..J
WORLD HEALTH ORGANIZA nON
... REGIONAL COMMITTEE Thirty-second session Seoul 22-28 September 1981
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RtGIONAL OU PACIFIOUE OCCIDENTAL
•
ORGANISATION MONDIALE De lASANTE
WPR/RC32/INF.DOC./1 8 September 1981
ORIGINAL:
ENGLISH
THE MANAGERIAL PROCESS FOR WHO I S PROGRAMME DEVELOPMENT (Document MPWPD/81.1)
may wish to provide the Secretariat present at the fhif~X~ session of the Regional Conunittee with their couunents on thE; f:tft:~~l)~4 qpcument, either verbally orin writing .. s~cond
~presentat1ves
WORLD HEALTH ORGANIZATION ORGANISA nON MONDIALE DE LA SANTE
HPWPD/I:ll.l
27 July 198 L
ORIGINAL;
ENGLl~H
THE MANAGERIAL PROCESS FOR WHO'S PROGRAMME DEVELOPMENT
This erocess
document
1S
a
succinct
account It
of has
the
managerlal prepared
for WHO's
programme deve topment.
been
to provide information on this process to government representatives at regional committees, delegates to the World 8S
Health to
Assembly,
and to members of
the Executive Board, its applicat1011. of the The
well as
guide WHO staff members on cribes the various of and the
document process -
del:lthe
components general
managerial of work;
preparation programmes
prograllunes the
medium-term moni-
progrannne
budgets;
implementation,
toring and evaluation of programmes; and the related information support and demonstrates the links between these components. In a also
It emphasizes the use of all well coordinated and
the components of the process supportive manner. It
mutually
stresses the importance ot developIng WHO's programmes on information resulting from the managerial process for national health develQ,pment
MPP/HQ
MPWPD/81.1 page 2
CONTENTS Page Paragraphs
1.
INTRODUCTION • • • • • • • • • • • • • • • • • • • • • • • . EXECUTIVE SUMMARY DESCRIPTION OF THE PROCESS • POLICY FORMULATION GENERAL PROGlUUiME OF WORK COVERING A SPECIFIC PERIOD •• MEDIUM-TERM PROGRAMMING • PROGRAMME BUDGETING • • MANAGEMENT OF OPERATIONS (IMPLEMENTATION) EVALUATION INFORMATION SUPPORT •
3
1-5 6-12 13-77 13-18
;0.
II.
5 6
III.
6 8 10 13 17
19-24 25-34 35-49 50-50 57-64 05-77
19 21 25
IV.
MECHANISMS FOR CARRYING OUT THE PRUCESS
78-86
ANNEXES ANNEX 1. EXAMPL&.OF THE APPLICATION OF THE WHO MANAGERIAL PROCESS: DEVELOP~lliNT OF THE ORAL HEALTH PROGRAMME • • • • . • . GLOSSARY OF TERMS USED IN THE MANAGEkIAL PROCESS FOR WHO'S PROGRAMME DEVELOPMENT .
29
ANNEX 2.
50
MPWPIJ/!H • 1 page j
I.
INTRODUCTION
1
Under its Constitution, WHO acts "as ttle directing and coordi2 nating authority on international health work". It thus has the responsibility to formulate international health policies that, on the one hand, will promote higher levels of health in all countries, and, on the other hand, will determine WHO's programme of work in support of Member States.
1.
2.
Ideally, WHO's programme represents a response to ttle neeas or
Member Scates as identified in their national strategles for health for all with the help of their natlonal health development process. What is essential with respect to the managerial process tor WHO's progranune development, is that the goals expressed in the national strategies and plans of action and the specific produc~s
oi the
managerial process for national health development .become the substantive bases for WHO progranunes. Thus, the managerial process for
WHO's progranune development is based on information resulting from the manager1al process for national health development, and 1t should operate in close harmony with the development ot natlonal health programmes.
3
3.
Tne process required to manage WHO's programme development
shares similar principles and approaches with the managerlal process utilized at the country level tor national health development. The
individual components of these processes call for aaapted ways of implementation.
A number of terms used in this document may be unfamiliar to the reader or may have a special slgnlficance in the contexc ot WHO's programme development. To aSS1Sl the reader, a "Glossary of terms" 1S provided In Annex 1.. A more complete glossary ot WHO terminology covering varlOUS aspects of the Orgarllzation's actlvltles wlll be issued shortly. 1. ConstLtution ot WHO, Article 2(a), Haslc Documents, Tillrty-tll:st cdillOll, Geneva, 19H1, page 2.
J "Managerial Process [or National Hf'allil [)evel()~)mt'n(, CULdLlll:, Princlples Lll Support or Stra[(~gies tor Hea 1 til tor All by [tIe Year lUUU" ~ lO be publlstled 111 Lile "Health for All" Series, Nu. ')}.
, MPWPD/8l.1 page 4
4.
Recog01z10g that an appropr1ate maoager1al process 15 necessary
10 order to respond adequately to the needs of Member States, toe Thirty-first World Health Assembly requested the j)lrector-General "to ensure that managerial methods for health development are deV1sed and applied by WHO in an integrateo manneL" 1
SpeCl.i1Caily,
the Director-General was asked "to cont1nue to develop in an 1ntegrated manner the Organu~ation'
s processes tor meo1um-term program-
m1ng, programme budgeting, health programme evaluat10n and the provision of adequate information support". Together witn the
policy decisions of the World Health Assembly, the genera! programmes of work, and the implementation of the Programme, these processes cover all aspects ot WHO's international health work. and in this document they are referred to as "programme development".
5.
No managerial process can be any better than the people who This introduces the elusive human factor. The
carry it out.
successful implementation of the managerial process for WHO's programme development in accordance with the resolution ot t.he Worla Health Assembly is dependent on full ident1t1cation wlth, partlc1pdtion in, and a sense of responsiblity for the process by all wHO staff in all regions and at all organ1zational levels. W1tn th1s 1n
mind, this document is intended to describe the managerial process for WHO's programme development and ind1cate how its var10US components complement each other in a mutually supportive manner. lt
also describes t.he mechanisms necessary for carrY1ng out the process.
1 Resolution WHA31.43, Handbook of kesolut10ns and Decis10ns ot the Worid Health Assembly and the Executive Board, Vol. II, Fourth Edition, Geneva 19~1, page 25.
MPWPO/ Iii. 1 page 5
II.
EXECUTIVE SUMMARY
OUTLINE OF THE PROCESS
6.
The varlOus components of the managerial process are:
- policy formulation
- formulation of the general programme of work
- medium-term programming
- programme budgeting
- management of operations (implementation) - evaluation
-
- information support
7.
These components are briefly described below and discussed in Each of the above mentioned
more detail from paragraph 13 onwards.
components has its own charact~ristics, its own time-frame and lts oWn periodicity. tinuous process. Together and individually they constitute a con-
8.
The policies that govern programme development in WHO are
formulated by the Member States, acting collectively through the World Health Assembly and the regional committees, and by the Executive Board. These policies, which define the long-term strategies
of the Organization, thus reflect the needs and wishes of the Member States, as further discusseQ in paragraphs 13-18.
9.
The elaboration of the programme needed to give ettect
to the policies of the Organization proceeds ln three stages. First, a general programme of work covering a specific periOd (usually six years) is drawn up, as described in paragraphs l~-24. This establishes the programme framework and Ldentifies broad obJectives. Through a process known as medLum-term programming (see
paragraphs 25-34), a more detailed programme is then developed,
MPWPD/81.1 page 6
setting out specific targets, approaches, ana activities for each programme area during the six-year period. graphs 35-49). Finally, this mediumterm programme is translated into biennial programme budgets (see para-
10.
Once a programme budget has been approved by the World Health The Monitoring of
Assembly, the programme is ready to become operational. Member States at country, regional and global levels. graphs 50-56). 11.
implementation phase is also conducted in close collaboration with implementation is an essential feature of this pbase (see para-
WHO's Programme, as well as the entlre programme development
process, must be subjected to contlnuous evaluation (see paragraphs
57-b4), with the ultimate purpose of ensuring that the relevant policies of the Organization are being followed and that the programme is being carried out efficiently and effectively. Evaluation enables the experience gained with the current programme of work to be used to reorient policies and progr ..... in responae to
-
the evolving world health situation and is thus an integral part of the programme development process.
12.
At each of the stages of the process outlined above, informaWHO's informatlon sy.tem (see parainfo~tion
tion 1S needed and generated.
graphs 65-77) collects. stores, and supplies
on the
world health situation, national and WHO progra-.e., the availability of resources, and other relevant questions.
III.
DESCRIPTION OF THE PROCESS
.. SOURCES OF POLlCY
POLICY FORMULATION 13. In addition to the Constitution of WHO, the main sources ot reg~onal
WHO pol1cles are the resolutions adopted collectively by the Member States in the World Health Assembly and, at the the six regional committees. level, in The maln functions of the Executlve
Board are to give effect to the policies and declsions of the Health Assembly and to act as its executive organ in the process of tranalating policies into programmes.
MPWPD/81.1 page 1
TOWARDS HEALTH FOR ALL BY THE YEAR 2000
14.
An important example of internationa 1 heal th policy
formulation by Member States acting collectively through the Health Assembly is the decision by all Members that "the main social target of governments and WHO in the com~ng
decades
should be the attainment by all citizens of the world by the year 2000 of a Level oL health that will permit them to leaa a socially and economically productive life" 1 The Health Assembly then
invLted Member States in turn to act individually in formulatLng national strategies and collectively Ln formulating regional and global strategies. Since then a large numDer of countries in all A global strategy
of WHO's regions have developed such strategies.
was prepared on the basis of these, and was approved by the Thlrty2 The Strategy desfourth World Health Assembly in May 1981. cribes the broad Lines of actLon to be undertaken at policy and operational levels, nationally and internationally, in the health and in other social and economLC sectors, to attaLn "healtn for all by the year 2000".
PRIMARY HEALTH CARE
15.
Furthermore, the Health Assembly, in endorSing the Declaration
of Alma-Ata, confirmed that the provision of primary healtn care is the key to attaining "health for a11".3 It follows, therefore,
that the programmes developed on the one hand by Member States and on the other hand by WHO in support ot Member States should be shaped around the primary health care concept. The Member States or
WHO have formulated their national health strategies, as well as the Global Strategy for Health for All, to wh1ch WHO must respond through the appropriate tramework of its general programmes ot work.
1 Resolution WHA30.43, Handbook of ResolutLons and Decisions of the World Health Assembly and the Executive Board. Vol. II. Fourth Edition, Geneva, 1981, page 1. 2 Global Strategy for Health for All by the Year 2000, ("Health for All" Series, No.3), Geneva, World Health Organization, 1981. 3 Alma-Ata 1978: Primary health care ("Health for All" Series, No.1), Geneva, World Health Organization, 1978.
MPWPD/81.1 page 8
aESPONSIBlLITlBS OF
16.
With the help of the Executive Board, the Health AssembLy is
responsible not only for the global policies and strategies of WHU and for the corresponding programmes, but also for ensuring that the Organization's directing, coordinating and technical functions are mutually supportive and that the work of the Organization at all levels is properly interrelated. I 11. The WHO regional committees are responsible for developing At the same time, they have to exer-
COMSTlTUTIONI.L .JODIES
..
regional health policies in support of national, regional and global strategies for health for all. cise their control so as to ensure that those policies are properly reflected in WHO's regional programmes and WHO's action in indivi. 1 d ual COuntries.
In the context of research, the Global Advisory
Committee on Medical Research and the Regional AdVisory Committees on Medical Research have a similar role to play. 18.
To carry out the above functions, the policy organs o'f WHO have
to be provided with pertinent information about the world health situation, the problems to be faced, the obstacles likely to be encountered, the strategies, programmes of and actions being taken by countries, progress made, the need for support action, past and current WHO programmes, and possible strategies, programmes and actions for the future, the overall aim being the achievement of health for all by the year 2000. GENERAL PROGRAMME OF WORK COVERING A SPECIFIC PERIOD
CONSTITUTIONAL BASIS
19.
Article 28 of the Constitution of WHO defines as one of the
functions of the Executive Board "to submit to the Health Assembly
.
for consideration and approval a general programme of work covering a specific period". Thus. the development of the WHO general WHO The one programme of work is the responsibility of the Executive Board. general prograUlllles of work usually cover a six-year period. covering the specific period 1918-1983.
valid at the time of writing is the Sixth General Programme ot Wock,
1 For more information on this aubJect. see resolut10n WHA33.17, Handbook of Resolutions and Decisions of the World Health Asaeably and the Executive Board, Vol. II, Fourth Edition, Geneva, 1981. page 30.
MPWPO/ tH • 1 page 9
PRINCIPAL FEATURES
20.
The general programme of work establishes the overall direction
of WHO's activities and determines the main objectives of the Organization for the period under consideration. It is built up
through an assessment of regional and global health pqlcies and an evaluation of the previous general programmes of work, and represents the Organizations's response to the individual and collective needs and strategies of its Member States in striving towards the attainment of health for all by the year 2000. Consequently, 1t
contains an analysis of the policy on which the Programme is based, as well as a statement of the health challenges that can be expected by the Organization and its Member States for the period under consideration. It then specifies the role and function of WHO durlng
the period concerned.
GENERAL PRINCIPLES
21.
Taking into account the evolution of health policies and
concepts mentioned above, the programmes of the Organization should comply with certain general principles. For example, they should
correspond to the major functions of the organization, have specific goals and meet defined criteria. The general programme of work
specifies the main criteria to be used by countries, regional committees, the Executive Board, the Worla Health Assembly Cinu tho:! Secretariat in reaching decisions regarding the organization's programmes. The basic criterion is that priority should be given to other criteria are used, for
the problems of developing countries;
example, to select programme areas for WHO involvement and to determine the organizational. level or levels at which programme activlties should be implemented.
PROGRAMME CONTENT
22.
For each programme in t.he general programme of work objectives
and approaches and, wherever possible, indlcatLve targets and out.put indicators, are indicated. in the glossary, AnnneK 2.) {Definitions of these terms are given
CLASSIFIED LIST
23.
The principal programmes of the general programmes of work are The general
organized 1n a classified list of programmes.
programme of work provides a framework for the Organization's total programme, which is made up of a number of speclfic progra~nes
each
consisting of an organized aggregate of activities directed towards the attainment of specific objectives. It is possible to group the
activities in smaller or larger aggregates and to call any of these
MPWPD/81.1 page 10
aggregations a "programme". defined.
A "right size" of programme has to be
The definition of a "r~ght size", so that it can be
powerful enough to have an effect, yet of such a size as to be properly manageable, is arbitrary. grouped under broader headings ~f
Similar programmes can be deemed necessary. The totality
of the programmes organ~zed as described above ~s called a "classified list of programmes". Such a list is used not only for
the general programmes of work but also for subsequent medium-term programmes, programme budgets, financial control, evaluation and information support, as well as for certaln adm1nistrative purposes. The efficient use of the classitiea list implies unifor-
mity throughout the Organizat10n 1n the activities to be incluaed under each programme.
INFOlU1ATION NEEDS
24.
The development of the general programme of work thus requ1res
information relating to the world health situation ana social and economic development, as well as information concerning health policies and strateg~es
at all levels, the needs of Member States, Tnis information is derived from
and WHO's ongoing programmes.
national sources such as national health programmes, statistical year books and health bUdgets, from regional offices through comparisons of national health programmes, reports ot regional directors, programme protlles, _, 1 .
past and ongoing programmes and
the~r
outcomes, and from various global sources, such as the World Health Situation reports, and the reports of the Director-General on the work of WHO.
'- _,~ .•.1
MEDIUM-TERM PROGRAMMING . MAIN FEATUH.ES :l5.
2
Medium-term programming takes the broad outline
conta~ned
1n
the general programme or work and.develops trom it a more detailed progranulle for implementation by WHO in collaboration with Member States.
1
Programme profiles are described in paragraph 69.
Anne~
2 Working guidelines for WHO's medium-term programming, document MTPWG/3/15, III (under revisi~n - to be issued as document MPWPO/8l.J).
MPWPD/Bl.l page it
26.
Medium-term programmes, which may be considered as plans ot
action, take into account the needs and resources of the varlOUS countries and regions. They are indispensable links between the
general programme of work from which they are developed and biennlal programme budgets.
LEVELS OF ELABORATION
27.
WHO medium-term programmes are elaborated at country and The global medlum-
regional levels as well as at the global level.
term programmes comprlse regional and headquarters components developed from the directives given by the general programmes of work. At each level, the programmes contain the intormatlon the closer a programme to the
necessary for their implementation;
place of implementation, the more detall it should contaln.
RESPONSIBILITY
28.
Medium-term programming lS carried out by the WHO Secretariat this procedure contrasts with
in consultation with Member States;
that for the general programme of work, which is the responsibillty of the Executive Board. In particul.ar, medium-term programming is
the concern of the persons who will be responsible for the implementat ion and management of the programme a teach leve 1. Overall
responsibility for the orientation, review and evaluation of mediumterm programmes, as well as thelr related programme budgets, rests with the internal programme committees (Regional Programme Committees, the Headquarters' Programme Comnnttee, and the GlODal Programme Committee). paragraphs 78-86. For further details on these mechanisms see
GENERAL PRINCIPLES
2'1.
Since the general programme of work emOO(lleS a worldwuJe
perspectJ.ve of WHO's activities, it describes only global themes, as well as the objectlves, targets and approaches in fairly general terms. These broad descriptions serve later on as the bases for the It is at the stage ot
formUlation of medium-term-programmes.
medium-term programming that prionty activities are assigned within different programmt"s, by each region and at the global leve1. this stage also, the broad targets laid down in the general programme of work may have to be specifled and quantifJ.ed, as appropriate for each level of the Organization. An example of a At
programme taken from a general programme of work and fOllowed through the various stages of programme development is glven in Annex 1.
MPWPO/81. 1 page 12
30.
In addition to the objectlves, targets anll approaches of the
general programme o( work, programme managers may have to take lnto account any new pOltcies and priorities that have been adopted by the World Health Assembly since the approval of the general programme of work. They also have to taKe account of the evaluatl.on Withtn
of previous medium-term programmes and programme budgets.
this general framework, programme managers are expectea to draw on their experience, judgement, and imagination in formulating medl.umterm programmes.
ELABORATION OF THE
31.
The first step 1n elaborating a medium-term programme 1S to
make an analysis of the situation in the particular programme area. The purpose of thiS Intuatlon analysis is to dlscover what has been done, what is being done, and what remains to be done in each programme to give effect to the general programme ot work, as well as the level (country, regional, global) at wh1ch actlon has been or needs to be taken. On the basis of thiS Information, It 1S then
MEDIUM-TERM PROGRAMME
possible to 1nterpret trom the approaches mentioned in the general programme of work what the specific activities of the Organization should be - whether they should be of a direct cooperating, catalytic, or coordinating nature, or whether they should conStst or stimulating or supplementing action taken at the national or regional level. The situation analysls can alsp reveal what
resources and facilities are available, as well as the order of magnitude of those reqUired.
32.
The situation analysis thus helps to specify the broao ObJec-
tives, targets and approaches of the general programme of work in more detail. Wherever targets exist in the general programme of where they do not, they can be estab-
work, they can be refined; lished.
This done, it is possible to select more specifiC
approaches, on the basis of thos! appearlng in the general programme of work, and to list the activities that should be undertaken to attain the objectives or targets. It may also be useiul to spec~11y
certain output indicators, which will be used later to measure progress in 1mplementing activities. At this stage, the apprOXimate
time sequence for carrying out the activities should be 1ndicated and rough estimates made of the resources needed and the cost of the
HPWPD/ (ll.l page 13
activities. ment -
It is not until the next stage 01' programme develop-
programme budgeting - that the costs are determined more
precisely and, taking into account the resources available and other factors, a definite tlme sequence or schedule is fixed for the implementation of the programme.
UPDATING OF MEDIUM-TERM
33.
As medlu~term programmes are usually elaborated for a perlod
of six years, it is Lnportant that they should be kept continuously under review so that mOdiflcations can be intrOduced rapidly to respond to changes in the needs or policies 01' countries. In partl-
PROGRAMMES
cular, a thorough review is undertaken every two years at the time of the preparation of the programme budget.
INFORMATION NEEDS
34.
Most of the intormation needed for the elaboratlon ot medium
term programmes will already have been collected when the general programme of work was prepared (see paragraphs 65-79), but it may need to be updated and ampllfied. Only rarely, however, should Lt
be necessary to carry out a speCial information survey.
PROGRAMME BUDGETING CONSTITUTIONAL BASIS
35.
The programme budget of WHO is prepared by the Dlrector-General E~ecutive
and submitted by him to the
Board, which in turn submits
the programme budget together with its recownendations to the Health Assembly for approval, In accordance with Articles 1(1, 34, 55, and
56 of the Constitution of WHO. The programme budget covers a two-year period, beginning in an even-numbered year.
PRINCIPLE OF PROGRAMME BUDGETING
36.
The concept of programme budget ing in WHO is based on the
principle of what has been called "programming by objectives and 1 budgeting by programmes" A health programme budget is understood to be a budget that ~ocu8es
upon the programme priorit Les for
attainment of health, the health work to be undertaken, and the obJectlves sought through that work (outputs), rather than mertdy the conventional budgetary objects of expenditure (inputs), to be consumed. Programme budgeting emphasLzes ends to be aimed at ana
translates them into costs required for their achievement.
1 WHO Official Records, No. 212, 1975, page 9, para. 1 .
...
MPWPD/81.1 page 14
OBJECTIVE
37.
The objective of programme budgeting in WHO is to encourage
flexible, programme oriented planning and allocation of resources to priority programmes at country, regional, and global levels that respond to the needs of Member States to attain health for all.
38.
The programme budget is based on the medium-term programmes Programme
and affects the speed at which they will be implemented.
budgeting is part ot the collaborative managerial process between WHO and Member States to elaborate, implement, control, evaluate, and reprogramme the international health work of WHO. The WHO
regular budget should also be used to attract extrabudgetary resources for countries' and WHO's programmes.
39.
The policies and procedures governing programme budgeting in
WHO are detailed in programme budgeting guidelines that are issued at the beginning of each programme budgeting cycle.
ESTABLISHMENT OF OVERALL BUDGETARY LEVEL
40.
The regular budget of WHO refers to that portion of the WHO
programme budget that is financed primarily by assessed contributions of Member States; it excludes funds from voluntary contribu_ tions or other extrabudgetary sources. The overall level of the
regular budget is derived from tentative budgetary projections or indications of future programme budget growth rates, established by the World Health Assembly in an oda-numbered year approx1mately three years prior to the financial period. Within these lim1ts, the
Director-General issues tentative budgetary allocat10ns to headquarters and to each region. The latter takes into account the sum
of national cons1derations based on a Wide runge ot factors such as: number of countries, size of population, health needs, govern-
ment interesl, absorptive capacity, state of development of health services, evaluation of results of previous efforts and availability of national and external resources. 1
1 WHO Official Records, No. 245, Appendix 2, page 48.
Ml'WPD/ 1:11.1
page 15
PROGRAMME
41.
Each Regional DLrector, after consultation with Member States,
BUDGETING AT COUNTRY LEVEL
issues regular budget provisional country planning figures to each country, within which t.h.· proposed WHO country programme budget tor the two-year financial period is t.o be developed. The provu;l.onal
country planning figures are developed taking into considerati·on a complex range of criteria, including the health situatlon and needS within individual countries and relevant WHO policies and programmes defined by the Member States acting collectively in the World Health Assembly and WHO regional committees. Based on the country health
plan and the results of continuing consultatl0ns on the use of WHO resources to support that plan, WHO and the authorities of the country concerned joint ly prepare a general programme of WHO technical cooperation for the financial period that responds to nationally defined needs and priorities and supports national strategles and programmes.
42.
The main directions of the proposed WHO technical cooperatlon
programmes at country level have to be grouped in accordance with WHO's classified list of programmes (see paragraph 23 above) for presentation in the regional draft programme budget, and ultimately for consolidation in the Director-General's propos~d progra~ne budget. These main dlrections are then progressively worked out and
expressed in the form of detailed plans of operation or work, including budgetary estimates for activitles, nearer to the operating period in the country, in harmony with the national health programming process. To the fullest extent possible, flexibility of re-
programming is malntained during both the planning and the implementation period.
43.
The programme budgeting process at country level should also
glve rise to the identification of issues requiring support at regional and global levels, ~ncluding WHO intercountry, interregional and global support programme activities, as well as technl:cal cooperation among countries. The process is useful for identi-
fying components of the national health plan for which external resources are required, thus enabllng the country to benefit from the role of WHO in mobilizing and rationalizing the transfer of external resources for national health development. In the last
analysis, the relevance and effectiveness of WHO's technical
• HPWPO/81.1 page 16
coopel-ation with its Member States depend on the commitment to and success of this Joint programme budgeting between WHO and natlonal authoritles at country level.
REGIONAL PROGRAMME
44.
The regional programme budgets are compiled trom country
programme budget proposals, which outline the WHO technlcal operation programme for heal th deve lopment. These narrative statemenls
BUDGETS
(country programme statements) are supported by budgetary tables, which compare the proposed estimates with t"he current approved biennium under regular bUdget resources and such other sources of funds as may be known to be available. The details are worked out
later, closer to the operating period and In harmony with the country's own budgeting, which is usually on an annual basLs.
45.
The regional programme budget document usually contalns: (b) summary
(a) the Regional Director's programme statement; budgetary tables; (c) programme analyses;
(d) regional and inter-
country programme proposals; and (e) the country programme atatements with supporting budget tables, to be revLewed by the regional committees.
GLOBAL PROGRAMME
46.
At global level, the WHO proposed programmtl budget document is
the result of the consolidation and integration of country, and regional, global programme proposals. The country programme state-
ments, their supporting budgetary tables, and most of the regional and intercountry programme details that are presented in draft regional programme budgets are not reproduced in the globally consolidated WHO proposed programme budget for the two-year financial period.
47.
The consolidated proposed programme budget usually contaLns;
(a) the Director-General' s introd,uction, which deals with salient policy. programme, and financial matters; policy, programme, and financlal matters; (b) selected summary lc) global programme (d) reglonal
statements with their supporting budgetary table~; and summary and other information annexes.
The document presents not 1 only the regular budget, but also all other extrabudgetary
1 The term "extrabudgetary" refers to that portion of the WHO programme bUdget that is financed by sources other than the "regular budget", such as UNDP, UNFl'A. UNICEF, World Bank, other United Nations system and voluntary sources.
MPWPI)/tH • 1
page 17
(voluntary) resources reasonab ly exp,'cted to become available during the findnclal periud.
SUPPORTING TABLES
48.
Tlw support.illg ~untains
blldg,~tal'y
tabll, tor the
~lobal
v['ugranune slale
ment
a global
1'I"0t;rarlIIne
estllnate for t.wo comvarallve
ilnancial periods, bruken down by rl't',lon and organizatl,unal level, under the regular budget and other sources, as i,llustrated in Annex 1.
REVIEW OF
49.
The globally consolidated WHO proposed programme bUl1get
lS
PROGRAMME BUDGET
reviewed by the Executive Hoard in January and approved by means of an appropriation resolutlon by the World Health Assembly in May of the odd-numberea year ilrunediately preceding the financial period.
MANAGEMENT OF OPEMTIONS (IMPLEMENTATION)
PURPOSE AND RESPONSIBILITY
50.
In the context of the managerial process for WHO's progranune
development "implementation" means the set of actions by Wh1Ch the decisions taken during the planning stages are carried out and programmes aloe delivered. The operational or implementatlon stage
of WHO's programme development is the natural continuation of the programmlng process. Like the earller stages describea above, it 1S
carried out in close cooperation with Member States;
its purpose lS
to activate, execute, and monitor the progranulle activities developed through the general programme of work and medium-term programmlng. Responsibility for implementation lles with prugramme managers at all levels. Management of operations requires support from the WHO
information system and it both makes use ot ana contributes to evaluation of the Organization's programme.
51.
Rules for day-to-day management and detailed operatLonal and
administrative procedures will be found in the "WHO Manual"l inclUding information on ftnancial control, personnel management and on other activities such as provision of supplies and equlpment, meetings, etc.
1 Note: The relevant sections of the WHO Manual are currently belng updatel1 to reflect developments in the managerial procesS.
• MPWPD/81.1 page 18
IMPLEMENTATl ON AT COUNTRY LEVEL
52.
At country level, implementation 1S carr1ed out Ln accordance
with the terms of a basic agreement between WHO and the government concerned, and such other agreements with cooperating agencles and institutions as may be appropriate to the particular situation. In accordance with Article 2(0) of the WHO Constitution, such technlcal assistance, recently replaced by technical cooperation, is furnished "upon the request or acceptance of Governments", which may be expressed in the form of a letter trom the governmental authorities, a signed plan of operations, or a similar document. 1
IMPLEMENTATION AT REGIONAL AND GLOBAL LEVELS
53.
At the regional and global levels, there is no formal require-
ment or specific need for such agreements, as mentioned above, but implementation might still necessitate the asslgnment to the activlty of the necessary national and Lnternational staff, having appropriate skills, due attention being paid to the importance of recruiting staff on as wide a geographical basis as possible. 2
BUDGETARY CONTROL
54.
In practice, there is a certain fleXlb1llty in regard to the Budgetary imple-
timing of the start of programme implementation.
mentation, however, begins ln the formal sense on 1 January of the first (even-numbered) year of the two-year financial period. "Allotments" indicating authority to spend during the tinanclal period are issued by Budget, in the regions or at headquarters as the case may be, prior to obligations or expeno!ture being incurred. The budgetary and financlal control functions in WHO are supported by the Admlnistration and Finance Intormation {AFI) System operating at headquarters and under development in the regional offices.
MONITORING
55.
Management of operations during the lmplementation stage
involves establishing and maintaining an effectlve control system, making use of any milestones, output Lndlcators, and targets developed during the earlier programming stages. This requires the
availability and selective feedback and transmlSS!On between organizational levels and divisions of appropriate management information. Thus management of operations includes the functions of monitoring.
1 See WHO Manual, Sections X.l and X.2 (under revlslon). 2 Constitution of WHO, Article 15, Basic Documents, Thirty-first Editlon, Geneva, 1981, page 35. (See a180 WHO Manual, Section 11.3, paragraph 370.)
MPWPD/81.1 page 19
NATURE
OF
56.
. Monitor1ng 1S t h e d ay-to- d ay follow-up of an activity durin~
...
MONITORING
its implementation to ensure that operations are proceedln~ as planned and are on schedule. It keeps track of on-going operational
activities, milestones achieved, personnel matters, supplies an~ equipment, and money spent in relation to budgets allocated. Monitoring of activities will also indicate the necessity of reprogrsuuning if implementation of these activities as originally planned proves impossible.
EVALUATION
NATURE
OF
57.
Whereas monitoring should facilitate an immeaiate corrective
EVALUATION
procedure with respect to a given Bet of activities, evaluation implies a more reflective process of analysis and Judgement. In the
\ .../
context of the managerial process for WHOs programme development, evaluation is an lntegral part of all other components of this process. Specific means, methods and necessary support for evalua"Guidelines for Health
tion, are describea in the document; Progranune Evaluation"l
USES
OF
58.
Evaluation can be applied to analyse the extent to which WHU's
EVALUATION
policies respond to the health situation throughout the world and to assess whether the health problems have been clearly defined. can also be used to verify the relevance of WHO's programmes in relation to its policies and to confirm that the priorities have been selected in accordance with needs, since the Organization cannot encompass the totality of the world's health problems. Evaluation is applied at all stages of the managerial process, starting with the preparation of the general programme of work. can then be used to help assess to what extent medium-term prograrllIl)es reflect the general programme of work and how well the programme budgeting process. translates the medium-term programmes into more precise programme budgets. It It
59.
Evaluation is not only applicable to the programming stages of
the managerial process, but continues into the implementatlon phase. During this phase, it is possible to use the information
generated through the day-to-day monitoring in order· to evaluate the I Document HPe/DPE/JiLI (revised verSion wilL shortly be availabl.e as document MPWPD/81.2) •
...
MPWPD/81.1
page 20
progress made in carrying out the activities that had been planned
...
and in evaluating the overall efficiency with which they are being carried out. The main purpose of evaluatlon, howev~r,
is to assess
the effectiveness of WHO's programmes in changing, or in having changed, the health situation for the better in particular countries and throughout the world. In the final analysis this effectiveness
can only be evaluated through a jOint assessment by Member States and WHO of their cooperative efforts.
lESPONSIBILITY FOR ,
60.
Responsibility for evaluation in WHO is an integrai part of the
functions of all those responsible for the formulation and implemen tation of programmes. Thus, it extends from the country to the The
EVALUATION
regional and finally global level, although the nature of the analysis and degree of detail may differ from level to level. involvement of the various operational levels provides the possibility of an internal-external perspective towards evaluatton; the immediate operational level having the direct internal perspective to which the next operational level can provide a kind of external view, without being totally unfamiliar with the circumstances. In addition, particularly for technical matters, outslde experts may Oe called upon to act either as a "peer review group", or to assist as individual experts in evaluation.
61.
As expressed in further detail in the "Guidelines for Health
Programme Evaluation", each organizational level also carries the responsibility to ensure that efforts are made to guarantee a reClprocal feedback of the evaluation results from one operational level to another and between the different internal organizational bodies, such as the Regional Programme Committees, the Heaclquarters' "
Programme Commtttee, the Programme Llevelopment Working Group, anoJ the Global Programme CommIttee. Only then can evaluatlon play Its role as an effectlve tooL for the il!lprol1ement of WHO's programmes. In addition to the obligations of the WHO SecretarLat. responsibility for evaluation also rests with the regional committees, the Executive Board and its Programme Committee, as well as the Health Assembly.
MPWPD/~l.l
page 21
INFORMATION
62.
Evaluation requires reliable information that is objective and This implies adequate
....
NEEDS
relevant to the issue being evaluated. tional levels.
information flow and feedback among the various policy and operaThe question of informat10n support for evaluat10n
is discussed in paragraphs 65-77. It 1S particularly important for health programme evaluation One
USE OF INDICA'rORS
63.
to be able to demonstrate changes in the health situation. indicators. As the name suggests. indicators are only an
means of facilitating the measurement of such a change 1S the use of "indication" or reflexion of a given situation. measure change d1rectly. . 1
They are variables
that help to measure change, even though they do not necessarily For example, a reduction in infant mortality from 100 per 1000 live births to 00 per 1000 l1ve births would be an indication of an improvement in the health status ot young children and possibly of the population as a whole, and 1n the socioeconomic conditions under which they live. care. ALTERNATIVES TO INDICATORS 64. Where indicators are difficult to define, it is often suffi~ssue
It 1S also a sensi-
tive indicator of the availability, use and eifectivenessof health
cient to ask pertinent questions in relation to the specitic
one wants to evaluate - for example, does the activity reflect the programme policy spelled out in the general programme of work, or has a training programme led to improved treatment? the evaluation of a programme is given in Annex 1. INFORMATION SUPPORT An example of
65.
At all stages of the managerial process it is essential to have The managerlal
ready access to pertinent, up-to-date information. way that it can be easily retrieved when needed. PURPOSE OF THE
process also generates inf?rmation. which must be stored in such a
66.
The WHO Information System has been designed to collect and
WHO INFORMATION SYSTEM
store information in a readily retrievable form and to select, analyse. and provide the information needed for the development ot ~IO's
programmes.
Information support is thus an integral part ot
the managerial process.
1 Development of indicators for monitoring progress towards health for a 11 by the year 2000 (to be published in "Health for All" series,_ No.4).
MPWPD/81.1 page 22
INFORMATION SYSTEM
67.
In response to the information needs of each stage of the mana_ the Internal Reporting System. the
gerial process. information support has been developed comprising at present the following systems: Administration and Finance Information (AFI) System, and a variety of 'special-purpose information subsystems, deallng largely w1.th technical and scientific information. 68. The Internal Reporting System provides systematic and compa
INTERNAL REPORTING SYSTEM
tible formats and procedures for reporting from the countries to the regional offices and further to headquarters, and for feedback to regional and country levels. The purpose of reporting 1.S to describe progress or the lack of it, to account for the use of resources and to report on the evaluation that has taken place at each organizational level. In order to ensure the select1.ve reporting of the most relevant information and to avoid the collection of too much anecdotal and insignificant intormation. the "prof1.le lt concept has been adopted. A profile consists of the main elements of the information requ1.red at each organlzatlonal level, and at the same time provides an agreed outline for reporting between levels.
PROGRAMME PROFILE
69.
A programme profile provides essential information on WHO's
collaborative activities at the country. regional, or global level and is intended to constitute the collective memory tor a programme. It comprises the following elements:
1.
Policy Basis, e.g., regional committ.ee, Execut1.ve Board and World Health Assembly resolutions; relevant parts of the general programmes of work, and medium--term programmes;
. 2. 3. Problem Definition; ~bjectives
and
Targets~
4.
Programme Description, i.e., approaches and programme components;
5.
Monitoring and Control, 1.e. budget and finance information related to programme activities, work &chedules, and milestones;
6.
Participating Persons, Groups ana Institutions;
MPWPO/81.1
page 23
7. 8. 9.
Essential i{eports, Documents and publicatlOns Related Programmes and Project.s Evaluation, i.e. indicators and criteria used, evaluation findings, problems encountered, and recommendations tor future action.
70.
Where relevant information is readily available in existing
management documents the respective profile elements should not be specially written but should contain an excerpt of pertinent information or a reference to the document containing the information. The pertinent management document should be included in the prof lIe if practical. All profiles would be expected to have, as a minimum,
the appropriate references to the relevant portion of the general programme of work, the medium-term programme, the current biennial programme budget, relevant project or programme country agreements, the means used by the programme director to plan and monitor programme implementation, and, as appropriate, the findlngs ot assessments and evaluation, including the recent contributions to the Director-General's and Regional Directors' annual reports.
....
71.
In the framework of the Internal Reporting System, country
programme reports are prepared semi-annua lly by the progralluue manager or by the WHO or national programme coordinator in a country and serve to establ ish or update the correspondlllg programme profile. They also provide a basis for regional prograllUne profiles,
which are prepared by the responsible regional programme officers according to a schedule established by each regional director. Global programme profiles are established and updated on the basls of information from regional programme profiles and on global and interreglonal activitles. Programme profiles and their updatlng are the responsibility ot WHO programme managers and their staff.
FEEDBACK
71. Progra~ne directors are expected to syntheslze the intormation received by them and return such synthesized information to the next echelon (i.e. headquarters to regional offices to country level) to enable those echelons to compare their plans and position with other countries and regions, and to identify those activlties WhiCh, in part or in total, could relate to their own activities, thus facili
• MPWPD/81.l page 24
tating the exchange of relevant experience.
The amount and style ot
such feedback is determined by each programme director, who is expected to periodically check it with the recipients, and adapt as necessary.
COUNTRY INFORMATION
73.
The collection of country informat10n required for the Most countries produce some
managerial process for national health development is the responslbility of the countries themselves. kind of summary documentation in the health sector (five-year plans, programme proposals and assessments, health-for-all strategies, annual reports, etc.). office. Such documents should be collected by the
WHO Programme Coordinator (WPC) with copies sent to the regional. In all cases, any efforts to assemble and structure country Special health information should serve a national purpose first, e.g. national programme formulation, proposals for donors, etc. exiating infonnation is inadequate or very out of date. efforts to compile country information shOUld only be undertaken if
THEAFl SYSTEM
74.
The Administration and Finance Information (AFI) System 1S a
computer-based system that supports the preparation of the budget, the control of expenditures against the budget, the operation of the accounts, and other administrative and financial functions of the Organization. It facilitates the preparation, modLfication, and control of the programme budget during the various phases of preparation, including its review by the policy organs of the Organization. For example, the system allows the recalculation or the budget with various hypothetical standard costs, salary scales or exchange rates.
15.
The system is also relevant to the management or the programme
operation as it provides a variety of reports showing obligations, for example against budgets periodically or on request. programme evaluation. By prOViding this financial information the system also contributes to The financial reports show the implementation by programme, source of funds, region and other indications.
MPWPD/8l.l page 2~
SPECIALPURPOSE INFORMATION
76.
Special-purpose information subsystems deal mainly with scien They
tific and technical information 1n support of programmes.
include systems for the support of scientific surveys and for the collection and analysis of country health and health-related information, as well as bibliographic reference systems. to the needs of the programmes that they support. are in support of certain administrative functions. These subOther subsystems An example of systems differ in scope, methodology and level of detall accoro1ng
SUBSYSTEMS
such a subsystem is the Master Mailing List which permits the coordination and rationalization of the many different mailing lists of the programmes and documentation services. 77. In summary, information support interacts intensely with all it analyses information in receives new information from Thus it
stages of the managerial process; it;
support of each stage of the process;
and stores and processes the information, making it available
to other stages of the managerial process as needed.
provides the link between all the various stages of the process.
III. 78.
MECHANISMS FOR CARRYING OUT THE PROCESS In order to ensure the promotion, application and coordination However,
of the managerial process for WHO's programme development described above, a number of mechanisms have already been set up. and trained in the process; these mechanisms can function only if staff have been fully informed identify with it, and participate in it Only then can this process at all levels and in all components. to its Member States.
become a real tool in the delivery of the Organization's activlties
79.
The above implies that the responsibility of apply1ng the pr,ograoune managers
process for the development and implementation of the Organization's programme lies with all WH'O staff at all levels; and responsible officers will have to make use of the managerial process in an integrated manner as part and parcel of the development and implementation of their prograounes.
MPWPD/81.l page 26
80.
The responsibility for the applicatlon of the managerlal
process for WHO's programme at the country level reets mainly with the WHO programme coordinators or national programme coordinators. Their task includes collaboration with countries ln the planning, implementation and evaluation of national health programmes with particular emphasis on WHO-supported programmes. It also includes ensuring that information related to country needs and priorities is transmitted to the regional level of the Organization, as one of the bases for the development of WHO programmes and programme budgets.
...
For countries without a WHO or national programme coordlnator, the responsible person at the regional office will perform the same tasks. 81. (DPM) At the regional level, the Directors of Programme Management 1
.-----'
are responslble for the supervision of the appllcation of ~IO'6
.
the managerial process for levels.
programme development to ensure
well coordinated programme delivery at the country and regional They ensure that the guiding principles for the implementation of the process are used in such a way as to permit flexlble application in different national contexts and at the various operational levels. The DPMs also provide guidance and support to WHO Programme Coordinators, other fiela staff and regional office staff in carrying out activities related to the managerial process for WHO's programme development.
82.
At the global level, the programme managers and the Assistant
Directors-General are responsible for the proper application of the process.
83.
To supervise and coordinate the applicatlon or the process at Wlthin each reglonal
all organizational levels, various mechanisms have been set up ln the form of committees or working groups. office and at headquarters, programme committees have been set up to
1 In the Region of the Americas this function Manager.
16
carried out by the Operatlons
MPWPD/ Hi-I page 27
review policies, evaluate prograoanes, and review and recommend regional and global programme proposals (Regional Programme Committees (RPCs) and Headquarters Programme Committee OWC». the Director-General, the Deputy Director-General, Regional Directors and the Assistant Directors-General, has been establ.lstled to coordinate the management of the Organization's programme at the highest executive level. In order to translate policy decis.lons into plans of action for wide application throughout the Organization, the GPC set up its Programme Development WorkLng Group (PDWG), comprised of the six Directors of Programme Management of the WHO regional offices, the Chairman of the Headquarters' Programme Committee, and the Director of Programme Promotion in the Director'-_/
At
the global level the Global Programme Committee (GPC) comprised of
General's office.
84. The governing bodies of WHO, that is the regional commi ttees, the Executive Board supported by its Programme Committee, and the World Health Assembly, constitute the highest levels of the Organization for defining and giving effect to WHO's policies. For
....
example, the elaboratlon of general programmes of work, the formulation of principles for their implementation, and the review and evaluation of their effectiveness, take place at these levelS. Among other things, these bodies engage in the promotion, coordination and control of the use of the managerial process for WHO's programme development.
85.
Now that all the components of the managerial process for WHO's
programme development have been worked out, attention has to focus on linking them systematically within a unified process. this is a function of the mechanisms outlined above. Ensuring
They will have
to ensur4\!, for example, that medium-term programmes properly reflect the general programme of wor:k; that the allocation of budgets for programme actLvities is only made if their place in the medium-term programme can be demonstrated, or, if it cannot, t.hat t.hey be added to it if new policies demand such an aduition; and that the progress and achievements of the prograuune have been evaluated.
MPWPD/IH .1
page 28
.....
86.
The mechanisms mentioned above, function within the
followin~
framework~
FRAMEWORK FOR THE MANAGERIAL PROCESS FOR WHO -S PROGRAMME DEVELOPMENT
Countrr level llegional level
Ministry of Health and I or equivalent bodies in ~ber States Regional committees witb 8ubcommittees for variou8 purposes.
National or WHO Programme Coordinator, WHO project staff. Regional Directors supported by Regional Programme Committees and regional office staff.
Global level
Executive Board supported by its Programme Committee; World Health Aasembly.
."
Director-General, supported by the Global Programme Committee with its Programme Development Working Group; Headquarters- Programme Committee; and Headquarters- staff.
\._-,./
MPWPI)/!H .1 page 29
ANNeX 1
DEVr:LOPMENT OF THE URAL HEALTH PROGRAMME
AN EXAMPLI-; OF THE APPLICATLON OF THE WHO
MANAGI'~RIAL PROCESS
One of the principal obJect1ves contained 1n the Sixth General Progranmle of Work was "To prevent and control 110nconunuoicable diseases". This was subdivided 10to a number of detailed objectives, one of winch was "To promote the development of policies and programmes tor oral health". In the example below, this objective is used to illustrate how, starting from the intol-mation 1n the S.lxth General Programme ot Work, a medium-term programme was developed cootain1ng specific objectives, detailed approaches, output 1ndicators, SpeCl.tl.C targets, and precise activitl.es. Further. the example gives extracts from the Programme Budget tor 19HO-l'j8l to illustrate how this is derived from the med1um-term programme. Similar extracts from the Programme Buaget tor 1982-1983 are also presented for purposes of comparison. Finally, the main appi1cation of evaluation and l.ntormation support to the development of the Oral Health Programme are brl.efly described.
CONTENTS
GENERAL PROGRAMME OF WORK . . . . . . . . • • . . • .
. . . . . . . . • . . . . ..
JO 31
MEDIUM-TERM PROGRAMME
PROGRAMME BUDGETS
• . • • . .
. • • • • . •.. • • • . • • • • • . • .
• • • • • ••
35
EVALUATION
INFORMATION SUPPORT • • • .
.
.
_ . .
. • • .
. .
• . . • • • • . .
. .
. . • • .•
40
• MPWPO/81.1 page 30
Annex 1 A
GENERAL PROGRAMME OF WORK
I
The following is a summary of the proposals for the Oral Health Programme given in the Sixth General Programme of Work. l •
Objective To p_r~ rlN ".~r of pelie;" and"... f r _ . for IJNlI "-ItIt.
Indicative target
" "Ibe tarlft could be the development of _ "..0<10 and ,Iv: coords..alioo 01' "...,.....mcs lor the promotion 0.oral _lib witt. • view to incl'Uli.. populauon
c - . .• ,
Approaches and activities These were described 1n the Sixth General Programme of Work in a very general way. It should be noted that a general indication of possible output indicators was also given:
"
WHO will collaborate with countries m .lUd.c. on the design, planning, admmostrallon and evaluation of oational and local Mal healtn servt<:es, The
disseminauon of information on lhe most recent <xpctience in preventive oral health aCllviti~ w.1I make it possible 10 include prevcnllve componenls in programme•. lOeluding thc lIuoridal.on of water when po>Slbl•. and dietary mean. for dental (aries prc:ventlon.
Ih.,.
(Output indicators could be the number or' COunme' collaborating with th. OrgalllZ8.tion on these a~"tiv· Itie, and the number lind qualllY, if poS5.blc. of data dISseminated on prevention.) The OrganiutJon will encourage and I"'rticipalC on the preparation of manual. and guides on the planning, ,.plannmg anll evalualion of oral ht;jOhh .. [vices. including aSpcc:l$ ()f manpower, .uppliCi and equIpment. It wIll Iceep up to date an epl~miological infmmation system On the prevalence of and trends on the oral dilCJUeli and on mSClOr.:h findings and the" apphcatlon .••• "
1 The following example of the development of the Oral Health Programme is valid for the Sixth General Programme of Work. In 1982-1983 it will be replaced by an example taken from the Seventh General Programme of Work.
MPWPJ)/ til. 1 pa)!;e :it Annex 1
MEDIUM-TERM PROGRAHUE 1 Specific Objectives From the overall objective of the Si_xth General Programme of Work the following specific objectives were developed during the mediumterrn progrannning process: , .. .,.. ." J.
\1
:. 5 ..
b.
To promoce implementaclon at an "ftective plann'"g and evaillation or Or"l Health programme" at the national level, lne luding prllna~y health care. To promot:e planning and implementativn of national prevenClon programmes wich speci.a.l attention co high risk grl..ltJps To promote the Eralning and reorlencation of dental personnel, ineludin~ auxiliari"s and primary healch work"rs, to lmolement aral healch programmes specLilc for the neeas and resources of each countr-y as identified in rn" SiCUaCLOn anOlly!"". To develop, reVlse and test meLhoduiogy tor use by COuncrles. To LOlciare and COOtdLnate ",ssenclal reseal-ch at i.nrernatlonal scope provided that "xtra-budgetary support is availabl", To collect:, use and disseminace .ntormaLio" necessary for planning health services and monlcorlng succe53 of country programme.,"
Approaches During the medium-term programming process the following approaches were identified:
• There are three essential parts of the fundament.3l activity ill any councry, n",cessary to achieve the staced guat. TI,ey are: (a) perlodic roonit:on.ng of disease prevalenc" wic:hln a situ~cion ,n.llY'ls ( (b) ongoing planning .1nd evaluaclon based on eha monitoring Lnput and (c) cop priority for preventlve programmes ,,\.thln the overall pian These theee pares are the main pLllars of the intel!rated olannln~ process, the surveys alld planning proceoures belng dra\ITI rrom WHO manuals dntl che ·p~ntlVe methods adapted fe·OIU It vaCl.eey of sources, Ho,,",ver, Updatlng and exten8ion of metnodology are required as support act1vlei"s for the QlaLn th.rust:.. ..
\
Output indicators The medium-term programme specifies also how to measure the outcome of the progrannne. An overall indicator of success or failure will be t More details on the prograllune, including the situation analysis, can be found in document ORH/BO,l which is the global medium-term programme for Oral. Health.
...
...
• KPWPD/BL 1 page 32 Annex 1
...
the achievement of an average of not more than three decAyed. missing and filled teeth (DMF) at 12 years of age in all countries by the year 2000. The following table shows how success can be measured during the medium-term programme period by output indicators. Expected output indicators by the end of the medium-terwprogratmne 1978-1983 Mo. Cat"llory Long-Term
ElqIected O[
Countr~oI!S
(Year 2000)
By end of thi.. MTP
(1983) (i)
The national avera&e will be reduced to the 3 DMF l .. v .. l at 12 year. In; The present level of caries vi 11 be
) 19 developing 18 highly induatrialized}
4
( ii)
27 developinl
)
retained in: ( iii) !iational averages below ) OMF at 12 y.a-r. will be prevented from riain3 i.n; Initial data will be obtaia.d frOllI
8 highly induatrialized} ) 34 developing i hi.&hly industrialized} ) 511 developinl 8 highly induatrialized)
3S
7
(Ly)
26
Targets and activities
Finally, for each objective, targets (based on detailed targets coming from both countries and regions) were elaborated and precise activities described in relation to each of these targets. An idea of the timing of these activities was given. as well as their location. In addition. information on linkages with other WHO programmes or external bodies was indicated. The medium-term programme also contained a chapter dealing specifically with resources and giving a broad indication of what was needed to carry out the programme. The following tables show the targets and activities corresponding to the six specific objectives. They have been selected because they demonstrate how the approaches and activities 6f the Sixth General Progratmne of Work described on page 30 have been translated into more concrete activities for implementation. l
1 The following are some abbreviations used in the tables with which the reader may not be familiar: DANIDA ~ Danish International Development Agency; FDI = International Dental Federation; !ADR '" Int.ernational Association of Dental Research; AFR = African Region; EMR = Eastern Mediterranean Region; WPR a Western Pacific Region; HSM ~ Health Statistical Methods; EDP = Electronic Data Processing.
MPWPD/IH .1 page 33 Annell. 1 To prnmclte illlplclrl("ltat:l01l 01 an (;'1 f{~ctlV{~ planning and evahwtion of uriil lHo;ilth rr(Jgr,)tnm~s at the national level, including primaTY he.lith care ..
.---------------.-----r---.------..----------.------.------T---··---ACTIViTIES
I-_______ T_A.R __ GE_:T_S _________ I. Initiation of integrated planning 6-l~
·----~~~=79.__ _==C---~~~=-B-l--· plans (1 mth/country).
..
l.INKAGF.S
---1-9-S-2--·S-3-.- - - t
Situation analyses and formulation of najional oral health
countries/year
projects as needed () months/country) 1 Consultant assistance for training projects (3 mths/' country) fellowships etc. I Monitoring, evaluation, and re-analysis (} mth/country)
Implementation of overall plans & training & demonstration
Dental Public Health Courses: DANIDA, Thailand 1979 WPR; 1979 EUR, 1980 -
DANIDA, Thailand, 1982WPR, 1983
IIMD
Bulgaria: Rural
DANlDA
Oral Health Services.
IJPR, 1981
- - - - - ---------4----------j-------tII. Promotion and assistance wit.h planning, implementing and data analysis for pathfinder surveys for collection of baseline and monitoring data on oral health in 20-30 countries per year. 2 45 surveys
All Regions 60 surveys
60 surveys
To promote planning and implementation of national preventive pTogranunes with attention to high risk groups.
~pecial
t---------------.------- ----------------.---------.-.----- -------
I. Implementation of national oral
~,
disease preventive programmes
the basis of situation analyses identify appropriate programmes. organize pra(:tical arrangements ilnd facilities
Prevention Methods and Programme.
required (lIZ month/country) in 10-20 countries(year. EHa, AFR and SEAR. I Expert Committee 1983 Pl anning, organizat iOn and monitoring, fi at evaluation aiter 3 ~r 5 years, 3 trials 1978-1982; and )-5 trials 1981-19"~ ()-1/2 months over life of project).
.-------------------I----------If--------if-------.----.---.-.II. Field demonstrations of pteventive measureS for caries, periodontal
diseases and oral cancer II. l'eriodontal Project - 2nd stage testing of control programmes in b c()uncrif's.
~-----.--------------t__--.---
... ---.. -.. --.....--.---------f-.----.--+--------l Planning. organization and implementati(ln;evdJuation after 5 yrs 1~81-8S
f---.
.~~.:'eek~ count ry '2'rl EMR
IV. Estab lishment and development of
SEAR, Tliai land
L AFR
~~:::_~-!n-a~~~~-:-:-~_~-~-s:::---. V. Participat"e in eval.llation of
________._. _____ ~_______ _ ________ _ val1~l !.)' ld
IADR FOI .. _._---------dootJrs
u:sults of te~tjng pn)ject5.
alternative fluoride delivery methods
1 WR,
IJPR
-_._--------_._---_..... _-----. 10
0~ ~ ___
__ . __ ._0_0 _ _ _ _..-:..__________
To promote the training and reorientation of dental persolloel. includinR auxiliaries and primary heal (to, worker~, to impl~menl ocal heal ch prog.r-ammes SIH~C i fie tor' the identified in [h~
1
._L ________.________.____ il}iHS.
and
<.1m. IJPR
needs and rp,'iOUrccs of c.aeh countty as
situation analysis.
r - - - - - - - - - - - - -..- - - - - . - TARGET Collaboration in planning & reorientating oral health personnel
ACTIVITIES
·-----197~.. -79---T--·_19_·~_~._~;-_1
_
=r I
l.INKAGES 1962-83
Analyses of e~isting training ta~ilitie8 & currictJla and prepare overall training and deployment plan and curricula
training course. in 3-6 countries per year.
guidel llle. for all le·,els of personnel (2 mthslcountry). All R~givns.
I
IIMD
Ini[iate t~ainillg projects as nepded for: i) primary health wor~er4; Ii) ope~~tinB Auxili&rietii iii) non-op~ra[ing auxiliaries; Iv) reori.ntation tor staff and teac.ht!' . . a (1-1)2 mths/country, plu. ] mths cons./ country). All !(e.giO"..
-----'"-----
L ,
~Evaluation
-
of training courses & ... npaver plRna (2 I1lth./countl"y)
-----------.-
MPWPD/81.1 pal!,e 34
Annex 1
4
To develop. revise and test methodulogy tor use by cotlnrries
TARGET:
-------------Preparation of sT.andard nanuals I
-----~-.-
-- ------------1 ~80-81
and/or !,-uidelines 1982-83
I
l.lNKAGES PUB
ACT1VITIES
]918-79 Preparation of the manual and review 0/4 mth). RevielJ of docun'tmt (3/4 mth)
1. Manual on planning and evaluation ot oral health servic.". 2 .. Guide to <fental equipment and mateTials
-- 1------.Publication
(l
mth)
Publication (l mt.h) Preparation of the
SUP
3. Guide to
imple~ntation
of
Pub li cat ion (1 mth)
pre~encive
programmes
4. Guidelines for curriculum development for dental personnel a) dentists, b) auxiliaries c) primary health workers
document and review (J. ~ mths) 1st draft 0/4 mth s) 1st draft revie"" (1 mth) Publ iCiltion (l mth) 1st draft review 0/4 mth} Field-testing 0/4 mth) AFR, EHR, WPR 1st draft and pilot study 0.5 mths) SEAR (Sri Lanka) Pilot studies (3/4 meh) Data analysis (] mth)
Count ry projects
0/4 mths) AFR, WPR. SEAR, EMR
S. Oral health recording and reporting manuals and ICD-DA 6. KIlnual On oral canee.· earl y datection and prevention
Pub Ii cation
(1
mth)
OHS
Count ry testing PTOje.cts 0/4 mths) SEAR, WPR Meeting (3/4 ath) Country ptojecu (1.5 mths) Revision 1\ publication (1.5 mths)
CAN
7. Oral Health Surveys Basic Kethods! a) dentofacial anoma1ie. b) periodoneal disease. e) revision of DRS 1M a) Publication (1 ath) a) & b) Pilot studies 0/4 mt h) pllI
POI
fUR. WPR, AFR, f!MR
...
8. Guide ro Epideaiology and Diagnosis of Oral Mucosal Oi8ea.e8 and Condition.
Pilor studies (3/4 ath) SF.AR es.en~ial
Pub Ii cat i on (1 meh)
S To initiate and coordinate support iN available.
re.earch of international .cop". provided exerabud.eeary ACTIVITIES
TARGETS 1978-79 I. Identify areas of essential
LINKAGES
1980-81
P982-83
research whieh need more "tfort, concentyacing on those that require international cooperation. 1J. lmplementation of the study of ingestion & .... taboli.m of fluoride from all sources
Annual Oral Rt:search Advisory Group Keetings
I
FDr and IADII Collaborating Centres &
---------...---- Identiilcar.ion Preparat.ion of protocol
insts. of
I---
"
suitable study sites. ~ite . visits, final planning. definicioo of D,ethudology 0-3 mths f()T 4-0 countries. & 6 tath •
Training 1\ collahoNUT rat ton of country Collaboradng teams, organization Centre.s of data & aa.mple & insts. c.ollec.tion. ch~mical a.Da} yHe.s etc. (6
mths/country)
.... lhodology developll. Continuation ot Internati ona1 Collaborati ve Study of Uenlal Manpower Systems (inc! . addi tiona] countries) Preliminary report of S count TY Tesult~
---
ment) ~---.----
"
Coordination of country COlftributions, sitt' visits t m~ering lY80.
Analyses of
COUl-
-- -----Coll.bora~ing
bined results for 1\ c(luntrie& • pre-
Count·ries FDl
pararion of publi011.
IV. Provide assistance with cocoordination /I methodology for research of international scope: a. Slandardiz,at ion ot f!uorid~
call ---_ - -_.._------_. ---- -----..
I
andyr ical methods b. Psychosocial study of fluoridation c. ne"elopment of epi deluio logi Cit] 8tar-istjcB IICtthods
and
Loofitult81.ion and assistance with method. of results as nec4!'ssary
<OO<T"''00
MNII FDI
L
MPWPD/til.1 page 35 Annex 1
L
~,.,., dac~
b.nk.
...,.- " .... J
r(') coll.ct. IU'. And 'il.".min .... t. lntoCGlat."Qn n.e •••• ry tor plann,nl h•• Lt." •• tvI.C •• tmd munitori.hlili aUlli l4lc proRt.vln,n. UpdatlnllJ or d.t;& bolll'lk.
I
\
~1).nd co lnf;: h.d.. dat:& trOll .ociono. records. A.n4lva.e exUttna: au.:vt:y d.;&t. I)on 'de to~ i:.t..a" bO countr 1 •••
.,'C.
U.
AQPual .... ~'uarion oc pcoqres8 t.ow.reb Glob~\ CuaL foe lUno
o\onu.t.t IDOnll:ol"inM: of n.", dat ..-to ide-neity di .......
I
cc.Qd.
dnd
.\lalu~u:e
pICOS' . . . . a.chlc ....... nt ••
.
I
l I
I !
HSD EDP
The following extracts from the programme budget statement for the period 1980/81 show that the programme budget is based directly on the activities planned as described in the medium-term programme:
Progranune Budget 1980·-1981
..
to check th. pre:Jent trend tow.rd. incr •••• d oral dl ••••• in 4.vcloplaa countriea by proeotlng national polich!. end prolt . . . . . tor oral h •• lth. eo llabor.tina wi th cOl.lntri.. ill th. p t .. nn. hi, llDl) l .... ent.c ion and .value t ton of ,.aclonel and Local oral health •• rv1t;:e., and par-tLclpatinl 1n the deve-lapraetlt and LmproveGltnt. of ir~t:.rn.tton.lly acceptable raechodology ..
Cooperatton with and amona countries Desptce the generally low priority of oral diseases compared with te •• prevele.nt but more dr.matte condition., the co.t-b.netit equation for action in chi. field ia ve~y favourable J eepecl&lly in v1ew of che clearly demon.trated. rapid and •••• lve Lnere.M •• in the prevalence of dencal carie. in developinl countrt... Concrol of periodontal dl •• a •• a 4nd d. ... tel cari •• depend. 1ars.ly
on mound organh:.t1on of available preventive lDe.'ur •• t.hrough the u •• of exis ttog manpower such an hee itb auxi liarles and 8choolteacher-l.. The
.lternatlve ia to meet the strong srowlng d~and by the introdu~tton of • very expensive dental .erv1~e which will abjorb more'of the total he.lth re.ource8 than would be acceptabJ. 1n the light of ot.he.: health. prl()Tltle.~
With the emphaeis on pre~entiont the activft1ea of the oral h.alth prolulDBe In 1980-198L .. Ul 1.11 within .1x interconnected .r.... : - integrated pl.nni~1 in the Deal health .ector will continue ~o b. b •••d OL
the further developaant _nd applL,.tlon of 8tand.rd au.pie _.tho4010I' for coostructing o~al care p~ogr ..... appropriate to· the specific n •• d. and reeource' of each couQtry~ l~t. methodology puce cmph.ala on pI.ci •• Ibeaeurcb le 80al*; the oral h •• l th sector provide. apec:1.1 opportun 1tt8" in thie r~spect. tor both preventiv4 and cu~ative or reh.billtative .erv1ce.~
Corresponding particularly to specific objectives 1 and 2 of the MTP.
The .ethodology alao provide. for calcul.tlon of the m.npowec needed to ach.ieve t.he. atated goal& and for the moni.toring of achieveD.l\t ot t.he 8 oale ;
FlPWPD/81.1
page 30 Annex 1
- acttvit.le8 Ln epideai.ololllc.al . . thoda and data collection wtll continue to
provtde the b•• ic tooll and the lntona.tlon input n.c •••• ry for the latelr.t6d plMhR1nS of oral health •• rvic ••.
- activities in the atora,lt. retrteval and dls8enlnation of lnform.attOI~ wl11 .. pro~ld. an ••• tntlal servtce to .11 other elements of the programme and to plannel'l, • • 'nlecratora and love.tig.tora. The ay.tem vill Cover: bastc health and populatton par •• eter. uleful for p1annln&. health priority
Corresponding to specific objective 6 of the MTP.
are •• ;
available •• rvlcea;
Ilobel dtle••• Itacu • • nd trend.; •• p.cially in prevention;
a lia, of planned ana ongoln& activitt •• ; and informatlon on onlo1nl re.earch •
- pr~tlon of natlonal aad cOlWllunlty preventive proljr"mrnel, the priority
ac •• of the or.l h~.lth pl.onlft& .~tlv1'ic.
pro.r~ •.
l • • 1.0 the
fLr~t
con.ideratton 1ft All
thte pTo8r~• • pplt •• to all reg10nsj change. in emph •• is. where chay ext.t. "alat.e only to datail. within .ach ac.ti.vity. In the African .esioR, to follow up the multidi.clpliRlry Intercountry pl.anlRI •• atlnl held in 1918, two work.hop. tor public h •• lth admini.trator. are ,lanDed. ~h••• cond of tbea in 1980~ Tb~ plane and proSt ••••• forwulat.d at tb••• work.hop. will b. u.pl...ntld durin, 1960-196). Priority Will b. liven to the prepal'ac.loa of appropriat.e 1U.hpOV... 10 dental cara tacl1itlel to i.mpl.merlt., ,rol"_•• and provtde ...rleney care •• rvi_ ••••. _ •
...
,r_tt._
Corresponds in particular to specific objectives I, 2 and 3 of the MTP
In the South-lalt Alia legion, pl.n. for the eotabliahmcnt of « regional aDd 4..onatratlon Centr. for oral health by 1980 ara ~ell .dvanced~ The centr., which will be b•• ed In Thailand, i. being ~.tablilh.d with .uleia.tional aupport and will be oper.cad by the parclclpatina councrie.. It will provld. a focua for tralnlRI and retr •• her courle. for .11 level. of per.annel, la_lu4!nl prtaary orll b.llth workerl. It will allo ace ••• coordinating cen~~. for r .... reh into the dellv.ry of ••rvic •• , 1ncludinl tbe deaon.tratlon &Ad t.ltiDI of pT.venttve . . thodoloBY Ind techniquel and adapted delivery .,.~",. It 11 . .p.cted that tbl. initiative will eventually bave·broad lat.r~.ltOb.l •••• 11 •• intercountry effecta. ~r.lftlD1
Corresponds in particular to specific objectives 3, 4 and 5 of the MTP
In 1980 • reSionel ...lner will be organized in the Eaa~.rn Mediterranean leSion to •••••• the oral health .tatua of countrte.~of the Reglon and [0 review p['olr ••• in the d . . . l.,.,..nt of oTe1 health care ••"lea'. Ae p.ct of the . .dl~t.~ pro.r...tus proc •••• cart. to ~ountrte. have already expre •• ed lnt.~.at in p.rtlculu priority Ictlvltl •• ; At,,,.nhtln and "the Libyan Arab J . . .hlriy., in lntasr.,.d planninl of oral bealth •••vic •• ; Egypt end the SYI'l.ao Al'ab llapublt.c. 1n o~.l healtb _npower development; D_ocrs:ti.c Y_en, Smul1. and y_..... in epld ... iolollcal studiea; \.1me;) , 1n re.f:arcn 1n dept.al
Corresponds in particular to specific objectives 1, 2, 3 and 5 of the MTP
cari •• ; Ilypt .nd tbe Syrian AYab Republic. Ln vater fluorid8[lon; and KuwaIt, 10 tbe clev.lo,...-nt of .aocIel .Y.'.' for the delivery of 0t'81 health r.are. If
'fhe supporting budgetary table for the global programme statement contains a global progral1lIDe estimate for the two comparative financi.al periods as illustrated below;
·, MPWPD/ iH. 1 page 37 Annt:'x 1
BUDGET TABLES
1978-1979 Eslimated obligations Reg" tAr Other
1980-1981 Estimated obLJg.tiona
----Total
Regular budget
budgeL
aourc.a
Other Boun;ee liS
Total liS $
us S Region.: Air-iea Araerica ••..• ~ ....•...•.....•.................•..• South-East A.ia •.....•........................... Europe ........................................... .
us
$
us
$
us S
S
78 000
53 700 296 800 ~O
632 000
000
119 !lOO 81 100
78 ()()() 885 7(10 ~96 BOO 139 !lOO
14~ (>()()
E•• tem Medt teTranean ••... • ..............•••.••. Weatern Pactflc ..................•...........•...
130 000 2JO 000 808
217 700 230 000 I. 848 100
131 368 213 62 407
600 '100 500
924 60n
145 000 056 200 368 70ll
20 000
700 700
aoo
----1144 800
233 500 62 700 4()1 700
I 03Y 800
_._--- -----85 800
339 :100
a
273 flOO
Global and intarUBional Ictivitlc • . . . . • . . . . . . . . . . . K.. dquartero •...................................... Total
81 300 452 000
893 600
1100 !lOO 452 000
709 700
795 500 4~O
450 600 n~4
600
341 800
1 933 :100
J 281 000
1 865 600
1
300
3 519 (lOO
PrDJect
-
.0.
1918·\919
1980·1081
19111-19/.
1980"198'
us s GLOBAL At(D tMTERJ.!.GIONAI. ACTIVITIES COUl". tn delltal public health ,luoridatlon and dental he. it" Hanpower ahd .ervicea pla(JO;tns end dilvelop..ent: and 'cc-vice. [0 CDUl1l r tit" • Ol\lt 01)8
us •
OM 011 ~.chnlcal
2/0
_/0
tH 800 1)4 h)()
246 8')(')
cooperation "11th QRIt Oil ORH Oll 01l.H OR" mUi ORIt 01111 01111 Oil" Oll 01) Oil, 014 016 016 Ill] Olt" 011 ORH 019 OiUIOll) OlJl Ollli 024 GlUt 016
9 O(X)
'0 800 94 ;'00
Oral h •• lth;
sundards and a .... tdel1nu
lJ 000 14 000 )8 100
14 500 42 100
.,td_tolo.)':
.ur",.y. of oral di.ullu, and c:.ondiLtona
3l )00 191 lOU )0 000
10
~oo
out dUe'le etioloKY and rrevelltlon field tettt"g ot d.U. •• ry .yatal' IJnd ple\1t:ftt he pcolec:t8 ..... 01'11 heelth in'or ... r:ton: at."1r It IE' , n t d ..... l and dtlse"tn.tion .... npuw ... develtlp.. ent •. Meet In. btl tc81n'ng .. nl'! UIlC of denl.ll!llndJiarleli ••..
Prevention/research!
)21 ,00 114 700 , 100 11 000 2~
on
'lOt)
..... rch .ethIc au'! lnuu.tlonal colJ .. borathe atudy of dental aanpower "Y"(III.n Co.udtnethln of ........ ch: 0 ... 1 Re •• arch Ad"hol'y Group .e.tLn ••
OIM 006 OIUt Ol8 oeM OUI
It tOO .0 000
11000 14 900 }6 900
49 900
2/0 Of whi.ch;
980 900 II }O<l 891 600
19) )00 e) 800 109 100
aalulu· bu41U Other 80,.&,<. ••
2/0
....
• MPWPD/81.1
page 3H
Annex 1
-
Programme budget 1982-1983
QbJectivu To promote the develo .... nt of etfective planniog, implementation and evaluation of oral health prOlt ....... at All level. af th. coaaprehanelva ..atlonal health aervice.; and of national prevention progt...... , with part1cula:c attention to
h1&h- clak ,roupa; t.o prOlAOte the t:ra1nlna and reorientation of dental per.annel. both prof ••• lonal and nonprof"" •• ional (includln& coaaWlity worker. and auxiliarie.), with. view to 1aplementing oral health prOarAIIBCI adapted to tbe lpeclflc needa
and r •• ourc •• of each country; to develop, [elt and reviae approprlat • .ethodolo81ea for ule by countri •• , and to 1nit1ate And coordinate el.entt .. l relearch; to COllect, analyee and di •• eminate relevant infol1Dbtlon for planning effective country progl'aaee.. in oral he<h ..
Cooperation with and among countries As 1n 1980-1981, with the emphasis on prevention, the activities of the oral health programme in 1982-1983 will fall within six interconnected areas; Corresponding particularly to MTP specific Objectives:
....
InlCI,l'ilted plannlng. The propos. it in thi. top-priority area tor action b Y ] Member Stet.e. are designed to _et the need, of n&t10n.. 1 .leu.tloo c"alYll •• plannins and progralllm!"& every five yearl ••• well •• ongoiua 1apleaencation of th. r ••ultant preventive progr-...ea. It i .... t!.ated that 8iupport for theae national effort •• totalling .ome 600 •• paral.& analyae. and plannina activitl •• betveen 1980 and 2000, w111 require eight aali-year. of "'"0 Itaff or conault.nt tt-. at all level., in 1982 and ill 1983, falling to ~O7. of that total by 1990. 4. a.uuae of the nature of the global probl • • in oral hulth. and the &PproaCh~ they ~.q"1re:. the prograrar.e ha. a cOllaOn baa1. in all ccuntr1e:a and regions. Thu. the pal't uf the activity baaed at headqwtrter. baa .. large interre8,ional component. tbe [' . . . tadeI" of the work beLn, dependant on reglonal ataff and con.ultanta.
1 and 2
1 and 2
Plan of act 10n Follo.,ing a butld-up in 1980-1981 to the requ1red level of act1vity. the will operate at itl plI!ak in 1982-1983 and the following biennlum. Thia will aho be the period of peak ct!ntral input into country analyses ami planning proceil.ea (at LeBat 1) countrles l..ec year) _ and of groateot volume of ••• 1.t4nc. with aucvey1na to obcain b •• eline 4nd monitorina data (}O cO\Ulccie. per Y4!:lLr) ; thie latt.er work fonna pa.rt uf integrated planning and will b411 .uppocted by the oral. , ••• lth det .. bank a. Demonatratlon .nd tra1rd.ns prosranae. and actlvitie. for the aolut1on of problema in plan 1mple. . ntation will be at a con. taCit level (.lx and four countrle. per year reapect1vely). but evaluatlon and folloW"'up activiti •• "ill peak 1n later yean. • pro&['~
1, 3 and 6
In .ddltloa to the central thru.t of integrated p.an01nl in which prevention] ha. top priority, apectfic activiti6' in prevent10n ",111 conc.entrate.. on fi.ld trial. in cart •• and periodontal dt ....... And on de • .:m.u·aUe,., aDd tra1n1na centre. 1n 1982 .. 198); tha .arly decection and prevention of oral cant:er wLl1 b. developed. ~t activities. TIli. part of the progr4DlDe will concentrate on e ••ential input tD en.ure that countries and region. have the tool. with wl1ch to work and that the global goal can be aChieved.. That central input wlll relate to: updating and development of Plethodolog1ea tor .urveys, piannin&. prevention. wnpowar production. IDIln.sement and .e.livery. b.ck~ up aurvey utartal. t auldance aDd .nalyat •• and aaaintenaDce uf the ,lob.l 0("&1 data bank; and &;oll.aborativo r •••• rch. Moat of the r •••• rch, de.Laned. to contribute to th~ ceaUl.atlo" of the slobal loal •• will require extl"abudgetary tundlns. However. aome proviaion from th. reaular budaet 1 . . . . .atl.1 for the initial promotion and develo~nt of ~•••• rch.
2
3, 4, 5 and 6
~11'Wl'))/ pdl!)~
111. 1 39
Support in manpower development ",11) concentrate on appropriate educational
ob,ectives and curricula for all per80nnel providIng orad health .ea:-v:I.I.:elil, hut _mph•• t&ina .uxi Uary .nd nth.&" frunt~ U"a h .... lth Wt)rIHu·,. Hhort ~UUl'tUUI vj 11 b. 81v.n in tlhu' C(JtHlLJ:t • • • 4eb y ••• ' ,uld _pun.lI.lad hi ui-htu·. to .u.uaulat. pro,l' ••• in tht. Ueld.
In the and t.st.ing of Mt:hodology, the pnJlramme will empha.1xa the .tandardlzatlon of data frOlll recorda, tlpucltlc epidemiological mea.ulemClnta. and auidelin •• for curricula development •• central oftlce functIon.. and the Application of planning and prevuntive Jaethods, record". procedures, specific .ptdttmlolog1c.Al meadlH."ements, ear 1y detectlon methods fo .... or.1 cllncel". and training prograuae. for all level .. of denta.l personnel 48 country a(;t1vitle ••
d.velo~nt
J J ]
Annex
Corresponding particularly to MTP specific objt\ctiv~H:
3
4
Reiea["ch actlvitic& will focus on the main coll.hur.tive study of fluoride ] ingestion from all 80UJ~ce8. The international collaborative .tudy of dental manpower systems. covel~ing an extended seriea of 11 countciell, will be finalized.
5
The information component will concentrate on maintaining the global oral epidemiology data bank. expanding it if and as nace"aaI)'. and on evaluating progr. . . to ...
"d.
the global goa! of oral health
f".
all by the year 2000.
6
Regionally, the p'l'ogratmle differs only in emphasis.. The African and SouthEast Asia Regions will concentrate on keeping national averagllt> below the global indicator. while providing a.dequate aWlnpower. The Region of the Americas and the European Region will endea.vour to quicken the trend of decreasing oral disease 80 as to reach the level defined by the global indicator. at the !lame time avoidlng manpower excesses which ma.y thul devel.op, The. laa tern M.ed U.erranean and Wes tern Pacific Region6 \IIill selectively work along bot.h of t.hese linea because of the very different situat1.o(1S and concra.ting trend. in oral health in Member Statea.
The supporting budgetary tables for the global programme statement contain a global programme estimate for the two comparative financial periods as illustrated overleaf.
r- "...-
~
)-
.~
1980-1981 Ettim&ted obl1ptloal
1982-1983 loti_ted obl1 .. Uon.
IDcrea.e (d.eer••• e) between 1980-1981 aDOl 1982-1983
ro
0 0
OGlE: !» "tl ~
~~
><
~
at",lar budaet US $
Other
,ource' US $
Total US~
Iosular bllcllet US $
Other
.ouree.. US $
Total US$
-
COO ~
t:l ......
Resu Iar budS" t US $
....
Reliona: Afric:a .•••••••.••..••••..••••.•••.•..•••• , ••••••• Aller1c.a. • ........................... , ••••..••••••• South-East Alia .................................. Europe ...........•..••••••••••••.. , ...•.•...•.••• E•• tern Mediterranean .......................... < • • Weotero Pacific ..................................
145 131 368 213 62 407
000 600 700 500 700 700
145 000 754 300 39 600 143 000 185 900
I Global a . I.l\to<ro&ioool activities ................
!
.
368 253 205 407
700 100 700 700
220 234 616 291 69 407
000 000 300 100 000 200
6ll 1000
30 000
220 845 616 321 69 407
000 400 300 100 000 200
75 000 102 400 247 600 77 600 6 300 (500) 508 400
1 329 200 85 800 450 600
936 900 956 800
2 266 100 I 042 600
1 837 600
641 400
2 479 000 378 600 420 000
378 600 420 000 2 636 200
292 &00 (30 600) 770 600
lle.adquarterl ........................................ Total
450 600 1 893 700 3 759 300
I
I
1 865 600
641 400
3 277 600
I Project No.
Ma.n-ye4rajaonthl
EstiJut.ed obligations
1980·1981
1982 ·1983
1980-1981 US $
1982-1983
Sourc. ef fund.
us $ 28 600 D
CLOMI. All)) II!TEIUGIOIIAL ActIVITIES
ZXpe:rt c~ttee on prevent.ion _thoO. and prcograa-t., for oral disease ....
H' .U'"
. . . . . . . . ...
OI!H 401
Plumin.& and developaent of mao.pover and services: Tec.hn1cal cooperation with aDd. aerviee. to countries ••••.•.. ~ .............................. , .. ~ .......................... , ................. .. ScaDtarcla and ",i4eU.Del .................................................................... . 'ield te'ting of delivery syat.em!! and prevent ion projects .......................... .,.. ........... .. Information storale, retrieval and d.issemination ....................... , ..................... '0' Manpc>ft r deve i "",""at ••.•....•••.•..............••....•.•.••...•.•........•....••••••.•.•.•••• Meetln& on tr&i.niua and uae of dental auxiliaries ........................... · ........ ·· .. · .. ••· .. ··• ..
OI!H OI!H OI!H OI!H ORR ORR OI!H ORR
012 012 013 013 020 023 024 026
40800 94 200 14 500 48 100 274 700 5 sao 13 000 26900
D YO
D YO YO
D D YO
luearch activl.tiea: te.....rch; development and t.T'aining for oral nealth prograames ........................................ .. OI!H
002 7/0 488 000 12 000 24 900 524 900 042 600 85 800 9 5~ 800
350000
D IIC
Fluori.d.a tioo and dental hea 1 th ••..•..........•.••...•..•...............•....•••.....••.•.•• Adviaor')' group OD oral rese.arch •..•••...•.•..•......•.................. , .....•.•......•.•••
OI!H 011 OI!H 018 OI!H 018
D VG
SubtotAl - IleJ.e.arch activitle. Total - GLOI>AL Am: INTERREGIONAl. ACTIVITIES
7/0 7/0
350 000 378 600 378 600
Of which:
Regular budget Other sources
7/0
I
"
l,
MPWPO/131.1
page 41
.. EVALUATION
Annex 1.
A universally relevant long-term simple measurable indicator for assessing achievement in national oral health care programmes has been identified - "the number of decayed, missing and filled teeth per person at 12 years of age; the.target being no more than three". This figure can only be attained by a country having a strong, coherent preventive dental care policy reflected in plans to extend basic essential care prevention, pain relief and residual coverage - to all sectors of the community. Evaluation criteria for the specific objectives (see page 31) of the global medium-term programme h.;lve been determined. Objective 1: To promote implementation of an effective planning and evaluation of oral health programmes at the national level, including primary health care. Criteria (a) The number of Member States performing situation analyses, including a baseline or monitoring survey. as appropriate, and formulating/ restructuring plans for a national oral health service. (b) The extent to which goals specified in national plans and projects have been achieved; for example, the increase in the percentage of a population having access to different l~vels of care in the medium-term, i.e. at the end of five or ten year plans, as appropriate; or the decrease in the percentage of adults over 35 years of age exhibiting failed care, i.e. edentulousness, in the long-term. Progress with this objective is further detailed in the table below.
TARGETS
ACTIVITIES 1978-79 Situation analysis in Sudan, Democratic Yemen, Oman, Pakistan, Somalia, Saudi Arabia, Egypt, Iraq; AI-'R: Botswana, Tanzania. EMR:
ACTIVITIES 1980 Situation analysis tn EMIt: Syrita, Jordan; AFR: Malawi; WPR: China. Follow-up implementation activities: Sudan, Syria, Saudi Arabia. Dental Public Health courses - EUR: Bulgaria 1980.
....
I .
Initiation of integrated planning 6-15 countries/year.
Dental Public Health courses - Danida: SEAR: Thailand 1979; Singapore 1979. WPR:
MPWPD/81.1 page 42 Annex 1
TARGETS II.
ACTIVITIES 1978-1979 51 surveys: 8 - AFR; 8 - AMR; 16 - EMR; 8 - EUR; 5 - SEA!?; 6 - WPR.
ACTIVITIES 1980 4 surveys completed; 29 in progress;
Promotion and assistance with planning. implementing and data analysis for surveys for collection of baseline and monitoring data on oral health in 20-30 countries per year.
13 in planning.
Difficulties encountered and recommendations There have been strong tendancies to react to incurred oral disease prevalence in traditional ways. i.e. more schools for dentists rather than auxiliaries. development of curative/restorative/rehabilitative facilities rather than preventive programmes. However these tendancies are changing as a result of diffusion of information about oral disease prevalence and trends from the WHO data bank with emphasis on the relative costs in manpower and support services of the contrasting approaches. Because of the low priority accorded to oral health- the diseases involved are not "illness" .. there is often reluctance to expend resources on this areas of health. The implementation strategy depends on creating a broad base of personnel who can apply the methodology. There are difficulties in getting governments and institutions in developed countries to release senior staff to work as consultants and thus assist in the formation of this group of experts. Further information about the aims and strategies of the programmes need to be directed to countries. stressing the importance of releasing staff tor work in other countries and the advantages that accrue to the donor countries. Ideally such involvement should extend over a period of years. There is a need to "integrate" oral health into general health services as much as possible .
. Objective 2: To promote planning and implementation of national prevention progranmes with special attention to high risk groups. Criteria (a) The number of Member States that have established preventive plans and have identified appropriate strategies such as fluoridation of water, staff, teacher supervised rinsing progranmes, .... for implementation of these plans. (b) The number of pilot/field demonstration projects implemeted to new or combinations of preventive measures in populations. tes~
(c) Specific results of the evaluation of national or pilot preventive programmes. Reduction of mean caries increment by x % over 3/5 years.
MPWPl)/IH • 1 page It'.!
Annex 1 (d) Reduction in specific disease indices (e.g. percentage of population with calculus, mean DMF) used in the national surveys at five or ten year intervals. Progress: --~--
--------. ACTIVITIES 1978-79 ---
------------ACTIVITIES 1980 Support activities Syria, Sudan Saudie Arabia, French Polyuesia
TARGETS I. Implementatiuu o~· national oral disease prevent,;ive prOi;l'a~"lmes
Syria, Sudan, French Polynesia
II. Field demonstrations of preventive measures for caries, periodontal diseases and oral cancer
French Polynesia, Thailand - chewing gum, fluoride rinse trial 1977-82 Thailand - chlorhexidine trial French Polynesia sugar replacement trial. 1st stage testing of methodology
Projects using "high fluoride" tooth paste in planning.
.-
III. Periodontal Project ---2nd stage testing of control programmes in 6 countries. IV.Establishment and development of 3 training, research and demonstration centres.
2nd stage country projects in planning (fund raising)
Centre in Thailand established.
Centre in EMR (Syria) under negotiation Proposal for AJ'R in prel)arstion
V. Partic:Lpate
Ul
evaluation of alternative fluoride delivery methods
Milk fluoridation project AHR. EMR 1979.
-
Remineralizing solution project - EUR, WPR.
----Difficulties encountered and recommendations Successful or~l
disease preventive programmes depend on:
1;
good central organization and existing health and other systems;
2. availability o_t necessary materials (e.g. sodium fluoride powder, cups for rinsing, etc). If these materials are not produced in a country, importation may pose foreign currency problems - bulk purchase at regional or central lev~l can ~meliorate this problem; 3. use of non-dental personnel such as school teachers and health workers. It is of tea difficult to get agreement from authorities for school teachers' participation in such activities because of entrenched professional attitudes and if the relevant authorities are not involved in the development of the programme. It is less difficult, but still a problem, to get health workers to accept responsibility for such proErammes. . ...... .
HPWPD/81.1
.page 44 Annex 1 ?bjective 6: To collect, use and disseminate information necessary for plannlng oral health services and monitoring the success of country programmes.
List of countries with: 1.
Recent reliable data:
(i) (ii)
with DMFT equal to or less than 3 with DMFT greater than 3. (i) (ii)
I
2.
Data older than 10 years:
with DMFT equal to or less than 3 with DMFT greater than 3. (i) (H)
3.
Qata between 5 and 10 years old: No reliable data at all.
with DMFT equal to or less than 3 with DMFT greater than 3.
4.
\
TARGETS l. Maintain and expand oral data bank.
ACTIVITIES Annual update of the global data bank includes all information on disease and manpower available. Tables sUlIll1larizing the caries situation in all countries classified into five-year data intervals will be prepared as from 1980. Annual meeting of chief dental officers at World Dental Congress of FDI.
II. Anuual evaluation of progress towards Global Goal fClr 2000.
III.
Dissemination of information.
The following tables detail DMFT at 12 years of age. two regions are presented •
Examples of
.
1
DMFT
~
decayed, missing. filled teeth.
MPWPU/IH • l page 45
Annex 1
~JEST[R/'!
PJ\CIFIC IlEGILll
I1fT~3
(age 12 years)
crurrRY Data since 1968
I ll'fT
l)auLli;' '-"
ftFT>3
----
(age 12 year.)
NO Ii\lE 1978 1978 1917 1969 ]970 CHINA I'Jlllf'OCtlEA
DflTI~
DATE 1978
(ron IN 1966
11fT
FIJI
...
GILBERT ISl.I>IIDS* tO~G J<l:U>" KOREA (SOUTH) WlLAYSIA PAPUA NE~I
3.0 0.5 2.0
I'I''fRICm SAl-llA"
3.7 4.9
1911 197fJ 197JJ3
coot( I SLAIUlS" fREllCH POLYNESIA* NHI CALf.lUHA It
10.7
lAOS
0.6 2.7 3.0
197011 1~7114
IIEVI IIEIIR IDES· AIJSlilAl IA
GUINEA
SItIGAPOHE SOlu-m I SlH-IDS·
L.9 1.7 1.9 1.1 1.11 0.7
1970 J969 ]911
Ji\PAlI NEVI ZEAlAND
4.11 3.4 l.6-6.0 19T98 5.5 1915 6.0 1973
VIEHWI I'o'E.STEHN SIV'OA
1972 ~~:wL
Data
b~fo ••
lYbl
,
PHI LI PP illES HJI'IGA
]%1 19btJ
TkUSTIERRI roRY Of· THE 1'1\( I f: Ie
5.1 -
19fJ6
, ----~----
-------------
[j\SlEI~'j
Vfll! 1EPJljlJfjIJj P[GIW
- - - - - - - - - - - - - - ------- ----------- ----- - - - - - - - - ---------_.. _ - - - - -----------------.., [H~r 63 (age 12 years) !J'n;;> 3 (age l2 years) NO DArA f--------------------- -------- ----..----- - ------------------ - - - - , - - - i--~---_Cl"!t@"---- !!I!_ 1I!\1~ _________________1WrlUiL__..1tfl___ 001E_----------------JlJltiLWlcJL12_!,_!l. EGYI" IRNI
1.7 7,'\
lCJn ](\71\
IHNl LEBNI'l"
Li.O 3.!) Lj,5
]C179 ]'1/ 1\
AI
~;IVVHSTNJ
Hl\ll!l,\\N (YiTlUS
LIBYA 0/11\14 PIII<IST/IN
l.3 ),5
Jfill)
SYHIII
1"l/4
FJ79 1979
D.ll flOUI I K\/.'I/IIT Q/\rAI~
SIII1l I Sl!lAN
AI~AB
IA ..
51."'1.111 veel ARAB HEPUBUC
:".1 1.9 1.1 J .1
1979 lfVa 1978
lXHlED NWl HlIRI\IES
YEJ1Etl (DEI''OCRATI c) Tl1'IIS1A
1.2 0.2
1979
Data before JORl¥\N
12~~
ISRllEL L-.._ _ _ _ _ _ _ _ _ _
i.4
MPWPD/81.1 page 46 Annex 1
Difficulties encountered and recommendations Although it is impossible to quantify, it is expected that there is a considerable deficiency in disseminating information on prevalence and trends of oral disease and on available manpower to all public health administrators and especially to lay persons involved in policy creation. In 1979, with the collaboration of the International Dental Federation (FDI), an annual meeting of chief dental officers was instituted at the FDI annual congress. This ensures that those officers who are able to attend have the latest data, but does not greatly assist the generalized dissemination that is essential for suffi.cient priority to be given to oral disease preventive programmes.
INFORMATION SUPPORT The eabloration of the oral health medium-term progranune and the related programme budget was made possible by a special-purpose information
...
sub-system:
"The Global Oral Epidemiology Data Bank" comprising all the baseThis information also
line information on oral disease levels and trends. provides the means for evaluation of the programme.
In addition to this specific information system, the Oral Health Programme Profile reports more details. Extracts of two elements (Policy Basis and
Essential Reports. Documents and Publications) from the Oral Health Global Programme Profile are given below as examples, while the rest provided in the previous section on EVALUATION (pages 41-46) forms part of Element 9 of this profile. "Element 1. A. POLICY BASIS
WORLD HEALTH ASSEMBLY RESOLUTIONS
WHA6.17 (1955)
Resolution recommended that provision for a programme in dentistry
in the programme and budget for 1955 should be allowed within the available financial provision. WHA24.64 (1971) recommends that the World Health Organization (a) undertake a programme of:
Nl-'wPlJ/iH. i pa6~
,.7
Annex
(i)
the promotion of community water fluoridation and other approved for the prevention of dental caries.
melhod~.,
(ii)
co~rdination
of study and research into the et 101 ogy and prevention of
dental caries and related problems. (iii) the development of information systems to facilitate the gathering and dissemination of information which may link the prevE:nlion and research activities together thereby making ('aeh more effective and u"eful to member states. and (b) assist Member StfHes i.n the planning and implementation of nHti.ol1al caries prevention programmes.
~IA21.5(J
(1'J7~)
urges l'1ember States to illlplcmt'llt, within !lati.onal plans for the
preventiun and control of oral disease, the fluoridatiun of public drinking water supplies, when and where appropriate, and where fluor·idation of drinking water is not fsasible for techni~al
or other reasons,
alternDliv~
....
methods of achieving an optimum daily intake or application of fluoride should be considered, and requests that tile Organization provide assistance and advice to countries for those purposes.
B.
REGIONAL COMM ITTE£ RESOLUT IONS AFR/RC25/TD/WlJ/J recommended that: national epidemiological surveys of oral
diseases sllould be made as soon as possible, planning of oral health serviceb and personnel sh0uld be included in the overall health policy and should be based bn survey results; special efforts should be made to ensure adequate
coverage of the total population and preventive programmes should r.avt' high priority. EUR/RCIS/R6 stressed the need for: (i)
better dental health services for children. more attention to child dental health school programmes.
(ii)
(iii) better dental health education. (iv) water fluoridation and other methods of administration of
fluorides as caries prevention.
HPWPD/Bl.l page 48 Annex 1
.-
"Element 7. 7.1
ESSENTIAL REPORTS, DOCUMENTS AND PUBLICATIONS
WHO Reports, documents and publications 1. Technical Report Series TRS No. 146, 1968 - Expert Committee on Water Fluoridation TRS No. 163, 1959 - Expert Committee on Auxiliary Dental Personnel TRS No. 207, 1961 Periodontal Disease TRS No. 242, 1962 - Standardization of reporting of dental diseases and conditions TRS No. 244, 1962 - Dental Education TRS No. 298, 1965 - Organization of Dental Public Health Services TRS No. 449, 1970 - Dental Health Education TRS No. 494, 1972 - The Etiology and Prevention of Dental Caries TRS No. 589, 1976 - Planning and Evaluation of Public Dental Health Services TRS No. 621, 1978 - Scientific Group on the Etiology, Epidemiology and Prevention of Periodontal Diseas8s
...
2.
Monograph Series Honograph Series No. 59, 1970 - Fluorides and Human Health
4.
WHO Offset Publications No.9, 1974 - Cost and Benefit of Fluoride 1n the Prevention of Dental Caries No. 40, 1978 - A Study of Caries Etiology in Papua New Guinea
6.1
WHO Publications Application of the International Classification of Diseases to Dentistry and Stomatology (ICD-DA),- 1978 - World Directory of Dental Schools, 1963 - Oral Health Surveys, Basic Methods, 2nd Edition, 1977 - World Directory of Schools for Dental Auxiliaries, 1977 - Guide to Oral Health Epidemiological Investigations, 1979 - Common Oral Diseases: for Teachers, 1980 Prevention and Emergency Care - A Manual
- Guide to the Epidemiology and Diagnosis of Oral Mucosal Conditions and Diseases, 1980 - Guide to the Planning and Evaluation of Oral Health Services, 1980
MPWPU/ tll. 1
page 49 Annex 1 6.2 Oral Health documents - Inter-Regional Seminar on the Training and Utilization of Dental Personnel in Developing Countries, New Delhi, 1967 (IR 392) - Report of Expert Consultation on Xylitol. ORH/PREV.XYLITOL/79.2 Geneva - Progress Reports on Preventive Programme. 1976, 1977, 1978 - Reports of Oral Health Research Advisory Group Meetings 1976. 1977. 1978. 1979
...
- International Collaborative Study of Dental Manpower Systems (Interim Report) 1979."
...
.
MPWPD/81.1 • page 50
ANNEX 2 GLOSSARY OF THE TERMS USED IN THE MANAGERIAL PROCESS FOR WHO PROGRAMME DEVELOPMENT 1
Allotment
An authority to spend during the two-year financial period of the progranune budget. It is issued by Budget prior to incurring "obligations" (q.v.) and is the basic mechanism for budgetary controL.
Approach
The means to be used or the procedure to be followed in order to attain an objective or target. described in broad terms. In programming, approaches are For example, if one objective of an oral
health programme is to reduce the incidence of dental and periodontal disease, the approach might be the development and application of standard simple methodology for constructing oral care programmes. Appropriation Resolution The resolution by which the World Health Assembly approves the amount of the budget for a given financial period and the amounts to be allocated to different broad sections of the WHO programme, known as "appropriation sections", such as disease prevention and control, health manpower development, and health information. (These corres-
pond to the progranune areas of the Sixth General Progranuae of Work.) Appropriation section Budgetary allocation Criterion See "Appropriation resolution".
A portion of the total budgetary resources allocated to a region or to headquarters.
A standard or principle by which something is judged. decision on the choice to be made or the action needed.
As a factor For
used in judging a situation, it helps the planner to reach a rational
example, in the Sixth General Programme of Work, the following criterion is aimed at helping to determine the organizational level or levels at which programme activities should take place:
1 A more complete glossary of WHO terminology covering variOUS aspects of the Organization's activities will be issued shortly in the Health for All Series •
..
• MPWPD/ !:S1.1
page 51 Annex 2
"Country activities should alm at solving problems ot major puol lC health importance in the country concerneo, particularly those of underserved populations, and should result from a ratlonal procesti at "identifying countries' priority needs by such means as national planning process."
Effectiveness
The degree to which a plan, a programme, or a project achieves its objectives.
Efficiencx
The ratio of the output of an activity to the input into the activity. The greater the ratio, the higher the efficiency; thus,
whereas effectiveness is a measure of the extent to WhlCh an ObJective is achieved, efflciency is a measure of the skill with WhlCh minimum resources are used to achieve the objective (or wlth wnlch maximum output is obtained from a given amount of resources).
Evaluation
Systematic assessment of the relevance, progress, adequacy, efficiency, effectiveness, and impact of an activity in relation to ltS objectives. It is a management technique for improving both current decis~on-making,
activities ana future planning, programming, and
ano
makes possible the setting of priorities and the reallocation ot resources in accordance with changing health needs.
Heal th development
Progressive, continuous improvement of the health situation ln a community, a country, a reglon, or the world as a whole. The [erm
is also applied to the sum total of the measures used to ralse the level of health .
... Implementation The operational phase of an activity, including the provlslon ot services, the carrying out of the activity, and the monitoring ot performance.
Indicator
A variable whLch helps to measure one or more aspects of a given situation or of changes in a situation.
Information support
The provision of all the intormation needed for
formulatLn~.
implementlng, monitoring, and evaluating a programme.
The WriU
Information System has been set up to provide this support.
MPWI'D/81.l ~
p~ge 52
Annex 2
Medium-term erogramme
A detailed programme or set of programmes developed from a general programme of work. It sets out specific objectives, targets, and approaches and describes the act1vities to be undertaken durlng the It serves as six years covered by the general programme of work. the basis for the preparation of the biennial programme bud~ets.
Milestone
An event of major significance for evaluating the progress ot a programme, for example, the completion of an important activity or group of activities.
Monitorin&
In programme management, continuing follow-up of the progress made 1n implementing a programme or activity in order to ensure that it is proceeding according to plan and achieving its objectives. Monitoring keeps track of achievements, personnel matters, supplies and equipment, and money spent in relation to available resources, maklng it possible to apply immediate corrective measures if the activities do not stay on course or do not keep to schedule.
O~jective
The desired end-state that a programme seeks to achieve. of an objective would be:
An example
"To foster education and information activities which will encourage people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health, and to seek help as needed." An objective is usually stated in descriptive text rather thao 1.0 numerical terms and is less specific than a target (q.v.). ". Obligation
A legal financial commitment of the Organizatlon during a flnanC1.a! period.
Output indicator
A variable that provides a measure ot the extent to wnich an actlvlty For example, the is producing its desired output and objectives. number of community health workers that are employed in primary health care services can be an indicator of the output of a training programme for primary health care.
MPWPU/81.l page 53 Annex 2
Profile
A selection of information structured according to established needs, such as the description of a programme or a health situation broKen down into predetermined elements. contains the following elements: objectives and targets; control; projects; For example, a programme profile policy basis; problem definit1on; monitoring and essential
programme description;
participating persons, groups and institutions; evaluation.
reports, document, and publications; pages 21-24.) Programme
related programmes and
(Further information on profiles is given on
An integrated series of services, activities and development projects directed towards the attainment of defined objectives. Annex 1. An example is the Oral Health Programme, the main features of which are shown 1n
Programme budget
A budget that concentrates on the objectives of a programme and translates into costs the activities that will be required for their achievement. The principle has been described as "programming by The way in which this objectives and budgeting by programmes".
principle is applied in WHO is described in detail on pages 13-16. Programme development The entire managerial process by which WHO's international health work is planned, coordinated, implemented and evaluated. It includes the policy decisions of the Health Assembly, preparation of the general programme of work, medium-term programming, programme budgeting, management of operations, evaluation, and the provision of adequate information support.
Target
A specific end-result to be achieved by an activity or activities, usually expressed in numerical terms. It differs from an object1ve (q.v.) in being more specific and limited both in scope and in time; a further difference is the fact that an objective is seldom expressed in numerical terms and is, indeed, often not quantifiable. For examples of targets, see Annex 1.