will have selected priorities for intervention; a few countries will be implementing programmes through their health services, based on the strategies and methods identified and tested, to demonstrate the feasibility of preventing and controlling cardiovascular diseases among the entire population.

(2) (3)

Plan of Action 3. Epidemiological research in different populations on the incidence and prevalence of cardiovascular diseases will be promoted. Research on the etiology and pathogenesis of major cardiovascular diseases, such as ischaemic heart disease, stroke, hypertension and rheumatic heart disease, will be essential. 4. Particular importance will be attached to identifying the precursors of such diseases occurring during childhood and adolescence. On the bas is of findings, approaches to "primordial prevention" can be developed and evaluated for their effectiveness in preventing the cievelnpment of risk factors in populations where cardiovascular diseases are not yet of major importance. WHO wi 11 collaborate 1n preventing the development of risk-inducing habits, such as smoking and faulty diet. Methods of changing behaviour for a healthier lifestyle will first be developed for the younger age group.

5. WHO will collaborate in developing innovative and community-based approaches to integrated cardiovascular disease prevention and control programmes within the health services. Such approaches will be adapted and field-tested in different settings so as to demonstrate their feasibility and relevance. Limited national rP.AOHrres point to the need for training, in particular short training programmes which will have immediate impact. The use of non-medical health staff and the evaluation of their work will be promoted through training. 6. In collaboration with nongovernmental organizations, nomenclature, diagnostic criteria and methods will be classified and standardized and their use promoted internationally. 7. For all collaborative activities, contributions may be expected from other programmes, such as health manpower, health information support, public information and education for health and other noncommunicable diseases. Programme Activities for 1984-1985 8. Cooperation will be provided in carrying out epidemiological studies to assess changes in the extent of the cardiovascular disease problem. Such studies will also be focused on determining the risk factors, especially in hypertension and stroke, in high risk populations. WHO Collaborating Centres and other appropriate institutions 1n the Region will be involved. Demonstration programmes will be developed for cardiovascular disease control at community level, integrated with the existing health services and with the control of other noncommunicable diseases. Such demonstration programmes will be carefully evaluated. Opportunities will be provided for training in thP. epi clemiology and community-based control of cardiovascular diseases in order to promote national self-reliance. Research activities, in coordination with WHO Collaborating Centres, will be directed towards identified priority issues, in particular hypertension. Efforts will continue, to establish and maintain a directory of research projects, research groups and institutions and to disseminate relevant material. The standardization of criteria, methodology and nomenclature will be promoted.

151

152

4.13.16

CARDIOVASCULAR DISEASES

1982-1983 Estimated obligations Regular budget Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources us$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Total

Regular budget US$

us$ Regional 4GO&&<a&OGGQ

us$

Country or area Intercountry

... ...... Total

168 100 180 000 348 100 =======

168 100 180 000 348 100

196 000 275 900 471 900 =======

196 000 275 900 471 900

27 900 95 900 123 800

=========

=======

=========

-------

=======

4.13.17

OTHER NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

Medium-Term Programme for 1984-1989 Objective 1. To prevent and control other noncommunicable diseases, chronic respiratory and rheumatic diseases. Targets 2. By the end of 1989: (1) most countries or areas of the Region, through strengthening community-oriented prevention and control measures, will have identified improved strategies and methods to reduce significantly the socioeconomic burden caused by noncommunicable diseases of major public health importance, such as diabetes mellitus and chronic respiratory and rheumatic diseases; some countries or areas will be implementing integrated programmes for the control of the major noncommunicable diseases through their health services. prevention and in particular diabetes mellitus, gout, and

(2)

Plan of Action 3. In collaboration with a limited number of countries and with the assistance of relevant nongovernmental organizations, a potential methodology for a comprehensive noncommunicable disease control programme will be developed, through the evaluation of existing and newly developed technology, special care being taken to recommend only those measures that have proved to be cost-effective. 4. Diabetes mellitus will be used, particularly in the South Pacific area, as a model for the further development of a comprehensive programme. Methods will be developed and tested for the combined control of a number of noncommunicable diseases, including cancer and cardiovascular diseases. This will require the strengthening and reorganization of the health care delivery system; research on the etiology and pathogenesis of such diseases as diabetes mellitus; the training of health personnel in the elaboration and implementat~on of prevention p=ogrammes; the strengthening of selected

153

154

institutions; the exchange of technical information; and the provision of advice on appropriate technology and standardization for community-based programmes. For all activities, contributions may be expected from programmes such as health manpower, health information support and public information and education for health. 5. As well as support from the WHO regular budget, extrabudgetary resources will be sought.

Programme Activities for 1984-1985 6. Cooperation will be provided in carrying out epidemiological studies in order to assess changes in the extent of the noncommt!nicable disease problem. Such studies will be focused especially on determining the risk factors in diabetes mellitus among Pacific populations. Demonstration programmes for integrated noncommunicable disease control at community level will be developed. Health personnel at all levels will be trained in the prevention and control of diabetes mellitus, particular attention being paid to the epidemiological and community-oriented aspects. Research on the delivery of health care for noncommunicable diseases, as well as on other priority issues, will be supported and will include cost-benefit assessments. Efforts to establish and maintain a directory of research projects, research groups and institutions will continue and relevant material, on metabolic diseases in particular, will be disseminated. The standardization of criteria, methodology and nomenclature will be promoted.

4.13.17

OTHER NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL ACTIVITIES

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

OG&ooooo•o•

Country or area Intercountry

... Total

3 000 35 000 38 000

11 000

14 000 45 000 59 000

83 500 13 000

83 500 13 000 96 500

80 500 (22 000) 58 500

0&00111'0

10 000 21 000

96 500

======

=========

======

155

156 5.14.0 HEALTH INFORMATION SUPPORT

Medium-Term Programme for 1984-1989 Objective 1. To ensure the availability of valid scientific, technical, managerial and other information relating to health, in printed or other forms, whether originating within the Organization or outside it, particularly in relation to attaining the target of health for all by the year 2000. Targets 2. By the end of 1989: (1)

most countries or areas services;

of the Region will be self-reliant with regard to health literature

(2)

an agreement will still be in operation to facilitate cooperation among Member States in the exchange of scientific and technical information. This will include access to international bibliographic systems and data bases in health and health related areas; information with regard to the availability of WHO publications, their distribution and their sale, will be reaching an increased number of health workers and institutions.

(3)

Plan of Action 3. Activities will be initiated to prolong the current agreement which provides access to international bibliographic systems and data bases, with a view to possible extension to include a wider range of activities. The participation of national focal points in the biomedical information system will be strengthened and WHO Collaborating Centres, particularly for software development in health literature services, will be designated. An in-depth technical survey of existing biomedical resources and facilities will also determine existing and future biomedical information needs, and enable precise and detailed proposals to be made for a comprehensive regional biomedical information network, applying advanced data processing and telecommunication technology. The special scheme for the distribution and sale of WHO publications will be implemented to a greater extent and brought to the attention of an increased number of health workers and institutions.

Programme Activities for 1984-1985 4. Cooperation will be extended in training staff in the operation and management of modern library and information services. Modern library equipment and materials, including micro-computers, will be provided. National fut:al puiuL~; in tleveloping Member States will be supported in providing users 1 training, and resource-sharing for the international exchange of information will be strengthened. Union lists of serials and catalogues of books will be established and updated in priority biomedical and health services research areas. Computer software for information storage and retrieval will be developed and adapted. The special scheme for the distribution and sale of WHO publications will be promoted and rights will be granted for the translation of WHO publications in languages other than the official languages of WHO.

1982-1983 Estimated obligations Regular budget US$ Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

Regional

........... Country or area ... Intercountry ...... Total

454 000 70 000 10 000 208 000

454 000 278 000 10 000

568 300 100 000 94 600

114 300 30 000 84 600

534 000 =======

208 000

742 000

762 900

228 900

=======

=========

=======

157

158 5.15.0 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.

1982-1983 Estimated obligations Regular budget US$ Regional 2 871 600 Extrabudgetary sources US$ 639 900 Regular budget US$ 4 090 600

1984-1985 Estimated obligations Possible extrabudgetary sources US$ 809 600

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$ 3 511 500

Total US$ 4 900 200

Regular budget US$ 1 219 000

•••••••••

•

Country or area Intercountry

... ...... Total 2 871 600 639 900 3 511 500

4 090 600

809 600

4 900 200

1 219 000

=========

=======

=========

=======

=========

5.15.1 Medium-Term Programme for 1984-1989 Objective

PERSONNEL

1. To recruit personnel of the highest levels of competence, integrity and efficiency, having due regard to considerations of geographical distribution; the need to increase the number of women employed, especially in the professional grades; the prospective expansion in the role of national staff in the execution of WHO collaborative programmes in their own countries; and the need for health generalists with experience in health policy and management and the intersectoral approach to health development.

Target 2. The necessary personnel will be recruited on time so that all WHO collaborative programmes may be implemented expeditiously and successfully. Plan of Action, including activities for 1984-1985 3. Personnel policies will be adapted to the overall medium-term goals of WHO and appropriate criteria for the development, assignment, utilization and evaluation of staff will be adopted, in accordance with those goals. 4. Support will be implementation of organizations. The regarding employment staff. extended to technical units in recruiting the personnel necessary for the smooth programmes. Personnel policies will be coordinated with those of related personnel office will act as coordinator for all United Nations agencies in Manila conditions for general service staff and post adjustment questions for professional

159

160

5.15.1

PERSONNEL

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

'0(!)(10;0(109&$0

300 400

15 400

315 800

373 800

19 600

393 400

73 400

Country or area Intercountry

...

...... Total

300 400

15 400 ======

315 800

373 800

19 600

393 400

=======

73 400

=======

========

======

=======

======

-~···

5.15.2

GENERAL ADMINISTRATION AND SERVICES

Medium-Term Programme for 1984-1989 Objective 1. To provide efficient and effective internal facilities and other support services. Target 2. Modern technology will be applied and modern equipment installed, services for WHO collaborative activities in the Region. Plan of Action, including programme activities for 1984-1985 3. General Administration and Services will arrange for and assist ~n the provision of physical facilities for WHO meetings, including interpretation facilities. It will provide serv~ces and facilities in relation to mail and telex dispatch, internal distribution of communications, and messenger and security functions; internal reproduction and photocopying of documents and reports; building and maintenance, including maintenance and improvement of the premises, and requisition and maintenance of interpretation, audiovisual and other electrical equipment; records management, maintenance of central files in the registry, and reference and archive services; travel and transportation of staff, consultants and other official visitors, and facilities for the transportation of personal effects and customs clearance; security services; and cafeteria services for WHO staff and participants in meetings held at the Regional Office. ~n

order to provide more efficient

161

162

5.15.2

GENERAL ADMINISTRATION AND SERVICES

1982-1983 Estimated obligations Regular budget US$ Regional 1 952 000

1984-1985 Estimated obligations Regular budget US$ Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Extrabudgetary sources US$

Total US$

Regular budget US$

•

•••

563 600

2 515 600

2 895 900

710 000

3 605 900

943 900

Country or area Intercountry

... ...... Total l 952 000

563 600 =======

2 515 600

=========

2 895 900

710 000

3 605 900

=======

=========

943 900

=======

5.15.3 Medium-Term Programme for 1984-1989 Objective

BUDGET AND FINANCE

1. To provide timely and efficient administration of both regular budget and extrabudgetary funds permit the Organization to execute its programme of cooperation effectively. Target 2. To achieve the optimum utilization of funds internal control, monitoring and reporting system. and proper cash disbursement, with an

appropriate

Plan of Action, including activities for 1984-1985 3. Services will be provided in respect of the budgetary aspects of the planning, preparation, implementation, monitoring and control of the Organization's programme of cooperation under all sources of funds. Status reports and forecasts on programme delivery will be furnished to the Programme Committee, with a view to ensuring efficient delivery of cooperative programmes. Support services will be provided, in the area of finance and accounts, in the most expeditious manner, accompanied by appropriate internal controls and proper cash management. Such services will include the receipt and disbursement of funds, settlement of claims and suppliers 1 invoices, maintenance of accounts, and preparation of financial reports. Currency and cost fluctuations will be monitored, in order adequately to maintain daily subsistence allowances and fellowship stipend rates in countries or areas of the Region.

163

164

5.15.3

BUDGET AND FINANCE

1982-1983 Estimated obligations Regular budget US$ Regional Extrabudgetary sources US$ Regular budget US$

1984-1985 Estimated obligations Possible extrabudgetary sources US$

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Regular budget US$

••

••••••••

474 400

34 300

508 700

618 900

46 000

664 900

144 500

Country or area Intercountry 0

... •••••

Total

474 400 =======

34 300

508 700

618 900

46 000

664 900

======

144 500 =======

=======

======

=======

5.15.4

EQUIPMENT AND SUPPLIES FOR MEMBER STATES

Medium-Term Programme for 1984-1989 Objective 1. To provide procurement and related supply services for the successful implementation of the WHO programme of cooperation, including the reimbursable procurement of supplies and equipment on behalf of countries or areas of the Region.

Target 2. The timely delivery of appropriate supplies and equipment procured at competitive Plan of Action includ activities for 1984-1985 pr~ces.

3. The availability of supplies and equipment, the purchase of which is organized or facilitated by WHO in time and at competitive cost, is essential to the progress of many programmes. Meeting these requirements will be facilitated by making available basic lists and standard specifications, adapted as necessary to special requirements, as well as developing mechanisms for price and cost control, and production, procurement and marketing schedules. Local production and intercountry cooper-ation will also be encouraged in order to provide the best possible supply services.

165

166

5.15.4

EQUIPMENT AND SUPPLIES FOR MEMBER STATES

1982-1983 Estimated obligations Regular budget US$ Regional 144 800 Extrabudgetary sources Regular budget US$ 202 000

1984-1985 Estimated obligations Possible extrabudgetary sources US$ 34 000

Increase(Decrease) between 1982-1983 and 1984-1985

Total US$

Total US$ 236 000

Regular budget US$ 57 200

us$

ooeooeeooo9

26 600

171 400

Country or area Intercountry

... ...... Total 144 800 =======

26 600

171 400 =======

202 000

34 000

======

=======

======

;;;;..;.;;:=====

236 000

57 200 ======

INFORMATION ANNEXES

168 CONTENTS

Summary of country and intercountry activities ANNEX I ANNEX II Australia

........................................... •••• It •••••

169 173

Regional Committee and Regional Office Country or area programmes •..•..•.••....•..•..•••••

••••••

••••••••••••••••••••

American Samoa

•

••••

•

•••••••••••••

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

. ...... .

oooooooo o ••• 0 • • • 0

ooooeoo •• 0 •• 0 ••• 0

ooooooooooooooo • 0 0 ••• 0

China Cook Islands Democratic Kampuchea Fiji French Polynesia Guam ..•.•.

Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia New Zealand Niue ...... . ••••••••••••••.•••••••••• 0 • • • • ••••••

Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga ••••••••••••••••••••••••••••••••••••••ooeooooo Trust Territory of the Pacific Islands ••••••••••••••••••••••••••••••••••••••••••••••• •••••••••••••••••••• 0 ••• 0 •••••••••••••••• •••••• 0 •••••••••••• 0 ••• 0 0 0 0 •••••••••••••••••••

Tuv a 1u

•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• e •••••••••••••••••••••••••• 0 •••••••••••••••••••••••••••• 0

••••••••••••••••••

Vanuatu Viet Nam ANNEX III

••••••••••••••••••••••••oooooeooaoO>ooooooooooooo•oooooooooooooooooooooo •••••••••••••••••••••

177 181 184 197 203 204 209 217 224 227 231 239 249 252 263 266 270 278 286 294 303 308 315 318 325 333 337 345 359

Intercountry programme

ooeoooooooooeoo••••••••••••••••••••••••••••••••••••••

SUMMARY OF COUNTRY AND INTERCOUNTRY ACTIVITIES

Estimated oh ligations COUNTRY OR AREA Regular budget US$ American Samoa Australia China Cook Islands + Democratic Kampuchea Fiji French Polynesia Guam .......................................... Hong Kong ............................................. Japan + Kiribati <>• Lao People's Democratic Republic Macao Malaysia ........................................ New Zealand ......... " ......................... Niue ............................................ Papua New Guinea Philippines ................................. Republic of Korea Samoa Singapore Solomon Islands Tokelau ............................................ Tonga Trust Territory of the Pac i fie Islands Tuvalu ............................................ Vanuatu . . . . . . . . . . . . . . . . . . . . . . c . . . . . . . . . . . . . Viet Nam Intercountry progrannnes (including Regional Advisers) ••...•••••••.

1982-1983 Extrabudgetary sources us$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources US$ Total US$

Increase/ (Decrease) Regular budget US$

........................... .. ········· .................... .......... ····· .................... <> e c " ~

.................... ... ········ .......................... • • • • • • • o • • eo eoee oeeo ee eo ... 0 .. " .. " ............ 0 .....

o a

•

o o

•

o o

.._ •

•

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

O<>

000

ea ..... e

e<>O•

eeeeeo

.................................... . ~ ~

........

•

...

•

••

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

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

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

....................................... Total

115 100 2 500 447 500 944 70 80 110 100 54 7 l 267 50 l 127 60 50 1 il89 1 624 l 498 694 415 744 10 547 647 75 794 3 333

000 000 000 300 000 800 000 000 000 000 100 700 000 500 000 000 701) 900 000 600 700 600 000 300 300 000 600 60()

5 512 700 88 500 237 300

9 000

105 200 540 200 475 300 16 718 124 42 229 261) 542 300 400 600 500 300 700 900 3 100 206 000

l l

2 1 1

56 800 99 000 2 769 800 5 800 ?00 17 R43 8()0 ::-==-====::::::.:::::;

115 100 012 535 737 944 70 80 119 100 652 R07 50 602 60 66 608 749 'i40 923 682 287 13 753 647 131 893 103

000 000 700 800 300 800 000 000 000 000 500 900 000 ROO 000 300 100 500 'iOO 900 400 500 100 300 300 800 600 400

115 100 4 242 452 500 1 004 70 80 110 100 622 1 430 50 1 159 60 58 2 205 l 758 l 544 824 552 849 20 824 672 75 904 3 751

000 000 800 300 000 900 000 000 000 000 300 000 000 100 000 000 800 400 300 700 000 700 000 300 300 000 800 400

1 010 900 96 100

207 400 433 000

638 700 68 100 292 800 457 000 137 700 16 500 400 000 2

llS 000 100 000 ') 2'53 700 548 400 500 000 1 004 900 70 000 80 000 110 000 100 000 829 700 l 863 000 50 000 l 159 100 60 000 58 000 2 844 500 1 758 400 l 544 300 892 800 844 800 1 306 700 20 000 962 000 708 800 75 000 l 304 800 3 751 400 16 640 800 44 556 100

1 742 800 5 000 60 100

75 000 162 300 31 600 8 316 133 46 130 136 105 10 000 100 500 )00 100 100 100 000 277 000 25 000 110 200 417 800 1 314 400 5 106 600

13 168 ">00

18 968 800 51 357 300 ==:::::======.:::

14 483 000 38 620 100 =====::;:;;::;:;=:;;:::

157 800

33 513 500 ::u::=:;:;z===~:::::~ ""-----~~.~~""~"'••C-••

5 936 000

==========

=========

169/170

ANNEX 1 REGIONAL COMMITTEE AND REGIONAL OFFICE

REGIONAL COMMITTEE

Estimated obligations 1982-1983 US$ 1984-1985 US$ 280 000

sources of funds

Regiona 1 Committee for the Western Pacific

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

131 000

REGIONAL OFFICE Programme

Man-years/months 1982-1983 1984-1985

Estimated obligations 1982-1983 US$ 1984-1985 US$

Source of funds

1.2 .o

WHO's general programme development and management 1. 2.1

1.2 .3 1. 2.4

Executive management General programme development External coordination for health and social development

6/00 36/00 10/00 54/100

8/00 36/00 10/00 54/00

334 900 1 043 700

420 000 1 369 500 341 800 2

RB RB RB

268 200 1 646 800

131 300

2.3.0

Health system development 2. 3 .1 Health situation and trend assessment 4/00 4/00 22/00 4/00 - 4/00 22/00 148 400 ---155 700 454 000 177 500 191 200 568 300 RB RB RB

2.6.0 5.14 .0 5.15.0

Pub 1 ic information and education for health Health information support Support services 5 .15 .1 5.15.2 5.15.3 5.15.4 Personnel General administration and services Budget and finance Equipment and supplies for Member States

16/00 2/00 102/00 40/00 4/00 10/00 4/00 178/00 262/00 252/00 10/00

16/00 2/00 104/00 40/00 4/00 10/00 4/00 180/00 264/00 254/00 10/00

300 400 15 400 1 952 000 563 600 474 400 34 300 144 800 26 600 3 511 500 5 916 400 5 276 500 639 900

373 800 19 600 2 895 900 710 000 618 900 46 000 202 000 34 000 4 900 200 7 968 500 7 158 900

AS RB

AS RB AS

RB AS

Total - REGIONAL OFFICE of which~

Regular budget Other sources

809 600 173/174

ANNEX II COUNTRY OR AREA PROGRAMMES

AMERICAN SAMOA NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The major aim, stated in the economic development plan for Amer:it.:<:m Samoa, 1979-1984, is to maintain and improve economic efforts and expense potentials, which are primarily based on existing resources, before embarking on a more expansive economic programme. Activities are directed towards expanding the local fishing industry and promoting and supporting agriculture, thus reducing dependence on outs ide sources; improving and expanding the tourist industry; promoting the development of small businesses and industry; exploring the potential of the Territory as a regional market and transportation centre; providing adf!quat:P. mAnpower and training to meet local needc, enhancing local labour force develO!Jttteul and reducing unemployment; and enhancing the efficiency and effectiveness of Government administration, operation and maintenance functions. The aims within the health infrastructure include increasing the availability of potable water and improving its quality, to meet territorial water quality standards. A stable and reliable source of electric power is also of the highest priority.

2. The overall policy relating to improvement of the health status of the population and of the health system remains consistent. 3. The greatest potential for health status improvement by the year 2000 lies in disease prevention, primary health care, and the maintenance of good health through a healthful life style, which includes good nutrition, reduction of cigarette smoking, and adequate physical exercise. If significant progress is to be made, thP.rP. needs to be a major c:hAner: in emphasis with regard to programme priorities and the investment of resources, away from expensive inpatient services towards the priority areas mentioned above. 4. I t is aimed to develop a self-reliant health system, with increased individual contributions to health care, which will include a health insurance scheme, federal assistance for health care of the poor, and increased taxes. The expansion and development of health centres form part of a move to decentralize health care to the communities, closer to where people reside. Emphasis is placed on improving the efficiency and effectiveness of government health services. Containment of health care costs is also a high priority, particularly the rapidly escalating costs of medical referral outside the Territory. The availability, accessibility, and appropriate utilization of services for mothers and children continue to receive appropriate priority. The need to provide adequately trained health manpower remains of great concern. This is the area in which WHO can provide the greatest support.

177

178

5. Reflecting overall policies and strategies, a major goal ~s to improve the health In particular: (1)

all

citizens.

every individual should have the knowledge and the capacity to improve his own health, to maintain a high level of good health and to protect himself from ill_ness, injury, disability and premature death, by accepting appropriate responsibility and taking action for personal and community well-being; the infant mortality rate should not exceed an average of 16 per 1000 live births for any consecutive three-year period and should not exceed 20 per 1000 for any individual year; life expectancy at birth and at age 25 should not be more than 5 per cent. below the national average for the United States of America; the average crude birth rate should not be higher than 25 live births per 1000 population; deaths from preventable communicable diseases should be less than 12 per lOO 000 persons. incidence of diseases preventable by immunization should approach zero. Measles should eliminated as an endemic disease. Ninety per cent. of children aged 2-14 years should immunized against diphtheria, tetanus, pertussis, poliomyelitis, measles and mumps; females aged 12 years against rubella; premature mortality from chronic diseases should be reduced; the blood pressure of at least 70 per cent. of identified patients with hypertension should be maintained within normal limits; the government water system should be fluoridated in order to achieve and maintain a prevalence of not more than two decayed, missing, or filled dental surfaces in the population aged 12 years. The be be and

(2) (3)

(4) (5)

(6) (7)

(8)

6. To guide the future development of the health services, the overall health system goal is defined as follows: the efficient organization and operation of a system of high quality health services, delivered either directly or through cooperative arrangements, in such a way as to ensure the most effective ulilization of health resources in meeting the public need. Such health services will have been determined, by accepted criteria, to be both needed and appropriate; reasonably accessible to those who need them, at a time and location appropriate to the need; organized and interrelated so as to bring the consumer into contact with the appropriate service as the need arises; designed and delivered in ,a manner which promotes mutual respect between the consumer and the provider and enhances their acceptability; provided by health personnel performing at levels above minimum standards for the Territory, as determined by peer provider and consumer representatives; and provided at the lowest cost consonant with adequate quality, accessibility, and acceptability. 7. To achieve the health services system described above, adequate resources must be made available to support expansion and improvement. Among the three major resource categories (manpower, facilities and equipment, and finance) the development of manpower is of primary importance and requires the greatest amount of time and effort. Health manpower needs could be temporarily met in a relatively short period by contracting with expatriate health professionals. Given adequate funds, however, the long-term goal is to meet the needs through the education and training of local staff in the various health personnel categories required, in order to develop a stable local health manpower force. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 8. Given the overall health development policies, strategies and goals, the greatest need from WHO, in efforts to achieve the health status and system of services desired, is long-term cooperation in the development of an appropriately trained and deployed health manpower force, to support the programmes and services deemed necessary. WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 9. Health manpower

WHO will cooperate 1n the development of health manpower as appropriate.

179

180

AMERICAN SAMOA Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 Health Manpower Total - AMERICAN SAMOA

115 000

115 000 115 000

115 000

=::::=====

=======

::::::::::t::n=::::==

==:;:::=c:==

=======

AUSTRALIA

NATIONAL HEALTH DEVELOPMENT STRATEGY 1. Australia is a federation of seven states and territories: New South Wales, Victoria, Queensland, South Australia, Western Australia, Tasmania and the Northern Territory. The Australian Capital Territory is the seat of the Commonwealth Government. 2. The Commonwealth Government has limited direct involvement in the provision of health care services. The primary responsibility for the provision of health services 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 Capital Territory Health Commission. 3. Prior to an amendment to the Constitution in 1946, the only health function of the Commonwealth Department of Health was in relation to quarantine. Consequent upon this amendment, the Commonwealth Government was given powers to make laws with respect to pharmaceutical, hospital and sickness benefits and medical and dental services. The Commonwealth Government has also used its powers under section 96 of the Constitution to make grants to the States for health purposes. In addition, the Commonwealth Government gives financial assistance to certain organizations concerned with public health matters. It plays a significant role in such areas as the supervision of private health insurance and the financial support of hospitals and other servic~s. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 4. The Government of Australia will continue to collaborate actively with the World Health Organization and the countries or areas of the Pacific in various health system development programmes, including medical research.

181

182

WHO SUPPORT FORESEEN FOR 1984-1985

2.5.0

Health manpower

5. The provision of health manpower and tra1n1ng in Australia is a complex process extending over a number of different interests and authorities: hospitals, universities, other educational institutions, registration authorities, professional associations and State and local governments. 6. Since the WHO fellowship programme is a vital aspect of the overall health system development programme for countries of the Pacific, Australia is most willing to again share in this collaborative activity for the 1984-1985 biennium.

AUSTRALIA Progranune Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 Health

Man~ower

100 000 100 000

100 000

Total - AUSTRALIA

========

=======

100 000

====::;;:==

100 000

=======

100 000 c:==•===

=====t::==

183

184

CHINA

NATIONAL HEALTH DEVELOPMENT STRATEGY

The health services in China constitute an important component of the national development programme. They will be improved concurrently with the growth of the national economy. The fundamental tasks of the health services at the present stage are disease prevention and treatment, the successful implementation of family planning, and upgrading of the health standards of the urban and rural population, which will include a high level of material and spiritual well-being, in order to better advance the socic.list cause and ensure the attainment of health for all by the year 2000. While promoting and expanding technical cooperation and exchanges in the health field with WHO and other international organizations and with friendly countries, the Government has always adhered to the principle of self-reliance in health development. 2. On the basis of the above principles and tasks, the following objectives have been established: (1)

to implement the principle of prevention first and to series of patriotic mass health campaigns, promoting improving food hygiene, environmental sanitation and wastes. Efforts must be made to control various types a grave danger to the people's health;

enhance disease control by conducting a the supply of safe drinking water, and the proper disposal of human and animal of disease, especially those which pose

(2)

to continue to reinforce the development of the rural health services and the reorganization of health institutions, especially in the counties, and to strengthen the health services in the cities, factories and mines; to intensify research on traditional Chinese medicine and to support the principle of v1gorous development and long-term co-existence of the three disciplines of traditional Chinese medicine, western medicine, and integrated tranitional and western medicine, in order to develop a new school of medicine characteristic of China; to strengthen maternal and child health and family planning through the provision of technical guidance;

(3)

(4)

(5) (6)

to develop medical education and scientific research professionals and management staff of high quality;

and

train

medical

and

health

to improve the management of health institutions at various levels Rnrl increase work efficiency.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 3. Initial experience in collaborative activities with WHO has been satisfactory. During the period 1984-1989 WHO support will be sought in achieving the objectives and aspirations inherent in commitment towards health for all by the year 2000. The management and development of the health services are seen as major areas for continuing collaboration, as are improvement and rationalization, both quantitatively and qualitatively, of the different categories of health worker. 4. With the changing patterns of morbidity and mortality, it is anticipated that WHO cooperation will be needed to a lesser extent for control of the cldssical infectious diseases and more in relation to the chronic, degenerative and neoplastic diseases. In addition, expans~on of the rehabilitation programme must be considered. 5. As in the past, China is ready to share its experiences as a developing country committed to "health for all" with friendly countries, through the l.Jorld Health Organization. WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

6. Over a period of time, a wide range of morbidity and mortality related statistical data have been collected. Existing knowledge and skills in epidemiological methods need constantly to be updated by maintaining contacts with well known centres in other countries as well as by providing training for national health personnel in surveillance techniques and in the interpretation and utilization of the data collected. WHO will continue to cooperate in fulfilling those needs.

185

186

2.3.2

Managerial process for national health development

7. Studies will be conducted on the existing systems of health services management. It is an important function of the management sciences to achieve the best possible results at the least possible cost. WHO will cooperate in improving the level of scientific management through the training of scientists and those working in the areas of health economics and health statistics and information. 2.4.0 Organization of health systems based on primary health care

8. One of the priorities of the national health programme is to ensure the success of primary health care 1n rural areas where over 80 per cent. of the population lives. This will be done in stages and in groups. It is planned to strengthen the health institutions in one third of the counties by the year 1985. Emphasis will be placed on developing these county-level health institutions into centres for disease prevention, medical practice and family planning, as well as bases for personnel training for the entire county, thus accelerating improvement of the technical level of the rural primary health care network as a whole. The three WHO Collaborating Centres for Primary Health Care (Conghua County in Guangdong Province, Jiading County in Shanghai Municipality and Yexian County in Shandong Province) will be further strengthened and their potential will be developed, as a vital component in attaining the goal of health for all by the year 2000. WHO, UNDP and the World Bank will cooperate in raising the technical level of the primary health care services. 2.5.0 Health manpower

9. 'Training of sen1or and middle-level medical and health professionals is a top priority in the national health programme, in order to ensure accomplishment of the fundamental tasks of the health serv1ces and the modernization of medical sciences. Health manpower development will be further promoted and it is expected that WHO will provide fellowships for Chinese scholars to study abroad, WHO will continue to make efforts to seek extrabudgetary funds from such sources as the World Bank, UNDP and UNICEF to support the needs in personnel training in various disciplines.

3.7.0

Research promotion and development

10. Twenty Collaborating Centres have been designated by WHO for research and personnel training (both Chinese and international professionals) from among the meoiral research institutions recommended by the Chinese Hinistry of Public Health. WHO will cooperate in upgrading the training capabilities and the level of management in those Centres. Considering that the development of capabilities in the modern biomedical sciences and the laboratory animal sciences are interdependent, and that the quality of experimental animals has a direct bearing on the findings of scientific experiments, it is planned to establish an experimental animal centre in Beijing. The centre will cooperate with WHO by training scientific and technical staff in order to provide high quality experimental animals and promote the development of the medical sciences. 3.8.1 Nutrition

, processing, storage and 11. Advances in science have stimulated devel in relation to food supply, and new foodstuffs are becoming available. Research is needed on food ingred :Lents that are China is rich in its scientifically nutritious so as to improve the nutritional status of the people. food varieties and styles of preparation, Further cooperation from WHO, UNDP and UNICEF will enhance research capabilities in this area. 3.8.2. Oral health

12. Oral and dental diseases are common in the rural areas, where dental caries and malocclusion among children and periodontis among adults constitute a problem. It is essential to develop oral health care and research activities on the prevention and treatment of oral diseases. An institute in Beijing has been designated a WHO collaborating centre for research and training in preventive dentistry. The Centre is receiving support from UNDP in training oral health workers and in raising the standards of research on prevention and treatment.

187

188

3.9.1

Maternal and child health, including family plannin&

13. The Government encourages the one child family. Maternal and child health and family planning are priority tasks of the national health programme. To ensure that the total population does not exceed 1200 million by the end of the century, efforts must be made to protect the health of women and children, including efforts to reduce morbidity and mortality, improve perinatal care and promote eugenics. WHO, UNDP, UNICEF and UNFPA will cooperate in the areas of maternal and child health and family planning. 3.9.3 Workers' health

14. For protecting the health of workers, great importance is attached to improving working conditions, research on labour hygiene, the formulation of health standards, the enforcement of labour protection, and the energetic control of occupational diseases and the effects of toxic substances. In cooperation with WHO, training will be intensified. 3.9.4 Health of the elderly

15. In China, aged people enjoy the respect of society. With increased life expectancy, research on senile diseases (such as diabetes) and geriatric medicine have become prominent. A research institute in geriatric medicine will be established in Beijing. 3.10.1 Psychosocial factors in the promotion of health and human development

16. Mental health is a relatively recently re-established discipline in China and WHO will cooperate 1n the organization of a national seminar on the psychosocial aspects of primary health care in 1983. In the biennium 1984-1985, studies on the psychosocial aspects of health will be undertaken, especially in relation to the one child family.

3.10.3

Prevention and trPAtmP.nt of mental and neurological

~i~orders

17. WHO collaborating centres for research and training in mental health and for research and training in neurosciences have been designated in Beijing and Shanghai. Training of personnel and community prevention and control will be further strengthened and an epidemiological study will be undertaken.

3.11.1

Community water supply and sanitation

18. China is committed to the aspirations of the International Drinking-Water Supply and S;mi tAti on Decade, with national activities coordinated through the Patriotic Health Movement under the leadership of the Ministry of Public Health. 19. WHO and UNDP will cooperate in improving technology to achieve national programme goals. 3.11.3 Control uf environmental health hazards and developing existing infrastructure, manpower and

20. The problem of environmental pollution resulting from industrial development is of great concern and national policies have been formulated for environmental protection. Research on environmental pollution and human health, environmental monitoring, and the management of pollution, have assumed increasing importance. China has joined the Global Environmental Monitoring System/Air and will continue to cooperate with WHO and UNEP. 3.11.4 Food safe be further strengthened, collaborative

21. With WHO cooperation, the monitoring of food safety will research activities expanded, and staff training promoted. 3.12.1

ClinicAl,

laboratory and radiological technology for health systems based on primary health care

22. In cooperation with WHO and UNDP, a national clinical diagnostic reagents experimental centre will be established, which will provide standard diagnostic reagents. In addition, it is hoped to cooperate with the World Bank in the establishment of two national clinical laboratory centres, in Beijing and Shanghai, in order to develop standards, disseminate new technology, and improve diagnostic skills at basic and other levels.

189

190

3.12.3

Drug and vacc1ne quality, safety and efficacy

23. Within the national health programme, emphasis 1s placed on further development of the pharmaceutical industry, the study and production of preventive, diagnostic and therapeutic drugs, and the strengthening of quality control and standardization of pharmaceuticals and biological products, so as to meet the needs of medical and health institutions in urban and rural areas, especially those of the rural primary health care services. 3.12.4 Traditional medicine

24. Traditional Chinese medicine has played an important role in protecting the people's health and in developing primary health care. Hence, the national health programme calls for the continued use and development of the country's medical legacy and for the intensification of research on traditional Chinese medicine and pharmacology. As an embodiment of the experience of the Chinese people in their fight against disease over several thousand years, Chinese medicine and pharmacology are rich in practical experience and theoretical knowledge. Their systematization and upgrading wi 11 not only benefit the nation but also contribute to mankind as a whole. 3.12.5 Rehabilitation

25. In endeavours to provide basic health care, rehabilitation has been accorded lower priority. Changing demographic patterns of disease, however, reveal the emergence of cerebrovascular and cardiovascular diseases. In view of this and of increased life expectancy, there is clearly a need to expRnd the rehabilitation services. WHO and UNICEF will collaborate in expanding national capRhility in order to satisfy anticipated demands.

4.13.1

Immunization UNICEF will cooperate in immunization activities, improving and enhancing vaccine production raising the quRlity of preventive vaccines, and developing the cold chain. Research will be on new vaccines and more diseases will be included in the immunization programme, in order pressing needs for the prevention of communicable diseases through primary health care.

26. WHO and technology, carried out to meet the

4.13.3

Malaria

27. Wet rice cultur~ hAR Pxp;mrlPrl nnrthwards, thus altering the epidemiological pattern of malaria in China. WHO will cooperate in studying better ways of controlling the main vector, Anopheles sinensis, through the WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, as well as in research activities and staff training. 4.13.4 Parasitic diseases

28. While schistosomiasis has been controlled to a large extent, small pockets of disease still exist. Other paras~t~c infestations, such as clonorchiasis and paragonimiasis, continue as public health problems. WHO will collaborate, through its Collaborating Centres, in control activities. 4.13.6 Diarrhoeal diseases

29. Seasonal outbreaks of diarrhoeal disease, probably of mixed aetiology, occur in China. Further study is needed and, at the same time, oral rehydration methods must be made more readily available. WHO will cooperate in activities to those ends. 4.13.7 Acute respiratory infections

30. Respiratory infections are an important cause of morbidity, especially among children, in whom they are the major cause of death. Continued WHO cooperation is envisaged in studies to ascertain the aetiology of the infections and in training, in order to enhance the effectiveness of preventive and curative efforts. 4.13.8 Tuberculosis WHO

31. Although effective prevention and control programmes have been continuing for some time, collaboration will ensure an awareness of up to date approaches and the availability of technology.

191

192

4.13.10

Zoonoses WHO

32. Brucellosis and leptospirosis are the main diseases to be addressed under this programme. cooperation will continue in control activities initiated after a technical visit in 1981. 4.13.13 Other communicable disease prevention and control activities

33. A range of communicable disease of public health importance are endemic in China, such as viral hepatitis, influenza, dengue haemorrhagic fever and other haemorrhagic fevers. WHO will cooperate in activities for their control. 4.13.14 Blindness course ~n

34. Cooperation from WHO, which commenced in 1982 with a training ophthalmologists and the initiation of a field study, will continue. 4.13.15 Cancer

epidemiology

for

35. The incidence of cancer is increasing. WHO Collaborating Centres for Research on Cancer have been designated ~n Beijing for cancer of the aesophagus, in Shanghai for cancer of the liver, and ~n Guangzhou for nasopharyngeal cancer. They will carry out studies on the aetiology and early diagnosis and treatment of the disease and their research findings and experience will be made available to international workers. It is expected that similar studies will extend to other important cancer sites, such as the stomach. 4.13.16 Cardiovascular diseases

36. Cardiovascular and cerebrovascular diseases, are becoming major causes of morbidity and mortality, affecting both the urban and the rural population. 37. WHO Collaborating Centres for Research and Training in Cardiovascular Diseases have been designated to study the epidemiology and the community based prevention and control of these diseases. Further research activities need to be promoted. Experience in China will be made available for international exchange.

4.13.17

Other noncommunicable disease prevention and control activities

38. Kaschin-Beck disease, which occurs mainly in the rural areas of north China, is an endemic disease that gravely endangers the health of the people. It results in physical underdevelopment or dwarfism and deformation of the joints through the obstruction of bone growth. This has an adverse effect on the lives of patients and persons severely afflicted lose their ability to work. Research on the aetiology of the disease has so far concentrated on grain and water, but trace elements in the soil may also be a contributing factor. Special importance has been attached to this disease in the national health programme. A national leading group and research institution have been established for the purpose of undertaking epidemiological and aetiological studies and clinical and laboratory research, with a view to the prevention and treatment of the disease. WHO will increase its cooperation and the designation of a collabor·ating centre will be considered.

39. With the support of WHO and UNDP, the national biomedical information centre and network have been strengthened. Cooperation in this field, including health information support, will be further promoted and use will be made to the fullest extent of WHO's information system, and its publications, documents and medical materials.

193

194 CHINA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

2.3.0 Health sxstem

Develo~ent

2.3.1 Health situation and trend assessment 2.3.2 Managerial process for nutionnl hQa1th development Cost of WHO Programme Coordinator's Office, Beijing, China 2.4.0 OrEanization of Health sxstems Based on Primarx Health Care 2.5.0 Health Man£ower 3.7.0 Research Promotion and Develo£ment 3.8.0 General Health Protection and Promot it?,!'. 3.8.1 Nutrition 3.8.2 Oral health 3.9.0 Protection and Promotion of the Health of S£ecific Poeulation Groues 3.9.1 Maternal and child health including family planning 3.9.3 Workers' health 3.9.4 Health of the elderly

40 000

000

so 50

000

10 000

50 000

oou

50 000

198 900

24 2 800

242 800

43 900

280 000 1 111 100

372 000 730 700

DP DP

652 000 1 841 800

200 000 2 000 000

331 000

S31 000 2 000 000 200 000

( 80 000) 888 900 200 000

200 000

20 000 16 600 DP

20 000 16 600

50 000 50 000

30 000 50 000

10 000 30 000

2 459 000

2 469 000 30 000

000

679 900

729 900 50 000

40 000 20 000 80 000

50 000 80 000

so 000

CHINA Programme Regular budget US$ 3.10.0 Protection arid Promotion of Mental Health 3.10 .1 Psychosocial factors in the promotion of health and human development 3.10 .3 Prevention and treatment of mental and neurological disorders 3.11.0 Promotion of Environmental Health 3.11.1 Counnunity water supply and sanitation 3.11.3 Control of environmental health hazards 3 .ll.l+ Food safety 3.12.0 Dia~nostic, TheraEeutic 1 and Rehabilitative Technolo~l:

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget

US$

35 000

25 000

(10 000)

35 000

25 000

(lO 000)

800 000 30 000 40 000 473 500 25 000

800 000

30 000 50 000 50 000

30 000 20 000 10 000

DP DP

503 500 65 000

3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 3.12.2 Essential drugs and vaccine 3.12.3 Drug and vaccine quality, safety and efficacy 3.12.4 Traditional medicine 3.12.5 Rehabilitation

70 000

70 000 31 000 DP

50 000

(20 000)

31 000

210 000

244 000

454 000

70 000 100 000 20 000

(140 000) 100 000 20 000 195

196 CHINA Programme Regular budget US$ 4.13.0 Disease Prevention and Control 4.13.1 4.13.2 4.13.3 4.13.4 4.13.6 4.13.7 4.13.8 4.13.9 Immunization Disease vector control Malaria Parasitic diseases Diarrhoeal diseases Acute respiratory in.fec t ions Tuberculosis Leprosy 131 '100 S1'

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds US$ Total

Increase/ (Decrease) Regular budget US$

us$

30 000 10 000 70 000

50 000

20 000 (10 000)

50 000 50 000

50 000 50 000 50 000 50 000 30 000

(20 000) 50 000 50 000 50 000 30 000

000

50 000 30 000 131 900 50 000

4.13.10 Zoonoses 4.13.13 Other communicable disease prevention and control activities 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular diseases 4.13.17 Other noncommunicable disease prevention and control activities 5.14.0 Health Information Support Total -~ 70 000 2 500 000 mea•======

50 000

•. 70 000 10 000 70 000 70 000 VB 70 000 10 000 70 000 70 000 70 000 50 000 100 000 100 000 70 000 50 000 100 000 100 000 50 000 30 000 30 000

11 000 208 000

DP DP

11 000 278 000 8 012 700 ==cr•===m=

50 000 100 000 4 242 800 ===:t:=====

50 000 100 000 1 010 900 S:II:J:::C:::====

50 000 30 000

==========

5 512 700

5 253 700 ==•=•=a•=

•=*••==-=·

1 742 800

COOK ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The first national development plan covering the period 1982-1985 is under preparation. The Ministry of Health has already prepared the health sectoral plan, which will be an integral part of the national development plan. A thorough review of the current health structure was made in October 1981, resulting in pertinent recommendations aimed at attaining the goal of health for all by the year 2000. 2. The principal long-term objective, as stated in the health sectoral plan, is "to provide the best possible comprehensive health service, preventive and curative, for every individual residing in Cook Islands at a cost that the country can afford at every stage of development in a spirit of self-reliance and self-determination". 3. The detailed strategies for attainment of health for all by the year 2000 are yet to be developed. However, the general directions for long-term health development, as described in the health sectoral plan, are the following: (1) to provide and maintain an effective public health programme for the prevention and control of diseases and to ensure the adequate protection of the environment against unnecessary pollution by nox~ous agents; to ensure the provision and maintenance of effective hospital services and to provide the highest quality of service for the diagnosis of disease and the restoration of health for all people living in Cook Islands; to provide the highest possible level of dental health to all inhabitants through application of appropriate curative, preventive and other dental public health measures; the

(2)

(3) (4)

to provide adequate facilities, equipment and trained manpower on all is lands for the purpose of ensuring the effective delivery of health services on each island;

197

198

(5)

to educate the people of Cook Islands with regard to prevailing health problems and methods of preventing and controlling them; to encourage and promote those health and allied research application and benefits for the people of Cook Islands. programmes that have practical

( 6)

4. Detailed long-term national health development targets are yet to be developed. Based on the current status of health development and the changes projected for the coming two decades, and taking into consideration socioeconomic development, it is anticipated that the following major targets will be reached by the year 2000: (1)

Primary health care will be available to the entire population, 1n that: health care facilities will be accessible and essential population within one hour's walking or travelling distance; drugs available to the whole

at least 95 per cent. of births will be attended by trained health personnel;

and

at least 95 per cent. of children will be immunized against diphtheria, tetanus, pertussis, measles, poliomyelitis and tuberculosis. (2) At least 90 per cent. of local communities will have well-established voluntary and community organizations, committed to continuous primary health care action programmes. formal

(3)

The whole population will be served with safe water in the home or within 15 minutes' walking distance. The infant mortality rate will be below 30 per thousand live births. Life expectancy at birth will be over 65 years. At least 95 per cent. of newborn infants will have a birth weight of at least 2500 grams.

(4) (5) (6)

5. More attention will be directed to developments on the outer islands, especially the less developed areas.

6. Emphasis will be laid on the development of community self-reliance and a multisectoral approach to health problems at the community level. The health system will be reoriented towards primary health care development.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 7. In the context of overall development development, WHO cooperation will aim at: (1) policies and strategies and general trends ~n

health

the development of capability to organ~ze and manage health systems based on pr~mary health care, which will include development of community potential to participate in health programmes, facilitation of intersectoral coordination to solve health problems and ~mprove the health of the people, tra~n~ng of health workers to provide health care services, the application of appropriate technology for· primary health care development, and the rationalization and strengthening of hospital services so that an effective referral system can be developed to support the primary health care network; the development and application of technology for improving health, particularly in relation to environmental health and maternal and child health, including family planning, with health education as an integral component; the development of capability to organize the epidemiology and disease surveillance services, and the development and application of technology for the prevention and control of communicable and noncommunicable diseases; the development of health manpower, including undergraduate and postgraduate training of health personnel under the fellowship programme; the development of management, research and health information system capabilities; the promotion, and provision of support for, studies on traditional medical practices.

(2)

(3)

(4)

(5) (6)

199

200

WHO SUPPORT FORESEEN FOR 1984-1985 2.4.0 Organization of health systems based on primary health care

8. A national seminar on primary health care was conducted in 1981. Follow-up meetings on primary health care will be conducted at the district level and a pilot area developed in 1982-1983. In 1984-1985, the experience gained in the pilot area will be applied to the development of primary health care in other areas, with particular emphasis on community participation and intersectoral cooperation. The health care delivery system will be reoriented to provide the eight basic components of primary health care. Studies will be carried out on the feasibility of developing village health workers. A study tour will be arranged for senior health officials to observe primary health care development in other countries. WHO will collaborate in developing the primary health programme. UNICEF is expected to contribute to the programme. 2.5.0 Health manpower

9. Shortage of health manpower is still a critical constraint on the development of the health services. Programmes for the local training of auxiliary staff and the inservice training of health personnel at the periphery will be reoriented in line with the development of primary health care. WHO will continue to provide fellowships for undergraduate and postgraduate studies in health courses not available locally. The basic programme in nursing education H firmly established but cooperation will be required in developing specific areas of the nursing programme. 2.6.0 Public information and education for health

10. A health education unit has been established. With WHO cooperation and coordination of effort between the Ministry of Health and the Ministry of Education the health education programme will be strengthened in order to support development of the eight basic components of primary health care. 3.9.1 Maternal and chilrl hPRlth, including family planning approach will be developed and applied to the maternal and child health/family planning the context of primary health care, with more attention being paid to improving the the outer islands. UNFPA will continue its support to the integrated maternal and child planning services.

11. The risk programme in programme on health/family

3.11.1

Community water supply and sanitation

12. Programmes for the development of water supply and sewerage systems and the provision of latrines will continue. Appropriate technology ~n community water supply and sanitation will be further developed. More assistant health inspectors will be needed for development of the sanitation programme, especially on the outer islands. Continuation of UNDP support will be requested. 4.13.1 Immunization

13. A national training course on the expanded programme on immunization has been conducted. The cold chain will be further improved. The programme will be evaluated in 1984-1985. WHO cooperation will continue and UNICEF will be requested to provide the vaccines required.

201

202 COOK ISLANDS Programme Regular budget US$ 2.3.0 Health Slstem 2.3.2 Develo~ent

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudgetary sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

Managerial process for national health development Share of costs of WHO Programme Coordinator's office, located in Suva, Fiji

47 300 20 000 143 000 20 000

52 300 37 500 204 500 18 000

52 300 37 500 204 500 18 000 (

5 000 17 500 61 500 2 000)

2.4.0 2.5.0 2.6.0 3.9 .0

of Health Systems Based on Primar~ Health Care He a 1 th Man£ower Public Information and Education for Health Protection and Promotion of the Health of S~ecific Po£ulation Group_:: 3.9.1 Maternal and child health, including family planning

Or~anization

77 600

56 100

3 .ll.O Promotion of Environmental Health 3.11.1 Community water supply and sanitation 7 100) 3 800) DP FB

200 000

210 900

140 000

40 000

180 000

(60 000)

4.13.0 Disease Prevention and Control 4.13 .1 4.13.4 4.13.7 lnnnunization Parasitic diseases Acute respiratory infections J 000

3 000

(3 000) (5 000) (6 000) (3 000) 452 300

5 000 6 000 3 000 447 300 88 500 =-=======

5 000 6 000 3 000 535 800 96 100 548 400

4.13.16 Cardiovascular diseases Total - COOK ISLANDS

=======

5 000

======

DEMOCRATIC KAMPUCHEA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.4.0

Organization of Health S~stems Based on Primar~ Health Care

500 000

4.13.0 Disease Prevention and Control 4.13.3 Malaria 4.13.8 Tuberculosis Total - DEMOCRATIC KAMPUCHEA 150 000 87 300 DP DP 150 000 87 300

500 000 ::::::::::::::::::-;::::::::::::::

237 300 ::::;;:::;::::;::::::;:::;:::::::::

737 300 ::::::::;;:::;;;:::;:.:::::;:

500 000

=======

========

203

204

FIJI

NATIONAL HEALTH DEVELOPMENT STRATEGY 1. Fiji's eighth national development plan (1981-1985) outlines detailed sectoral and regional development objectives, strategies and programmes to achieve the desired national development objectives. The main national development objectives for 1981-1985 are: to strengthen and further diversify the economic base of the nation; to promote a more equitable distribution of the benefits of development; to ensure that opportunity for productive and rewarding social and economic activity is available; to promote policies and attitudes for increased self-reliance; to promote a greater sense of national unity within a multi-ethnic society; and to promote regional and international cooperation. 2. The overall national development objectives seek improvements in six interrelated areas: economic diversification, equity, productive employment, self-reliance, national unity, and international cooperation. These objectives imply an improvement in the quality of life of the average citizen, with emphasis on the distribution and type of economic growth rather than on growti. as an end in itself. 3. The health sector objectives in support of the overall national development plan are: (1) to direct the health services and to monitor basic needs in regions where deficiencies exist, special attention being given to low-income areas; to generally promote the physical, mental and social well-being of the nation; to improve and maintain the quality of health standards throughout the country.

(2) (3)

4. The components of Fiji's national strategy for health for all by the year 2000 follow the basic tenet that programmes aimed at ameliorating health standards in any community should include the direct participation o[ Lhe community and not merely depend upon thP initiatives of the authorities concerned. The concept of primary health care was adopted during the previous development plan as a strategy for implementing the aims of the health sector. The present health sector plan and its associated detailed programmes of action have primary health care as the focus of all major health activities.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. Primary health care in Fiji means making essential health care accessible to the community in an acceptable and affordable way, with the fullest participation of each community. It is envisaged that, with WHO's cooperation, the Government's efforts will fnr.11R on: (l) the training of health workcro at all levels, emphasizing the above-mentioned strategy; (2) assisting communities to realize their full potential for self-reliance in health care; and (3) developing and implementing appropriate technology which addresses the major concerns in promotion of proper nutrition, environmental and basic sanitation, prevention of infectious and acute diseases, control and surveillance of chronic and noncommunicable diseases, family planning, maternal and child health and health education. 6. The Fiji National Health Plan stresses the need to upgrade technical skills within the many support services required to maintain the health delivery system. The plan also places stress on sensitizing technical and supervisory staff to the need to improve their management capabilities. 7. Inadequate coverage of the population by skilled professional staff ~s partly a insufficient number of health workers produced in the country. The objective, as stated Health Plan, is to provide the manpower necessary for the different health programmes in manner as possible. In Fiji, the key institutions for the production of health manpower of Nursing and the School of Medicine. These institutions offer a variety of courses international - in professional and technical fields. The Government of Fiji looks continuing to collaborate through 1989 in supporting the Fiji School of Medicine and Nursing and in upgrading the technical skills of health workers in general. WHO SUPPORT FORESEEN FOR 1984-1985 result of the in the National as efficient a are the School - national and forward to WHO the School of

2.3.2,

Managerial process for national health development

8. A contiuuous review of ministerial management practices is needed. The current status of a managerial process is to seek the appropriate level for the most efficient execution of operational functions. Activities will continue, with the inclusion of specific management training.

205

206

2.4.0

Organization of health systems based on primary health care

9. Primary health care 1s the approach adopted for the implementation of all priority health programmes. At national level, mechanisms are being developed to truly integrate operational health programmes through primary health care. At community level, promotional activities have been very successful and will be continued. The present phase of activity involves collaboration with communities in speci fie health projects. The Ministry assists with training needs, advisory services and the development of appropriate technology as required; for example, in relation to sanitary measures, water supply, nutrition and laboratory serv1ces. 2.5.0 Health manpower

10. A comprehensive manpower plan has been completed and various options to meet the planned objectives are being actively pursued. The three priority areas, in which WHO is expected to collaborate, are the School of Medicine, the School of Nursing and postgraduate training. A plan has been developed under which all posts at the School of Medicine will eventually be staffed and a formal tutor training programme will be initiated. At the School of Nursing emphasis is placed on ensuring that its work is compatible with the overall primary health care approach. The two major tasks involving WHO are implementation of a revised curriculum and tutor training. It is recognized that there is a need to make more effective use of the fellowship programme. A new project is being developed which involves an exchange/training scheme with several Australian institutions. This project will not only provide needed skills but accomplish the training at very reasonable cost.

3.11.1

Community

w~ter

supply and sanitation

11. Lack of safe water supply in rural areas continues to be a major public health concern. The establishment of new industries demands that attention be given to pollution. The objectives of the environmental health programme are to improve environmental conditions. The implementation strategy includes the primary health care approach through the community. Training of environmental health workers is a vital need to achieve this objective.

FIJI Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

2.3.0

He a 1th Sptem Development 2.3.1 2.3.2 Health situation and trend assessment Managerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fijil

35 000

(35 000)

10 000

94 800

101-! 900

1Q/.; 900

10 100

2.4.0

Organization of Health S~stems Based on Primary Health Care Health Maneower General Health Protection and Promotion 3.8. 1 Nutrition

110 000 500 000

50 000 820 000

( 60 000) 320 000

2.5.0 3.8.0

25 000

( 2 5 000)

3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and treatment of mental and neurological disorders

90 000

(90 000)

1 Total cost of WHO Programme Coordinator's office in 1982-83· Total cost of WHO Programme Coordinator's office in 1984-85·

US$567 800 US$628 300

207

208

FIJI Progranune Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Inc-cease/ (Decrease) Regular budget US$

3.11.0 Promotion of Environmental Health 3.11.1 3.12.0 Community water supply and sanitation Thera~eutic

50 000

20 000

(30 000)

nia~nostic, Technolo~;z:

and Rehabilitative 3.12.1 Clinical, labor atory and radiological technology for health systems based on primary health care

20 000

(20 000)

4.13.0 Disease Prevention and Control 4.13.16 Cardiovascular diseases Total 20 000 944 800

20 000 944 800 m=:a:s•=r• u :a::u::u:su:a:=

(20 000) 1 004 900 2:!:UI3l:USI::=:=s=t

-ill!

·=-=····

1 004 900 :ll:::lal:18:=1:1111

•:a•••*•=•

60 100 •••=m••

FRENCH POLYNESIA

NATIONAL HEALTH DEVELOPMENT STRATEGY

1. In conformity with the goal uf WHO Member States, which is to achieve by the year 2000 a level of health permitting all citizens of the world to lead a socially and economically productive life, and taking into account the fact that, in general, the health services provided by existing health structures are more elaborate in French Polynesia than in other areas of the South Pacific, health policies are being developed and constantly adjusted, through the enlightened action of political decision-makers. 2. Previous efforts in the area of preventive medicine and health education have resulted in the establishment of a health education section attached to the Department of Public Health. As a result of the yearly training provided to health education auxiliaries by short information courses dealing with priority issues, the health education section is active among teaching staff, schools and denominational establishments. These activities should be extended in the near future to rural minorities living in remote areas; so far this has only partly been taken care of, by the media. 3. The various programmes established for the prevention services (hygiene and environmental health, oral health, school health, mother and child health) have given satisfactory results, particularly in Tahiti and Moo rea. However, implementation at the periphery presents problems, as the population is widely dispersed over a large number of islands, islets and secondary atolls. 4. Efforts need to be continued to achieve A mnrP Pq••itable distribution of serviceo of oimilar quality to communities living in isolated areas. The oral health service, with its fixed and mobile structures, is the best organized service in this respect and covers practically all islands. It took about 15 years to achieve this ambitious and difficult goal, a fact which augurs well for the activities of the other serv1ces which are directed towards the same goal. As the Territory is divided into health districts corresponding to the various archipelagos, activities developed at central level by the various services and implemented by teams at the periphery will be strengthened. For each programme (hygiene and environmental health, school health, mother and child health and health education), sub-structures need to be set up within the health districts so that their action, integrated into primary health care activities, will have a better impact on the communities settled in villages and remote valleys.

209

210

5. The population is satisfactorily covered by the medical care services, thanks to the facilities of the territorial hospital in Papeete which is able to handle most of the problems arising. Evacuation of patients from the Territory is limited to cases requiring special treatment. Many patients are transported by air or by surface to the hospital in Papeete, where they receive medical attention of a high standard.

6. In the remote archipelagos, the development of existing structures technological innovations; otherwise the technical gap will become even serv~ces will eventually end up as mere referral centres, devoid of any diagnosis and treatment. This would be contrary to the principal resolutions of serv~ces for all.

needs to keep pace with wider and the peripheral potential for prevention, tending towards uniformity

7. A pilot experiment within the framework of primary health care development is being undertaken in the Tuamotu Gambier archipelago, which is very typical of the Territory; its population is unevenly dispersed over about 40 islands covering a huge area. 8. Community health workers possessing a very modest educational background are recruited and trained by a medical team, which provides them with technical and moral support on the occasion of periodic visits or general missions, and organizes refresher and further training courses in the Capital. 9. The territorial school of nurs~ng, under the Departmellt of Public Health, trains nurses for the State Diploma, and is the only school to award a national diploma. Since 1967, numerous classes have graduated and joined the paramedical staff of the health serv~ce. In addition, the school provides an 18-month course for public health auxiliaries, i.e. nursing assistants, psychiatric assistants, assistant health inspectors, auxiliary health educators, dental hygienists, laboratory assistants, and junior assistants to dispensing pharmacists. 10. The Territory depends on France for the training of specialized personnel (doctors, pharmacists, midwives, technicians, laboratory technicians, X-ray technicians, nurses, health inspectors, instructors for the School of Nursing, paediatric nurses, assistant anaesthesiologists).

11. In view of the size of the Territory of French Polynesia, it is not planned to set up a university. However, the increasing need, both quantitative and especially qualitative, for public health personnel creates a problem. The establishment, in Papeete, of a training school for paramedical personnel, attached to the nursing school, with technical and financial support provided by a metropolitan university, would enable the necessary intermediary-level personnel to be t-rained in one or two years for the development of health activities. One year of further training in France would be necessary to obtain a diploma equivalent to those awarded in France. People trained in this way would no longer have to be absent for three years and health development activities would thus receive the necessary support. I

12. The Government continues to favour progressive training of the most qualified personnel in order to 1mprove health action at the community level. The training of community health workers in the Tuamotu Gambier archipelago is an example and the Territory is ready to share the experience thus acquired with WHO and other countries or areas of the Region. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989

13. Within the framework of regional strategies, WHO support could be directed towards health situation and trend assessment, the organization of health systems based on primary health care, maternal and child health and family planning activities, the care of youth and the elderly, nutrition, health education, disease prevention and control, the promotion of environmental health, the development of health manpower and health information support. 14. After the establishment of a medical statistical service under the Department of Public Health, adapted to the situation prevailing in French Polynesia and its relative isolation, liaison will be maintained with WHO for the exchange of data and the use of a nomenclature by non-medical personnel. A need should soon be felt in the field of health legislation. This will conceivably be outside the scope of the French legal framework, which is ill-adapted to the local situation.

211

212

15. Primary health care services should be adapted to the geographical characteristics of French Polynesia. The population is either scattered over numerous large and small atolls spread across a wide area, as in the case of the Tuamotu archipelago, or grouped in isolated valleys which are difficult to reach, as in the mountainous islands of the Marquesas. In the Tuamotu archipelago, persons selected by the community on each atoll are placed in charge of first aid centres, after undergoing basic training in general health problems, obstetrics and first aid and after daily radio communication has been established between each post and the medical centre. They are supervised by a medical team which undertakes periodic inspection tours. It has been decided to improve the training of this category of personnel and provide them with a well-defined status within the community; their activities will be integrated into the health service. In Papeete, these health workers undergo an eight months' training, which is given in French as well as in the native dialect, and places emphasis on health education, better hygiene, environment, behaviour, nutrition, as well as case finding and surveillance of the most common diseases. The pilot training will be followed up in the field by the medical team of the health district. It will be extended progressively to the entire archipelago and to the other circumscriptions. WHO collaboration and the development of training programmes for this category of field personnel could be very useful for both the team in charge of training and the team in charge of superv~s~on. Experience thus acquired could later be shared with neighbouring countries or areas wishing to undertake similar activities. 16. Health education activities must be continued with a view to eventual programmes under implementation in the various health distri~ts may be adapted decentralization so that to local circumstances.

17. In v~ew of the situation prevailing in the various archipelagos with respect to obesity, hypertension and diabetes and the lack of recognition of the role of nutrition in health, it is clear that the public health services cannot confine their activities to case-finding and treatment alone but must undertake preventive action based on better education of the population. With WHO collaboration, based on field observations, and with appropriate sensitization to the problem, it should be possible to define a programme of action. Filariasis is under control but leprosy ~s still a problem. Viral infections, such as influenza and dengue fever, remain a threat. The eventual, much needed, establishment of a public health 1aboratory, which could be supported by the Pasteur Institute, might facilitate technical cooperation. Considering the risks involved, great importance is attached to the continuation of studies on vector biology and control. The further development of case-finding and preventive services related to cardiovasCular diseases is envisaged.

18. To improve environmental health, activities at the primary health care level will be developed in the health districts and implemented at the peri-urban level and on the islands. Food safety and surveillance of food industries, food stores and markets, which are the responsibility of the public health services, are satisfactory in the towns but need to be reinforced at the periphery, where there is no systematic control, owing to the widely dispersed population. WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

19. After the establishment of a medical statistical service under the Department of Public Health, adapted to the situation prevailing ~n French Polynesia and to its relative isolation, liaison will be maintained with WHO for the exchange of data and the use of a nomenclature by non-medical personnel. 2.5.0 Health manpower

20. In conformity with the development stategy, the Government attaches priority to training. Problems stemming from the need to send personnel abroad for training can be overcome, as is shown by the increasing number of staff engaged in development activities. However, the availability of local training for certain categories of staff would encourage a greater number of candidates. The development of training presents problems and it is proposed to seek the cooperation of a university in France. A dialogue with WHO could also facilitate the establishment of a programme adapted to the regional situation. 3.9.1 Maternal and child health, including family planning

21. Efforts should be directed towards decentralization of maternal and child health and family planning activities to the primary health care level. 3.9.4 Health of the elderly

22. A consequence of changing socioeconomic conditions ~s often a lack of family concern for the elderly. In addition, as a result of the increase ~n life expectancy, there ~s now a greater proportion of the elderly ~n the population. These problems must be addressed now, so that appropriate action can be planned.

213

214

3.10.2

Prevention and control of alcohol and drug abuse The health sector must address

23. Another consequence of the changing times is the problems of youth. the issue of the increase in alcohol and drug abuse. 4.13.11 Sexually transmitted diseases

24. Family ties are failing, at least temporarily, to hold the youth to the traditional values. Health programmes must, in consequence, address the problems associated with sexually transmitted diseases. 4.13.15 Cancer

25. The Government wishes to cooperate with neighbouring countries and to exchange information on cancer. 4.13.17 Other noncommunicable disease ion and control activities

26. A progressively healthier population will lead to the emergence of a different pattern of health needs, particularly those associated with the older age groups. A definitive programme which addresses the noncommunicable diseases must be planned in the early stages of this transition period.

FRENCH POLYNESIA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$-

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.3.0

He a 1 th s:z:stem DeveloEment 2.3.1 2.3.4 Health situation and trend assessment Health legislation

10 000 5 000

6 500

( (

3 500) 5 000)

2.4.0

of Health sxstems Based on Primar:z: Health Care Health Man2ower General Health Protection and Promotion 3.8.1 Nutrition

Or~anization

5 000 30 000

5 000 30 000 24 500 24 500

( (

5 000) 5 500)

2.5.0 3.8.0

5 000

( 5 000)

3.9.0

Protection and Promotion of the Health of SEecific Po2ulation Grou2s 3.9.1 Matern a 1 and child health, including family planning Health of the elderly

5 000

6 500 6 500

l 500 6 500

3.9.4

3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and control of alcohol and drug abuse 3 .11.0 Promotion of Environmental Health 3.11.1 Community water supply and sanitation

6 500

5 000

( 5 000)

215

216

FRENCH POLYNESIA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decres.se) Regular budget US$

4.13.0 Disease Prevention and Control 4.13.2 Disease vector control 5 000 5 000 6 500 6 500 6 500 6 500 ( 5 000) 6 500 6 500

4.13.11 Sexually transmitted diseases 4.13.15 Cancer 4.13.17 Other noncommunicable disease prevention and control activities Total - FRENCH POLYNESIA

6 500

=··-··

70 000

··=····

70 000 cc::aa=•••

=······

70 000

........

....... 70 000

.......

GUAM NATIONAL HEALTH DEVELOPMENT STRATEGY 1. For over 20 years Guam has been largely dependent on the United States for both military aid and the infusion of monies through federal assistance. Only over the past decade has it charted a course of socioeconomic development by developing a tourist industry, primarily to attract the Pacific tourist market. More recently, efforts have also been exerted to study and promote agriculture, fisheries, and manufacturing industry, but these have been minimal. 2. The health status of the people is closely linked with the state of the economy. A higher socioeconomic level will result in higher incomes, better ability to pay for services, better education, and ultimately a healthier population. 3. The health status of the people of Guam is illustrated by the low crude death rate, though the infant mortality rate is fairly high compared with the United States average. The traditional leading causes of death of many years ago have been replaced by chronic diseases such as cardiovascular diseases, cancer and cerebrovascular diseases, although infectious and parasitic diseases still rank high. This trend suggests that communicable diseases are well-controlled by immunization, but the increase in incidence of chronic diseases as leading causes of death means that more attention must be paid to environmental factors and the changing life-style of the population. 4. Assuming that Guam will continue to grow economically, and that the standard of living will continue to improve, the goals for improvement of the health status of all citizens by the year 2000 are: (1)

to reduce the birth rate to 15 per thousand population; infant mortality to 10 per thousand live births; neonatal mon:ality to 3 per thousand live births; and deaths through early infant disease to 0.08 per thousand population; to establish a network of three major public health centres which will be readily accessible, providing essential primary care services, particularly for pregnant women, mothers, and infants, and basic acute care outpatient services to all those without health insurance, medicaid, or medicare coverage;

(2)

217

218

(3)

to reduce teenage pregnancy (15-19 years of age) from an incidence in 1982 of 70.2 per thousand to 55 per thousand; to reduce the number of deaths due to cancer by 17 per cent.; to reduce the incidence of infectious diseases, thousand and hepatitis to 75 per hundred thousand; such as tuberculosis, to 20 per hundred

(4) (5)

(6)

to reduce dental caries in children by 70 per cent. through fluoridation of the drinking water supply; to reduce the rate of mortality from cardiovascular diseases; to reduce mortality caused by accidents; to reduce the incidence and mortality rate of diabetes; to reduce mortality due to the abuse of alcohol, including death from cirrhosis of the liver and alcohol-related traffic fatalities, by at least 35 per cent.; to improve the quality and coverage of health education and wellness programmes and services, with particular attention to the prov~s~on of basic information and education on health-promoting practices, as well as on risks associated with specific health conditions, in order to increase general awareness among all residents of Guam of the basic determinants of health and illness;

(7) (8) (9) (10)

(11)

(12) (13)

to provide clean water and sanitation for every home and family on the island; to control diseases causes; through the use of chemicals and pesticides to eradicate the vector-borne

(14)

to ensure the cleanliness of facilities and premises through preventing the contamination of water sources, particularly those which are for human consumption; to establish regulations and a milk sanitation programme to ensure the sanitary production of locally processed dairy products.

(15)

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. a~m

In consonance with the overall strategy of health for all by the year 2000, WHO collaboration should at: (1)

developing and using appropriate tuberculosis and hepatitis;

technology

for

the

control

infectious

diseases

such

(2)

developing technology for the improvement of health, especially in relation to nutrition, environment and personal health, with health education as an integral part; strengthening disease surveillance activities and advising on special problems;

the

(3) (4)

developing primary health care, through the intercountry programme, particularly as it concerns the medically indigent; promoting environmental health, through the intercountry programme; coordinating hospital services in support of primary health care and in providing specialized medical services.

(5) (6)

219

220

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

6. A health information system will be established which will encompass the entire health care delivery system. Procedures for reporting will be developed which will include the training of appropriate personnel. Capability will also be developed in analysing and interpreting data for use in planning and evaluation. 2.5.0 Health manpower

7. The health manpower needs of Guam continue to reflect the concern to provide increased technical support for a population with health demands that are increasing as the population's socioeconomic position improves. As the demands for health services increase, the key strategy in health manpower planning will be the development of middle-management skills, so that the health services can increase the level of technical support while containing the cost of the overall health system. WHO collaboration in the health manpower plan to achieve that goal will take the form of fellowships for appropriate personnel. Priority areas will include primary health care and supporting services such as nursing, nutrition, health education, health services administration, food and drug administration, chronic and communicable disease control, laboratory services, environmental health, and public health administration. 8. The expanding level of services provided by the Health Department creates a unique demand for personnel with specialized skills. The strategy to meet that need is to use consultants who can provide a critical service and at the same time upgrade the skills of selected Department staff through practical training sessions. 9. In addition to the WHO programme of cooperation to upgrade manpower skills, continued participation in the seminars and training courses sponsored by WHO will enable Guam to train health personnel who will be able to contribute more effectively to the development of the Territory's health services, as well as to the achievement of the goal of health for all by the year 2000.

2.6.0

Public information and education for health

10. In collaboration with the Department of Education, a programme will be developed to train health education teachers and to cooperate in implementing the training programme within the public school RyRtPm. TPrhniral cooperation will be necessary to evaluate the effectiveness of the health education curriculum. An education campaign covering the whole community is also needed, on particular health problems and to identify the population at risk.

3.8.1

Nutrition

11. A survey will be conducted to identify the intake of sugar, sodium, and saturated fats of a sample group and to reduce excessive levels through education and individual diet counselling.

3.11.3

Control of environmental health hazards

12. Environmental surveys and hazard assessments will be conducted to provide a basis for termination, modification, or improvement of programme activities.

3.11.4

Food safe

13. Workshops will be conducted for occupational groups, such as those engaged 1n the food serv1ces or in food processing, on the sanitation principles and practices necessary to ensure consumer protection.

4.13.4

Parasitic diseases

14. Laboratory capability in screen1ng for parasitic diseases will be improved. 4.13.6 Diarrhoeal diseases

15. WHO will cooperate in activities to decrease the unusually high incidence of salmonellosis.

221

222

4.13.15 4.13.16 4.13.17

Cancer Cardiovascular diseases Other noncommunicable diseases prevention and control activities be made to reduce chronic

16. With cooperation from the WHO intercountry programme, efforts will diseases such as cancer, cardiovascular diseases, and diabetes mellitus.

GUAM Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

19.84-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 2.6.0

Health ManEower Public Information and Education for Health

80 000

62 000 6 000

(18 000) 6 000

3 .11.0 Promotion of Environmental Health 3.11.4 Food safety 4.13 6 000 6 000 6 000

Disease Prevention and Control 4.13 .6 Diarrhoeal diseases Total GUAM --

6 000

6 000 ---

80 000 ::::e:::::::;;:;::::::::::::::::

80 000 =====::::;;:;:::

80 000 ===:::::::::::~::::::::

80 000 ::::::;:;:::::::::::;;;;::::::;;;:;:: :::::::::::::::;;;::;::;::::;::;;:;:;; :::::::::::::::;:::;::::;.;;

=======-

223

224

HONG KONG NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The health development strategy is embodied in a White Paper on "The Further Development of Medical and Health Services in Hong Kong". The Government's objectives in the 10-year medical development programme are to: (1)

build new hospitals and clinics to meet expected population growth; provide more specialist treatment for psychiatric cases and the elderly; relieve overcrowding in Government Government-assisted hospitals; improve and expand the health services: hospitals and secure greater use of beds in

(2) (3)

(4) (5) (6) (7) (8) (9)

family health serv1ces and industrial health services;

establish and further expand the Central Health Education Unit; establish ~

community nursing service;

develop further the medical treatment of drug addiction; introduce a school dental care service; establish a dental school to train dentists locally.

2. In addition, a White Paper on "Integrating the Disabled into the Community: A United Effort" sets out the Government's proposals for further development of rehabilitation services. The policy objective is to provide ouch comprehensive rehabilitAtion sprvices as are necessary to enable disabled persons to develop their physical, mental and social capabilities to the fullest extent pe,rmitted by their disabilities. The specific areas for further development include prevention and early diagnosis, medical treatment, medical rehabilitation services, education and training, and social rehabilitation services.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 3. The expansion programme described above, covering a wide range of medical and health services, will necessarily require a considerable number of medical and health staff. Additional local training facilities for doctors, nurses and pArnmerlir;:!l personnel are being established. There is, however, still a great need for staff of the medical and health services to obtain training and experience not available locally, in such health serv~ces fields as planning and management, care of the aged, disability prevention and rehabilitation, health education, communicable disease prevention and control, industrial health, dental health, family health and nursing education.

WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 Health manpower of the health manpower development process,

4. The health manpower requirement is an integral part linked with the health plan and policies outlined above.

225

226

HONG KONG PrograliUlle Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar) sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 Health Maneower 3.8.0 General Health Protection and Promotion 3.8.2 Oral health Total - HONG KONG

110 000

9 000 110 000 9 000

9 000 119 000 ::::::=:=::uc::

=======

z====•=s=;;

=======

110 000

110 000 u=:s::::«:as:c

===:=::::::=:

=:"=::::tl!iii!II:IUIJ;:::

JAPAN

NATIONAL HEALTH DEVELOPMENT STRATEGY There has been a remarkable improvement in the lifestyle of the people in recent years. At the same time, the various factors influencing the nation's health have grown more complex. The high rate of economic growth has alerted people to the importance of maintaining the good health essential to the conduct of social and economic activities. Under the circumstances, it has been necessary to further expand the public health programme to provide easy access to the medical and health services which have developed so extensively with the aid of modern medical science and technology. 2. The improvement 1n the health situation has been clearly reflected 1n a reduction in mortality rates, which has contributed greatly to the prolongation of life-expectancy. A further consequence has been a shift in the principal causes of death, from communicable diseases to the chronic degenerative diseases, such as malignant neoplasms and cerebra-cardiovascular diseases. In view of the growing importance attached to the control of these diseases, mass screening programmes for the early detection of stomach and uterine cancer, as well as for the prevention of circulatory diseases, have been intensified. With a view to giving the necessary support to rural health measures, the equipment of rural screening centres has also been strengthened. 3. The community health programme is currently being implemented through the health centres, which form the nucleus of the respective health districts. However, it is planned to establish a health and medical serv1ce division in each prefecture and to formulate a community health and medical service programme for the area covered by that division. It will therefore be necessary to review the organization of the community health services, giving due consideration to the provision of appropriate medical services in each division and to the functions of the health centre.

227

228

4. The high rate of economic growth and rapid industrialization have created new problems of environmental pollution through deterioration of the environment, while the general improvement ~n the nation's health has resulted ~n greater priority being attached to the health and welfare of the elderly. Other priority government programmes resulting from new health problems are aimed at the prevention and control of cerebra-cardiovascular and geriatric diseases, the surveillance of certain communicable diseases transmitted through international traffic, the prevention of congenital anomalies, the development of drug safety measures, research on and control of certain specific diseases of an intractable nature, such as subacute mye lo-optico-neuropathy ( SMON) and diseases due to environmental pollution, the promotion of mental health, and the development of health manpower. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. · In order to meet the above-mentioned needs and to achieve the goals of national health development policies and strategies by 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, mainly through the WHO fellowship programme. This will result not only in the introduction of modern technology and the acquisition of information necessary for the improvement of the health services, but also in enriching the knowledge and improving the technical ability of health officers. 6. Health service development programmes \vill focus on the following (1) (2) health manpower development; control of degenerative diseases such as cancer, cerebro-cardiovascular diseases and infectious hepatitis; control of environmental hazards; promotion of the health of the people; promotion of the international exchange of health information; health administration planning; areas~

(3) (4) (5) (6)

WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 Health manpower

7. WHO will continue to collaborate, through the fellowship programme, in (1) postgraduate training in puulic health; (2) training in national drug policies and management; (3) training in means of evaluating the adverse effects of chemicals on human health and the environment; (4) training 1.n coordination of the preventive health services and the medical care services within the context of primary health care, with particular reference to the role of public health nurses and clinical nurses; and (5) in providing the opportunity to study existing systems and programmes of international cooperation between developed and developing countries, including programmes for technical cooperation among developing countries, 3.S well as the prevailing health situations, problems and needs of other countries.

229

230

JAPAN Progranune Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 Health Manpower Total

100 000 100 000

JAPAN

=======

====e==

=======

========

=======

KIRIBATI

NATIONAL HEALTH DEVELOPMENT STRATEGY

1. The national development plan for 1979-1982 ~s approaching the end of its term. The plan for 1983-1986 is being prepared. The Ministry of Health and Community Affairs is developing a five-year national health services programme plan for 1982-1986, which will form part of the new national development plan and will provide a thorough review of the health services. 2. The goal of health for all by the year 2000 has been accepted, as well as the general policy that services related to health care should be developed through using the primary health care approach, with the aim of improving the physical, mental and social well-being of citizens, by keeping the population at optimal level, providing appropriate health care, and raising the general standard of living. The necessary health services infrastructure will be developed in order to achieve coverage by the health services of from 74 to 85 per cent. of the population. To improve effectiveness and efficiency, an integrated approach will be used in carrying out activities related to health, involving coordination between health and medical disciplines and other ministries and agencies, such as agriculture, fisheries, public works, education and communication. The full participation of the community will be promoted and encouraged. For ultimate self-sufficiency, activities will be carried out as much as possible within the country's own resources and its cultural and religious traditions. The most practical and appropriate technology will be utilized. The priority health problems to be addressed are: respiratory tract diseases, diarrhoeal diseases, wounds and sores, eye diseases, skin diseases, ear diseases, communicable diseases, anaemia, malnutrition, fish poisoning, worm infestation, dental diseases, alcoholism, and the noncommunicable diseases. 3. TI1e objectives and targets, for achievement by the end of 1986, (1) ~n

relation to

these

problems

are:

to provide services for at least 85 per cent. of infants and children under five years of age, in relation to immunization, minor treatment and referral, and for at least 85 per cent. of mothers, in relation to pregnancy, regular antenatal care, delivery, and necessary referral; to provide to at least 85 per cent. of eligible members of the community, through community participation, advice on family planning methods, such as IUD insertion, tubectomy and vasectomy, and to distribute contraceptives;

231

232

(2)

to provide the living conditions essential for the promotion and maintenance of good health to at least 85 per cent. of the population, by developing a potable water supply and appropriate human and domestic waste disposal facilities, through the self-help activities of the community; with the participation of the community, to reduce morbidity and mortality due to communicable diseases by at least 15 per cent. in at least 85 per cent. of the population, through immunization, case detection, prompt treatment and good follow-up; to enable at least 85 per cent. of the population to achieve appropriate growth, increased strength and the capacity to resist disease, through the promotion of community self-help activities 1n relation to the production, preparation, preservation and consumption of food and drink; to provide, to at least 85 per cent. of the population, effective, efficient and prompt dental and medical referral serv1ces through the Ministry's system and with community-organized transport; to reduce lhe prevalence of periodontal diseases from 70 to 20 per cent. in adolescents and expectant mothers and of dental caries from 40 to 5 per cent. in school children and preschool Oral prophylaxis and conservation and dental health education will be the means of children. achieving this, through community self-help activities supported by health-related staff; through the Women's Clubs, to encourage at least 85 per cent. of mothers to organize themselves and their families for healthful living; through self-help activities in relation to dental and medical care, and appropriate living conditions and resources, to encourage at least 85 per cent. of young people to organize themselves, in order to develop a healthy way of life under healthful conditions; to prevent abnormalities among at least 85 per cent. of school children, to correct them as soon as possible if they occur, and to maintain the children in good health; to disseminate the concept of prevention, prompt treatment and maintenance of health to parents and the community through the cooperation of related health staff in support of the efforts of the Ministry of Education; to reduce morbidity and mortality due to diabetes and hypertension by at least 15 per cent. in at least 85 per cent. of the population, through community self-help activities in relation to screening, simple treatment, follow up and referral of serious cases.

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 4. Within the country's socioeconomic, cultural and religious framework, the national health serv~ces programme plan for 1982-1986 is designed to develop the services infrastructure and improved health conditions necessary to achieve the following: (1) acceptance of the policy of health for all by the year 2000, which is already being implemented by the Ministry of Health and Community Affairs, within the national development plan; implementation of health-related activities, through the primary health care approach, before the year 2000. The mechanism for initiating community participation has been developed and will be implemented in stages in every district as part of the national health services programme plan, gradually covering the whol8 country, so that all the communities are organized in self-help bodies; primary health care available to all, resulting in at least the following: (a) potable drinking water, available to every household within 15 minutes' walking distance; if this is not possible because of geographical conditions, the idea of boiling water for drinking purposes will be promoted; adequate toilet facilities, available to every household within 3 minutes' walk; every child immunized against diphtheria, tuberculosis; tetanus, pertussis, measles, poliomyelitis and

(2)

(3)

(b) (c)

(d)

at least simple health care, with the possibility of obtaining not less than 20 essential drugs, available within one hour's walking or travelling distance in any part of the country; at least one maternal and child health-aide, trained to advise during pregnancy, attend childbirth and care for infants, available in every village through the public health nurs~ng and referral system, to attend to at least 98 per cent. of the needs of the village;

(e)

233

234

(f)

at least 90 per cent. of newborn infants with a birth weight of at least 2500 g. 90 per cent. of children with a weight-for-age corresponding to WHO standards; reduction of the infant mortality rate by at least 50 per cent.; life expectancy at birth at least 60 years. and strategies and the general thrust

At least

(g) (h)

5. In the context of overall development policies development efforts, WHO cooperation should aim at:

of health

(1)

the development of capabilities to organ1ze and manage health systems based on primary health care, which will include the use of appropriate technology for primary health care, the training of health 'vorkers, and faci li tat ion of intersectoral coordination to solve health problems and improve the health of the people; the development and use of appropriate technology for the control of tuberculosis, leprosy and other communicable diseases of priority public health concern, including diseases that can be controlled by immunization; the development of technology for the improvement nutrition, the environment, and personal hygiene, component; of health, particularly 1.n relation to with health education as an integral

(2)

(3)

(4)

the development of management, research and health information system capabilities at different levels; the orientation and strengthening of the hospital, so that it can function as a major referral centre in support of the primary health care network, and provide specialist treatment services; the promotion of, anu JJrovision of support values and on traditional medical practices. to, relevant studies on ~nltural

(5)

(6)

and traditional

WHO SUPPORT FORESEEN FOR 1984-1985

2.4.0

Organization of health systems based on primary health care

6. The Government has developed its national hP.al th sPrvi ~es programme plan for 1982-1986, which hno health for all by the year 2000 as its goal, and the primary health care approach as its way of operation. WHO collaboration will continue in public health administration activities and, through both the Ministry of Health and Community Affairs and the Ministry of Education, ~n the school health programme. 7. Use of the community participation approach has been incorporated into the programme plan for 1982-1986 and WHO cooperation in community work will help to evaluate the process and provide feedback for improvements in 1985. Workshops in primary health care, following the one held in 1982 to promote the approach and the one planned for 1983 to orient the staff and implement the programme plan at district level, are planned for 1984-1985, Two areas will be used to study primary health care development and the results will be utilized, with cooperation from WHO, to improve or introduce the approach in other parts of the country. UNICEF will be involved in some community participation efforts.

2.5.0

Health manpower

8. Since activities under the national plan have been reoriented in line with the primary health care approach and family planning is stressed, the existing health staff will need training ~n this new orientation as well as in new methodology. Such training is not available locally. To make the hospital more effective as a referral centre, several hospital staff will need specialist training.

2.6.0

Public information and education for health

9. WHO will continue to cooperate in health education activities and ~n the more specialized aspects of health education, such as printing.

235

236

10. The role of health education in support, and as an integral part, of all health-related programmes has made it necessary for the Health Education Section to formulate an infrastructure development plan. It has also been provided with five new posts. The staff appointed to those posts will need educating in the field of health education to diploma or degree level. WHO will also uphold the Section in fulfilling its very broad supportive responsibility in relation to all activities of the Ministry. 3.8.1 Nutrition

11. Malnutrition has been identified as a health problem in the programme plan for 1982-1986. It is a new field of activity and it is therefore considered necessary to seek WHO cooperation. Later the support of the World Food Programme may also be requested. 3.9.1 Maternal and child health, including family planning

12. The Government realizes the possibly catastrophic effect of overpopulation on this island country. It has adopted family planning as a first priority programme to achieve the objective of a population growth rate of 1.6 per cent. by the year 1985 and zero by the year 2000. The full support of UNFPA for its maternal and child health, including family planning, programme has therefore been requested.

13. Community water supply and sanitation have always continue. Some support from UNDP may also be requested. 3.12.1 Clinical,

been major

problems

and WHO cooperation will

laboratory and radiological technology for health systems based on primary health care

14. The laboratory is at present considered one of the weakest units in the general hospital. WHO will cooperate in its development and in training, not only for strengthening laboratory services at the hospital but also at the periphery. 4.13.1 Immunization

No serious 15. Communicable disease control activities have been carried out for several years. epidemics have occurred 1n recent years, apart from an outbreak of cholera in 1977, and of Immunization is an ongoing ac ti vi ty and UNICEF has been requested to supply conjunctivitis in 1982. vacc1ne.

KIRIBATI Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

2. 3.0

Health 2.3.2

S~stem

Develo2ment

Managerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fiji

47 300

52 100

52 300

5 000

2.4.0

Or~anization

of Health S;tstems Based on Primar;t Health Care Health Maneower

134 000 172 000 20 000

219 300 149 700 115 000

85 300 (22 300) 95 000

2.5.0 2.6.0 3.8.0

Public Information and Educatio~ for Health General Health Protection and Promotion 3. 8.1 Nutrition

13 000

3.9.0

Protection and Promotion of the Health of Seecific Poeulation Groues 3.9.1 Maternal and child health, including family planning

105 200

207 400

3.11.0 Promotion of Environmental Health

---

3.11.1 Community water supply and sanitation

50 000

000

20 000

(30 000)

237

238

KIRIBATI Progranme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3.12.0 Diagnostic, Thera£eutic and Rehabilitative Technolo~

3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 4.13.0 Disease Prevention and Control 4.13.1 Immunization Total - KIRIBATI

114 000

53 000

(61 000)

10 000 547 300 •===•au=

--===·=== 105 200

10 000 652 500 =z=====

(.!.£....Q.Q2.) 622 300 :mu:a=::2:c

207 400

=======

829 700

=====·=

75 000 *X:i:liiHo!l::=::;a;.c

LAO PEOPLE'S DEMOCRATIC REPUBLIC NATIONAL HEALTH DEVELOPMENT STRATEGY 1. National development policies have been formulated with the following main concerns: to normalize the material and cultural life of all the people; to concentrate on developing certain enterprises which are strategically significant to the economy and to national defence, with the aim of gradually and firmly establishing technical bases for the national economy. 2. In this context, attention will be directed to living conditions 1.n zones where hardship exists, mainly the rural areas. The next five years will be devoted to: agricultural development to provide adequate food for the population; the development of small-scale industry and educational, cultural and public health activities to ensure that all able-bodied workers are employed. 3. To help in the realization of these goals, the Government has set priorities 1.n the health field as follows: to improve the health of mothers and children and promote population growth; to reduce communicable diseases, such as malaria, gastrointestinal diseases and acute respiratory diseases; to change attitudes and behaviour based on superstition and, where they are harmful to health, on traditions and beliefs.

239

240

Within the population, the priority groups for health activities are the cadres production and defence, mothers, children and the minorities. The main emphasis will be on: (1) (2) (3) (4) (5) increasing the capacity for prevention; promoting and expanding the use of traditional medicine; consolidating the network of health institutions; improving the production and distribution of pharmaceuticals; upgrading the training of health personnel.

engaged

5. Managerial processes are being further implemented and, in the near future, the Government will be in a position to decide upon its long-term strategy and to determine indicators, in order to attain health for all by the year JOOO.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 6. At this stage of the country's development, with problems being encountered in all sectors, it is difficult to indicate clearly the magnitude of the resources required to implement strategies until the year 2000. In the ten years ahead, the country will need a high input of external resources until, in 1990, certain sectors of the local economy will have developed sufficiently to provide the resources for other sectors, after which the country will gradually become self-sufficient. 7. In the light of development policies and strategies and given the main thrust of health development efforts, WHO collaboration should aim at: (1) upgrading the organization and management of the health system. This '"ill include the use of appropriate technology for primary health care, the training of health workers to provide that care, and facilitation of intersectoral coordination to solve health problems and improve the health of the people; the development and use of appropriate technology for the control of all communicable diseases, priority being given to such diseases as malaria, diarrhoeal diseases, parasitic diseases and acute respiratory infections;

(2)

(3)

the development of maternal and child care, nutrition, and environmental and personal hygiene, all supported by an appropriate health education system; the development of management research periphery to the central level; and health information system capabilities, from the

(4)

(5)

the upgrading of different types of clinic and hospital support of the primary health care network;

function as

referral

centres

(6)

the promotion of relevant studies on cultural and traditional values and traditional medical practices and the provision of support to such studies.

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

8. The health information system is being organized with the creation of a central health statistical unit and the implementation of local training courses in statistics. This development should take some time, so as to establish a feasible system extending from the periphery to the central level. Priority areas and indicators will be identified and established, while appropriate procedures will be developed and personnel trained to generate relevant data. Epidemiological surveillance will be improved and strengthened. Studies will be carried out to obtain relevant data. 2.3.2 Managerial process for national health development

9. The existing managerial processes will be reviewed and upgraded through training of national personnel in health development. Further development of managerial processes will include detailed programming, implementation and the evaluation of priority programmes. This will be closely linked with the development of an information system to support operations, the evaluation of the programmes and reprogramming if necessary. 2.3.3 Health systems research

10. Cooperation from the intercountry programme will be extended in creating a research group at central level and developing its capability to identify priority research areas and carry out studies in those areas.

241

242

2.3.4

Health legislation

11. New priorities established by the Government require new legislation, in the formulation of which WHO \o7ill provide cooperation.

2.4.0

Organization of health systems based on pr1mary health care

12. With the new rural development programmes funded by UNDP, community involvement in health activities will be developed through intersectoral cooperation. The way in which the primary health care approach is used will be reviewed and upgraded to fulfil community needs. As more rural development programmes are implemented, primary health care will be integrated with the rural serv1ces. The other United Nations agencies will contribute as far as possible. 2.5.0 Health manpower

13. Health manpower planning will be developed and training upgraded, with the cooperation of WHO and UNDP. The nursing services curriculum will be reviewed and adapted to new health practices. 2.6.0 lie information and education for health

14. All the health education programmes will be revie\ved a::, a priority established by the Government. They will be integrated at all levels of rural development and in other health programmes.

3.8.1

Nutrition

15. The nutrition programme will be implemented, together with family health, and the necessary policies formulated. WHO will cooperate in training and research activities to determine the best solutions to local problems.

3.8.2

Oral health

16. The oral health programme will be developed and integrated in the school health programme, which is under consideration. In rural areas, surveys will be carried out and oral care will be integrated with primary health care.

3.9.1

Maternal and child health, including family planning

17. A revision of the maternal and child health programme is being considered and major developments will be undertaken within the framework of primary health care and rural development programmes. Cooperation in the upgrading of the services is necessary and attention will be directed to a 1 ArEJ~r input in the training of health workers. Support will be sought from UNFPA.

3.9.3

Workers' health

18. With industrial development being accorded priority by the Government, the health of workers will be a main concern of the health authorities. More attention will be given to this population group and some surveys and studies will be carried out to obtain relevant data to help create a workers' health service.

3.10.3

Prevention and treatment of mental and

1 disorders

Studies will be carried out, to determine ap?ropriate procedures to be undertaken for prevention and treatment. and sanitation

19. Mental disorders are of concern and more attention will be given to this problem.

20. With the development of rural water supply for the International Drinking-Water Supply and Sanitation Decade, appropriate technology will be developed. A rural water supply and sanitation programme will be implemented with community participation. Of maJor concern will be training activities. UNICEF, UNDP and bilateral agencies will be the major contributors. 3.11.4 Food safety Laws will be

21. The food safety regulations will be revised and appropriate legislation formulated. enforced to ensure the safety of food on the market. 3.12.1 Clinical,

laboratory and radiological technology for health systems based on pr1mary health care to provide better

22. Equipment needs to be revised and laboratory procedures reviewed. Training service will be the main concern. UNDP, UNICEF and WHO will provide cooperation.

243

244

3.12.2 3.12.3 3.12.4

Essential drugs and vaccines Drug and vaccine quality, safety and efficacy Traditional medicine

23. Pharmaceutical problems are rece~v~ng careful attention. Important developments can be expected with support to be requested from UNDP and UNICEF. Procedures for the preparation, procurement, management and distribution of essential drugs and vaccines will be reviewed and improved to ensure regular supply at primary health care level. 3.12.5 Rehabilitation

24. The social welfare authorities are paying increasing attention to rehabilitation as it relates to social medicine. Further studies will be carried out to improve the services and to decentralize them to the rural areas. 4.13.1 Immunization Further training will The development of the

25. The necessary manuals traaslated into Lao will be reviewed and distributed. be conducted in all aspects of the expanded programme, including the cold chain. programme will be accelerated with the collaboration of UNICEF. 4.13.3 Malaria

26. The malaria programme will be extended to the whole country step by step. Continuous studies will be carried out to improve procedures, training and control. More external resources will be sought. 4.13.4 Parasitic diseases A larger input, ~n

27. This programme, integrated with primary health care, will be reviewed. training and research, will be necessary. 4.13.6 Diarrhoeal diseases and implemented at

terms of

28. Training activities will be developed integrated with primary health care.

the periphery.

All

activities will be

4.13.7

Acute resEiratory infections studies are required to determine the epidemiological pattern Training will improve procedures for prevention and treatment. of acute respiratory

29. Further infections.

4.13.8

Tuberculosis

30. Training will improve treatment and prevention procedures at the periphery.

4.13.9

Leprosy

31. Surveillance will be improved and training carried out in treatment procedures and rehabilitation techniques. 4.13.17 Other noncommunicable disease 1on and control activities

32. Further studies will be implemented to develop prevention and treatment procedures, as well as to obtain relevant data.

245

246

LAO PEOPLE'S DEMOCRATIC REPUBLIC Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

2.3.0 Health S:t:stem DeveloE!!!ent 2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development Costs of WHO Programme Coordinator's Office Vientiane, Lao People's Democratic Republic 2 .3.4 Health legislation 2.4.0 of Health S:i:s terns Based on Primari: Health Care Or~anization

112 000

31 500

(80 500)

34 500

267 700

285 000 13 000

17 300 13 000

157 000 433 000 5 000

45 500

202 500 433 000 5 000

175 000 489 000 25 000

175 000 489 000

18 000 56 000 20 000

2.5.0 Health Man£OWer 2.6.0 Public Information and Education for Health 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral Health-

-25

000

11 500 21 500

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3.9.0

Protection and Promotion of the Health of SEecific PoEulation GrouEs 3.9.1 Ma terns 1 and child health, including family planning

43 500 34 500

3.9.3

Workers' health

3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and treatment of mental and neurological disorders 3.11.0 Promotion of Environmental Health

5 000

9 000

4 000

---

3.11.1 Community water supply and sanitation 3 .11.4 Food safety 3.12.0 DiaJ:lnostic 1 TheraEeutic and Rehabilitative Technolo~z: 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 3.12.5 Rehabilitation

305 000

305 000 19 000

400 000

400 000 19 000 19 000

20 000 112 000

189 700

209 700 112 000

18 000 20 500

33 000

51 000 20 500

( 2 000) (91 500)

247

248

LAO PEOPLE'S DEMOCRATIC REPUBLIC Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

4.13.0 Disease Prevention and Control 4.13 .1 4.13 .3 4.13 .4 4 .13.6 4.13.7 4.13 .8 4 .13. 9 Immunization Malaria Parasitic diseases Diarrhoeal diseases Acute respiratory infections Tuberculosis Leprosv cable disease prevention and control nctivities Total 5 000 5 000

34 500 146 000 146 000 104 000 13 000 11 500

34 500 104 000 13 000 11 500

34 500 (42 000) 13 000 11 500

9 000 5 000 5 000 9 000

9 000 9 000 (

9 000 4 000 5 000)

.:. .13 .17 Other noncommuni-

18 500

- LAO

PEOPLE'S DEMOCRATIC REPUBLIC

1 267 700

540 200

1 807 900

=========

===a::::==-=

==========

··=======

1 430 000

433 000 =:am:====

1 863 000 ==:z•===::=

·=-==•==

162 300

MACAO NATIONAL HEALTH DEVELOPMENT STRATEGY 1. Rapid economic development has contributed to good living conditions, a healthy environment and a generally satisfactory health situation. Politically, the area is stable. The main social concerns stem from the influx of refugees and the population growth, which, in conjunction with immigration and low mortality rates, could create eventual problems, the implications of which have not yet been assessed.

2. The Government of Macao is aware of the importance of the health serv~ces and allocates sufficient resources for their development. The main problem is a shortage of qualified health personnel rather than inadequate financial resources. In terms of disease, the main problems are considered to be tuberculosis, drug addiction, and problems of the mentally and physically handicapped. 3. The objectives for the next t\venty years are as follows: to eradicate tuberculosis; to further reduce the incidence of other communicable diseases; to control cancer, tobacco smoking and drug addiction; to improve nutrition and conditions for the handicapped; to min~m1ze environmental pollution; to ameliorate problems caused by mental illness; to solve problems of waste disposal; to introduce proper sanitary conditions and regulations in industry; and to provide free medical care to workers and the population in general. 4. Strategies for achieving such objectives will comprise: expansion of the immunization programme in order to achieve total coverage; establishment of adequate institutions to deal with the diagnosis and treatment of cancer and the mentally and physically handicapped; and the introduction of programmes for the control of tobacco smoking, the control of environmental pollution and the improvement of nutrition. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. WHO collaboration will be extended in efforts to develop a health system capable of dealing with priority problems, particularly tuberculosis, cancer, drug addiction and mental illness, and to provide free medical care for workers and for the population as a whole. 6. Other areas of collaboration will be the development and application of technology for controlling tobacco smoking, decreasing the risk of cancer and occupational health hazards, and abating environmental pollution.

249

250

7. Research will be required on the implications for the health of the people of population growth and the reduction in mortality, and the response required by the health care delivery system.

WHO SUPPORT FORESEEN FOR 1984-1985 4.13.8 Tuberculosis

8. Cooperation will be needed in the area of health manpower development to support the action against tuberculosis, which is a priority health problem. Medical, paramedical and senior medical personnel of the tuberculosis services will be trained as well as laboratory technicians in bacteriology related to tuberculosis.

MACAO Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5 .0 3.8.0

Health ManEower General Health Protection and Promotion 3.8.1 Nutrition

35 000

(35 000)

5 000

( 5 000)

3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and control of alcohol and drug abuse 3 .11.0 Promotion of Environmental Health

5 000

(

5 000)

---

3.11.3 Control of environmental he a 1 th hazards j4.13.0 Disease Prevention and Control 4.13 .8 Tuberculosis Total

5 000

(

5 000)

50 000

50 000 50 000

50 000

- MACAO

000

======::::

========

50 000

=======

251

252

MALAYSIA

NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The objective of the Ministry of Health is to facilitate the attainment and maintenance of a standard of health which will enable each individual to lead an economically and socially productive life. 2. The role of the Ministry rema~ns supportive of the new economic policy and is directed towards improving the health standards of the individual and the community, by means of programmes geared to this objective. It is accepted that a healthy population will constitute a major contribution to achievement of the objectives of the new economic policy and the economic well-being of the nation. In line with the policy, therefore, the Ministry accords the highest priority to population groups living in economically depressed areas, as well as areas not served or underserved by the essential health services. Similarly, continued emphasis will be given to disadvantaged States on a regional basis, such as those on the east coast of Peninsular Malaysia, Sabah and Sarawak. Health technology has established that preventive health measures produce lasting improvements in health standards. As in the past, priority will thus be given, under the Fourth Malaysia Plan, to preventive health, as evidenced by the specific strategies of the Plan. It needs to be emphasized that the impact of programme activities within the health plan, which is the major component of the country's overall health effort, is closely linked with the impact of the health-related activities of other agencies in the social sector, for example those concerned with food production, education, communication and the environment. 3. To achieve the Ministry of Health's objective under the Fourth Malaysia Plan, strategies in continuation of those under the Third Malaysia Plan have been devised: (l) the following broad

provision of essential health care to the entire population, utilizing the primary health care approach; continual upgrading of the quality, and expansion of the scope, of services provided, taking into consideration the changing life-style of the population, its needs and demands; the changing pattern of diseases; the need for an intersectoral approach; and the involvement and participation of the community in the improvement of its health status;

(2)

(3) (4) 4.

development of a balanced promotive, preventive, curative and rehabilitative health service 1n urban and rural areas; promotion of a healthy living environment.

Specific strategies are: (1)

to maintain emphasis on the development of health and health-related serv1ces for identified target populations and areas most in need of such services, through a more equitable resource allocation; to maintain emphasis activities; on the preventive and promotive aspects of health and health·-related

(2) (3)

to continue providing curative and rehabilitative services which are appropriate, accessible, effective and efficient, taking note of the changing pattern of diseases; to maintain emphasis on preventable communicable diseases; to continue and to promote the use of appropriate technology which can be widely distributed and/or v.rhich can solve a number of health and health . related problems.

C!+)

(5)

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. In the context of the collaboration should a1m at: (1)

above health

strategies

and

line with

the new econom1c

policy,

WHO

the continued development of health manpower, to acquire the appropriate technica 1 expertise and scientific and management competence, in order to maintain and develop the national health system in relation to both the curative and preventive aspects of health care; the development of capability to organize and manage the health system based on primary health care. Included in this will be the introduction of specialized serv1ces to the whole population, the provision of supportive services, and the organization and management of health facilities as well as the maintenance of such facilities and their equipment;

(2)

253

254

(3)

the development of capability to carry out health system research and use the findings as a tool to ~mprove decision making, planning, and the organization and operation of the health system; the development of national policies, strategies and technology in relation to food safety and hygiene with a view to establishing quality standards. Capabilities in food laboratory analysis, enforcement of regulations and import control mechanisms will have to be continuously developed in order to have an effective food safety programme; the development of national drug policies with regard to production, distribution, quality control, procurement and legislation, in order to achieve economies of cost, and ensure the efficacy and availability of essential drugs and vaccines to meet the country's health requirements; the development of the occupational health programme with the objective of providing preventive health care to industrial and agricultural workers. Problems will be identified and appropriate technology adapted in order to solve them, and the working environment and occupational hygiene will be improved. The training of manpower for the Occupational Health Institute will be emphasized; the development anJ strengthening of national capability for assessing the general health situation, as well as trends, especially in the epidemiological surveillance of communicable and noucommunicable diseases.

(4)

(5)

(6)

(7)

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

6. The epidemiological surveillance of communicable diseases will be further strengthened and that of noncommunicable diseases and environmental hazards will be developed. Emphasis will be given to tra~n~ng, in order to develop capability in research and service evaluation methodology, and in the utilization of statistical information.

2.3.3

Health systems research

7. Health systems research, as a tool of health development, will be undertaken in a systematic manner. WHO cooperation will involve development of the overall programme, as well as the establishment of a cadre of trained and committed staff at the Public Health Institute, who will play a leading role in planning, conducting and supervising health systems research activities. This will facilitate the formulation of policies and strategies and permit continuing and detailed monitoring of health programmes. 2.4.0 Organization of health systems based on primary health care

8. A study tour will be organized for middle and senior level management on the organizational structure and management of staff and services ln large and small hospitals, in order to strengthen the management of general and district hospitals. 9. Hospital planning and design is a new field of collaboration which Malaysia seeks ln Vlew of the number of hospitals being built under the Fourth Malaysia Plan with the objective of improving and upgrading the patient care programme through the provision of more and better hospital facilities. It is provision of more and better hospital facilities. It is necessary to ensure that hospital facility planning and design will result in effective and efficient services. Issues such as the optimum size of hospitals, improved maintenance of equipment and plant, and actual management of hospital services, are critical to planning and design. WHO will cooperate in developing a balanced, effective and efficient hospital service, in strengthening the integration of the curative and preventive health services, with emphasis on primary health care, and in improving management capability, as far as the financial and administrative aspects are concerned, in support of health programmes. It will also collaborate ln further refinement of the primary health approach through the development and extension of the referral system as envisaged in the hospital regionalization plan. 2.5.0 Health manpower

10. Health manpower planning and training will be further developed, and improved collaboration should aim at strengthening the capabilities of local resources to achieve the objective of the training and manpower planning programme. 11. Support to the preventive and curative health servlces of the Ministry needs to be strengthened by improving capabilities in management, research and training at all the required levels.

255

256

2.6.0

Public information and education for health

12. It is expected that construction of the Audio Visual Production Centre (AVPC) will be completed during 198L~-1985. This will serve as a training centre for audiovisual programmes, which will produce audiovisual materials for health education activities at state and national level. The capabilities of the personnel need to be improved through training. There is also a need to strengthen and to effectively implement the patient education programme covering the east Malaysian states of Sabah and Sarawak. 3.8.1 Nutrition

13. The Ministry will continue to develop and establish a national nutrition surveillance system. Health personnel are being trained in this respect. Nutrition education will also continue to be further developed in line with a community-based approach through the community nutrition education strategy. Emphasis will be placed on improving toddler and pre-school coverage through the community activities of the nutrition surveillance strategy. 3.8.2 Oral health

14. The oral health programme will continue to provide promotional and preventive dental servlces at all levels. Dental health education activities will be further intensified, while specific dental services (paedodontic) will receive attention. 3.9.3 Workers' health

15. Activities in the field of workers' health are gaining momentum as a result of rapid industrialization. The programme will be further enhanced with the establishment of the National Occupational Health Centre which is expected to become operational in 1983. The Centre will carry out research, provide tra1.n1.ng, and support other institutions in the areas of occupational health and rehabilitation, as well as other government depArtments and ministries, such as labour, welfare, trade and industries, and transport. Cooperation will be provided for the training of the Centre personnel in such various disciplines as occupational hygiene, occupational nursing and toxicology, as well as in enabling the head of the Centre to gain further experience for the organization and management of the Centre.

3.10.2

Prevention and control of alcohol and drug abuse

16. Methods and facilities available in advanced countries of the Western Pacific and South-East Asia Regions for the treatment and management of alcohol and drug abuse will be studied in support of the overall national programme for the prevention of alcohol and drug Rhuse. 3.11.4 Food safety

17. The food quality control programme will be strengthened, through the tra~n~ng of personnel, with a view to updating and upgrading their knowledge and skills in the fields of food analysis and food import control. WHO will cooperate in activities to that end and also in the drafting of standard and uniform procedures, such as the proposed manual for food inspectors, which will enable personnel to perform their tasks more efficiently. 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care

18. With WHO cooperation, services in advanced, as well as developing, countries will be studied, with a view to extending clinical laboratory services to the rural areas and radiological serv~ces to the semi-urban areas. Efforts will be made to develop more sophisticated screening and diagnostic techniques. 3.12.2 Essential drugs and vacc~nes

19. Activities will be geared towards the formulation of programmes in drug administration and inventory control techniques, and in medical supply management. 3.12.3 Drug and vaccine quality, safety and efficacy

quality

control

20. Existing technical knowledge in the field of drug quality and analytical control techniques will be upgraded, so as to ensure that drugs and vaccines of good quality and effectiveness are produced economically. 3.12.4 Traditional medicine

21. WHO will cooperate in a training act~v~ty whereby knowledge can be acquired from countries that have already integrated traditional medicine within their health systems in order to formulate an appropriate programme in Malaysia.

257

258

4.13.2

Disease vector control

22. Technical expertise among managerial staff at the ministerial level as well as among the implementing officers at the State level will be developed and upgraded, to ensure effective planning and implementation of the national vector-borne disease control programme. The new programme will be launched in early 1983.

4.13.4

Parasitic diseases

23. With WHO support, new techniques for the purification and characterization of parasite antigen and antibodies will be acquired to improve diagnostic capabilities. 4.13.7 Acute respiratory infections

24. Through WHO cooperation in training, diagnostic techniques and control activities 1n these diseases will be further developed with particular reference to a recently recognized pathogen. 4.13.8 Tuberculosis

25. Training of personnel at all levels in tuberculosis control will be continued, through participation in courses overseas. Prevalence surveys in selected States will be carried out. Methodology training in assessment and evaluation of the different components of the tuberculosis control programme will be conducted and developed.

4.13.9

Leprosy be reviewed and a long-term leprosy research and evaluation

26. The leprosy control programme will programme will be developed.

4.13.15

Cancer

27. WHO will continue to cooperate in the development of the cancer programme, in particular 1.n the establishment of a national cancer registry and the evaluation of the cytology services. 4.13.16 Cardiovascular disease

28. A national survey of cardiovascular disease will be carried out in the near future. WHO will cooperate in training for the assessment of the information obtained on related diseases, such as stroke and hypertension.

259

260 MALAYSIA Programme Regular budget US$ 2.3.0 Health Slstem Develoement 2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development SharP. of costs of WHO Programme Coordinator's Office, located in Kuala Lumpur, Malaysial 2. 3. 3 Health systems research 2.4.0 Or~anization

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

31) 800

36 800

47 000

10 200

127 500

349 100 100 500

349 100 100 500 150 000 95 000 12 000

21 600 100 500 104 200 (49 100) 2 000

of Health SlRtems Based on Primarl Health Care Man~:ower

45 800

800

150 000 95 000 12 000

2.5.0 He a 1 th

144 100 10 000

2.6.0 Pub1 ic Information and Education for Health 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral health 3.9.0 Protection and Promotion of the Health of S£ecific PoEulation GrouEs 3.9.1 Maternal and child health, including family planning

21 400 31 000

19 500 25 500

( (

1 900) 5 500)

60 000 64 600

475 300

535 300 64 600 58 000 58 000

(60 000) (

3.9.3 Workers' health

6 600)

1Total cost of WHO Programme Coordinator's Office in 1982-1983· Total cost of WHO Programme Coordinator's Office in 1984-1985·

US$353 500. US$385 100.

MALAYSIA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3.10 .0 Protection and Promotion of Mental Health 3.10 .2 Prevention and control of alcohol and drug abuse 3 .11.0 Promotion of Environmental Health

3 000

---

3.11.1 Community water supply and sanitation 3 .11.4 Food safety 3.12.0 Thera2eutic and Rehabilitative TechnoloE~ Dia~nostic,

99 100

99 100 55 600 63 500 63 500

(99 100) 7 900

55 600

3. 12 .l Clinical, laboratory and radiological technology for health system based on primary health care 3.12.2 Essential drugs and vaccines 3.12.3 Drug and vaccine quality, safety and efficacy 3.12.4 Traditional medicine

10 000 31 600

13 500 58 500

13 500

3 500 26 900

58 500

89 200

40 500 9 000

(48 700) 9 000

26\

262

MALAYSIA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

4.13 .o Disease Prevention and Control 4.13.1 4.13.2 4 .13.4 4.13.7 4.13.8 4.13.9 Immunization Disease vector control Parasitic diseases Acute respiratory infections Tuberculosis Leprosy 23 600 9 400 22 200 1 127 500 :r:u::za::r:ua=c•

6 400 39 200

6 400 39 200 31 500 4 500 4 500 21 000

( 6 400) 31 500 4 500 4 500 21 000 18 000 (

7 700) 4 500 4 500 21 000 18 000

18 000 23 600 9 400 22 200 475 300 ======a

4.13.11 Sexually transmitted diseases 4.13.15 Cancer 4.13.16 Cardiovascular diseases Total - MALAYSIA

(23 600) 32 000 3 000 1 159 100 32 000 3 000 1 159 100 :c:::r:::==·-= ll::aDa•aca:a•

22 600 (19 200) 31 600 •=m=•==

1 602 800 Cllll!tUllfDa:a:ei!C:m

=========

NEW ZEALAND NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The national health policy of New Zealand is expressed in several Acts relating to the promotion or conservation of human health, including in particular the Health Act of 1956, the Hospitals Act of 1957, the Mental Health Act of 1969, Part II of the Social Security Act of 1964, and all other public Acts. The Department of Health is responsible for administering those Acts. The major programmes supported include research and education, environmental health, family health, disease control, accident prevention, and delivery of medical care. Current emphasis is directed towards a downward delegation of authority.

Specific goals of the Department of Health are to: (1)

develop responsibility for environmental health at local authority level; maintain a well-qualified career public health service, which sets standards and advises local authorities on all health matters; develop, on the basis of existing hospital board structure, the concept of a unified medical care delivery service administered by a single health authority in each area; equip the Department so that it can effectively discharge responsibility for the direction of policy, determination of priorities, general financial control, and evaluation and surveillance of the efficiency of management; further the development of primary health care 1n the community.

( 2)

(3)

(4)

(5)

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 3. Because of New Zealand's comparatively isolated situation and the restrictions placed on overseas travel, it is very difficult for senior staff of the health services to study areas of interest in other countries. It is intended, subject to the necessary support being available from WHO, to continue the training of selected staff as part of the Department's overall manpower development scheme.

263

264

WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 Health manpower

4. The Government of New Zealand will continue to collaborate actively with the World Health Organization and the countries or areas of the Pacific in various health system development programmes, including training and medical research. 5. Since the WHO fellowship programme is a vital aspect of the overall health system development programme for countries of the Pacific, New Zealand is most willing to again share in this collaborative activity for the 1984-1985 biennium.

NEIV ZEALAND Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0 Health Manpower Total - NEW ZEALAND

60 000 60 000

60 000 60 000 :=::;::;==== ~ezc.====

60 000 60 000

=======

=.======

=======

265

266

NIUE NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The national policy for the health sector is to provide total medical and dental care for the people of Niue. The health component of the current national plan specifies the health sector objectives as: (1)

to achieve as effective a programme of free preventive and rehabilitative health care as the community will accept and the Government can afford; to control the costo of the health services; to achieve a hospital service offering all reasonable care to inpatients and outpatients.

(2) (3)

2. The Health Department has for some time had a policy emphasizing a community-based programme for the achievement of its objectives. Through this policy, the community has accepted an increasing share of the responsibility for solving its health problems and creating a more healthful environment. During this programming period, the Health Department will continue to nurture community involvement 1n health. To support this overall strategy, the following specific objectives have been set: (1)

to develop medical and dental personnel relevant to the needs of the community;

to full

practitioner level,

each with a speciality training;

(2) (3) (4) (5)

to ensure that there is an adequate level of paramedical and nurs1ng staff with basic

to maintain a continuous postgraduate training programme aimed at ensuring that the knowledge of all staff is up to date and that they are competent and efficient; to upgrade the administrative ability of the section heads and improve channels of control and communication; to regulate and improve the human environment and to promote a wide understanding of preventive health measures.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 3. The current development plan outlines very explicit policy statements, which provide clear guidance for health development. It indicates that the main requirements for continuing the high standard of health care on Niue are replacement of capital items and adequate training programmes. Training peogranunes will be consistent with the Government's objective of reducing health manpower costs while attaining the highest standard of skills. Although some small changes will be made, the concept of a free service will continue, as the social advantages are important. The overseas training programme will aim at providing specialist training for medical and dental officers, and regular training for nursing, health inspection, laboratory and X-ray staff. 4. WHO will collaborate in developing appropriate plans and technology to achieve these goals and will cooperate as required in their implementation. WHO SUPPORT FORESEEN FOR 1984-1985 2.3.2 Managerial process for national hea~th

development

5. The achievement of health sector objectives will necessitate a qualitative improvement in the existing resources which make up the health system. This will call for improvements in administration, supervision and some technical skills among health personnel. In addition, the need to promote community involvement in achieving health sector goals will continue to be a part of the responsibilities of all health workers. 2.5.0 Health manpower

6. This is a continuing programme to improve the standards of performance and efficiency. With cooperation from WHO, the Health Department's overseas training programme has the objective of providing the required specialities for curative and preventive programmes. The New Zealand bilateral aid training scheme supports much of the basic training required to maintain the Health Department establishment. Cooperation will be required for the post basic training of medical officers, dental officers, nursing staff and paramedical staff.

267

268

3.11.1

Community water supply and sanitation

7. The project to build sanitary latrines, which has been completed, has clearly shown the effectiveness of community involvement ~n major health activities. The Health Department, in collaboration with WHO, will continue to seek ways to further the development of a healthy environment in each community. 4.13.1 Immunization

8. Over the past years, the Health Department has continued to maintain a high level of immunization coverage. Collaboration with the WHO immunization programme will continue, ~n order to maintain immunization standards and seek improved efficiency. 4.13.2 9. Disease vector control ~n

The control of vectors and pests

the environment will continue to be a priority concern.

NIUE Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0

Health Man2ower

000

50 000

58 000

8 000

3.12.0 Diasnostic 1 Thera2eutic and Rehabilitative Technolo~:z::

3.12 .1 Clinical, labor a tory and radiological technology for health systems based on primary health care Total

16 300 50 000 16 300 -::::::;:::;;;;;:::;;::;:=::;:

16 300 66 300 58 000 58 000 8 000

NIUE

=======

269

270

PAPUA NEW GUINEA

NATIONAL HEALTH DEVELOPMENT STRATEGY 1. National development policies and strategies strongly support efforts to attain the goal of health for all by the year 2000 using the primary health care approach. Support for primary health care is mainly directed at upgrading the performance of the peripheral health workers, especially the aid post orderly. Although some of the projects developed use a multisectoral approach to primary health care and aim at progress towards self-reliance at community level, such projects are comparatively small and some lack guidance and coordination. 2. Devolution of the health services to the twenty provincial governments, started in 1978, is now complete. The Department of Health is responsible for training. It also provides technical support and advice to the provincial administrations. 3. The Department of Health published two volumes on health manpower planning in 1980 and 1981 which are being used as the basis of the next five-year health plan at present being finalized. 4. Priority concerns of the Department of Health are the development of strategies and primary health care activities in the provinces, together with a health information system, a national health development network, and expansion of the peripheral health serv~ces. 5. The national public expenditure plan (NPEP) forms the policy basis for management of the national health programme. I t provides a framework for the development of health policies within the overall socioeconomic development policy. NPEP also provides an administrative mechanism for the regulation of government spending so that it is focused on the more important sections for long term health improvement, e.g. rural education, welfare, food production and nutrition. 6. A number of continuing health-related projects are financed through the national public expenditure plan, while large health development projects are planned in certain provinces, financed by loans from the World Bank and the Asian Development Bank.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 7. WHO collaboration will be required in the following areas: (1)

health systems development, with particular reference to community involvement in the provision of basic health care related to the leading causes of mortality and morbidity. This will include the training and use of community members as birth attendants, and in malaria control and environmental sanitation activities; health planning and management support and tra1n1ng, especially at the provincial level. The national health development network, provincial planning and evaluation systems, and the health information system need to be improved; health manpower development studies, as part of operational research into delivery of the peripheral health services. Such studies will lead to the reorientation and retraining of peripheral health workers, especially aid post orderlies and nurse aides, to enable them to be more effective in support of primary health care intervention for alleviation of the leading health hazards; development of appropriate technology, related particularly to methods for controlling malaria, acute respiratory infections, tuberculosis, leprosy and diarrhoeal diseases, and improving water supply and sanitation, and nutrition.

(2)

(3)

(4)

WHO SUPPORT FORESEEN FOR 1984-1985

2.3.1

Health situation and trend assessment

8. WHO will continue to cooperate in the development and strengthening of national capability to assess With an accent on training, epidemiological the general health situation and disease trends. surveillance will be improved.

2.3.2

Managerial process for national health development

9. WHO will collaborate in the further development of a national health programme designed to achieve health for all by the year 2000.

271

272

2.4.0

Organization of health systems based on primary health care

10. Based on operational research studies in pilot areas, WHO will cooperate in modifying the provincial health plans to incorporate improvements 1n the delivery of the rural health services with fuller community participation. WHO >vill cooperate \vith the central and provincial governments in increasing the population's awareness of its major health problems and in developing community organizations to help the health services to alleviate those problems, in order to realize the goal of health for all by the year 2000. 2.5.0 Health manpower

11. As more national staff graduate from the university, technical institutes and high schools, they need further specialized training in order to meet the growing needs of the health services, especially in rural areas, and also to occupy posts at present held by expatriates.

12. WHO will collaborate in improving the standard of the instruction given to peripheral health workers, for example aid post orderlies and nurse aides, and in expanding the community-oriented skills of the trainees. Technical support will be given in the areas of nursing education, nursing administration and community health and, \vhere necessary, it will also be provided to the University of Papua New Guinea and the College of Allied Health Sciences. 2.6.0 Public information and education for health

13. WHO will collaborate in the training in health education of primary health workers and pn_mary school teachers, as well as in the development of health education teaching aids.

3.8.1

Nutrition

14. Through

the intercountry programme, WHO will collaborate 1n the development of nutrition surveillance to identify communities where nutrition is pour and to assess changes in the nutritional level. Nutritionists will also be trained to take over from the expatriate volunteer nutrition workers.

3.8.2

Oral health to collaborate ~n

15. WHO will continue periodontal diseases. 3.9.1

programmes

for

lowering

the prevalence of dental

car~es

and

Maternal and child health, including family planning

16. Mortality and morbidity rates are still high among mothers and children, especially in rural areas. WHO collaboration will continue in strengthening the maternal and child health services, especially through the training of nurse aides and aid post orderlies and the identification of mothers and babies at high risk. With support from UNFPA, traditional birth attendants will be trained and the family planning services developed. 3.10.3 Prevention and treatment of mental and neurological disorders promotion of mental health ~n a WHO will also cooperate ~n the

17. WHO will cooperate with respect to psychosocial factors ~n the society undergoing rapid change in its sociocultural environment. training of health workers in mental health. 3 11. 1 o

Community '"a ter supply and sanitation

13. Lack of a safe water supply and poor sanitation contribute to the high incidence of disease in many rural areas. As part of International Drinking-Water Supply and Sanitation Decade activities, and with support from UNDP, WHO will collaborate in the planning of national serv~ces for the provision of community water supply and sanitation facilities and encourage community participation ~n the implementation of rural water and sanitation projects. 3.12.1 Clinical, laboratory and radiological technology for health systems based on pr~mary

health

care

19. WHO will cooperate, through the intercountry programme, in the training of medical technicians, to raise the standard of diagnostic investigations at health centre level.

laboratory

27 3

274

3.12.5

Rehabilitation

20. WHO will collaborate in the training of primary health care workers, to enable them to identify disabled persons in the community and assist in their rehabilitation. Training in geriatric care and of physiotherapists will also be supported. 4.13.1 Immunization

21. Collaboration will continue, through the intercountry programme, in expansion of the immunization programme, which will include vaccination against tuberculosis, diphtheria, pertussis and tetanus, poliomyelitis, measles and pig-bel. Surveillance of the cold chain for the transport and storage of vaccine will continue and coverage of the population at risk will be improved. 4.13.2 Disease vector control field activities will alm at preventing malaria and mosquito-borne disease

22. With WHO's cooperation, in the major towns. 4.13.3 Malaria

23. Malaria remalns a major cause of mortality and morbidity in most parts of the country, with an increasing incidence of the disease and operational difficulties, especially during spraying operations. Collaboration will be extended in improving control activities ln the denser populated areas with a high incidence of malaria. 4.13.6 Diarrhoeal diseases

24. Oral rehydration is accepted as the major intervention ln the treatment of diarrhoea, and oral rehydration salts are used down to aid post level. Support will be provided from the intercountry programme in teaching rehydration to communities as an early treatment for diarrhoea. 4.13.7 Acute respiratory infections

25. Through the intercountry programme, WHO will continue to collaborate with the Institute of Medical Research, Goroka in the prevention and treatment, by primary health care workers, of acute respiratory infections.

4.13.8

Tuberculosis

26. The tuberculosis programme is integrated with the basic health services. Extrabudgetary resources will be .sought for act1v1t1es aimed at alleviating the technical and operational problems associated with the control of this disease.

4.13.9

Leprosy Extrabudgetary resources

27. The leprosy programme is also integrated with the basic health serv1ces. will be sought for continuing cooperation in control activities.

275

276

PAPUA NEW GUINEA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.3.0 Health

S~stem Develo~ent

2.3.1 Health situation and and trend assessment 2.3.2 Managerial process for national health development Cost of WHO Programme Coordinator's Office, Port Moresby, Papua New Guinea 2.4 .o of Health S:tstems Based on Primarl Health Care Or~anization Man~wer

99 600

170 000

174 000

389 700

465 800

465 BOO

76 100

179 000 450 000 31 000

399 000 295 300 185 500

220 000 (154 700) 154 500

2.5.0 Health

2.6.0 Public Information and Education for Health 3.8.0 General Health Protection and Promotion 3.8 .1 Nutrition 3.8.2 Oral health 3.9.0 Protection and Promotion of the Health of SEecific PoEulation Grou2s 3.9 .1 Maternal and child health, including family planning 3.9.3 Workers' health

29 000 29 000

29 000 29 000 21 500 21 500

(29

ooo)

( 7 500)

184 400 27 000

308 700

308 700 (27 000)

PAPUA NEW GUINEA Progrannne Regular budget US$ 3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

treatment of mental and neurological disorders 3 .11.0 Promotion of Environmental Health

24 000

6 500

(17 500)

---

3.11.1 Comunity water supply and sanitation 3.12.0 Dia~nostic 1 Thera~eutic and Rehabilitative Techno1ollz

236 000

108 900

344 900

300 000

160 000

460 000

64 000

3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 3.12 .3 Drug and vaccine

27 000 '!

27 000

(27 000)

quality, safety and efficacy 3.12.5 Rehabilitation f4.13.0 Disease Prevention and Control 4 .13.2 Disease vector control 4.13.3 Malaria 4.13.8 Tuberculosis 4.13.9 Leprosy

96 000 116 000

96 000 116 000 26 500 26 500

(96 000)

(89 500)

20 000 236 000 162 700 162 800 ST ST

20 000 236 000 162 700 162 800

13 700 318 000

( 6

300)

82 000

Total - PAPUA NEW GUINEA

=====:====

1 889 700

718 400 ======::

2 608 100

2 205 800

Ill::.========

z:===:====

638 700

-=======

2 844 500

=========

316 100

======= 277

278

PHILIPPINES NATIONAL HEALTH DEVELOPMENT STRATEGY 1. To guide activities under the National Health Plan for 1983-1987, the following policies will be arlopted: (1) health development programmes ~..rill be focused at the community level. In keeping with the concept of primary health care, which emphasizes self-reliance in health, service coverage will be increased through community involvement and participation; priority will be placed on countrywide infrastructure construction, repair and rehabilitation;

(2) (3) (4) (5) (6) (7)

appropriate health technology, suited to local needs and conditions, will be developed; programmes for the prevention of malnutrition and for disease control will be improved; the introduction of a family-oriented services delivery system will be pursued, together with the development of self-reliant individuals, families and communities; the participation and involvement of the private sector in the health care delivery system will be encouraged and maximized; activities aimed at improving environmental sanitation, especially the provision of an adequate and safe water supply, will be intensified; efforts to curb the rapid population growth will be intensified, through the family planning programme; interdisciplinary, at all levels; intrasectoral and intersectoral linkages will be developed and strengthened

(8)

(9)

(10)

health manpower development, geared towards participate fully and effectively 1.n the intensified;

increasing the capabilities of health workers implementation of primary health care, will

to be

(ll)

operational research, related to mAjor health concerns, will be emphasized.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 2. As a contribution to the development and implementation of primary health care as a key approach 1.n improving the health of Filipinos, WHO collaboration will focus on: (l) the development of capability in using the primary health care approach and effectively managing activities related to the development of health infrastructure based on primary health care, the generation and use of appropriate technology, the development and upgrading of the knowledge, attitudes and skills of health workers, and the promotion of intra- and intersectoral partnership in solving health problems and improving the health of the people; the generation, development and use of appropriate technology, geared towards meeting priority health needs related to communicable and non-communicable diseases, malnutrition, poor environmental sanitation, and rapid population growth; the development of essential support programmes critical to community to respond adequately to its own health needs. education are examples of such support; enhancing the capability of the Health information and health

(2)

(3)

(4)

the evolvement and development of the managerial processes for national health development necessary to support primary health care and to help generate and mobilize the resources required.

279

280

WHO SUPPORT FORESEEN fOR 1984-1985

2.3.1

Health situation and trend assessment

3. Using data generated by current studies, the health information system will be further developed with WHO cooperation. Primary health care indicators will be identified and will form the basis of the information requirements of the health system. Emphasis will be placed on the development of procedures for lay reporting of health information and its integration into the national system. Training of health personnel in this area is anticipated. 2.4.0 Organization of health systems based on primary health care

4. With WHO collaboration, the capabilities of health workers at all levels will be developed, to enable them to cope adequately with the changes in the health system. Support will also be derived from UNICEF, USAID and othec international agencies for specific project components. 2.5.0 Health manpower

5. The focus of development act~v1t~es will be the Ministry of Health and the Institute of Public Health of the University of the Philippines System, to which WHO will extend cooperation. The training programme for teachers of health professionals at the National Teacher Training Centre will be expanded, with WHO cooperation. 2.6.0 Public information and education for health

6. The information, education and communication skills of pealth educators, as well as health workers at the periphery, will be further developed and updated. 3.7.0 Research promotion and development

7. The Philippine Council for Health Research was formally established in 1982 as the central coordinating body for health research. Through its intercountry programme, WHO will collaborate in strengthening national mechanisms and facilities for biomedical, health service and behavioural research.

3.8.2

Oral health

8. With WHO cooperation, it is aimed to reduce the incidence of dental caries by 40-50 per cent. among pre-school and school children, through active involvement of the community.

3.9.1

Maternal and child health, including family planning

9. With WHO cooperation, activities will focus attention on strengthening the maternal and child health programme as a part of primary health care. The high risk approach and community-based maternal and child health activities will be emphasized.

3.11.1

Community water supply and sanitation

10. Continuing staff development should increase capability to further develop and implement the comprehensive sanitation programme in support of the United Nations International Drinking-Water Supply and Sanitation Decade. 3.12.1 Clinical laboratory and radiological technology for health systems based on primary health care

11. WHO will cooperate in further improving the medical physics and radiation services, through upgrading capabilities in the repair and preventive maintenance of X-ray and electro-medical equipment. 3.12.2 Essential drugs and vacc1nes the capacity of the Ministry of Health to

12. WHO will cooperate w activities aimed at developing provide essential drugs for primary health care. 3.12.3 Drug and vaccine quality, safety and efficacy

13. DPT vaccine production in support of the immunization programme will be evaluated.

281

282

4.13.1

Immunization

14. Officially launched in 1976, the immunization programn1e aims at increasing coverage to 80 per cent. of the eligible population by the end of 1985. It is planned to evaluate the impact of the programme in terms of reduced incidence and lowering of the mortality rate. 4.13.3 Malaria

15. With WHO cooperation, the Malaria Eradication Service will conduct a countrywide evaluation of the malaria control programme, to provide a basis for future direction. 4.13.4 Parasitic diseases on schistosomiasis epidemiology and management will be evaluated and their

16. Training programmes impact determined. 4.13.6

Diarrhoeal diseases

17. The diarrhoeal disease control programme will focus on promoting the wide use of oral rehydration salts in the management of diarrhoeal diseases, especially in hospitals. Training, and education of the public, will aim to promote a better understanding of the programme and the use of oral rehydration. 4.13.8 Tuberculosis

18. With the active participation and support of the community, tuberculosis control activities will be further intensified. WHO will collaborate in evaluating the programn1e and training staff. 4.13.15 Cancer

19. Activities for the control of cancer will concentrate on reducing incidence through the promotion of feasible preventive measures, such as PAP smear testing, self-examination of the breast, and anti-smoking campaigns. WHO will collaborate in such activities as a part of primary health care. 4.13.16 Cardiovascular diseases

20. With WHO cooperation, feasibility studies will be undertaken at community level. Resulting activities, primarily training of health personnel and technical cooperation, will be integrated within primary health care.

PHILIPPINES Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget

us$

12.3 .0

Health Slstem Develo12ment 2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development Costs of WHO Programme Coordinator's Office, Manila, Philippines

27 000

35 500

8 500

198 900

240 400

41 500

~.4.0

of Health S:istems based on Primar;t Health Care

Or~anization

352 600 143 000 39 600

24 800

377 400 143 000 39 600

453 300

453 300 192 100 38 500

100 700 49 100 (

b.s.o He a 1 th Man12ower b.6.0 Public Information and Education for Health .8.0 General Ilea 1th Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral health .9.0 Protection and Promotion of the Health of SJ2ecific PoJ2ulation Grou12s 3.9.1 Maternal and child health, including family planning 3.9.3 Workers' health

192 100 38 500

l 100)

25 200 29 600

25 200 29 600 23 500 23 500

(25 200) ( 6 100)

19 200 37 000

44 500

25 300 (37 000)

283

284

PHILIPPINES Progrannne Regular budget

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget

1984-1985 Posnble extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget

us$

uS$

3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and control of alcohol and drug abuse 3 .11.0 Promotion of Environmental Health

61 400

(61 400)

---

3.11.1 Community water supply and sanitation 3.11.2 Environmental health in rural and urban development and housing 3 .11.3 Control of environmental health hazards 3.12.0 Dia~nostic, Thera2eutic and Rehabilitative Techno1o~l

34 900

200 600

165 700

15 600 179 200

(lS 600) (179 200)

3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health carP 3.12.2 Essential drugs and vaccines· 3.12.3 Drug and vaccine quality, safety and efficacy

19 200

83 500 26 000

64 300 26 000

25 400

3 000

(22 400)

PHILIPPINES Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

4.13.0 Disease Prevention and Control 4 .13.1 4.13.2 4 .13.3 4.13.4 4.13 .6 4.13 .8 4.13 .9 Immunization Disease vector control Malaria Parasitic diseases Diarrhoeal diseases Tuberculosis Leprosy 93 700 2 700 40 900 46 400 6 200 27 600 22 900 l 624 900 124 600 93 700 2 700 40 900 46 400 6 200 27 600 22 900 1 749 500

28 500 9 600 50 000 88 600 99 800 ST

28 500 9 600 50 000 188 400

30 000

30 000 (

1 500 9 600) 32 500 (54 100) 72 000

82 500 34 500 72 000 29 000

(64 700) (

2 700)

4.13.10 Zoonoses 4.13.11 Sexually transmitted diseases 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular diseases Total - PHILIPPINES

(40 900) (46 400) ( 6 200) 104 000 65 500 1 758 400

104 000 65 500 1 758 400 ===::====

76 400 42 600 133 500

==========

=======

=========

=======

285

286

REPUBLIC OF KOREA NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The following constitute the overall societal image towards which national development efforts are directed: (1)

an advanced industrial society, in which individuals are engaged in efficient organization and management, using high-level technology. This will extend to processes of production and to daily lives, thus enhancing productivity and income levels; a sophisticated citizen's society, ~n which the community's participation decision-making process is universally acceptable and in which the private leading role, in both the economic and the social fields; an open country, which international cooperation; plays and an important economic, political and in the public sector plays a

(2)

(3)

cultural

role

(4)

a welfare state, within the family and group orientation of present Korean society, in which every individual has equal access to ~ncome and. participation ~n the mainstream of health development activities.

2. Policies within the national development plan place great emphasis on health care for rural communities and the urban periphery, on the medical insurance scheme, and on population growth. In more specific terms, it is aimed to: (1)

improve rural health, emphasis being given to equality in providing health services; to establishing an economical health care system, including improvement of the referral system; to training staff; and to integrating special health programmes within a single health service; strengthen urban and periurban health services, with the accent on development of a close relationship with nongovernmental health services and cooperation among health-related sectors of the economy;

(2)

( 3)

remove the financial barrier to access to adequate medical care by health insuranc e scheme and containing the rising cost of medical care;

further

developing

the

(4)

ensure that every citizen has access to a safe water supply, enjoys the benefits of sanitary waste disposal facilities, and is prot e cted from environmental pollution; maintain a low population growth rate.

(5)

3. The national heal t h development strategy, in s eek i ng t o ach iev e e quality and in ad op ting the pr imar y health care approach, is clearly oriented towards the majo r goal o f he a l tb fo r a ll by the y e ar 20 0 0. The Government has started, and ~-:ill further inte n s ify, e ff o r t s in ex pandin g primary h e alt h care t o cover the entire population through networks of h eal t b cent r e s , sub-c entres an d h o spital s , and th e training and employment of community health practiti oners in p a r tn e r shi p wit h t h e pr ivate s e ctor and the community. 4. As they are ma jor d e terminants i n all healt h de v elopme nt efforts, proper attention will be given to the distribution and e ffe ctive ut ili zation of heal t h manpmo!e r and the relevance of training programmes. In addition to t h e needed clinic al skills, national c a pabi lity in the managerial process for health development and in health s y stems re s e a r ch wi ll be enh anced .

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. In the context of the health strategies contained 1n the fifth five-year econom1c development plan,

1982-1986, WHO collaboration will aim at: (l)

the development of national capability to organi z e an d manage a h e a ltb syst em b ased on pr1mar y health care, which will include research and d e velopment i n ru ra l , p eriurb an and urban p rllllar y health care, regionalization of hospital serv i c es a nd t heir e f fecti v e ma nag ement, f urther and th e expansion and improvement of the medical insur a n ce s ch eme , cost -c on t ainmen t, integration of special programmes into the general health services; further improvement of the planning process, information system; including the development of a responsive health

(2)

287

288

(3) (4)

the strengthening of capability in health services, behavioural and biomedical research; strengthening and implementing the environmental health surveillance and preservation plans for the major r1ver basins; supporting the development of health manpower; continuing support to the maternal and child health and family planning, mental health, and disease control programmes; and strengthening drug quality and safety control. programme, with emphasis on

(5)

( 6) (7)

WHO SUPPORT FORESEEN FOR 1984-1985

2.3.1

Health situation and trend assessment

6. With cooperation from WHO, the health information system, including health statistical reporting at all levels, is to be steadily strengthened. WHO will also cooperate in training staff to serve in all areas of health statistics.

2.3.3

Health systems research

7. Through the Korean Institute of Population and Health, research will be undertaken, with WHO collaboration, on the entire health care delivery system, in order to provide health planners with reliable data. The work will involve the Institute in all aspects of health systems development and also in the application of health science and technology, particularly as it concerns the health of the family.

2.4.0

Organization of health systems based on primary health care

8. Under the fifth five-year economic development plan, 1982-1986, the health insurance scheme will be expanded to widen the coverage of medical insurance benefits. A more complex monitoring system will be required and WHO will collaborate in activities to achieve the established objectives and in training. Accent will be on community participation in primary health care, based on the health and medical care network system which is already set up at all levels. WHO will collaborate in such activities 1n relation to maternal and child health, water supply, nutrition and health education.

2.5.0

Health manpower

9. The activities of the National Teacher Training Centre for Health Personnel, Seoul National University, are expanding to encompass all health professions. Emphasis is being placed on the further development of provincial and national medical and other health profession schools and on developing the Seoul National University Medical School as a graduate training centre. WHO will collaborate in both these areas. 2.6.0 Public information and education for health

10. A health education division was established at the Ministry of Health and Social Affairs in October 1981. Qualified staff are needed to plan a national programme. 3.8.1 Nutrition particularly ~n

11. With WHO cooperation through the intercountry programme, nutrition, coastal fishing areas, will be improved, and key workers trained. 3.9.1 Maternal and child health, including family planning and child

rural

and

12. With assistance from the World Bank, ninety-one maternal constructed by 1984 for integration with existing health centres.

health

centres

are

13. It is planned to improve the family planning practice rate through various efforts, including the health insurance scheme and other support. WHO cooperation is therefore required to monitor and evaluate activities and to plan future activities in accordance with national policy. 3.9.4 Health of the elderly

14. With WHO cooperation, greater attention will be g~ven to the health and social aspects of old age. 3.10.3 Prevention and treatment of mental and neurological disorders

15. The increasing number of mental cases constitutes a problem that has to be solved, with cooperation from WHO. Enactment of a mental health law is planned, as well as the extension of mental health facilities.

289

290

3.11.1

Community water supply and sanitation

16. It is intended to expand the coverage of water supply facilities from the 52 per cent. of the population served in 1980 to 92 per cent. in 1986, which means that all villages with 20 households or more will have simple piped water supply systems. As only 6 per cent. of the total population is served with sewage treatment facilities, it is planned to 1ncrease the coverage to 25 per cent. by 1986. WHO will collaborate in activities to achieve those targets. 3.11.3 Control of environmental health hazards

17. Consideration will be given to the abatement of air and water pollution in major cities and industrial estates. For the implementation of projects to cope with environmental pollution, 1356 billion Won will be allocated.l WHO collaboration will continue. 3.11.4 Food safety

18. In order to improve food sanitation through introducing adequate measures for ensuring the quality of food manufacturing, standards for food factories have been strengthened and uniform standards for food manufacturing have been introduced. In addition, food factories are to be inspected regularly to see that their standards are adequate, and controls for seasonal foods in high demand are to be strengthened. 19. The dissemination of information on harmful foods and the institution of control activities have been greatly encouraged through radio broadcasts and through the voluntary organizations established to protect consumers. Regular education sess1ons are provided to government officials as well as to employees working in the food business. 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care

20. WHO will cooperate in expanding the radiation protection programme especially with regard proper maintenance of X-ray and other medical equipment.

to the

l735 Won =US$ 1.00

3.12.2

Essential drugs and

vacc~nes

21. To ensure that drugs of better quality are produced, quality control will be emphasized and The affiliation of small scale manufacturers obliged to observe drug manufacturing standards. businesses and the import of new technology will be encouraged. 3.12.3 Drug and vaccine quality, safety and efficacy

22. Programmes for the assessment of drug efficacy will continue and a food and drug safety centre, which will have functions similar to those of the Food and Drug Administration of the United States of America, will be established by 1983, in order to improve the quality control functions of the National Institute of Health. 4.13.13 Other communicable disease prevention and control activities

23. With the cooperation of WHO, preventive measures against acute communicable diseases have to be strengthened. WHO will collaborate in the training of key workers at the National Institute of Health. 4.13.15 Cancer

24. Efforts, in which WHO will cooperate, will concentrate on the further development of hospital-based cancer registries and a national cytology service for the diagnosis of cervical carcinoma. 4.13.16 Cardiovascular diseases and stroke will be developed. WHO will

25. A national programme for the control of hypertension collaborate in the training of national staff.

291

292 REPUBLIC OF KOREA Progrannne Regular budget US$ 2.3.0 Health S:z:stem Deve loE!!!ent 2.3.1 2.3.2 Health situation and trend assessment Managerial process for national health development Costs of WHO Prograllll1le Coordinator's Office Seoul, Republic of Korea 2.3.3 2.4.0 Health systems research 1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$ 1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$ Increase/ (Decrease) Regular budget US$

33 000

298 000 118 000

334 300 197 600

36 300 79 600

Organization of Health S:z:stems Based on Primar:z: Health Care Health Man2ower Public Information and Education for Health Protection and Promotion of the Health of Seecific Poeulation Grou2s 3.9.1 Maternal and child health, including family planning Health of the elderly

15 000 652 000

208 100 180 000 6 600

193 100 (472 000) 6 600

2.5.0 2.6.0 3.9.0

13 000 20 000 20 000 9 000

13 000 9 000

13 000 (ll 000)

3.9.4

3.10.0 Protection and Promotion of Mental Health 3.10.3 Prevention and treatment of mental and neurological disorders

20 000

10 500

( 9 500)

REPUBLIC OF KOREA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3.11 .0 Promotion of Environmental ~ 3 .11,1 3 .11.3 3 .11.4 Community water supply and sanitation Control of environmental health hazards Food safety 266 000 266 000 29 900 361 900 27 600 29 900 361 900 27 600 29 900 95 900 27 600

3.12.0 Dia!lnostic 1 Theral!eutic and Rehabilitative Technolo~l

3.12 .l

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

30 000

12 000 17 200

(18 000) 17 200

3.12.2 3.12 .3

25 800

4.13 .0 Disease Prevention and Control 4.13.13 Other connuun icab le disease prevention and control activities 4.13.15 Cancer 4.13.16 Cardiovascular diseases Total - REPUBLIC OF KOREA 59 000 20 000 1 498 000 42 500 c::::c::::=:==

61 300 42 500 ST 101 500 20 000 1 540 500

61 300 6 000 10 500 1 544 300

61 300 (53 000) ( 9 500) 46 300

6 000 10 500 1 544 300

=========

===::::=====

=======

==========

======= 293

294

SAMOA

NATIONAL HEALTH DEVELOPMENT STRATEGY 1. Samoa 1 s health development strategy has been designed in accordance with the National Development Plan. The period 1984-1985 covers both the final year of the Fourth National Development Plan (1980-1984) and the commencement of the Fifth National Development Plan (1985-1989). 2. With the endorsement, and adoption in principle, of the goal of health for all by the year 2000, as declared at the Alma-Ata Conference in 1978, and as health is closely linked to social, economic and political development, the health status and health development need to be viewed in a broader context. 3. Samoa's economy has not recovered sufficiently to undertake the various national development strategies. However, in spite of the slight reduction in the momentum of development in some sectors, health activities have continued ~n a moderate way. 4. The strategy for "health for all" is being updated in accordance with recent developments and within the context of the primary health care approach. Time frames have been set according to the five-year national development plans, each five-year time frame being designated as a phase of health development. Thus the present fourth national development plan constitutes the first phase of activities, and will be followed by the second, third and fourth phases to reach the goal of "health for all" by the end of 1999. 5. To develop the strategy for each time frame or phase of the planned health activities, task forces, one for each specific objective, such as attainment of a safe water supply or disease prevention and control, have been set up. These task forces will formulate strategies and establish health status and health services targets for each specific objective. With these specific targets as the basis, major national targets will be formulated for each phase or time frame and ultimately for all the phases, to reach the goal of health for all by the year 2000.

6. Although the newly formed task forces, while formulating their strategies, have not as yet set targets for the entire period up to the year 2000, some major national targets for the end of the first phase (1984) have emerged. These are: (1)

to reduce the infant mortality rate to 30 per thousand live births (from 36 per thousand in 1979), the maternal mortality rate to 0.2 per thousand (from 0.3 per thousand in 1979), and to increase life expectancy to 65 years for males and 67 years for females (from 61 for males and 63 for females in 1976); to improve nutritional status, or low birth weight; although Samoan children do not have third degree malnutrition

(2)

( 3)

to provide a constant supply of clean potable water; at present 95 per cent. of homes are within 15 minutes' walking distance of a water supply which may, however, be irregular and not of optimum quality; to reduce the incidence of communicable disease as follows: filariasis to less than 1 per cent. (2 per cent. in 1976), tuberculosis to 35 per hundred thousand (from 52 per hundred thousand in 1976) and leprosy to 25 per hundred thousand (from 33 per hundred thousand in 1976); to reduce the incidence of the chronic diseases, such as cardiovascular diseases, and metabolic diseases, such as diabetes; to achieve better family health and reduce the population growth rate, so that the crude birth rate is reduced to 30 per thousand (fro~ 35 per thousand in 1979).

(4)

(5)

(6)

The above-mentioned targets will be achieved through: (1) close cooperation between the community groups, especially the well developed village women's committees, and the national authorities;

295

296

(2)

the development of a national health system infrastructure based on primary health care, with strengthened managerial processes for national health development, and related health manpower development. Samoa being a small country, with a small population and good coastal roads connecting 85 per cent. of the villages, there is no problem of accessibility to health institutions. It is only in the quality of its manpower that its weakness lies. to

8. It 1.s not possible, at this stage, to indicate the order of magnitude of resources required implement the plan of action for the "health for all" strategy, since it is still being formulated. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989

9. National health system infrastructure development will be organized in line with the WHO Seventh General Programme of Work covering a specific period (1984-1989). The main lines of action in support of national priorities over the next six years will be as follows: (1) (2) (3) (4) strengthening the managerial process for national health development; organizing the health system, based on primary health care; developing health manpower to suit the country's needs; using appropriate technology for laboratory services in the rural areas and in disease prevention and control, such as for the control of filariasis vectors, and in tuberculosis and leprosy control activities; encouraging health protection and promotion activities in relation to oral health and nutrition; protecting and promoting the health of specific population groups, such as mothers and children and workers; promoting environmental health, including water supply and sanitation; improving rural hospitals and health centres in support of the primary health care network, and providing basic treatment serv1.ces.

(5) (6) (7) (8)

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

10. A major revision will be carried out to improve the quality and promptness of reporting on the Indicators will be quantified and usable information disseminated. health situation and on trends. 2.3.2 Managerial process for national health development

11. Based on health situation and trend assessment, managerial processes for the national health programme '"ill be developed with the participation of national staff, and WHO cooperation through the intercountry programme. 2.4.0 Organization of health systems based on primary health care

12. National health system infrastructure development will proceed, to obtain a sound health care delivery system for the eight basic components of primary health care. Community involvement, especially of the village women's committees, will be systematically utilized. WHO will cooperate in these primary health care programmes and UNICEF and UNFPA support will be sought. 2.5.0 Health manpower

Local training programmes will be 13. A review will be made of health manpower requirements. WHO will encouraged. Post-basic nursing and assistant health inspectors' training will continue. support these activities. 2.6.0 Public information and education for health

14. WHO will collaborate in activities under this programme, which forms an integral and important part of all other programmes.

297

298

3.8.1

Nutrition the South Pacific Commission and

15. With WHO collaboration and support from other sources, such as UNICEF, activities under the nutrition programme will be intensified. 3.9.1 Maternal and child health, including family planning

16. Strategies to strengthen the maternal and child health programme, including family planning, will be developed and an evaluation will be made of the results of the programme, to which UNFPA support is being extended from 1982. 3.11.1 Community water supply and sanitation

17. With WHO and UNICEF support, the community water supply programme will be strengthened; the community having greater responsibility for the maintenance aspects of water supply. All resources will be mobilized to promote International Drinking-Water Supply and Sanitation Decade activities. 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health ~n

care

18. Collaboration will be extended services in rural areas. 3.12.2 Essential drugs and vaccines

the development

of appropriate

technology

for

the

laboratory

19. Essential drug and vaccine requirements at the rural hospitals and health centres will be quantified and a systematic distribution system formulated. It is expected that, in addition to support from WHO, activities under this programme will benefit from extrabudgetary resources. 3.13.1 Immunization

20. Coverage surveys will be conducted to monitor the progress of the immunization programme. The community will participate, through mothers' discussion groups organized by the village women's committees. WHO will collaborate in some of these activities.

4.13.4

Parasitic diseases microfilaria positive cases will be followed up and an intensive treatment

21. With WHO cooperation, programme formulated. 4.13.6 Diarrhoeal diseases

22. Surveys will be conducted to obtain data on the extent of diarrhoeal diseases, including the percentage of cases with dehydration. The use of oral rehydration salts will be encouraged, with WHO collaboration. 4.13.8 Tuberculosis

23. Case finding and treatment will continue. 4.13.9 Leprosy

24. Follow-up of registered cases and treatment will continue. 4.13.16 Cardiovascular diseases by means of health education. Surveys will be

25. Control of cardiovascular diseases will continue, conducted to define the extent of the problem. 4.13.17

Other noncommunicable disease prevention and control activities

26. Preventive measures will be taken to control diabetes by means of health education in good dietary practices.

299

300

SAMOA Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

lq84-1985 Possible extrabudl!:etar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.3.0 Health Slstem Develoement 2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development Share of costs of WHO Programme Coordinator's Office, located in Suva, Fiji 2.4.0 Orsanization of Health SJ::stems Based on Primar~ Health Care 2.5.0 Health Maneower 2.6.0 Public Information and Education for Health 3.8.0 General Health Protection and Promotion 3. 8. 1 Nutrition 3.8. 2 Oral health 20 000 20 000 2 000 2 000 2 000 (20 000) 3 000

3 000

94 600

104 700

10 100

130 000 305 000 5 000

185 000 480 000 10 000

55 000 175 000 ) 000

SAMOA Programme Regular budget US$ 3.9.0 Protection and Promotion of the Health of S2ecific Po2ulation Grou2s 3.9.1 Maternal and child health, including family planning Workers' health 5 000

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

127 100

127 100 5 000

68 100

68 100 (

3.9.3

5 000)

3.11.0 Promotion of Environmental Health 3.11.1 Community water supply and sanitation 3.ll.2 Environmental health health in rural and urban development and housing 3.12.0 Dia~ostic, Theraeeutic and Rehabilitative TechnoloH

15 300

5 000

110 000

010 000)

3.12 .l Clinical, laboratory and radiological technology fbr health systems based on primary health care 3.12.2 Essential drugs and vaccines

5 000

5 000 9 000

5 000 9 000 9 000

301

302

SAMOA Programme Regular budget US$ 4.13.0 Disease Prevention and Control 4.13 .1 4.13.4 4.13.6 4.13.8 4.13.9 Immunization Parasitic diseases Diarrhoeal diseases Tuberculosis Leprosy 7 500 7 500

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

5 000 86 900 ST 86 900 2 000 2 000 7 500 7 500

5 000 2 000 2 000 2 000 2 000 4 000 ( (

5 000 2 000 2 000 5 500) 5 500) 1 000)

2 000 2 000 4 000

4 .13 .16 Cardiovascular diseases 4.13.17 Other noncommunicable disease prevention and control activities Total - SAMOA

5 000

(

4 000 694 600 :=::a:ac.a:s:::

--68 100

4 000 892 800

4 000 130 100 ==::c::cu:n::::::

229 300

923 900

824 700 ::u::::s=c==

=======

=:::z=====

=-=•-===

··=···=

SINGAPORE NATIONAL HEALTH DEVELOPMENT STRATEGY 1. While a national health plan for Singapore is being developed for health situation, as it exists at present, is outlined below: rev~ew

by the end of 1982, the

2. In 1981, the population of Singapore was estimated to be 2 443 300. The infant mortality rate, a key indicator of the state of health, was 11.7 per 1000 live-births. The crude birth rate was 17.0 per thousand and the crude death rate 5.3 per thousand. Population growth remained at 1.2 per cent. 3. Primary health care continues to play an important role in the delivery of health care. Steps are being taken to upgrade and improve the standards of service. The maternal and child health services provide ante-natal and post-natal care as well as family planning and immunization services. The immunization programme for infants, undertaken by the maternal and child health services, is continued by the school health services when the children enter school. 4. The school health services screened nearly 480 000 school children in 1981. The screening involves a general medical examination, visual, auditory, nutritional and mental assessment, smallpox revaccination, and booster doses of diphtheria, tetanus and poliomyelitis vaccines. Girls in primary form six are also vaccinated against rubella. Polyclinics or outpatient dispensaries are designated to serve the student population within each zone. School health services doctors can refer school children with health problems to the designated clinic for follow-up health care. 5. To serve the dense population in the new town and housing estates, two polyclinics were opened in 1980 ~n Bukit Merah and Clementi. These provide a comprehensive range of health care services, including curative, preventive and dental serv~ces. 6. Curative health care ~s available through a network of 12 polyclinics and 14 outpatient dispensaries, 3 staff dispensaries and 2 is land clinics. There are 29 maternal and child health clinics, of which 12 are sited in polyclinics, 12 in full-time clinics and 5 in part-time clinics. 7. Health education continues to play an important role in the promotion of health. As a follow-up to the national health campaign of 1979, the theme of which was "Combat diseases due to harmful lifestyles",

303

304

and in conjunction with World Health Day 1980, a "Smoking and Diseases" campaign was launched, the target group being youth in secondary schools, vocational institutes and junior colleges, and national serv1cemen. The Training and Health Education Department organizes health education talks, shows educational films at maternal and child health and outpatient clinics, and holds exhibitions at community centres, vocational institutes, army and police camps, and factories. To spread the health education message even further, the Department contributes health education artie les to companies and organizations for publication in their newsletters.

8. June 1981 saw the official opening of the Mandalay Day Centre, which is the first government-run community-based psychiatric day centre. Its objective is the occupational rehabilitation of persons who have been mentally ill but who can be economically productive. It is hoped that such persons can be rehabilitated into the community. 9. To realize the goal of health for all by especially in the training of hP-alth personnel. MAIN DIREC'fiONS FOR WHO SUPPORT 1984-1989 the year

2000,

WHO

cooperation will be

essential,

10. In line with policies and strategies for health development, WHO collaboration will a1m at: (1)

the strengthening of preventive health care. The delivery of health care will be upgraded by the use of appropriate technology, the training of health personnel, and health education to improve general awareness, within the community, of the need to stay healthy and of the means to achieve health; the development of management research and health information system capabilities at different levels; the promotion and provision of support to strengthen specialist treatment services, including the training of specialist manpower.

(2) (3)

WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 Health manpower Planning and the training

11. With WHO cooperation, the tra1n1ng of health manpower will continue to be emphasized. methodology in relation to health manpower development will be further improved through undertaken. 3.9.3 Workers' health

12. With support from UNDP, the protection and promotion of workers' health will be enhanced through training in appropriate fields. The International Labour Organisation and WHO will collaborate 1n executing the project. 3.11.2 Environmental health in rural and urban development and housing

13. Appropriate technology in urban development will be adopted to enhance environmental health. 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care

14. The main concern is to strengthen standards for radiology appropriate health care. 4.13.11 diseases. Sexual~y

for delivery through primary

transmitted diseases prevention and control of sexually transmitted

15. Procedures 4.13.17

will be developed to improve the Training capabilities will be enhanced.

Other noncommunicable disease prevention and control activities 1n the prevention

16. Appropriate mechanisms will be developed for training and community involvement and control of such noncommunicable diseases as kidney diseases.

305

306

SINGAPORE Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget OS $

1984-1985 Possible extrabudgetary sources Source of funds US $ Total

Increase/ (Decrease) Regular budget US$

oss

2. 3.0

Health S::t:stem Develol2!!!ent 2.3.1 2.3.2 Health situation and trend assessment Managerial process for national health development Liaison Office of the WHO Programme Coordinator, Kuala Lumpur, Malaysia 15 500 15 500

(15 500)

115 700* 223 000

115 700 223 000

252 000* 280 500

252 000 280 500

136 300

2.5.0 3.8.0

Health ManEower Genera 1 H . e al th Pro te ction and Pr om oHon 3.8.2 Oral health

57 500

24 000

(24 000)

3 .9.0

Pro t ect ion and Pr omo tion of the Health of SEe ci fic PoEu l at i on Grou Es 3.9.3 Workers' health 266 700 DP 266 700 292 800 DP

r ..•

292 800

3 .10.0 Protection and Promotion of Ment a l H e alth 3.10 .1 Psychosocia 1 factors in the promotion of health and human develo pment

14 000

( 14 000)

*Includes share of costs of WHO Programme Coordinator's post stationed in Kuala Lumpur, Malaysia. 1982-1983 US$26000 1984-1985 US$36000

SINGAPORE PrograDDDe Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US $

1984-1985 Total US$ Regular budget US $ Poss i ble extrabudge tar sources Source of funds US$ Total US$

Inc r ease / (Dec r ease ) Regular budget US$

3 . 11.0 Promotion of Environmental Health 3.11.1 3.11.2 Community water supply and sanitation Environmental health in rural and urban development and housing Food safety 11 000

11 000

(11 000)

11 000

4 500

(

6 500) 1 500)

3 .11.4 3 .12.0

1 500

(

D i a~no s tic 1 Theral!eutic and Rehabilit a t i ve Techno lo.gy

3.12.1

Clinical, laboratory and radiological technology for heal th systems based on primary health care

6 000

"". 13 .o Disease Prevention and Control 4.13 .11 Sexually transmitted diseases 4.13.17 Other noncommunicable disease prevention and control activities Total

r . .•

4 500

4 500 415 700 266 700 682 400 552 000 292 800 ==n=====

4 500 844 800

4 500

SINGAPORE

=======

=c======

=======

136 300 ====c==

=======

307

308

SOLOMON ISLANDS

NATIONAL HEALTH DEVELOPMENT STRATEGY

1. The major aim of national development policies is to achieve a more equal distribution of economic benefits, which will include equal levels of income for the people· and equal levels of service in different areas of the country, as well as the decentralization of economic activity, planning and government spending, with emphasis on agricultural development, village industry, better internal trade and more spending channelled to local and area bodies. The status of women will be rapidly enhanced through the creation of opportunities for them to participate in all forms of economic and social activity. The control of population growth is another major aim. 2. National development policies related to health refer particularly to rural health and population growth. With respect to rural health, the emphasis is on equalizing the basic services in various parts of the country, improving the referral system, expanding both those services, improving staff tra1n1ng, integrating special programmes within a single general health service and developing a close relationship with nongovernmental health services in rural areas. Emphasis is also placed on promoting the principle of a self-reliant economy, through the development of a health insurance scheme and through maintaining the cost of the health services within the bounds of what the country and the people can afford, through, for example, limiting the construction of new major hospitals. 3. With regard to the population policy, particular attention is given to research to determine likely population trends/distribution, to making the people aware of the results of rapid population growth, and to changing attitudes in order to limit family size. 4. With overall development policies and strategies forming the basis, the goal of national health In development policies and strategies by the year 2000 1s to improve the health of all citizens. particular: (1)

to reduce infant mortality in the rural areas to no higher than 50 per thousand and to 1ncrease life expectancy to at least 60 years; to improve nutritional status so that third degree malnutrition 1n children is eliminated and the proportion of low birth-weight babies is reduced to 10 per cent. of the total number of live births;

(2)

(3) (4)

to provide clean water and sanitation to all, either distance;

the home or within 15 minutes' walking

to reduce the incidence of communicable diseases, primarily tuberculosis, diarrhoeal diseases, malaria, leprosy and acute respiratory infections. School entrants will have a less than 5 per cent. tuberculosis infection rate; the diarrhoeal diseases incidence rate will be less than 200 per thousand; the annual parasite incidence rate for malaria will be less than 10 per ten thousand; the incidence rate for leprosy will be less than 0.5 per hundred thousand; and the pneumonia and influenza mortality rate will not exceed 100 per hundred thousand for infants, and 10 per hundred thousand for children aged 1 to 4 years; to reduce chronic diseases; to regulate fertility, so as to ensure better health and social well-being through a population growth rate not exceeding 1 per cent. per year.

(5) (6)

Priority will be given to rural areas, especially the less developed areas. 5. The above-mentioned goals will be achieved through: (1) (2) the development of community self-reliance and a partner relationship between the Government, the private sector and the community; the development of a health system which will provide integrated and equally distributed preventive and curative services to all citizens, through hospitals, health centres and village health posts, within one hour's travel.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 6. WHO support will be provided to development policies and strategies: (1) the following activities, in the context of overall national

the development of capabilities to organize and manage health systems based on primary health care, which will include the use of appropriate technology for primary health care services, the training of health workers to provide those services, and facilitation of intersectoral coordination to solve health problems and improve the health of the people; 309

310

(2)

the development and use of appropriate technology for the control of malaria, tuberculosis, leprosy and other conununicable diseases of priority public health concern, including diseases that can be controlled by immunization; the development of technology for the improvement of health, particularly in relation to nutrition, the envir'onment and personal hygiene, with health education as an integral component; the development of management, research and health information system capabilities at different levels; the orientation and strengthening of hospitals so that they can function as major referral centres in support of the primary health care network, as well as provide specialist treatment sP.rvices; tlte promotion and prov1.s1on of support to relevant studies on cultural and traditional values and on traditional medical practices.

(3)

(4)

(5)

(6)

WHO SUPPORT FORESEEN FOR 1)84-1985 2.3.1 He~lth

situation and trend assessment

7. With support from the intercountry programme, procedures for assess1ng the health situation and future trends will be improved. Current recording systems will be further improved. With the introduction of community health nurses, and the increase in the number of village health aides and assistant health inspectors, quicker and more reliable information on the health situation will become available. Decentralization will result in greater community participation in the provinces, which will further increase the amount of health information that will become available through better record keeping and better statistical information systems. For quicker action, spotter procedures will be used to a greater extent at the periphery. 2.3.2 Managerial process for national health development

8. With support from the intercountry programme, services will be improved and increased through local and international training in management. The Ministry of Health and Medical Services will be flexible in meeting changing needs.

2.4.0

Organization of health systems based on primary health care

9. Involvement of the community in the health services is a major priority. Campaigns against the main health problems, such as malaria, will very much involve the community in future, if safe levels are to be attained. 10. Hospitals will always be necessary but with the development of the health centre principle, :tn conjunction with improvements to clinics and other rural health services, there will be a need for better referral services, in both directions. The decision on whether to build a new national hospital will depend largely on the workload envisaged and the need for improved services for referral from the periphery. It is hoped that, by 1984-1985, a firm decision will have been taken. ll. The Ministry of Health and Medical Services will be reorganized to cater for the preventive and curative health services, while ways to improve primary health care will be studied. 2.5.0 Health manpower

12. To increase the number and :tmprove the quality of national staff :ts regarded as having high priority. Training at all levels, both within and outside the country, will be intensified and new posts created. Much of the training will be inservice training in the various departments within the Ministry. As well as ensuring adequate staffing at supervisory level, training of appropriate staff at the periphery is a priority. This will be increasingly emphasized, as there are constant gaps in the delivery of primary health care at grassroot level. 2.6.0 Public information and education for health

13. The Health Education Section of the Ministry of Health and Medical Services needs to be adequately staffed so as to extend services to the provinces. Activities will be promoted to meet community needs. Programmes, including the manpower involved, will be improved both quantitatively and qualitatively. Facilities will be needed, as well as the methodology, for greater use of the mass media and other appropriate means of involving the community.

311

312

3.8.1

Nutrition

14. Following studies which will take place in 1982-1983, activities will be increasingly implemented in accordance with the policies formulated. The main emphasis will be on encouraging the production and consumption of local foodstuff, rather than importing western forms of food. Breast-feeding will be fully supported and legislation against imported formula milk will be introduced. The dissemination of knowledge on weaning foods made from local products will be emphasized, through health education at all levels. 3.9.0 Maternal and child health, including family planning

15. In view of the high mortality and morbidity rates among mothers and children, especially in the rural areas, WHO collaboration will continue, with support from UNFPA. The primary health care approach will be emphasized through strengthening of community health education and participation.

3.11.1

Community water supply and sanitation

16. The progress of the rural water project has been encouraging. Activities will continue to be vigorously pursued with the cooperation of WHO and support from UNDP. Lack of sanitation in the rural areas 1s a major cause of the high incidence of faecally transmitted diseases. WHO will cooperate 1n planning for the provision of adequate facilities, emphasizing greater community participation.

3.12.2

Essential drugs and vaccines of essential drugs is considered to be Cooperation wi 11 be extended in obtaining

17. Providing village health aides with adequate stocks important. Vaccines are currently provided through UNICEF. currently used drugs and improving their distribution. 4.13.3 Malaria

18. The malaria situation is causing very serious concern. The results of up-to-date evaluation clearly indicate the need to investigate the overall situation so that new control strategies may be considered, involving intersectoral and community resources. The continuing cooperation of WHO and UNDP is of vital importance.

SOLOMON ISLANDS Programme Regular budget US$

1982-1983 Extra budgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.3.0

Health sxstem 2.3.2

Develo~ent

Managerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fiji

94 600

104 700

10 100

2.4.0

of Health sxstems Based on Primarx Health Care Health man2ower Public Information and Education for Health General Health Protection and Promotion 3.8.1 Nutrition

Oq~anization

176 000 261 000

213 000 329 000 10 000

37 000 68 000 10 000

2.5.0 2.6.0 3.8.0

lO 000

10 000

3.9.0

Protection and Promotion of the Health of s2ecihc Po2ulation Grou2s 3.9.1 Maternal and child health, including family planning

157 100

200 000

3.11.0 Promotion of Environmental Health

---

3.11.1 Community water supply and sanitation

250 800

112 000

313

314

SOLOMON ISLANDS Progrannne Regular budget US$ 3.12.0 Dia~nostic

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

1 Theraeeutic and Rehabilitative Techno1o~x 3.12.2 Essential drugs and vaccines 10 000 10 000 10 000

4.13 .0 Disease Prevention and Control 4.13 .3 Malaria Total - SOLOMON ISLANDS 213 000 744 600 135 000 542 900 DP 348 000 1 287 500 173 000 849 700 145 000 457 000 DP 318 000 1 306 700 (~)

=======

========

=========

=======

==========

=======

105 100

TOKELAU NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The national health development strategy for Tokelau is closely linked to primary health care and the nutritional status of the population, which are key issues. In requesting cooperation, several factors which could influence the kind of support Tokelau may anticipate from the World Health Organization, until the year 2000 and beyond, should be mentioned. 2. For many years, the population has remained stable, more as a result of migration to New Zealand than of family planning. It is now possible to expect an increase in the dependency ratio (among the very young and the elderly). 3. Economically, Tokelau has little to offer as yet to decrease its dependence on outside cooperation, nor, in the foreseeable future, can it expect a dramatic improvement in its subsistence economy, in spite of the present development of short-term cropping (for example, vegetables), livestock rearing and coconut planting. It is in the agricultural sector that cooperation, both financial and technical, will be increasingly needed. 4. The health of the people in Tokelau is remarkably good, considering its limited food resources. With a higher level of primary health care in all sectors and improvement in the diet, it should be possible to achieve a still higher status of health by the year 2000 than has been achieved so far. MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 5. Because of Tokelau's rural characteristics, which are unlikely to change, the future development of the health services should be focused not only on primary health care and nutrition, but also on the continuous development of health science and technology and the health system infrastructure. As yet there are no immediate plans to modify the present health system, but it is envisaged that it may have to adjust to an increasing demand for the more effective delivery of curative health services.

315

316

6. Development of health manpower will hardly be affected if the administrative centre for Tokelau remains in Samoa. If, on the other hand, the Office for Tokelau Affairs is to be relocated during this period, then not only will a stronger base for the curative health services be required in Tokelau but also a new phase of development in the paramedical services should be undertaken before the end of the present decade. In addition, suitable buildings and appropriate laboratory and X-ray equipment will be required. 7. Vaccines needed for routine immunization will be sought from UNICEF. Because the country's needs are small, Tokelau is prepared to receive a biennial or annual supply direct from UNICEF. For those vaccines with a shorter shelf life, delivery through an agent would be desirable. 8. Although the three island dispensaries are fairly well provided with basic equipment, the cost of maintenance and replacement of this equipment will inevitably increase, mainly because of the corrosive action of the weather on, for example, weighing machines for babies, trolleys, and dental and surgical equipment. WHO may be requested to collaborate in a means of providing better maintenance, or the procurement of equipment suitable for island conditions. 9. WHO support for health information is appreciated and it is proposed information between Tokelau and WHO should continue at the present level. that the exchange of

10. With UNDP support, a long-term programme aimed at providing each household with a water-sealed latrine and a water cistern has been started. It will take some time, however, before a fair assessment can be made of its progress and acceptability to the people. It seems appropriate, at this stage, to propose a training programme for a qualified health inspector. WHO SUPPORT FORESEEN FOR 1984-1985 2.5.0 Health manpower

11. WHO will cooperate in developing health manpower planning and training capabilities.

TOKELAU Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.5.0

He a 1 th Maneower

10 000

20 000

10 000

3 .11.0 Promotion of Environmental Health 3.11.1 Cornmuni ty water supply and sanitation Total - TOKELAU

--10 000 ====e=

3 100 3 100

3 100 13 100 ======

--======= 20 000 20 000

--10 000

=====

=======

======

317

318

TONGA

NATIONAL HEALTH DEVELOPMENT STRATEGY

The long-term national econom1c and social objectives are to: achieve a sustained 1ncrease in the production of goods and services, and the real income of the people; achieve effective management of the national economy; achieve a fair distribution of goods, services and income among the people 1n different parts of the Kingdom; enhance the quality of life and the security of the people, the cultural heritage of the nation, and the preservation of the environment; develop harmonious relations and mutual cooperation 1n economic, social and related spheres with all nations and international organizations.

2. With respect to health, the Government of Tonga clearly accepts that the social target shall be the attainment by all its citizens by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. The natural growth rate of the population will be brought into balance with socioeconomic development. Priority is placed on reduction in the incidence of preventable diseases, while maintaining an appropriate level of curative services. Primary health care is adopted as the priority strategy in the health delivery system, with recognition of the importance of individual and community participation in promoting health. Health manpower will be strengthened both in number and in improved effectiveness. A balanced distribution of services to all parts of the country will be achieved. Protection of environmental health will be strengthened. 3. The following targets are tentatively offered as year 2000: (1)

indicators of the progress

to be achieved by the

health services to be conveniently accessible to all citizens, based on integrated prevention and cure at health centre level, with special arrangements for isolated islands; linked with effective referral systems for secondary and tertiary care and supported by efficient supply and supervision systems;

(2) (3)

all communities to be actively participating

the health services;

at least 5 per cent. of the gross national product to be devoted to the health services, with increased allocations to the preventive aspects. This will require the 10-15 per cent. of the national recurrent budget allocated to health to be maintained, further development of policy concerning appropriate private sector participation, and external resources for health development, the size of which will depend on national economic conditions, but might amount to an annual average of over US$1 000 000; safe drinking water population; and sanitary means of excreta disposal to be available to the entire

(4) (5)

the incidence of diarrhoeal disease among children under 5 years of age to be 50 per cent. less than current levels; adequate nutritional status to be maintained, with breast-feeding to at least one year of age to be practiced for at least 75 per cent. of infants; zero incidence to be achieved and/or maintained for poliomyelitis, measles, faucial diphtheria, neonatal tetanus and congenital rubella syndrome, with no deaths due to pertussis. A 5 per cent. or less tuberculosis infection rate to be achieved among school entrants; the health information system to be strengthened accurate within 5 per cent. of "true" values; so that most indices will routinely be

(6)

(7)

(8)

(9) (10)

a birth rate of 25 per thousand to be attained by 1985, and of 20 per thousand by the year 2000; the infant mortality rate to be under 20 per thousand live births by the year 2000.

Other targets will be established based on the strengthened application of epidemiological approaches.

319

320

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 4. In the context of overall development policies health development, WHO cooperation will aim at: (1)

and

strategies

and

the

long-range

objectives

reorientating the health delivery system towards emphasis on primary care as the basic approach, in order to prevent and control disease, as well as to promote positive health. This will involve strengthened planning and management, with stress on logistic and supervisory support, and systematic communication between parts of the system. In the national context, · health situation and trend assessment 1s seen as an inseparable component of this area of collaboration, as is the managerial process for national health development. By 1984-1989, many of the needed facilities will be available, well distributed throughout the country, and good progress will have been made in training the numbers of staff needed for primary health care. Thus emphasis will be on the programming and implementation of effective integrated services, in partnership with the communities served; continuing the health manpower development programme. Health manpower planning will be coordinated with the reorientation of the health delivery system. Health manpower development will emphasize national training for the delivery of primary health care, but there will also be a need for training abroad for persons in, or destined for, key leadership and specialized positions. Evaluation to ensure the effectiveness and efficiency of manpower will be an important aspect; continued strengthening of the technology to promote maternal and child health, including family planning. Health education and community involvement are major features needing attention, as is the need to ensure that appropriate contraceptive methods are used; ensuring the effective operation and safety of community water supplies, coordinated with improved sanitation. Community water supplies should be available to virtually all the population early in the 1984-1989 period, but cooperation will be needed in the effective operation and maintenance of the systems. For sanitation, the mobilization of resources will still be needed in order to extend appropriate effective systems throughout the country; controlling environmental health hazards, with emphasis waters as an essential step to avoid degradation; on monitoring the quality of lagoon

(2)

(3)

(4)

(5)

( 6)

preventing and controlling communicable diseases. It is expected that typhoid fever, hepatitis, dengue fever and meningitis, for example, may still be significant problems requiring epidemiological approaches to their control. Closely allied with epidemiological control activities will be the utilization of public health laboratory technology. For efficient management in a small country, the same epidemiological and public health laboratory activities will also be directed to the control of other communicable and noncommunicable diseases.

WHO SUPPORT FORESEEN FOR 1984-1985

2.4.0

Organization of health systems based on primary health care during 1982-1983, in planning and management and in pr1mary to develop systems for the effective use of available human, to be given special attention will include information and of the most effective organizational methods for monitoring in the immunization programme and in primary health care

5. On the basis of collaboration expected health care, cooperation from WHO will help physical and financial resources. Areas communications, logistics, and development and control. Collaboration from UNICEF, activities, is expected to continue.

2.5.0

Health manpower

6. As a result of previous cooperation, the capacity of the Tonga Health Training Centre for training several categories of health worker is expected to be further enhanced in 1984-1985. Training programmes already developed and the planning and coordinating function of the Centre for all aspects of health manpower development will continue. Continuing education programmes will also be a significant feature.

3.9.1

Maternal and child health, including family planning for community maternal and child health/family planning,

7. It is anticipated that health education which is supported by UNFPA, will continue.

321

322

3.11.1

Community water supply and sanitation

8. Support from UNDP to activities for strengthening the operation of rural water supply facilities and their maintenance is expected to begin in 1983 and to continue up to 1985.

3.11.3

Control of environmental health hazards 1n the long-term monitoring of lagoon water care

9. WHO will cooperate, with expected support from UNDP, quality.

3.12.1

Clinical, laboratory and radiological technology for health systems based on pr1mary health

10. WHO will cooperate in strengthening the network of laboratory health services. This activity will be carried out in close coordination with a health laboratory project supported by the Government of Japan. 4.13.13 Other communicable disease prevention and control activities

11. Disease control activities will be supported, 1n close coordination with the national health laboratory programme, as well as with WHO's intercountry epidemiological surveillance and disease control programme in the South Pacific.

TONGA

1982-1983 Regular budget US$ Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tan sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Progrannne

2.3.0

Health 2.3.2

S~stem

Develoement

Managerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fiji

47 300

52 300

5 000

2.4.0

Or~anization

of Health Sptems Based on Primar~ Health Care Health Haneower

170 000 250 000

240 000 338 000

70 000 88 000

2.5.0 3.9.0

Protection and Promotion of the Health of seecific Poeulation Groues 3.9.1 Maternal and child health, including family planning

99 300

57 700

3.11.0 Promotion of Environmental Health 3.11.1 Connnunity water supply and sanitation 3.11.3 Control of environmental hazards

50 000

106 700

156 700

40 000 40 000

DP DP

40 000 40 000

(50 000)

323

324

TONGA Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Pos8lble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3.12.0

Dia~nostic,

Theraeeut ic and Rehabilitative Techno1osx Clinical, laboratory and radiological technology for health systems based on primary health care

3.12.1

160 000

.13 .0 Disease Prevention and Control 4.13.3 4.13.8 Malaria Tuberculosis 5 000 20 000 5 000 20 000 (

5 000)

(20 000)

4.13.13 Other communicable disease prevention and control activities 4.13.16 Cardiovascular diseases Total -~

34 000 5 000 547 300 206 000 :::=•c===

34 000 (

34 000 5 000)

5 000 753 300 824 300 ===•c:nr:c• 137 700 •=:=~•a••

··=-==·=-=

=======

962 000 x:a11=•=u:c:.

277 000 ==••m••

TRUST TERRITORY OF THE PACIFIC ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The Trust Territory of the Pacific Islands is being organized into four self-governing areas: Commonwealth of the Northern Marianas, Republic of Palau, Federated States of Micronesia and Republic of the Marshall Islands. The WHO programme budget will be distributed to these entities during the detailed programming phase of the 1984-85 budget cycle. 2. The major aim, stated in national development policies, is to achieve a more equal distribution of· economic benefits, including levels of income for the people and of service in different areas of the country. This will involve the decentralization of economic activity, planning and government spending, with emphasis on agricultural development, village industry, better internal trade and more spending channelled to local and area bodies. 3. National development policies related to health refer particularly to rural health and population growth. In rural health, emphasis is on expanding the basic services in various parts of the country, improving the referral system, improving staff training, integrating special programmes within a single general health service and developing a close relationship with nongovernmental health services in rural areas. Emphasis is also placed on promoting the principle of a self-reliant economy through containing the cost of the health services within the bounds of what the country and the people can afford. 4. With regard to population policy, particular attention is given to research in order to determine likely trends, to making the people aware of the results of rapid population growth, and to changing attitudes in order to limit family size. 5. With overall development policies and strategies forming the basis, the goal of national health development policies and strategies by the year 2000 is improvement of the health of all citizens. In particular: (1) (2) to reduce infant mortality in the rural areas to no higher than 25 per thousand and to increase life expectancy to at least 65 years; to improve the nutritional status so that third degree malnutrition in children is eliminated and the proportion of low birth-weight babies is reduced to 5 per cent. of the total number of live births; 325

326

(3) (4)

to provide clean water and sanitary conditions for all; to reduce the incidence of communicable diseases, primarily tuberculosis, diarrhoeal diseases, leprosy and acute respiratory infections. Diarrhoeal diseases will have an incidence rate of less than 60 per thousand, leprosy an incidence rate of less than 6 per hundred thousand, and the pneumonia and influenza mortality rate will not exceed 250 per hundred thousand in infants and 25 per hundred thousand in children aged 1 to 4 years; to reduce chronic diseases.

(5)

Priority will be given to rural areas, especially the less developed areas. 6. Achievement of the above-mentioned goals will be through: (1)

the development of community self-reliance and a partner relationship between the Government, the private sector and the community; the development of a health system which will provide integrated and equally distributed preventive and curative services to all citizens, through accessible hospitals, public health clinics and village dispensaries.

(2)

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 7. In the context of overall development policies and strategies and g1ven the ma1n thrust of health development efforts, WHO collaboration should aim at: (1)

the development of capability to organize and manage health systems based on primary health care, which will include the use of appropriate technology for primary health care, the training of health workers, and facilitation of intersectoral coordination to solve health problems and to improve the health of the people; the development and application of appropriate technology for the control of tuberculosis, leprosy and other communicable diseases of priority public health concern, including the diseases that can be controlled by immunization;

( 2)

(3)

the development of technology for the improvement of health, particularly in relation to nutrition, the environment and personal hygiene, with health education as an integral component; the development of management, levels; research and health information system capability at different

(4)

(5)

the orientation and strengthening of hospitals so that they can function as major centres support of the primary health care network, and provide specialist treatment services;

(6)

the promotion of relevant studies on cultural and traditional values and on traditional medical practices.

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.2 Managerial process for national health development

8. Methodology for applying the managerial processes for national health programme development will be further tested and permanent functional mechanisms established, ~.,rhich will include the training of national personnel. 2.4.0 Organization of health systems based on primary health care

9. Appropriate mechanisms will be developed for community involvement in health activities, which will include intersectoral cooperation. To improve primary health care activities, studies will be carried out in such areas as community involvement, the financing and operation of the health services, and traditional medicine. 2.5.0 Health manpower

10. With WHO collaboration, health manpower development planning and methodology will be improved. The training of health workers in public health and environmental health will be developed in relation to local resources. In view of the size of the population, it is not expected that advanced level education will be available within the country. Overseas training will therefore still be needed for all levels of health worker.

327

328

2.6.0

Public information and education for health

11. A main concern is to strengthen health education and information of the public and integrate them within priority health improvement programmes, particularly in relation to nutrition, the environment, personal hygiene, and the control of communicable and chronic diseases. 3.8.1 Nutrition

12. Nutrition policies will be formulated, as well as methods for integrating nutr1t1on within pr1mary health care activities. Training capabilities will be enhanced and research of national relevance undertaken. Breast-feeding will be promoted. 3.8.2 Oral health

13. WHO will cooperate in reviewing the oral health situation and 1n providing suitable training for auxiliary dental health personnel. 3.9.1 Maternal and child health, including family planning

14. The risk approach will be developed and its use applied to the maternal and child health/family planning programme in the context of primary health care. Capability for planning, implementing and mobilizing resources for the family planning programme will be strengthened. Activities will be seriously delayed if UNFPA support for the programme is not forthcoming.

3.10.2

Prevention and control of alcohol and drug abuse

15. Alcohol is a major social problem. WHO will collaborate by providing guidance 1n the planning and implementation of prevention programmes. 3.10.3 Prevention and treatment of mental and neurological disorders Cooperation will be sought

16. In some ethnic groups, the prevalence of neurological disorders is high. in identifying the disorders and in genetic counselling.

3.11.1

Community water supply and sanitation

17. Appropriate technology in community water supply and sanitation will be developed. Implementation of the community water supply and sanitation programme will be facilitated, including the capability of the community to maintain it.

3.11.2

Environmental health in rural and urban development and housing

18. WHO will cooperate in supporting local programme managers in the implementation of environmental health programmes in the major centres and outlying areas.

3.11.3

Control of environmental health hazards

19. The country's life is based on the sea. It is therefore important to control hazards resulting from pollutants. Technical collaboration 1s necessary to support the country's efforts in preventing pollution. 3.11.4 Food safety

20. Since tourism is one of the main economic resources, it is important that effective food control should be implemented. Collaboration will therefore be extended in relation to training programmes.

3.12.1

Clinical, laboratory and radiological technology for health systems based on primary health

care

21. Support in the development of clinical, laboratory and radiological technology is urgently needed to provide better diagnostic services. 4.13.16 Cardiovascular diseases

22. Because of increased life expectancy and the better control of communicable diseases, the prevention of cardiovascular diseases is becoming of increasing importance. WHO will cooperate in the preparation of a plan for a cardiovascular diseases control programme.

329

330

TRUST TERRITORY OF THE PACIFIC ISLANDS Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.3.0 Health Slstem Develoement 2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fiji 2.4.0 OrEanization of Health Slstems Based on Primarl Health Care 2.5.0 Health Maneower 2.6.0 Public Information and Education for Health 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral health 3.9.0 Protection and Promotion of the Health of SEecific Poeulation GrouEs 3.9.1 Maternal and child health, including family planning 19 000 19 000 15 500

6 000

( 6 000)

27 000

47 300 24 000 456 000 20 000

52 300 36 500 332 000 36 500

5 000 12 500 (124 000) 16 500

15 500 24 500

15 500 5 500

24 500

42 000

36 500

(42 000)

TRUST TERRITORY OF THE PACIFIC ISLANDS Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

us$

3.10.0 Protection and Promotion of Mental Health 3.10.2 Prevention and control of alcohol and drug abuse 3.10.3 Prevention and treatment of mental and neurological disorders 3.11.0 Promotion of Environmental Health

13 000

11 000

---

3.11.1 Community water supply and sanitation 3.11.2 Environmental health in rural and urban development and housing 3.11. 3 Control of environmental health hazards 3.11.4 Food safety 3. 12.0 Diagnostic 1 Theraeeut ic and Rehabilitative Technologl 3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care

19 500

24 000 6 500 8 000 8 000 22 000

24 000 6 500 22 000

24 000 6 500

14 000

13 000

39 000

26 000

331

332

TRUST TERRITORY OF THE PACIFIC ISLANDS Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 PosSlble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

4,13,0 Disease Prevention and Control 4.13.2 4 .13.8 Disease vector control Tuberculosis 6 000 3 000

6 000 3 000 13 000 13 000

( (

6 000) 3 000) 13 000

4.13.16 Cardiovascular diseases 4.13.17 Other noncommunicable disease prevention and control activities Total - TRUST TERRITORY OF THE PACIFIC ISLAND

3 000

( 3 000)

647 300

=======

672 300 ===::::cct:

====s:a:::

36 500

708 800

=======

25 000 .D:ICll::U::!:l:B=

TUVALU NATIONAL HEALTH DEVELOPMENT STRATEGY 1. Tuvalu's national development is guided by three (1) (2) (3) pr~mary

long-term goals:

development of a sense of national identity and commonness of purpose among all the people; strengthening and diversification self-reliance; and of the economy as a means towards achieving ultimate

improvement in the standard of life of the people to reasonable levels that will ensure secure, healthy and productive family life within the context of the traditional social system and the customs on all the islands.

2. The current national development plan, following the primary development goals, outlines, as an objective for the social sector, the expansion of health and education services consistent with the resources available and the needs of the country. The health services will take into account the needs of rural dwellers and also the need to contain population growth, both generally, and particularly for the central island of Funafuti. 3. Specific objectives in the field of health, within the broad outlines of the national development plan, are: to continue to develop and maintain preventive health services on all islands; to extend and improve the quality of the basic health services; to promote and strengthen activities relating to family planning and maternal MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 and child health.

The national development plan provides clear direction as to where to focus the limited resources to achieve the national objectives. Within the framework of these national guidelines, the role of WHO collaboration to achieve the health sector's "health for all" objectives will include involvement with the following strategies: 333

334

(1)

attention will be focused on the development of health services using the primary health care approach. The Island Councils have universally mentioned health as a priority area. The Government will encourage the Women's Committees to promote the concept of primary health care and the further development of the health services; ante-natal, natal and postnatal services and child health care will continue to be developed. Family planning services will be extended to provide greater coverage of eligible women; more attention will be paid to the control of diarrhoeal, intestinal and parasitic diseases and tuberculosis. Further efforts will be made to extend the immunization programme against childhood diseases, including measles; water and sanitation facilities on the outer islands will be further developed. The main focus of attention will be on maintaining the high coverage of facilities that has been achieved and expanding the scope of environmental health work; manpower development is especially concerned with nurses and medical assistants. Postgraduate training of nurses will be required in the fields of midwifery, public health, psychiatric nurs~ng and theatre work. Local tra~n~ng in pr~mary health care will be required for sanitation aides, maternal and child health aides, nurses and medical assistants.

(2) (3)

(4)

(5)

WHO SUPPORT FORESEEN FOR 1984-1985 2.4.0 Organization of health systems based on pr~mary

health care

5. The Women's Committees have a long history of providing vital services to the people. The Ministry of Social Services' primary health care approach is to promote the message of self-reliance in health through the Women's Committees, which will be encouraged to develop their own priority projects. The Ministry will provide whatever assistance the local committees identify as beyond their immediate capabilities. WHO will cooperate in some activities. 2.5.0 Health manpower The practice of sending a number of students Training will also be required in post-basic

6. The priority concern is the limited number of nurses. each year for training in basic nursing will be continued. nursing, in dentistry, and to develop medical assistants.

3.9.1

Maternal and child health, including family planning

7. Maternal and child health and family planning will receive increased attention through the creation of a public health unit. With support to be requested from UNFPA, the family health programme will emphasize improved nutrition. All areas of maternal and child health care technology will be upgraded through inservice training and improved supervision of activities on the outer islands. 3.11.1 Community water supply and sanitation

8. The basic sanitation project has nearly achieved its objective, which is to provide safe water and sanitation facilities to all island communities. Emphasis will now be placed on the maintenance of those facilities and the expansion of the environmental health programme into other primary health care areas. 4.13.4 Parasitic diseases

9. With the objective of developing appropriate control measures, a survey of the entire population of Tuvalu will be carried out to determine the seriousness of the intestinal parasite problem.

335

336

TUVALU Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Posst.ble extrabudgetar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

2.4.0

Organization of Health Systems Based on Primary Health Care Health Manpower Protection and Promotion of the Health of Specific Population Groups 3.9.1 Maternal and child health, including family planning 75 000 75 000

9 500

9 500 (14 000)

2.5.0 3,9.0

61 000

50 900

3.11.0 Promotion of Environmental Health 3.11.1 Community water supply and sanitation 4.13.0 Disease Prevention and Control 4.13.4 Parasitic diseases Total-~

5 900

2 000

2 500

2 500 75 000

2 500

....... 75 000

56 800

131 800

75 000

VANUATU NATIONAL HEALTH DEVELOPMENT STRATEGY 1. The major aim stated in national development policies is to achieve a more equal distribution of economic benefits, which will include equal levels of income for the people and equal levels of service in different areas of the country, as well as the decentralization of economic activity, planning and government spending, with emphasis on agricultural development, village industry, better internal trade and more spending channelled to local and area bodies. The status of women will be rapidly enhanced through the creation of opportunities for them to participate in all forms of economic and social activity.

2. National development policies related to health refer particularly to the development of integrated community health services. In rural health, emphasis is on equalizing and expanding the basic services in various parts of the country, as well as improving the referral system, improving staff training, and integrating special programmes within a single general health service in order to make primary health care and basic health services available to all Ni-Vanuatu by the year 2000. Emphasis is also placed on promoting the principle of a self-reliant economy, through the participation of local government councils, and by containing the cost of the health services within the bounds of what the country and the people can afford; for example, by limiting the construction of new major hospitals. 3. With regard to population policy, particular attention will be given to research to determine likely trends, to making the people aware of the results of rapid population growth, and to making available information and means of attaining family health, which will include family planning activities. 4. With overall development policies and strategies forming the basis, the goal of national health development policies and strategies by the year 2000 is to improve the health of all citizens. In particular: (1)

to reduce infant mortality in the rural areas throughout the country to no higher than 40 per thousand and to increase life expectancy to at least 60 years; to improve the nutritional status so that third degree malnutrition in children is eliminated and the proportion of low birth-weight babies is reduced to 5 per cent. of the total number of live births; to provide clean water to all, either 1n the home or within 5 minutes' walking distance, and adequate sanitation facilities; 337

(2)

(3)

338

(4)

to reduce the incidence of communicable diseases, primarily tuberculosis, diarrhoeal diseases, malaria, leprosy and acute respiratory infections. School entrants will have a less than 5 per cent. tuberculosis infection rate; diarrhoeal diseases an incidence rate of less than 200 per thousand; malaria a less than 10 per ten thousand annual parasite incidence rate; leprosy an incidence rate of less than 0. 5 per hundred thousand; and the pneumonia and influenza mortality rate will not exceed 100 per hundred thousand in infants, and 10 per hundred thousand for children aged 1 to 4 years; to reduce chronic diseases; to make available to all ni-Vanuatu including family planning advice. information and means for family health activities,

(5) (6)

Priority will be given to rural areas, especially the less developed areas. 5. The above-mentioned goals will be achieved through: (1)

the development of community self-reliance and Government, the private sector and the community;

partner

relationship

between

the

central

(2)

the development of a health system which will provide integrated and equally distributed preventive and curative services to all citizens, through hospitals, health centres and village health posts, within one hour's travel.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 6. In the context of the overall development policies and health development efforts, WHO cooperation should aim at: (1)

strategies

and given the main thrust of

(2)

the development and use of appropriate technology for the control of malaria, tuberculosis, leprosy and other communicable diseases of priority public health concern, including the diseases that can be controlled through immunization; the development of technology for the improvement of health, particularly in relation to nutrition, the environment and personal hygiene, with health education as an integral component; the development of management, levels; research and health information system capability at different

( 3)

(4)

(5)

the orientation and strengthening of hospitals so that they can function as major referral centres in support of the primary health care network, and provide specialist treatment services; the promotion of relevant studies on cultural and traditional values and on traditional medical practices.

(6)

WHO SUPPORT FORESEEN FOR 1984-1985 2.3.1 Health situation and trend assessment

7. With WHO cooperation, the existing health information system will be reviewed in order to identify priority areas for further development and strengthening in the context of primary health care. Procedures for the lay reporting of health information will be developed, which will include the training of health personnel. Indicators will be identified and established and procedures developed for the generation of relevant data. 2.3.2 Managerial process for national health development

8. Methodology for applying the managerial process for national health programme development will be further tested and permanent functional mechanisms established, which will include the training of national personnel. 2.3.3 Health systems research

9. Activities will be undertaken to develop a core group of staff from the Ministry of Health and other institutions to work together and to promote and support health systems research.

339

340

2.3.4

Health legislation them as

10. WHO will collaborate in reviewing the relevance of existing health laws and revising necessary according to new developments in priorities established by the Government.

2.4.0

Organization of health systems based on primary health care

11. Appropriate mechanisms will be developed for community involvement in health activities, including intersectoral cooperation. The health care delivery system will be restructured to provide the eight basic components of primary health care. The functions of hospitals will be reoriented so that they are the major referral centres. Studies to improve primary health care activities will be carried out in such areas as conununity involvement and the financing and operation of the health services. As well as cooperation from WHO, bilateral aid is expected to make a major contribution to the programme; also support from UNICEF to a lesser extent.

2.5.0

Health manpower

12. Health manpower development planning and methodology will be improved as will tra1n1ng methodology and curriculum development; and the training and development o f health manpower will be reoriented.

3.8.1

Nutrition

13. Cooperation will be extended 10 the formulation of nutrition policies, as well as methods for integrating nutrition within primary health care activities. Training capabilities will be enh'am::ed and research of national relevance undertaken. Breast-feeding will continue to be promoted. 3.8. 2 Oral health techniques and procedures in preventive

14. Policies for lowering the prevalence of dental car1es and periodontal disease will be formulated and developed. Approaches to learning and implementing current dentistry will also be developed.

3.9.1

Maternal and child health, including family planning

15. The risk approach will be developed and its use applied to the maternal and child health/family planning programme in the context of primary health care. Capability for planning, implementing and mobilizing resources for the family planning programme will be strengthened. As UNFPA is a major contributor to this programme, a c tivities will be seriously delayed if its support is not forthcoming. 3.11.1. Community water supply and sanitation 16. Appropriate technology in community water supply and sanitation will be developed. Implementation of the community water supply and sanitation programme will be facilitated, including the capability of the community to maintain it. As well as cooperation from WHO, bilateral aid is expected. 3.12.2 Essential drugs and vaccines

17. Procedures for quantification, procurement and the distribution and management of essential drugs and vaccines will be improved, to ensure regular supply at the primary health care level. 3.12.4 Traditional medicine

18. Traditional medicine policies will be developed and introduced within the context of primary health care. Studies will be carried out to determine the pharmacological values of different plants. r ..• 4.13.1 Immunization

19. Manuals for the immunization programme will be prepared in the context of primary health care. Training will be conducted at all levels, including training in the cold chain. The cold chain will be further improved and expanded, which will involve the necessary research. The programme will be · evaluated. All these activities will be undertaken in collaboration with UNICEF and the Save the Children Fund. 4.13.2 Disease vector control

20. Activities will be strengthened for the control of vector-transmitted diseases, mainly dengue fever and Ross River fever.

341

342

4.13.3

Malaria

21. Malaria control will be integrated with primary health care activities. Approaches for the involvement of the community in malaria control operations will be developed. The programme will be evaluated and policies formulated accordingly. 4.13.6 Diarrhoeal diseases

22. Community participation in diarrhoeal disease control will be enhanced through primary health care and policies formulated according to the results of studies to be carried out. 4.13.8 Tuberculosis procedures will be

23. With a contribution from extrabudgetary sources as well as WHO cooperation, developed and the community trained in tuberculosis case detection and treatment. 4.13.9 Leprosy

24. Training of community workers in the domiciliary treatment of leprosy will be developed with WHO cooperation. Extrabudgetary support is also expected to continue. 4.13.11 Sexually transmitted diseases

25. Surveys will be carried out in order to evaluate the risk of sexually transmitted diseases being introduced as a result of increasing incidence in neighbouring countries.

1982-1983 1984-1985 Total US$ Regular budget US$ Poss1.ble extrabudge tar sources Source of funds US$ Total US$

VANUATU Progralllllle Regular budget US$

Increase/ (Decrease) Regular budget US$

Extrabudgetary sources Source of funds US$

2.3.0 Health Sl:stem Development 2.3.1 Health situation and trend assessment 2.3.2 Hanagerial process for national health development Share of cost of WHO Programme Coordinator's Office, located in Suva, Fiji 2.3.3 Health systems research 2.3.4 Health legislation 2.4.0 of Health Sls terns Based on Primarl Health Care Or~anization

124 000

30 000

(94 000)

45 000

94 600

104 800 10 000

104 800 10 000 13 000

10 200 10 000 ( 2 000)

15 000

13 000

154 000 273 000

190 000 118 000

36 000 055 000)

2.5.0 Health Haneower 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral health 3.9.0 Protection and Promotion of the Health of Seecific Poeulation Groues 3.9 .1 Haternal and child health, including family planning

15 000 15 000

99 000

60 000

400 000

460 000

60 000

343

344

VANUATU Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Poss1ble extrabudge tar sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

3 .11.0 Promotion of Environmental Health 3.11.1 3.12.0 Community water supply and sanitation

60 000

Dia~nostic 1 Theraeeutic and Rehabilitative Technolo~l

3.12.2 3.12.4

Essential drugs and vaccine Traditional medicine

13 000 5 000

4.13.0 Disease Prevention and Control 4.13 .1 4.13.2 4.13.3 4.13.6 4 .13.8 4.13.9 Immunization Disease vector control Malaria Diarrhoeal diseases Tuberculosis Leprosy 134 000 134 000 15 000 6 500 180 000 5 000 6 500 6 500 6 500 794 600 =:a:::u::u=•=

15 000 6 500 180 000 5 000 6 500 6 500 6 500 400 000 a:c:mmca•

15 000 6 500 46 000 5 000 6 500 6 500 6 500 110 200 auuua•••

4.13.11 Sexually transmit ted diseases Total - VANUATU 99 000 =•==:au::a

893 600 ~:a:====·

904 800 :cs:.:n==•

1 304 800 a:=======a:t

VIET NAM NATIONAL HEALTH DEVELOPMENT STRATEGY 1.

The national health development policies of Viet Nam are based on the following principles: (1)

the State is responsible for the overall management of the health system; all citizens, without discrimination, enjoy free health protection measures and have access to free health care; prevention 1s the basis of health activities; the aim 1s to integrate traditional medicine and modern medicine.

(2) (3) (4)

2. The national health development strategy is oriented to the major goal of health for all by the year 2000. Emphasis has been placed on the strengthening and development of the basic health services network, especially in the southern part of the country and in the highlands where the ethnic minorities live. All medical services are provided free of charge, but health protection in the rural areas is financed directly by the community through the workers' agricultural cooperatives. 3. High priority is accorded to the training of various categories of health personnel, to the prevention of communicable diseases, and to the production of medicaments, vaccines and reagents using local material. 4. Traditional medicine act1v1t1es, the basic health services. including acupuncture, are integrated in primary health care and

5. The population policy emphasizes the need to reduce natural population growth by changing attitudes and developing family planning activities. 6. Improvement of the health status of the people will be achieved by the control of communicable diseases, improved environmental conditions and reduction of fertility. 7. Priority will be given to underserved and highly endemic areas.

345

346

8. The health system covering the whole of the country will be further developed to carry out activities necessary to achieve targets. The health system will be strengthened, starting at district and commune level. 9. Particular emphasis will be given to the further strengthening of self-reliance in the production of pharmaceuticals and biologicals, and the training of adequate numbers of health personnel. 10. To achieve the annual targets, medium- and long-term plans for health development will be formulated within the context of national development plans. Progress will be monitored using the evaluation process; indicators to measure effectiveness will be developed.

MAIN DIRECTIONS FOR WHO SUPPORT 1984-1989 11. WHO collaboration will aim at the following: (1)

the development of capability to organize and manage health systems based on primary health care; the reorientation and strengthening of district and provincial hospitals for support to the primary health care network; the strengthening of training activities for certain categories of health personnel, especially to meet the needs of primary health care; the development and use of appropriate technology for the control of malaria, tuberculosis, diarrhoeal diseases, trachoma, sexually transmitted diseases, leprosy, and other communicable diseases which primarily affect public health; the development of technology for improvement of the nutritional status, the environment and personal hygiene; the provision of technology to strengthen the production of drugs, vaccines and reagents and the control of their quality;

(2) (3) (4)

(5) (6)

(7) ( 8)

the provision of technology for family planning activities; the development of studies to improve health education activities with in the community and various population groups, especially the young; the development of management, and provincial level; research and health information system capability at national

(9) (10) (11)

the strengthening of national institutes for epidemiological and health serv1ces studies; the promotion of studies on traditional medical practices;

12. As executing agency WHO will also support the construction of certain health institutions. WHO SUPPORT FORESEEN FOR 1984-1985

13. To reach the stated goals, the Vietnamese people must first of all put their own resources and efforts to work. Considerable support wi 11, however, be required from WHO and other international agencies. 2.3.1 Health situation and trend assessment

14. The health statistics service is still weak. There is a shortage of systematically trained senior staff in this field, and working facilities are insufficient. With WHO support, the organization of training and refresher courses for senior health statisticians will therefore continue, in order to create a pool of qualified senior health statisticians for the entire country. 2.4.0 Organization of health systems based on primary health care

the means for increasing the capacity of the communal health centres in treatment and consultation. It 1s planned that one complete polyclinic will be established for every group of 5 to 10 communes in the rural areas. WHO will cooperate in strengthening the activities of the polyclinics.

15. The polyclinics are

347

348

2.5.0

Health manpower

16. In order to keep pace with the latest technical developments and to acquire knowledge of the experience of friendly countries, senior personnel will be sent on study tours and specialized courses organized by WHO, in addition to the training and refresher courses provided for senior personnel within the country. 17. To increase the number and improve the quality of senior health personnel, an endeavour will be made to improve the standards of existing faculties and colleges. At the same time, new training institutions for senior personnel will be opened. This will require support from WHO. 18. The following institutions will be established during the biennium 1984-85: a college of medicine in Sonla (a province of the north-eastern mountain region); a faculty of medicine in Can Tho, Hau Giang (a province in the central Mekong Delta); a college of traditional medicine in Tue Tinh. 2.6.0 Public information and education for health

19. Emphasis will be placed on the propagation of health education in the community through the national radio and television networks. WHO will cooperate in augmenting the working capacity of the Medical Information Institute and Library and the Medical Publishing House. 3.8.1 Nutrition

20. The major objectives of the newly established National Institute of Nutrition include establishment of a national nutritional surveillance system, the definition of local standards for a normal population, and the development of nutrition activities as part of a new wider approach for maternal and child health, involving provincial, district and commune health and creche services. WHO will continue its collaboration in surveillance of the nutritional status and, with UNICEF, will support training and other activities.

3.8.2

Oral health

21. Maxillofacial stomatology is not yet sufficiently developed to meet requirements. In order to solve this problem, the National Institute of Maxillofacial Stomatology was established in Ho Chi Minh City in 1981 and a regional institute will be set up in Hanoi. WHO support will be provided for strengthening research activities at the Institute with a view to improving the prevention and treatment of oral diseases. Support will also be extended to some maxillofacial stomatology pilot services in certain provinces. 3.8.3 Accident prevention

22. The three emergency centres in the major cities of Hanoi, Haiphong and Ho Chi Minh City lack the proper facilities and equipment for emergency -care, though the centre in Ho Chi Minh City is relatively better equipped. WHO will continue to cooperate in strengthening the centres in Hanoi and Haiphong. 3.9.1 Maternal and child health, including family planning

23. The population growth rate remains high at 22.3 per thousand in 1980. The Government plan provides for a reduction to 17 per thousand in 1985. In recent years, international organizations such as UNFPA, the International Planned Parenthood Federation and the Swedish International Development Authority have supplied contraceptives, dtugs and information, and educational materials. Under its 1983-1986 programme, UNFPA intends to support Viet Nam in setting up condom and intrauterine device production facilities. WHO will provide the necessary documentation, magazines and journals on family planning and technical cooperation in conjunction with UNFPA and the International Planned Parenthood Federation. 3.10.3 Prevention and treatment of mental and neurological disorders diseases.

24. WHO will cooperate in a study of appropriate methods of prevention and treatment of mental 3.11.1 Community water supply and sanitation

25. With support from UNICEF, WHO cooperation will relate to the health aspects of increasing the number of districts with good water supply and sanitation.

349

350

3.11.4

Food safety laboratory for food control at the National

26. WHO will continue to cooperate in activities of the Institute of Nutrition.

3.12.1

Clinical, laboratory and radiological technology for health systems based on pr1mary health

care

27. To improve the standards of the polyclinics, the programme for the development of a laboratory system for the polyclinics and the peripheral laboratories in a number of districts will be continued. To make the polyclinics more effective, an intercommunal laboratory will provide for examinations and specialized diagnostical facilities. WHO cooperation will serve to widen the coverage.

3.12.2

Essential drugs and vaccines

28. Although the primary health care network is well established, there is still a shortage of essential drugs and vaccines. The present policy is to promote self-reliance in the production of drugs from local resources, especially plants used in traditional medicine. WHO will cooperate in providing the raw materials, not locally available, for the production of some essential drugs and vaccines.

3.12.3

Drug and vaccine quality, safety and efficacy

29. At present, there is a control post in each province responsible for checking the quality of the standard drugs produced and used. The majority of these posts are already provided with the necessary staff and facilities. WHO will cooperate in rendering them operational. 30. The conservation of drugs, chemical products and vaccines poses special problems. As a result of financial and material constraints and lack of experience, it has not been possible to construct suitable storage facilities. WHO will cooperate in establishing such facilities.

3.12.4

Traditional medicine

31. The integration of traditional medicine with modern medicine is one of the four policies established Traditional medicine activities, including by the Government for national health development. acupuncture, are already integrated in primary health care and the basic health services. In the past, WHO has extended cooperation to the National Institute of Traditional Medicine, Hanoi in strengthening its laboratory facilities. It will, similarly, cooperate with the Institute of Traditional Medicine, Ho Chi Minh City. 4.13.1 Immunization

32. In collaboration with WHO, UNICEF has provided support in vaccine production and control (DPT and BCG) and in general immunization services. WHO and UNICEF will now cooperate in extending the range of the cold chain facilities and training technical staff in research and evaluation activities, and 1n developing educational materials and health education programmes. 4.13.2 Disease vector control

33. WHO will cooperate by providing certain insecticides for the control of epidemics, particularly in relation to haemorrhagic fever. 4.13.6 Diarrhoeal diseases

34. WHO will continue, with UNICEF, to cooperate in the training of national staff. 4.13.14 Blindness

35. The trachoma rate is very high, about 40 per cent. of the population being affected in certain areas. The objective is to reduce the rate to 30 per cent. by 1985 and to eradicate entropion in one third of the districts throughout the country.

351

352

VIET NAM Programme Regular budget US$

1982-1983

1984-1985

Extrabudgetary sources Source of funds US$ Total US$

Regular budget US$

Possible extrabudge tar sources Source of funds US$

Increase/ (Decrease) Total US$ Regular budget US$

2.3.0 Health

S~stem Develo~ent

2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development

000

50 000

Costs of WHO Programme Coordinator's Office, Hanoi, Viet Nam 2.4.0 Orjiianization of Health S~stems Based on Primar::z: Health Care 2.5 .0 Health Man£OWer 2.6.0 Public Information and Education for Health 3.8.0 General Health Protection and Promotion 3.8.1 Nutrition 3.8.2 Oral health 3.8.3 Accident p revention

333 600

276 400

(57 200)

57S 000 1 100 000 2S 000

13 100

VK VD

588 100 3 583 400 2S 000

600 000 700 000 50 000

600 000 700 000

25 000 (400 000) 25 000

2 483 400

000

175 000

5 000 400 000 60 000

(170 000) 400 000 60 000

VIET NAM ProgratmUe Regular budget US$ 3.9.0 Protection and Promotion of the Health of Seecific Poeulation Groues 3.9.1 Maternal and child health, including family planning Workers' health

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudge tar sources Source of funds us$ Total US$

Increase/ (Decrease) Regular budget US$

38 500

38 500 50 000 (50 000)

3.9.3

000

3.10 .o Protection and Promotion of Mental Health 3.10 .1 Psychosocial factors in the promotion of health and human development 3.10.2 Prevention and control of alcohol and drug abuse 3.10.3 Prevention and treatment of mental and neurological disorders 3 .11.0 Promotion of Environmental Health 3 .11.1 Connnunity water supply and sanitation 3.11.3 Control of environmental health hazards 3.11.4 Food safet y

35 000

(35 000)

35 000

(35 000)

30 000

50 000

20 000

70 000 100 000 30 000

15 000

(55 000) (100 000)

15 000

(15 000)

353

354

VIET NAM Progranune Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Tot a 1 US$ Regular budget

1984-1985 Possible extrabudgetar sources Source of funds Total US$

Increase/ (Decrease) Regular budget US$

us$

uS$

3.12.0 Dia!i!nostic, TheraEeutic, and Rehabilitative Techno log~ 3.12. 1 Clinical, laboratory and radiological technology for health systems based on primary health care 3.12. 2 Essential drugs and vaccines 3.12.1 Drug and vaccine quality, safety and efficacy 3.12.4 Traditional medicine 3.12.5 Rehabilitation 4.13.0 Disease Prevention and Control 4.13.1 Inununization 4.13.2 Disease vector control 4.13.3 Malaria 4.13.4 Parasitic diseases 4.13.6 Diarrhoeal diseases 4.13.7 Acute respiratory infections 20 000 10 000 20 000 10 000 5 000 3 300 5 000 5 000 3 300 200 000 200 000 200 000 200 000 200 000 200 000 200 000 (20 000) (10 000)

50 000 100 000

29 800

79 800 100 000

400 000 315 000

350 000 215 000

125 000 50 000 50 000

68 900

19 3 900 50 000 10 000

180 000 80 000

55 000 30 000 (50 000)

5 000 3 300

VIET NAM Programme Regular budget US$

1982-1983

1984-1985

Increase/ (Decrease) Total US$ Regular budget US$

Extrabudgetary sources Source of funds US$ Total US$

Regular budget US$

Possible extrabudge tar sources Source of funds US$

4.13.9

Leprosy 41 700 70 000 3 333 600

96 200) 35 800) 4 100

vv ST

132 000 45 800 70 000 150 000 3 751 400 =====c=::c:::: •=:::t:u::s==~t:=

4.13.11 Sexually transmitted diseases 4.13.14 Blindness

(41 700) 150 000 3 751 400 ::m:=======a

80 000 417 800 ====::;:::::n:::

Total - VIET NAM ·1984-1985 CPF Costs of WPC Office

2 769 800 r:.=====uau:::

103 400

=========

:=::::=:.c:;;li::;=:===

3 475 000 276 400 3 751 400

355/356

ANNEX III INTERCOUNTRY PROGRAMME

INTERCOUNTRY PROGRAMME 1.2.0 WHO's general programme development and management Regional Director's development programme

1.2.2

1. As in previous years, the funds provided under this heading will be used for financing 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. 1.2.3 General programme development

2. The objectives, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 16 to 19. 3. The intercountry programme provides for a regional adviser in health information, a statistician, a computer systems analyst and supporting staff, to be responsible for ensuring that appropriate information system methodology, as well as modern data and text processing technology, are used to provide the necessary managerial information support for WHO's collaborative and coordinative activities. The training of WHO, and where appropriate national, staff will continue, in managerial processes and the relevant managerial skills, as well as in WHO's policies and strategies. 4. With support from UNDP, cooperation will be extended in increasing staff capabilities ~n planning, management and health systems research in order to upgrade the national health services of the South Pacific. It is anticipated that this will be done through a regional health development network composed of health departments and national and regional training and research institutions. 2.3.0 Health system development Health situation and trend assessment

2.3.1

5. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 24 to 26.

359

360

6. The intercountry programme provides for a team, consisting of an epidemiologist and an entomologist, to be stationed in the South Pacific to continue cooperation in strengthening national epidemiological and surveillance services. Among the team 1 s activities will be the improvement of standard teaching modules for use in national training courses; the development of a responsive mechanism for obtaining regular information with regard to disease incidence, mortality and morbidity and disseminating it throughout the Region; the improvement of data on known and suspected vectors of human disease; the improvement of laboratory practices; and the provision of cooperation 1.n the event of emergency situations resulting from outbreaks of communicable diseases. 7. For the development of national health information systems a problem oriented medical records (POMR) approach will be introduced and the principles underlying such an approach promoted. A regional inventory of epidemiological and nutritional surveillance systems will be established and a regional workshop will be organized on surveillance procedures. 2.3.2 Managerial process for national health development

8. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 27 to 29. 9. A programme manager and two technical officers will cooperate in developing national capabilities to achieve self-reliance in managerial processes for the formulation of national policies and strategies for "health for all". Such processes include broad programming, programme budgeting, detailed programming, implementation, and the monitoring and evaluation of health development at all levels, in coordination with related sectors. This will involve training programmes covering all components of the managerial process for national health development and also the enhancement of operational research capability. Activities will be carried out in close coordination with those of the health systems research programme and also staff development and training. UNDP will provide some support to the programme. 2.3.3 Health systems research

10. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 30 to 32.

11. Closely coordinated with activities to enhance capability in the managerial process for national health development will be the cooperation provided for health systems research in priority areas, in order to introduce the modifications in existing health systems necessary for the achievement of "health for all". 2.4.0 Organization of health systems based on primary health care

12. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 35 to 37. 13. Two regional advisers in the organization of health systems, one regional adviser in nursing and consultants will provide cooperation under this programme. An intercountry team will support the development of health systems based on primary health care through training, the restructuring of curricula and research and development. Through such approaches, community organization and participation will be promoted and strengthened; community health problems and their socioeconomic bases will be identified; and community plans of action will be developed and implemented. Effective means of intra- and intersectoral coordination will be sought. Technical cooperation among developing countries will be promoted through networking mechanisms. UNDP will support these activities through two separate projects: one for Asia, which will also cover countries of the WHO South East Asia Region, and one for countries or areas of the South Pacific. 14. In order to develop national self-reliance in the planning, design, management and maintenance of health facilities for the delivery of primary health care, a technical officer will be available to collaborate in training and other activities for the repair and maintenance of equipment, with emphasis placed on on-the-job training. Cooperation will be provided in the planning and design of health facilities, for which it is also proposed to organize a workshop in 1984. 2.5.0 Health Manpower

15. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984~1985 appear on pages 38 to 42.

16. Two Regional Advisers will provide cooperation under this programme. Through consultants and group educational activities, training programmes for middle-level health personnel will be improved, as will programmes to train the potential trainers of primary health care workers. Supportive activities will aim at developing and testing processes, manuals and guidelines to integrate the planning, production and management of health personnel; facilitating intersectoral collaboration in health manpower development; achieving equitable distribution of health manpower within countries and its retention within the health. system; and monitoring the standards of performance of health workers. 361

362

17. At least ten participants from the Western Pacific Region will be supported to attend the Meeting of Directors or Representatives of Schools of Public Health, to be held in a country of the WHO Eastern Mediterranean Region in 1985. 18. The intercountry programme also provides for the development of faculty 1n health institutions and educational technology in nursing and midwifery. The latter will include continued support to the regional module bank up to 1985 by which time it is expected to have become financially viable through the sale of educational modules. 2.6.0 Public information and education for health

19. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 43 to 46. 20. A regional adviser in health education and human resource development will provide cooperation under this programme.

21. The intercountry programme will provide for strengthening research and training in health education. This will include the training of health workers at the periphery in health education and the community approach; the integration of health education and the behavioural sciences in the basic tra1n1ng of various other categories of health personnel, particularly nurses, health inspectors, village health workers and medical assistants; the promotion of a community-oriented, competency based training approach in programmes for the training of health education specialists; and the formulation of policies, programmes and curricula to introduce health education in primary and secondary schools and teacher training colleges. 22. A consultant will visit the countries of those who participated in the 1981 and 1983 workshops on information, education and communication in health, to see how the lessons learned have been applied by the media. 3.7.0 Research promotion and development

23. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programm8 activities for 1984-1985 appear on pages 47 to 49.

24. The intercountry programme provides for a programme manager to implement the programme recommended by the Western Pacific Advisory Committee on Medical Research (WPACMR) and endorsed by the Regional Committee, which will include meetings of WPACMR itself, its subcommittees or its scientific groups, training in research, and grants to individuals and to institutes to carry out specific research activities. 25. The Regional Centre for Research and Training in Tropical Diseases at the Institute for Medical Research, Kuala Lumpur will continue its biomedical research and training activities in order to ~mprove methods for control of the major communicable diseases, especially those of parasitic origin. 3.8.0 General health protection and promotion Nutrition

3.8.1

26. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 51 to 54. 27. The intercountry programme provides for a regional adviser in nutrition, together with a medical nutritionist and a consultant, to cooperate in the development of multisectoral food and nutrition policies and programmes, with emphasis on the integration of nutrition activities within programmes for the organization of health services based on primary health care. Support to national workshops will be one of the approaches used to involve large numbers of national staff from different sectors. 3.8.2 Oral health

28. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 55 to 57. 29. The intercountry programme provides for a dental officer to carry out activities to achieve the objectives of the programme. A seminar will be organized in 1984 in two different countries, for participants directly involved in managing oral health programmes. 3.8.3 Accident prevention

30. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 58 to 60.

363

364

31. The intercountry programme provides for cooperation in collecting and collating information on the incidence and severity of road traffic accidents, as well as the resources being utilized in national road safety progranunes; and for research into the human factors involved, particularly behavioural factors in high risk groups.

3.9.0

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

3.9.1

32. The objectives, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 62 to 65. 33. The intercountry programme provides for a regional adviser importance of the risk approach in maternal and child health is support in documenting country experience and research findings as dissemination of information. Risk factor studies, the design of on the risk approach strategy, and the organization of perinatal supported. in maternal and child health. The stressed and provision is made for a means of promoting the exchange and maternal and child health care based care at country level, will also be

34. It is anticipated that a request will be made to UNFPA to continue its support of the intercountry family health project, at present consisting of two medical officers and a health education specialist, to continue to cooperate in countries or areas where its services are needed, particularly in the field of maternal and child health/family planning. 3.9.4 Health of the elderly

35. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 69 to 71. 36. The intercountry programme provides for consultants to cooperate in the collection and processing of statistical data for the future planning and implementation of health services for the elderly; and 1n studying medical and nursing curricula in order to strengthen the teaching of gerontology and geriatrics. Research in an area of high priority will also be supported.

3.10.0

Protection and promotion of mental health Psychosocial factors in the promotion of health and human development

3.10.1

37. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 73 to 75. 38. The intercountry programme provides for a regional adviser in mental health, who will coordinate the cooperation extended to Member States in this and the two following programmes. 3.10.2 Prevention and control of alcohol and drug abuse

39. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 76 to 78. 40. The intercountry programme provides for cooperation in reviewing the current status of national programmes for the prevention and control of drug dependence and for control of the use of psychotropic drugs. 3.10.3 Prevention and treatment of mental and neurological disorders

41. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 79 to 81. 42. A working group will be organized in 1985 to advise the Regional Director on future programmes of cooperation in relation to neurological disorders, particularly mental retardation. The intercountry programme also provides for: (1) research on schizophrenia, depression and psychogenic reactions, and (2) collaborative studies on the basic resources available to the mental health services, as well as the supporting family structure; on the development of psychiatric treatment, such as psychotherapy and community mental health care; and on child mental health. 3.11.0 Promotion of environmental health Community water supply and sanitation

3.11.1

43. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 83 to 85. 365

366 44. The intercountry programme provides for two regional advisers in environmental health. In addition, an International Drinking-Water Supply and Sanitation Decade "coordinator" and consultants will provide cooperation in the promotion, development and implementation of basic sanitary measures which will contribute to the control of water-related diseases, the improvement of sanitary conditions and the reduction of nuisances. UNDP will support Decade activities. A workshop will be convened in 1986 to discuss implementation half way through the Decade. 3.11.2 Environmental health in rural and urban development and housin&

45. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 86 to 88. 46. The Western Pacific Regional Centre for the Promotion of Environmental Planning and Appl~ed Studies (PEPAS) will cooperate in activities for: the development of national environmental policies and planning capabilities; the education and training of environmental manpower; the exchange of environmental information oriented to human health anci well-being; and the identification and adaptation of appropriate technology in the field of environmental health and engineering. These activities will aim at the facilitation of collaboration between the institutions and personnel of Member States within the Region and the development of self-reliance. Workshops on environmental planning will be organized in 1984 and 1985. 3.12.0 Diagnostic, therapeutic and rehabilitative technology. Clinical, laboratory and radiological technology for health systems based on primary health care

3.12.1

47. The objectives, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 95 to 98. 48. The intercountry programme provides for a medical officer to cooperate in promoting the development of national health laboratory services and standard health laboratory technology, as well as consultants to train national staff in the standardization of laboratory procedures. Research to solve local problems will also be supported.

3.12.2

Essential drugs and vaccines

49. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 99 to 101. 50. A scientist and consultants will cooperate in the formulation of national drug policies for the production, procurement, distribution, quality assurance, and storage of drugs, vaccines and biological products; the selection of essential drugs and revision of national essential drug lists; training activities; information exchange; and the coordination of technical cooperation among the developing countries of the Region. UNDP will provide support under the general heading of drug policies and management, and also to cooperative activities between the countries of the Association of South-East Asian Nations. 3.12.3 Drug and vaccine quality, safety and efficacy

51. The objective, targ2ts and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 102 to 104. 52. A small pro'r~s~on under the intercountry programme is intended as seed money to encourage extrabudgetary sources of funding to support activities which aim at fostering national or sub-regional capability in quality assurance and the evaluation of drugs, vaccines and biological products. 3.12.4 Traditional medicine

53. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 105 to 107. 54. The United Nations Development Programme will support activities to increase the use of traditional medicine in primary health care, particularly in rural areas; to train primary health care workers and traditional healers in order to improve their knowledge in relation to ethics and the safety of traditional methods and remedies; to standardize herbal preparations and formulae; to strengthen operational research in recognized traditional medicine institutes for the production of safe pharmacologically active herbal remedies; and to promote the exchange of information. 4.13.0 Disease prevention and control Immunization

4.13.1

55. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 112 to 115. 367

368 56. The intercountry progranrrne provides for a team, consisting of a medical officer and three field development officers, which, in addition to activities related to diarrhoeal diseases control, will cooperate 1n national immunization programmes, with the following aims: reducing mortality and morbidity from tuberculosis, pertussis, diphtheria, tetanus, measles and poliomyelitis by providing immunization against them for every child in the Region by 1990; promoting national self-reliance in the delivery of immunization within the context of the comprehensive health services; promoting regional self-reliance in terms of vaccine production and quality control; and developing and producing, with cooperation from a cold chain officer, the refrigeration equipment needed to store and transport vaccine. Operational research activities will also be supported. 4.13.2 Disease vector control

57. TI1e objective, targets and plan of action of the medium-term programme for 1984-1989 and progranrrne activities for 1984-1985 appear on pages 116 to 118. 58. The intercountry programme provides for an surveillance, control and training activities. entomologist and consultants to cooperate in vector

59. With support from UNDP, equipment and insecticides for use in the event of outbreaks of arboviral diseases will be kept available for countries or areas of the Pacific. 4.13.3 Malaria

60. The objective, targets and plan of action of the medium-term programme for 1984-1989 and progranrrne activities for 1984-1985 appear on pages 119 to 122. 61. The intercountry programme provides for a regional adviser in malaria; for the continuation of the antimalaria team, stationed in Kuala Lumpur, which will cooperate with governments in the prevention and control of malaria, including training and research activities; and for training of malaria workers to increase their technical competence and to introduce new approaches through primary health care. 4.13.4 Parasitic diseases

62. The objective, targets and plan of action of the medium-term programme for 1984-1989 and progranrrne activities for 1984-1985 appear on pages 123 to 124.

63. The intercountry programme provides for a parasitologist and consultants who will cooperate in strengthening operations for the control of parasitic diseases through the use of appropriate technology. 4.13.6 Diarrhoeal diseases

64. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 125 to 127. 65. A team, consisting of a medical officer and three field development officers will in addition to activities related to the immunization programme, cooperate in reducing mortality and malnutrition related to diarrhoea, particularly in children under five years of age. 4.13.7 Acute respiratory infections

66. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 128 to 130. 67. The intercountry programme provides for an epidemiologist and consultants to cooperate 1n establishing national acute respiratory infection programmes and coordinating research activities. It is planned that a third meeting of the principal investigators participating in such activities will take place in Beijing in 1984. Research and research training will be supported. 4.13.8 Tuberculosis

68. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 131 to 133. 69. The intercountry programme provides for the continuation of a regional tuberculosis control team, consultants in the production of BCG vaccine, and the Regional Tuberculosis Course held annually in Tokyo. 4.13.9 Leprosy

70. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 134 to 136. 71. The intercountry programme provides for a medical officer effective leprosy control programmes, throughout the Region but to cooperate in the development of mainly in the South Pacific; the

369

370 training of health workers of various categories and at various education activities directed at patients, health workers and operational research activities. levels; the promotion of health the general population; and 1n

4.13.10

Zoonoses

72. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 137 to 138. intercountry programme provides for consultants in the care and management of laboratory animals, rabies control, and the surveillance and control of plague, as well as support for research into zoonoses and infections or intoxications of animal origin.

73. The

4.13.13

Other communicable disease prevention and control activities

74. The objective, target and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 142 to 143. Two regional advisers in communicable diseases and one in chronic diseases will cooperate in activities related to the entire disease prevention and control programme. 75. New activities in communicable disease control will relate to bacterial, viral and mycotic diseases not covered under other programme headings; such as yaws, dengue fever/ dengue haemorrhagic fever, and viral hepatitis. Consultants will provide cooperation and research activities will be supported. 4.13.14 Blindness

76. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 144 to 146. 77. The intercountry programme provides for consultant ophthalmologists to assess the magnitude and nature of blindness in countries of the Region, including its aetiology; and to train health workers in primary eye care. 4.13.15 Cancer

78. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 147 to 149.

79. A regional training course on cancer epidemiology and which each participant should have prepared a protocol for of most importance in his country, or for a community intercountry programme provides for consultants to cooperate 4.13.16 Cardiovascular diseases

control is planned for 1985, at the end of an epidemiological study of the cancer site cancer control project. In addition, the in cancer control and research activities.

80. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 150 to 152. 81. A medical officer will cooperate ~n national programmes for the prevention and control of cardiovascular diseases. A training course, ~n 1984, will prepare participants to understand the epidemiology of cardiovascular diseases and means for community-based control; to apply statistical methods to the epidemiological surveillance of cardiovascular diseases; to acquire the skills necessary to prepare protocols for epidemiological studies; and to develop cardiovascular disease prevention and control programmes. Operational research will also be supported. 4.13.17 Other noncommunicable disease prevention and control activities

82. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 153 to 155. 83. The intercountry programme provides for consultants to cooperate in activities for the reduction of morbidity due to metabolic diseases, particularly diabetes mellitus and gout. 5.14.0 Health information support

84. The objective, targets and plan of action of the medium-term programme for 1984-1989 and programme activities for 1984-1985 appear on pages 156 to 157. 85. Consultants will be provided, under the intercountry programme, to cooperate in training at national In 1985, a workshop will be organized ~n relation to level in library services and management. biomedical information systems development.

371

37 2

INTERCOUNTRY PROGRAMME Progrannne Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget

1<184-1985 Possible extrabudgetary sources Source of funds

Increase/ (Decrease) Total Regular budget US$

us$

uS$

us$

1.2.0 WHO's General Pro~ramme Develoement and Mana~ement 1. 2. 2 Regional Director's

development programme 1. 2. 3 General programme

775 300 790 liOO 163 000

775 300

922 500 866 100 200 000 DP

922 ')00 1 066 100

14 7 200 7) 500

development 2.3.0 Health S~stem

953 600

Develoement 753 200 69 000

I VI 822 200 282 800 282 800 (470 400)

2.3.1 Health situation and trend assessment 2.3.2 Managerial process for national health development 2.3.3 He a 1 th sys terns research 2. 3.4 Health legislation 2.4.0 of Health Slstems Based on Primar~ Health Care Or~anization

525 800 160 800

90 000 57 000) 142 300) 9 200

DP VD ST FB

615 800 360 100 9 200

631 liOO 68 000

60 000

6<11 600 68 000

105 800 (92 800)

1 663 200

611 300 204 500 40 000 ll~O

DP ST AS ST VD VD ST

2 519 000

1 588 900

953 000

2 541 900

(74 300)

2.5.0 Health Manoower 2.6.0 Public Information and Education for Health 3.7.0 Research Promotion and Develofllllent

1 054 300

600 38 400 37 200

1 233 300

126 500

1 126 500

72 200

332 600 885 600

369 800 996 600

293 100 838 900

( 39 500) (46 700)

111 000

INTERCOUNTRY PROGRAMME Progrannne Regular budget US$ 3.8.0 General He a 1 th Protection and Promotion 3. 8.1 3.8.2 3.8.3 3.9.0 Nutrition Ora 1 he a 1th Accident prevention 403 800 254 600 12 000

198?-1983 Extrahu<igetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds Total US$

Increase/ (Decrease) Regular budget US$

us$

8 900

412 700 254 600 32 000

38il 100 224 000 56 000

388 100 224 000

(15 700) (30 600) 24 000

56 000

Protection and Promotion of the Health of seecific Poeulation Groues 3.9.1 Maternal and chi lei health, including family planning Workers' health Health of the elderly

I 129 800 10 000 23 000 ST 81i2 900 60 900

FP AS

1 O'i3 600 10 000 23 000

205 100

75 300

3.9.3 3.9.4

(10 000) 56 000 56 000 56 000

3.10.0 Protection and Promotion of Mental Health 3.10.1 Psychosocial factors in the promotion of health and human development 3.10.2 Prevention and control of alcohol and drug abuse 3.10.3 Prevention and treatment of mental and neurological disorders

129 800

188 100

58 300

28 000

42 900

70 900

13 000

05 000)

63 500

62 400

( 1 100)

373

374

INTERCOUNTRY PROGRAMME Programme Regular budget US$ 3.11.0 Promotion of Environmental Health

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetarv sources Source of funds US$ Tot a 1 US$

Increase/ (Decrease) Regular budget US$

---

3.11.1 Community water supply and sanitation 3.11.2 Environmental health in rural and urban development and housing 3.11.4 Food safety , 3.12.0 Dia~nostic, Thera2eutic and Rehabilitative ~~

516 600

530 000

1 046 600

712 500

170 000

882 500

195 900

963 000 25 000 20 000 ST

<l63 000 '•5 000

1 431 800

468 800

I I

( 25 000) 1

3.12.1 Clinical, laboratory and radiological technology for health systems based on primary health care 3.12.2 Essential drugs and vaccines

141, 800 140 800 285 000) 240 000) 13 100)

144 800

210 500 229 500 583 800 DP

210 500 813 300

65 700 88 700

DP ST VD

678 900

3.12.3 Drug and vaccine quality, safety and efficacy 3.12.4 Traditional medicine 4.13.0 Disease Prevention and Control 4.13.1 Immunization 4.13.2 Disease vector control

15 000 180 000 DP

15 000 180 000

13 000 180 000 I)P

13 000

(

2 000)

180 000

363 800 196 800

36 100 5 300) 19 000)

vv ST DP

399 900 221 100

327 100 214 500 11 000 DP

327 100 225 500

( 36 700) 17 700

INTERCOUNTRY PROGRAMME Programme Regular budget US$

1982-1983 Extrabudgetary sources Source of funds US$ Total US$ Regular budget US$

1984-1985 Possible extrabudgetary sources Source of funds US$ Total

Increase I (Decrease) Regular budget US$

US$

4.13.3 Malaria 4.13.4 Parasitic diseases 4.13.6 Diarrhoeal diseases

828 600 230 800 150 800

272 500 103 300 23 400) 201 500) 30 200) 172 ~00

DP ST ST

1 101 100 334 100 405 900

874 100 211 000 263 700

45 500 (19 800) 112 900

vc FB ST ST ST VL ST ST 505 000 553 500 5.52 000 20 000 12 000 I I

4.13. 7 Acute respiratory infections 4.13.8 Tuberculosis 4. 13.9 Leprosy 4.13.10 Zoonoses 4.13.11 Sexually transmitted diseases 4.13.13 Other communicable disease prevention and control activities 4.13.14 Blindness 4.13.15 Cancer 4.13.16 Cardiovascular diseases 4.13.17 Other noncommunicable disease prevention and control activities 5.14.0 Health Information SuEEort Tot a 1 - INTERCOUNTRY PROGRAMME

332 800 532 500 64 000

300 000 589 300 flS 600

300 000 589 300 85 600 18 000

(32 800) 56 800 21 600 18 000

21 000 434 500 53 500 20 000

18 000

10 000

2 000

oo ooo)

189 400

11 400 209 400 194 700

ST VD ST I

610 200 194 700 46 000 I

r,s7 300 13 000 137 500 275 900

657 300 13 000 117 500 275 900

267 900 13 000 91 500 95 900

46 000 180 000

180 000

35 000 10 000 13 168 600

10 000

45 000 10 000

13 000 94 600 14 4B3 000

13 000 94 600 2 157 800 16 640 800

(22 000) 84 600 1 314 400 =a•==••aa

··========

5 800 200 m========

18 968 800

==========

=========·

=========

==========

375

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1982

Source Organisation mondiale de la santé