Organisation mondiale de la santé (OMS) · Technical Documents

Proposed programme budget estimates for the financial period, 1982-1983

31 décembre 1980 Organisation mondiale de la santé

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REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Thirty-first session Manila, 9-15 September 1980

PROPOSED PROGRAMME BUDGET ESTIMATES FOR THE FINANCIAL PERIOD 1982-1983

The Regional Director has the honour to present to the Regional Committee for the Western Pacific the proposed programme budget estimates for the financial period 1982-1983.

Manila, June 1980

ABBREVIATIONS

The following abbreviations are used in this document: ASEAN CARE DAN IDA FAO Association of South-East Asian Nations Cooperative for American Relief Everywhere Danish International Development Agency Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Bank for Reconstruction and Development (World Bank) Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies South-East Asia Medical Information Centre of the International Medical Foundation of Japan Swedish International Development Authority South Pacific Commission South Pacific Pharmaceutical Service Technical cooperation among developing countries United Nations Development Programme United Nations Fund for Population Activities United Nations Children's Fund United States Agency for International Development Western Pacific Advisory Committee on Medical Research

IAEA IBRD PEPAS SEAMIC SIDA SPC SPPS TCDC UNDP UNFPA UNICEF USAID WPACMR

CONTENTS

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

Regional Director's programme statement SUMMARIES Summary Summary Summary Regular Sources of regional health programme: estimated obligations by source of funds ...•..••.•..... by major programme, programme and source of funds ...••.••••••..••..•••..••..•...• by major programme and organizational level • . . . • . . • . . . • . . . . • • . . . . • • . . . . . ...•.... budget 1980-81 and 1982-83 by appropriation section with percentages of the total ••.•...• of funds other than the regular budget: summary by major programme and programme ...•.... PROGRAMME ANALYSES 1 Policy organs 1.3 2 Regional Committee for the Western Pacific ......•...................•.....•...........

vii xiv

2 6

10 11

General programme development, management and coordination 2.1 2.2 Executive management ............................................................... .

General progrannne development and management •••.•••.••.•••••••••.•••••.••••.•••••.•. 2.2.1 2.2.2 2.2.3 General programme development Country health programming Information systems programme

19 21 21 25 29 32 32 34 37

2.3

External coordination for health and socioeconomic development 2.3.2 Collaboration with multilateral and bilateral programmes •••••••••.•.••••••••.••

2.4 2.5

Research promotion and development •..........•.........................•.............. Regional Director's development programme ...••....•..•............•......•••....•.....

iii

Development of comprehensive health services 3.1

Health services development 3 .1. 0 3.1.1 3.1. 2 3.1.3 3.1.4 3.1.5 3.1 .6

39 39 41 44 48 51 54 60 63 63

Programme planning and general activities Health services planning and management Primary health care Workers' health Care of the aged, disability prevention and rehabilitation Appropriate technology for health Health services research •......•.

3.2

Family health 3.2.1 3.2.2 3.2.4

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

Maternal and child health Nutrition •.•.... Health education

67 71

3.3

3.4

Mental health Prophylactic, diagnostic and therapeutic substances 3.4.0

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

75 78 78 80 83

3.4.1 3.4.2 4

Programme planning and general activities Drug policies and management Pharmaceuticals and biologicals

Disease prevention and control

4.1

Communicable disease prevention and control 4.1.0 4.1.1

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

87 87 89

Programme planning and general activities •••.•••••..•••••..••••••.•••.•••••.•. Epidemiological surveillance ................................................. .

4 .1. 2 Malaria and other parasitic diseases 4.1. 3 Bacterial, viral and mycotic diseases 4.1.5 Expanded programme on immunization 4.1. 7 Prevention of blindness ..•••.••. 4.1.8 Vector biology and control ...••..•..••.

92 97 108 111 114 116 116 118

4.2

Noncommunicable disease prevention and control

4.2.0 4.2.1 4.2.2 4.2.3 4.2.4 5

Programme planning and general activities Cancer •• Cardiovascular diseases Oral health ........... . Other noncommunicable diseases

121 124 127

Promotion of enviromrental health

5.1

Promotion of environmental health 5 .1.0 5 .1.1 5 .1. 2

130 130

5 .1.3 5 .1.4 6

Programme planning and general activities Environmental health planning and management Basic sanitary measures .....••••.•.••.. Recognition and control of environmental hazards Food safety

132 135 137 139

Health manpower development 6.1 Hea 1 th tnan"PQwer developnent ..•.•....•.•••••••••...•....•••...•••••.••••.••••••..•.•.

141 141

6 .1.0

6.1.1 6 .1. 2 6 .1.3

Programme planning and general activities Health manpower planning and management Promotion of training ..••...••••••• Educational development and support

143 146 149

Health information 7.1 Health information 7 .1.1

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

152 152 156 158

7.1.2 7 .1. 3 7 .1 .4 7 .1 .5

Health statistics ••..•..•..... WHO publications and documents Health legislation ....•... Health literature services Health information of the public

160 163

General services and support programmes 8.1

General services and support programmes 8 .1.1 8 .1. 2 8 .1. 3 8 .1.4 8 .1.5 8 .1.6

166 168

Staff development and training Personnel Supplies Conference, office and building services Budget Finance and accounts INFORMATION ANNEXES

170 172 174 176

178

Technical cooperation with and services to governments ANNEX I ANNEX II ANNEX III Regional Committee and Regional Office Country or area programmes Intercountry pro gr a1Il11l.e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

183

187 191 341

EXPLANATORY NOTES 1. In compliance with resolutions WHA30.20 (introduction of biennial budget cycle)l and WHA30.23 (development of programme budgeting and management of WHO's resources at country level)2 adopted by the Thirtieth World Health Assembly, the proposed programme budget estimates presented by the Regional Director include provisions for the biennium 1980-81 and requirements for the biennium 1982-83. The Regional Committee will need particularly to examine the requirements for the biennium 1982-83. 2. The programme budget of WHO is based on principles which can be summarized as "programming by objectives and budgeting by programmes". The technical components of the programme classification are based on the Sixth General Programme of Work covering a Specific Period (1978-1983)3. Each of the principal objectives of the General Programme of Work is represented by an appropriation section, under which detailed objectives are represented by a "major programme" and a "programme". The programme budget estimates are presented by "programme". 3. The programme statements consist of regional programme statements under each heading of the programme classification and country programme statements. The regional programme statements contain information with regard to the present situation, the objectives to be attained and the means to be employed to realize the objectives. They are supported by summary budgetary tables. 4. The country programme health for all by the year down by programme. In the statements under programme statements (pages 191 to 338) describe national strategies for achieving 2000 and are supported by planning figures for the country or area, broken case of the intercountry programme, a budgetary table is preceded by headings (pages 341 to 355).

5. The budgetary estimates for the Regional Office are shown on pages 187 to 188. The estimates for personnel costs are based on appropriate averages applicable to posts in both the professional and the general services category. The estimated obligations for programme 8.1.4 Conference, office and building services, include provisions for common services from both the regular budget and other sources.

lWHo Handbook of Resolutions and Decisions, Vol. II, 3rd ed., 1979, page 104. 2wHO Handbook of Resolutions and Decisions, Vol. II, 3rd ed., 1979, page 105. 3see resolution WHA29.20, WHO Handbook of Resolutions and Decisions, Vol. II, 3rd ed., 1980, page 5. vii

viii

6. The estimates for regional advisers, related secretarial assistance and duty travel are included 1n the intercountry programme under the appropriate technical programme. 7. The estimates for WHO programme coordinators and their offices, duty travel and common services are shown under the country in which the office is located, under the programme heading Country health programming. If a WHO programme coordinator is responsible for more than one country or area, the estimates are distributed over the countries or areas concerned. 8. As in previous years, provision is made for a Regional Director's development programme. The funds will be used for financing collaborative programmes with governments which could not be forseen when the programme budget estimates were developed. 9. The column headed "Other sources" in the budgetary tables includes all activities financed, or expected to be financed, from sources other than the regular budget. The fund codes used are as follows~ DP - United Nations Development Programme - Indicative planning figures FA - Trust Fund for the Special Programme for Research and Training in Tropical Diseases FP - United Nations Fund for Population Activities FT - Trust funds VA -Voluntary Fund for Health Promotion - Special Account for Assistance to the Least Developed among Developing Countries VB - Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (Prevention of blindness) VD - Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (Other) VG - Voluntary Fund for Health Promotion - Special Account for Medical Research (Specified) Other than human reproduction

VI - Voluntary Fund for Health Promotion - Special Account for the Expanded Programme on Immunization VK - Voluntary Fund for Health Promotion - Special Account for Miscellaneous Designated Contributions (DANIDA) VL - Voluntary Fund for Health Promotion - Special Account for the Leprosy Programme VP - Voluntary Fund for Health Promotion - Special Account for the Mental Health Programme VV - Voluntary Fund for Health Promotion - Special assistance to Democratic Kampuchea, Lao People's Democratic Republic and Socialist Republic of VietNam ST - Sasakawa Health Trust Fund

PROGRAMME CLASSIFICATION STRUCTURE 1. POLICY ORGANS 1.1 1.2 1.3 2. World Health Assembly Executive Board Regional committees

GENERAL PROGRAMME DEVELOPMENT, MANAGEMENT AND COORDINATION 2.1 2.2 Executive managementl General programme development and management 2.2.1 General programme development2

lRegional Director. 2Long-term planning; medium-term programming; evaluation; and office of the Directors Programme Management. ix

2.2.2 2.2.3 2.3

Country health programmingl Information systems programme

External coordination for health and socioeconomic development 2.3.0 2.3.1 2.3.2 2.3.3 Programme planning and general activities Collaboration with the United Nations system and other organizations Collaboration with multilateral and bilateral programmes Emergency relief operations

2.4 2.5 3.

Research promotion and development Director-General's and Regional Director's development programmes

DEVELOPMENT OF COMPREHENSIVE HEALTH SERVICES 3.1 Health services development 3.1.0 3.1.1 3.1.2 Programme planning and general activities Health services planning and management2 Primary health care3

lrncluding WHO programme coordinators. 2rncluding coordination of national health institutions; organization of medical care; diagnostic and therapeutic services; economics and financing of health services; national health service information support. 3rncluding community development and participation, and traditional medicine.

3.1.3 3.1.4 3.1.5 3.1.6 3.2

Workers' health Care of the aged, disability prevention and rehabilitationl Appropriate technology for health2 Health services research

Family health 3.2.0 3.2.1 3.2.2 3.2.3 3.2.4 Programme planning and general activities Maternal and child health Nutrition Special programme of research, development and research training in human reproduction Health education

3.3 3.4

Mental health Prophylactic, diagnostic and therapeutic substances 3.4.0 3.4.1 3.4.2 Programme planning and general activities Drug policies and management Pharmaceuticals and biologicals

DISEASE PREVENTION AND CONTROL 4.1 Communicable disease prevention and control 4.1.0 4.1.1 4.1.2 4.1.3 Programme planning and general activities Epidemiological surveillance Malaria and other parasitic diseases Bacterial, viral and mycotic diseases3

lincluding prevention of road traffic accidents. 2Including laboratory and radiological technology. 3rncluding zoonoses. xi

xii

4.1.4 4.1.5 4.1.6 4.1. 7 4.1.8 4.2

Smallpox eradication Expanded programme on immunization Special programme for research and training in tropical diseases Prevention of blindness Vector biology and control

Noncommunicable disease prevention and control 4.2.0 4.2.1 4.2.2 4.2.3 4.2.4 4.2.5

Programme planning and general activities Cancer Cardiovascular diseases Oral health Other noncommunicable diseases Immunology

PROMOTION OF ENVIRONMENTAL HEALTH 5.1

Promotion of environmental health 5 .1.0 5 .1.1 5 .1. 2 5 .1.3 5 .1.4

Programme planning and general act1v1t1es Environmental health planning and management Basic sanitary measures Recognition and control of environmental hazards Food safety

HEALTH MANPOWER DEVELOPMENT 6.1

Health manpower development 6 .1.0 6 .1.1 6.1.2 6 .1. 3

Programme planning and general activities Health manpower planning and management Promotion of training Educational development and support

HEALTH INFORMATION

7 .1

He a 1 th information 7 .1.0 7 .1.1 7 .1.2 7 .1.3 7 .1.4 7 .1.5

Programme planning and general activities Health statistics WHO publications and documents Health legislation Health literature services Health information of the public

GENERAL SERVICES AND SUPPORT PROGRAMMES

8.1

General services and support programmes 8.1.0 8 .1.1 8.1.2 8.1.3 8.1.4 8.1.5 8 .1.6 8 .1. 7 8 .1.8

Programme planning and general activities Staff development and training Personnel Supplies Conference, office and building services Budget Finance and accounts Internal audit serv1ces Legal services

xiii

xiv REGIONAL DIRECTOR'S PROGRAMME STATEMENT The proposed programme budget estimates for the biennium 1982-83 have once again been prepared in accordance with the priorities given by the Regional Committee to the principal and detailed objectives of the Sixth General Programme of Work covering a specific period (1978-83). Since 1978, however, much experience has been gained with managerial processes for programme development. The present estimates reflect to a greater extent than hitherto the results of country health programming and medium-term programming. The proposed estimates have been developed with the clear aim of providing cooperation to Member States in formulating, strengthening and implementing national policies, strategies and plans of action for achieving the social target of a level of health by the year 2000 that will permit all citizens to lead a socially and economically productive life. They will contribute to realization of the basic health doctrines established by Member States of the Region through the Regional Committee and ultimately the World Health Assembly. Throughout the programme budgeting exercise, WHO's coordinating role has been kept in mind, so that all programmes will be realized in accordance with the conceptual de fin it ion of "socially relevant technical cooperation programmes, directed towards defined national health goals, that further national self-reliance and contribute directly and significantly to the improvement of the health status of the populations served".l In this, technical cooperation with and among developing countries is a vital component. Individual country programmes will continue to receive considerable support from the intercountry programme Which, in view of the heterogeneous nature of the Western Pacific Region, has proved an effective and efficient means of providing cooperation in the right place and at the right time. Provision is made for collaboration in organizing national courses and seminars and for continuation of intercountry teams in fields such as health services development and management, primary health care, maternal and child health, epidemiological surveillance, tuberculosis, leprosy, malaria, nutrition and the expanded programme on immunization. Because of the vastly differing levels of economic and sociopolitical development, each country or area of the Region naturally has health problems peculiar to itself. In general terms, the causes of ill health are associated with a low standard of living and lack of the basic necessities of life, or with an urbanized lifestyle and a polluted environment. All these conditions may coexist in one country to a greater or lesser extent. Problems facing the newly industrializing countries include pollution of the environment, especially air, water and food, and hazards to workers in newly developing industries.

lSee resolution WHA30.30, WHO Handbook of Resolutions and Decisions, Vol. II, 3rd ed., 1979, page 102.

Where living standards are low, there are nutritional problems, acute infectious illnesses, including diarrhoea and respiratory infections, tropical parasitic diseases such as malaria, schistosomiasis and filariasis, tuberculosis, and leprosy. With industrialization and urbanization follow chronic degenerative diseases, cancer, alcoholism and drug abuse, road traffic accidents, some mental disorders, sexually transmitted diseases, industrial accidents, and occupational disorders. Of importance as basic necessities for health are adequate food, clothing and shelter, as well as a clean water supply, a priority for much of the Region. There is also the question of access to simple health care and to knowledge about health. For the Western Pacific Region, health/2000 is expected to mean longer life expectancy, lower infant mortality, lower maternal mortality, less disability, and adequate shelter, education and means of livelihood. The objectives for achieving them are: (1) a well nourished population; (2) safe drinking water for all; (3) sanitary disposal of human and animal waste; (4) minimal pollution of the environment; (5) communicable diseases no longer considered to be a major problem; (6) chronic diseases reduced; (7) psychosocial wellbeing and lifestyle conducive to health; (8) no pockets of ill-health; (9) regulation of fertility to ensure better health and social wellbeing; and (10) access for all to appropriate health care. Environmental health, particularly cooperation in the development of water supply and sanitation systems in support of the International Drinking~ater Supply and Sanitation Decade, health manpower development, the development of appropriate technology in support of primary health care, workers' health, and the control of communicable diseases, emerge as priorities for cooperation during the biennium. Primary health care, in a spirit of genuine and health specific technical cooperation and in keeping with a New International Economic Order, will form an integral part of all programmes, as will activities for the promotion and support of biomedical health systems research. In support of these conclusions it is interesting to note that, in accordance with Government requests, the highest proportion of resources is allocated to health manpower development, with health services development, communicable disease prevention and control and promotion of environmental health next in order of importance. General progrannne development and management includes the offices of the Director, Programme Management and the WHO Programme Coordinators as well as collaborative activities related to the strengthening of national and regional managerial processes and mechanisms for programme implementation. Cooperation in country health programming is continuing in Fiji, Malaysia, Papua New Guinea, Philippines and Samoa. A number of countries are considering the establishment of national collaborating networks or centres for health development. Malaysia, Philippines, Papua New Guinea and Republic of KOrea are planning to include formal management training and operational research activities as integral parts of health development XV

xvi programmes. In the light of experience gained and in anticipation of requirements for implementation of the Seventh General Programme of Work medium-term programming continues. The increase in provisions proposed for this major programme area reflects the importance attached to managerial processes for health developnent. Considerable progress has been made in the developnent and coordination of the major programme of biomedical research since the last programme budget estimates were submitted. The long-term objective, focusing on the goal of health for all by the year 2000, is to support Member States in achieving the self-reliance Which will enable them to carry out the health research activities most relevant to the solution of their major health problems. The present proposals take cognizance of the importance of (1) developing the necessary mechanisms at country level to identify research priorities and (2) strengthening national capabilities to carry out research which has the specific objective of solving a particular health problem, through national medical research councils or analogous bodies, with cooperation from the Western Pacific Advisory Committee on Medical Research CWPACMR). Proposals for research activities within individual programmes are included as integral parts of those programmes. The Regional Centre for Research and Training in Tropical Diseases, Institute for Medical Research, KUala Lumpur, will continue to function as an instrument of WPACMR in promoting basic and field research and training in tropical diseases. Extrabudgetary funds will be essential and will be sought to meet the growing need for financial support in the area of research. The major programme of health services development provides for the strengthening of basic health services, promotion and implementation of primary health care, and health services research. Among the trends observed are efforts to achieve decentralization, balanced development, an integrated approach to the provision of health care, intersectoral coordination, community participation and greater reliance on middle level and village health workers; and also to develop appropriate technology suited to the provision of primary health care. As has already been indicated, primary health care has become a major consideration in the design and management of health services delivery systems, which in turn will depend to a large extent on the planning information generated by national health information systems. WHO is collaborating in the development of such systems. Health services research plays an integral role in the planning and management of health services development programmes, through activities specifically identified as health services research and through research grants to national staff. It is expected that the national development networks being promoted by WHO will serve as specific mechanisms to enable Member States to carry out health development activities towards the shaping of responsive health care delivery systems, with primary health care as the core component. More attention is being given to problems emerging as a result of urbanization such as workers' health, rehabilitation, road traffic accidents, and care of the aged.

The major programme on family health encompasses maternal and child health, ·nutrition and health education, aimed at resolving the health problems and needs of mothers and children caused by the interrelationship of infection, malnutrition and lack of fertility regulation. Health care of the family as a whole and its integration into primary health care will continue to form the basis of programming for the period 1982-83. The same approach will also be used in programmes of cooperation for the formulation and implementation of national and regional strategies and plans of action to attain the overall objective of health/2000. Some emphasis has been placed, in programming, on the health of adolescents, a subject which has received inadequate attention in the past. The training of teachers for family health, as well as service-oriented research, are also major components of the programme for 1982-83. Support to research is mainly for the high-risk approach in maternal and child health care, toxaemia in pregnancy, assessment of the prevalence of respiratory infections among infants and children, nutritional deficiencies, and perinatal mortality and morbidity. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continues to provide support to collaborative research activities in the Region and to the strengthening of national capabilities for research. A recent and significant development has been the programme of collaboration between the Government of China, UNFPA and WHO in the fields of maternal and child health, family planning and research in human reproduction. UNFPA in fact supports more than two thirds of the programme of cooperation in family health in the Region. In accordance with the recommendations of the first meeting of the Regional Coordinating Group on the Mental Health Programme, held in April 1979, activities under the major programme of mental health will focus on the strengthening of institutes in the Region for designation as WHO Collaborating Centres and the establishment of national coordinating groups to develop strategies and plans for mental health programmes. Those programmes will emphasize the integration of activities for mental health in primary health care at the grassroots level. Concern for health problems caused by the excessive consumption of alcohol is reflected in provisions for the programme. There is awareness of the importance of providing essential drugs of adequate quality at a cost the community can afford, to support primary health care as well as specific disease control. Further extrabudgetary resources will be sought to enable cooperation at an increased level to be extended within the major programme for prophylactic, diagnostic and therapeutic substances. The intercountry programme on drug policies and management will continue. Cooperation in vaccine production will also continue with special attention given to quality control. Communicable disease prevention and control will continue as a priority in the achievement of health/2000. This major programme includes the expanded programme on immunization, for which provision continues to be made, and the diarrhoeal disease control programme which will need intensive support. Both programmes are delivered through the health services development and management programme. Greater xvii

xviii

attention is being given to the development of epidemiological services at all levels of the health services and to establishing and maintaining acute respiratory infection units in countries or areas faced with problems of mortality from such infect ions. A wider use of population-based epidemiological studies will be promoted to improve surveillance of diseas.es of major public health importance and monitoring of intervention for controlling such diseases. This calls for improvement in the teaching of epidemiology. Provisions for noncommunicable diseases prevention and control remain at the level reached for the biennium 1980-81 when it became evident that Member States were attaching increased importance to controlling cancer and cardiovascular diseases. Attention is also being directed to the metabolic diseases, such as diabetes. The oral health programme aims at increasing the productivity of dental personnel through effective national dental care delivery systems, providing for greater population coverage. To that end, organized programmes for improving the basic and continuing education of professional and auxiliary dental staff are necessary. Provisions for the promotion of environmental health show a slight increase and it will be necessary to seek extrabudgetary funding for this programme of high priority. A healthy environment is of paramount importance in achieving the Organization's aim of an acceptable level of health by the year 2000. Activities relate to cooperation with Member States in the development of basic sanitary measures through the provision of safe drinking water and sanitation facilities, in the control of environmental hazards which are now of considerable concern, and in the development of food safety programmes. Determined efforts will be made to attain the targets established for the International Drinking~ater Supply and Sanitation Decade and to meet the needs of those populations deprived of such services. Greater support will thus be given to national programmes for rural water supply and sanitation. The Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) has been in operation since early 1979 and has assumed a major role in delivering the programme of cooperation in the Region. Implementation of every strategy designed to achieve health for all by the year 2000 requires appropriately trained manpower. The considerable increase in provisions reflects awareness on the part of Member States that health manpower development must play a central role, with the fellowships programme as an important component. Other areas which will receive emphasis are: manpower planning and management, to promote the integration of planning, product ion and management of health manpower into the overall process of planning for socioeconomic development and to stress the need to establish collaborative links between those responsible for training and those responsible for delivery of the health services; training for all categories of health staff, to produce adequate numbers and appropriately trained categories of health

personnel and to develop health teams; educational development and support, mainly provided by the Regional Teacher Training Centre, Sydney. The use of modular instruction in nursing/midwifery education is being pursued. In the South Pacific, effective use is being made of a communication satellite network, in collaborative e £forts with Member States. The major programme of health information consists of activities to facilitate and guarantee coordinated and integrated development of information and includes health statistics and health literature services, in addition to the information systems development programme. Electronic data and word processing facilities contribute to effectiveness. The keeping of health statistics is an integral part of health programmes. Activities related to medical records systems are being developed further and a hospital management information system, based on the effective integration of medical records and hospital statistics, will be developed. Work to establish a regional biomedical information centre and a network of subcentres and libraries will be initiated and collaboration with Member States in the training and strengthening of national library and bibliographic reference services will continue. Information material for the public on WHO and its activities will be produced and distributed and further intercountry training activities will be carried out on information, education and communication. Staff of the general services and support programmes, that is personnel, supplies, conference, office and building services, budget, and finance and accounts, are available, on request, to provide cooperation to Member States in the areas of their specialization. It is anticipated that, as a result of changes resulting from the study of WHO's structures in the light of its functions, such support staff will participate in multidisciplinary teams at country and regional level. The training and development of WHO staff in the Region will continue so that their capabilities may be utilized more effectively in the new roles created by changing demands in the Organization.

Regional Director

xix

SUMMARIES

SUMMARY OF REGIONAL HEALTH PROGRAMME:

ESTIMATED OBLIGATIONS BY SOURCE OF FUNDS

1980-81 US$ Regular budget Other sources: Voluntary Fund for Health Promotion ............................................ . United Nations Development Programmes .......................................... . United Nations Fund for Population Activities .................................. . Trust Funds and Reimbursable ................................................... . Special Account for Servicing Costs ............................................ . Total - Other Sources 2 001 600 4 399 900 9 509 700 1 219 800 200 000 17 331 000 32 995 000

1982-83 US$ 38 769 000

201 000 3 587 300 3 080 600

500 000 7 368 900

Total

50 326 000

46 137 900

==========

SUMMARY BY MAJOR PROGRAMME, PROGRAMME AND SOURCE OF FUNDS

1980-81 Major programme/programme Regular budget US$ Other sources Total Regular budget US$

1982-83 Other sources US$ Total US$

us$

Increase/ (Decrease) Regular budget US$

1.3 2.1 2.2

Regional committee

••••••••••

•••

••

111 000 ----241 800

131 000 241 800

280 000 334 900

149 000 93 100

Executive management

•••••••••••

••••••

General programme development and management 2.2.1 2.2.2 2.2.3 General programme development Country health programming Information systems programme •••• 0 •••

•••••••

••

1 181 000 1 689 400 344 100 3 214 500

1 514 000 2 697 800 557 300 4 769 100

333 1 008 213 1 554

000 400 200 600

2.3

External coordination for health and socioeconomic development 2.3.2 Collaboration with multilateral and bilateral programmes • 0

••••••

••

268 200 1 349 900 643 600 64 200 1 414 100 643 600 885 600 775 300

268 200 885 600 I

268 200 (464 300) 131 700

2.4 2.5 3.1

Research promotion, and development

•••••

••

Regional Director's development programme Health services development 3.1.0 3 .1.1 3.1. 2 3.1. 3 3.1.4 3.1.5 3.1.6

...

775 300

Programme planning and general activities Health services planning and management ........................ Primary health care ................. Workers' health ..................... Care of the aged, disability prevention and rehabilitation ..... Appropriate technology for health (Health laboratory technology) (Radiological technology) Health services research •• 0 •••••• 0 ••• 0. 0. 0 0 ••• 0 0 ••• 0

645 900 3 572 600 963 700 161 900 27 000 831 700 264 900 49 13 69 826 400 200 000 900 510 000 185 300

645 900 4 082 600 963 700 347 200 27 000 881 278 69 7 294 100 100 000 600

519 200 2 782 000 1 439 400 223 600 330 000 443 79 278 6 096 800 200 800 000 11 000 730 000 20 000 314 400

519 200 3 512 000 1 459 400 538 000 330 000

(126 700) ( 790 600) 475 700 61 700 303 000 (387 (185 278 (371 900) 700) 800 700)

••

••••

••

6 467 700

1 075 400

454 79 278 7 171

800 200 800 400

1980-81 Major programme/programme Regular budget US$ Other sources US$ .Total US$ Regular budget US$

1982-83 Other sources US$ .Total US$

Increase/ (Decrease) Regular budget US$

3.2

Family health

3.2.1 3.2.2 3.2.4 3.3 3.4

Maternal and child health Nutrition ........................... Health education ••••• 0. 0 ••••• 0 •• 0 •••

...........

364 580 535 1 480

200 300 900 400

9 470 700 9 470 700 56 600

9 834 580 535 10 951

900 300 900 100

266 709 447 1 422

000 400 400 800

2 975 700 60 000 3 035 700

3 241 709 507 4 458

700 400 400 500

98 129 ( 88 ( 57 (

200) 100 500) 600)

Mental health

••

•••

••••

•••••••

••••••••

424 400

481 000

610 700

186 300

Prophylactic, diagnostic and therapeutic substances

3.4.0 3.4.1 3.4.2 4.1

Programme planning and general activities Drug policies and management Pharmaceuticals and biologicals •••• 0. 0 0 0 •• 0

•••••••

••••

•••

••

103 1 171 396 1 671

000 800 600 400

660 700 130 600 791 300

103 1 832 527 2 462

000 500 200 700

272 400 560 600 833 000

523 700 523 700

796 100 560 600 1 356 700

(103 (899 164 (838

000) 400) 000 400)

Communicable disease prevention and control

4.1.0 4.1.1 4.1.2 4.1. 3 4.1.5 4.1. 7 4.1.8

Programme planning and general activities Epidemiological surveillance Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization •• Prevention of blindness Vector biology and control ••••••• 0 0 0 0 0 •••••••• 0 •• 0

•

498 800 626 500 1 519 400 854 1 053 150 242 4 945 400 900 000 500 500

317 800 669 000 1 385 000 275 900 77 700 121 900 2 847 300

498 800 944 300 2 188 400 2 239 400 1 329 800 227 700 364 400 7 792 800

389 400 839 900 2 037 000 1 471 641 76 286 5 742 400 700 200 600 200

137 000 860 000 64 000

389 400 976 900 2 897 000 1 535 641 76 286 6 803 400 700 200 600 200

(109 400) 213 400 517 600 617 (412 ( 73 44 796 000 200) 800) 100 700

•••••

••••••••••

••

•

••••

•••••

••

00.".

••

•••••

••••

••

••••

1 061 000

1980-81 Major programme/programme Regular budget US$ Other sources US$ Total US$

1982-83 Regular budget US$ Other sources US$ Total US$

Increase/ (Decrease) Regular budget US$

4.2

Noncommunicable disease prevention and control 4.2.0 4.2.1 4.2.2 4.2.3 4.2.4 Programme planning and general activities Cancer •........••.•...• •. • • • · ... • • • • Cardiovascular diseases ............. Oral health •.....•.................• Other noncommunicable diseases

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

249 223 107 407 159 1 146

000 300 300 700 000 300

249 223 107 407 159 1 146

000 300 300 700 000 300

129 212 218 407 38 1 005

800 000 300 200 000 300

129 212 218 407 38 1 005

800 000 300 200 000 300

( 119 200) ( 11 300) 111 000 ( 500) (121 000) ~141

ooo5

5.1

Promotion of environmental health 5.1.0 Programme planning and general activities ........................ 5.1.1 Environmental health planning and management ........................ 5.1.2 Basic sanitary measures 5.1. 3 Recognition and control of environmental hazards 5.1.4 Food safety .••.•........•....•••.••• 260 600 1 119 800 549 100 487 500 62 700 2 479 700 569 400 1 110 600 260 600 1 689 200 1 659 700 487 500 62 700 4 159 700 259 600 1 454 700 707 900 580 200 160 100 3 162 500 354 600 763 600 259 600 1 809 300 1 471 500 580 200 160 100 4 280 700 (

1 000) 334 900 158 800 92 700 97 400 682 800

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

1 680 000

1 118 200

6.1

Health manpower development 6.1.0 Programme planning and general activities 6.1.1 Health manpower planning and management .•.•••••••..••..••...••• 6.1.2 Promotion of training •..•.••••.••.•• 6.L3 Educational development and support

········· ········ .......

421 600 309 900 3 617 100 1 257 000 5 605 600 1 200 000 155 000 1 355 000

421 600 309 900 4 817 100 1 412 000 6 960 600

375 100 219 000 6 687 :zoo 853 200 8 134 500 10 000

375 100 229 000 6 687 200 853 200 8 144 500

( 46 500) ( 90 900) 3 070 100 (403 800) 2 528 900

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

10 000

1980-81 Major programme/programme Regular budget US$ Other sources US$ Total Regular budget US$

1982-83 Other sources US$ Total

US$

Increase/ (Decrease) Regular budget US$

7.1

Health information

7 .1.1 7 .1. 2 7 .1. 3 7 .1.4 7 .1. 5 8.1

Health statistics ** WHO publications and documents Health legislation Health literature services Health information of the public .. 0. 0. 0. 0 ••••• 0 ••••••• 0 ••••

••••••••••••

...... 0 ••••

67 900 416 200 52 100 143 900 680 100

•••

518 417 20 116 216 1 288

000 500 000 500 500 500

518 417 20 116 216 1 288

000 500 000 500 500 500

450 1 20 64 72 608

100 300 000 400 600 400

General services and support programmes

8.1.0 8.1.1 8.1. 2 8.1. 3 8.1.4 8.1.5 8.1.6

Programme planning and general activities Staff development and training Personnel Supplies Conference, office and building services Budget Finance and accounts •••••• 0 ••••

•••••••••

••

•••••••••••••••

•••••••

•••

•••••

•••••••

•••••••••••

•••

290 24 224 102 1 475 183 212 2 513

600 000 500 800 700 300 200 100 223 000 16 000 239 000 17 331 000

290 24 224 102 1 698 199 212 2 752

600 000 500 800 700 300 200 100

379 288 300 144 1 572 286 187 3 160

400 800 400 800 600 600 800 400 526 000 18 900 544 900 7 368 900

379 288 300 144 2 098 305 187 3 705

400 800 400 800 600 500 800 300

88 264 75 42 96 103 ( 24 647

800 800 900 000 900 300 400) 300

•••

•••••••

••••••••••

••••••••

••••

•••••

•••

••••

Total

32 995 000

50 326 000

38 769 000

46 137 900

5 774 000

SUMMARY BY MAJOR PROGRAMME AND ORGANIZATIONAL LEVEL 1980-81 Regular budget US$ Other sources Total Regular budget US$ 1982-83 Other sources US$ Total

us$

US$

Increase/ (Decrease) Regular budget US$

1.3

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

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

131 000

280 000

280 000'

149 000

131 000

280 000

149 000

2.1

Executive management Regional ........................ Country or area Intercountry .....................

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

241 800

334 900

93 100

Total 2.2 General programme development and management Regional Country or area Intercountry

241 800

334 900

93 100

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

611 200 1 689 400 913 900 3 214 500

1 043 700 2 697 800 1 027 600 4 769 100

1 043 700 2 697 800 ' 1 027 600 4 769 100'

432 500 1 008 400 113 700 1 554 600

2.3

External coordination for health and socioeconomic development Regional .......................... Country or area Intercountry ....................

t 268 200 268 200 268 200

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

268 200

1980-81 Regular budget US$ Other sources US$

----·

1982-83 Regular budget US$ Other sources US$ Total

Total

'-----

US$

Increase/ (Decrease) Regular budget US$

2.4

Research promotion and development Regional Country or area Intercountry

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

100 000 1 249 9v0 1 349 900

64 200 64 200

100 000 1 314 100 1 414 100

885 600 885 600

(100 000) (364 300) (464 300)

2.5

Regional Director's development programme Regional ........................ Country or area Intercountry ....................

................. 643 600 643 600 643 600 643 600 775 300 --775 300 775 300 775 300 131 700 131 700 Total

3.1

Health services development Regional Country or area Intercountry

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

4 944 800 1 522 900 6 467 700

577 700 249 200 826 900

5 522 500 1 772 100 7 294 600

4 085 200 2 010 800 6 096 000

899 400 176 000 1 075 400

4 984 600 2 186 800 7 171 400

(859 600) 487 900 (371 700)

3.2

Family health Regional ......................... Country or area Intercountry

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

647 100 833 300 1 480 400

8 891 100 579 600 9 470 700

9 538 200 1 412 900 10 951 100

617 400 805 400 1 422 800

2 447 900 587 800 3 035 700

3 065 300 1 393 200 4 458 500

( (

29 700) 27 900)

Total

( 57 600)

3.3

Mental health Regional Country or area Intercountry

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

148 600 275 800 424 400

56 600 56 600

148 600 332 400 481 000

389 400 221 300 610 700

240 800 ( 54 500)

Total

186 300

1980-81 Regular budget US$ Other sources US$ Total Regular budget US$

1982-83 Other sources US$ Total

US$

Increase/ (Decrease) Regular budget US$

3.4

Prophylactic, diagnostic and therapeutic substances Regional Country or area Intercountry

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

1 505 600 165 800 1 671 400

130 600 660 700 791 300

1 636 200 826 500 2 462 700

677 200 155 800 833 000

523 700 523 700

677 200 679 500 1 356 700

(

(828 400) 10 000) (838 400)

4.1

Communicable disease prevention and control Regional Country or area Intercountry

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

1 504 500 3 441 000 4 945 500

805 100 2 042 200 2 847 300

2 309 600 5 483 200 7 792 800

2 142 100 3 600 100 5 742 200

924 000 137 000 1 061 000

3 066 100 3 737 100 6 803 200

637 600 159 100 796 700

4.2

Noncommunicable disease prevention and control Regional Country or area Intercountry

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

766 600 379 700 1 146 300

489 700 515 600 1 005 300

(276 900) 135 900 (141 000)

5.1

Promotion of environmental health Regional Country or area Intercountry

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

1 209 900 1 269 800 2 479 700

1 455 600 224 400 1 680 000

2 665 500 1 494 200 4 159 700

1 657 900 1 504 600 3 162 500

1 073 700 44 500 1 118 200

2 731 600 1 549 100 4 280 700

448 000 234 800 682 800

1980-81 Regular budget US$ Other sources US$ Total Regular budget US$

1982-83 Other sources US$ Total

US$

Increase/ (Decrease) Regular budget US$

6.1

Health manpower development Regional Country or area Intercountry •• 0 •• 0 ••• 0 0 •••••• 0. 0. 0 ••

•

••••••

••••

•••

•••••••••••••

••

4 565 000 1 040 600 5 605 600

1 200 000 155 000 1 355 000

5 765 000 1 195 600 6 960 600

7 080 100 1 054 400 8 134 500

10 000 10 000

7 090 100 1 054 400 8 144 500

2 515 100 13 800 2 528 900

Total 7.1 Health information Regional Country or area Intercountry 00 •••• 0

................. 0 ••••• 0. 0 •••

••

••••••••••••••

••••••••

574 700 67 900 37 500 680 100

574 700 67 900 37 500

758 100 207 000 323 400 1 288 500

183 400 139 100 285 900 608 400

Total 8.1 General services and support programmes Regional Country or area Intercountry ••••••••••••••••

. 239 000

680 100

................. 0 ••••••••• 0 ••

••

2 489 100 24 000 2 513 100

2 728 100 24 000

2 871 600 288 800 3 160 400

544 900

3 416 500 288 800

382 500 264 800 647 300

•••••••

Total Total Regional •••••• 0 •••• 0 0 •• ••••• 0 •••

239 000

2 752 100

544 900

3 705 300

4 047 800 17 149 400 11 797 800

239 000 13 060 100 4 031 900

4 286 800 30 209 500 15 829 700

5 556 500 20 043 800 13 168 700

544 900 5 355 000 1 469 000

6 101 400 25 398 800 14 637 700 46 137 900

1 508 700 2 894 400

Country or area Intercountry

•••

•••••••••

•••

•••••••••••••••••••

1 370 900

==========

32 995 000

==========

17 331 000

==========

50 326 000

==========

38 769 000

==========

7 368 900

==========

5 774 000

1.0

REGULAR BUDGET 1980-81 AND 1982-83 BY APPROPRIATION SECTION WITH PERCENTAGES OF THE TOTAL

Estimated obligations Appropriation Section 1980-81 US$ 1982-83 US$

Percentages 1980-81 1982-83

1. 2. 3.

Policy organs General programme development, management and coordination Development of comprehensive health services Disease prevention and control Promotion of environmental health Health manpower development Health information General services and support programmes Total

131 000 5 449 800 10 043 900 6 091 800 2 479 700 5 605 600

280 000 7 033 100 8 962 500 6 747 500 3 162 500 8 134 500 1 288 500 3 160 400 38 769 000

0.40 16.52 30.44 18.46 7.51 16.99 2.06 7.62 ---

0. 72 18.14 23.12 17.41 8.16 20.98 3.32 8.15 100.00

4. 5. 6. 7. 8.

680 100 2 513

100

32 995 000

---

100.00

SOURCES OF FUNDS OTHER THAN THE REGULAR BUDGET Summary by major programme and programme

------------------------------------------------- ----------------------------------------., Estimated obligations Major programme/programme

------------------.,-------------------l

---usr----------

1980-81

1982-83

us$

2.4 3.1

Research promotion and development Health services development 3. 1.1 3. 1. 5

38 200 ----

3. 1. 6

Health services planning and management ......................... Appropriate technology for health (Health laboratory technology) ................................ (Radiological technology) ..................................... Health services research ........................................

. . . .

102 300 19 100 13 200 700 135 300 21 600

3.3 3.4

Mental health Prophylactic, diagnostic and therapeutic substances 3.4. 1 3.4.2 Drug policies and management .................................... . Pharmaceuticals and biologicals ................................. .

----4.1 Communicable disease prevention and control 4. 1.1 4. 1. 2 4. 1.3 4. 1. 5 4. 1. 7

156 300 74 500 230 800

Epidemiological surveillance .................................... . Malaria and other parasitic diseases ......•...................... Bacterial, viral and mycotic diseases ........................... . Expanded programme on immunization .............................. . Prevention of blindness ......................................... .

317 140 691 275 77 1 503

800 800 500 900 700 700

137 000 64 000 201 000

6.1

Health manpower development 6 .1. 3

Educational development and support Total

72 000 -------2 001 600 ---201 000

Estimated obligations Major programme/prograunne 1980-81 US$

1982-83 US$

United Nat ions Development Prograunne 3.1 Health services development 3.1.1 Health services planning and management •••••••••••••••.••••.••••• 3.1.2 Primary health care ••••••••••••••••••••••••••••••••••••••..•••••• 3.1.3 Workers' health ••••••••••••••••••••••••••••••••••••••••••••••.••• 3.1.5 Appropriate technology for health (Health laboratory technology) •••••••••••••••••••••••••••••.••• 3.4 Prophylactic, diagnostic and therapeutic substances 3.4.1 4.1 Drug policies and management 406 800 523 700 324 000 185 300 30 300 539 600 730 000 20 000 314 400 11 000 1 075 400

Communicable disease prevention and control 4.1.2 Malaria and other parasitic diseases ••••••••••••••••••••••••••••• 4.1.8 Vector biology and control ..................................... .. 466 200 107 300 573 500 860 000 860 000

5.1

Promotion of environmental health 5.1.1 5.1.2 Environmental health planning and management ••••••••••••••••••••• Basic sanitary measures •••••••••••••••••••••••••••••••••••••••••• 569 400 1 110 600 1 680 000 354 600 763 600 1 118 200

6.1

Health manpower development 6.1.1 6.1.2 Health .manpower ~l~nning and management •••••••••••••••••••••••••• Promot1on of tra1n1ng •••••••••••••••••••••••••••••••••••••••••••• Total 10 000 1 200 000 1 200 000 4 399 900 10 000 3 587 .300

·-------------Estimated obligations l1ajor p>:ogramme/programme 1980-81 1982-83

---------------------United Nations Fund for Population Activities 3.2 Family health 3. 2. l 3.2.4 8.1 Maternal and child health ...................................... .. Health education ............................................... ..

uS$_ _ _ _ _

usr------

9 470 700 9 470 700 -----

-3-o:rr-700 26 000 18 900

2 975 700 60 000

General services and support programmes 8. 1.4 8.1.5 Conference, office and building services ........................ . Budget .......................................................... . Total 23 000 16 000 ----39 000 9 509 700

-44900 3 080 600

Trust funds and reimbursable 2.4 3. l Research promotion and development Health services development 3. l. l 3. l. 6

26 000

Health services planning and management ......................... . Health services research .........•...............................

83 700 68 300 152 000 35 000

3.3 3.4

Mental health Prophylactic, diagnostic and therapeutic substances 3.4. 1 3.4.2 Drug policies and management ................................... .. Pharmaceuticals and biologicals ................................. .

97 600 56 100 153 700

4.1

Communicable disease prevention and control 4. l. 2 4. l. 3 4.1.8

Malaria and other parasitic diseases ............................ . Bacterial, viral and mycotic diseases ........................... . Vector biology and control ..................................... ..

62 693 14 770

000 500 600 100

Estimated obligations Major programme/programme 1980-81 US$ 6.1 Health manpower development 6.1. 3 Educational development and support 1982-83 US$

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

83 000 83 000 1 219 800

SEecial Account for 8.1

Servicin~

Costs

General services and support programmes 8.1.4 Conference, office and building services ••••••••••••••••••••••• 0. Total Total - OTHER SOURCES 200 000 200 000 500 000 500 000

===========

17 331 000

==========

7 368 900

PROGRAMME ANALYSES

Appropriation section: Policy organs Major programme: Regional Committee for the Western Pacific

No. 1

1.3

The functions of the Regional Committee are defined in Article 50 of the WHO Constitution. The estimates cover expenses directly identifiable with the holding of a regular session in September 1982 and again in September 1983. Provision is also made for the organization of meetings of the two Sub-Committees of the Regional Committee - the Sub-Committee on the General Programme of Work and the Sub-Committee on Technical Cooperation among Deve-loping Countries. Through these sub-committees the Regional Committee is intensifying its involvement in the work of the Organization. In addition to the direct costs of holding the above-mentioned sessions and meetings, preparation for and servicing of the Regional Committee and its sub-committees are an integral part of many other programmes.

1.3

REGIONAL COMMITTEE

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

Regional

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

131 000

280 000

149 000

Country or area Intercountry

........ 131 000 =======

131 000

280 000

149 000

========

=======

Appropriation section: General programme development, management and coordination Major programme: Executive management

No. 2

2. 1

The Regional Director acts as technical and administrative head of the regional office, subject to the overall a~thority of the Ditector-General. 'Within the general programme of work and the policies established by the World Health Assembly, he 1s responsible for the planning and execution of the WHO regional programme. He formulates the proposed programme budget for submission to the Regional Committee, of which he is ex-officio secretary and, to that end, maintains direct contact with governments of the Member States of the~egion-and with international organizations and professional bodies. The Regional Director ensures coordination of WHO regional and country programmes and keeps the Director-General informed of major developments affecting the health situation of the Region.

2.1

EXECUTIVE MANAGEMENT

ESTIMATED OBLIGATIONS 1980-81 Regular buc!get US$ Regional Other sources US$ Total US$ 241 800 Regular budget US$ 334 900 1982-83 Other sources US$ Total US$ 334 900 Increase/(Decrease) Regular budget US$ 93 100

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

241 800

Country or area Intercountry

........ 241 800

=·======

=======

241 800

334 900

=======

·=======

=======

334 900

·========

======

93 100

Major

programme~

No. 2.2

General programme development and management Programme~

General programme development

2.2.1

Objectives To collaborate 1n the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policies; to proi~te the development and application of efficient managerial, information and evaluation systems for the planning and operation of health programmes, including the financing of health activities; to promote the integration of appropriate health components into socioeconomic development plans and current social and economic activities, with a view to reducing health hazards and increasing health benefits. Approaches Cooperating in national managerial processes for health development, utilizing a multidisciplinary approach through country health programming, programme evaluation, programme budgeting, information systems development, management training, and applied research in management (2.2.2 and 2.2.3). Ensuring that national health systems acquire self-reliance in implementing the managerial processes required to attain the goal of health for all by the year 2000, by collaborating in~ (a) (b) (c) training in planning and management; promoting and supporting management research; in some countries, strengthening and reorganizing institutions to enable them to serve as national health development centres providing training and advisory services and carrying out management research. At a later stage, such centres would respond to the needs of other countries in the spirit of technical cooperation among developing countries;

(d)

developing management procedures, methods and techniques for the formulation, implementation and evaluation of more effective programmes.

Continuing efforts, on the part of WHO, to provide support to Member States in formulating their policies and strategies for health for all by the year 2000, through~ (a) (b) Review Management training A training course in management for senior public health administrators in the South Pacific area and WHO staff was held in 1978. Subsequent exchanges were conducted by satellite, using the facilities of the University of the South Pacific. To date, six national training courses have been conducted in three countries, four being specifically orientated towards the support of primary health care. Evaluation WHO has collaborated in the evaluation of the expanded programme on immunization and the functions of the Ministry of Health in the Philippines, of hospital expenditure in Papua New Guinea, and the performance of village health workers in Solomon Islands. Guidelines for evaluation have been circulated to WHO staff and to some national staff. Operational research Operational research is being conducted as an integral part of the activities of other programmes, such as health services planning and management and primary health care. Office of the Director, Programme Management General programme development also covers the Office of the Director, Programme Management for the Western Pacific Region, which includes the programme directors and supporting staff, and which advises the Regional Director on the technical aspects of all the Organization's health activities in the Region. improving its medium-term programming and evaluation processes as experience is accummulated and reviewed; implementing the staff development and training programme (8.1.1).

It has the following functions: to assist in the formulation of policies on WHO's collaboration with governments; to develop, within the framework of the general programme of work for a specific period and the Organization's broad policies, proposals for programmes to meet the needs of governments; to provide technical support to WHO Programme Coordinators and field staff in carrying out their actjvities, including the application of technical procedures adopted by the Regional Office; to provide consultative services at the request of governments; to maintain liaison with agencies interested tn health and related activities as well as with those contributing funds for projects in which WHO cooperates. Regional Programme Committee A programme committee submits to the Regional Director collegiate recommendations on planning and execution of the programme. It reviews government requests for cooperation and considers programme proposals in the light of organizational policies, priorities and financial considerations. In the area of implementation, it considers programme modifications and revisions following changes in government priorities, submission of ad hoc requests and reprogramming of available financial resources. Regional Health Development Group A regional health development group, composed of staff of the Regional Office, reports to the Director, Programme Management. The group provides multidisciplinary support to the programme committee, to field staff, and to Member States in the formulation of their long term policies and strategies.

2.2.1

GENERAL PROGRAMME DEVELOPMENT

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total Regular budget usl~

1982-83 Other sources US$ Total US$ 988 200

Increase/(Decrease) Regular budget US$ 377 000

usl 611 200

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

611 200

988 200

Country or area Intercountry

........ Total

569 800

525 800

(44 000) 333 000 =======

=========

1 181 000

=======

=========

1 181 000

=========

1 514 000

=======

=========

1 514 000

Progrannne

No.

Country health programming

2.2.2

Objectives To encourage the strengthening of national capacities for the planning and management of comprehensive national health services, including the necessary technical, administrative and legal reforms, as well as logistic support; to promote closer cooperation among all into a single system where appropriate; serv~ces

concerned with health promotion and to integrate them

to collaborate in the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policy. Approaches Collaborating in organ~z~ng and conducting exercises for the formulation of medium-term health plans within the context of national perspective health plans for the year 2000, utilizing any suitable entry point in national activities for development. Supporting the development, and subsequently the activ~t~es, of core groups of trained national staff who could, in coordination with other programmes (2.2.1, 3.1.1 and 3.1.2), take the lead in all aspects of country health programming including research and training. In some countries, this would comprise a component of a national health development centre which would eventually also serve the needs of other countries. Encouraging and supporting the development of planning mechanisms (organization for planning, planning methods and planning information) suitable to individual country situations (2.2.1, 2.2.3 and 7.1.1), taking into account the need for an appropriate balance between the "top-down"/"bottom-up" approach, and multisectoral involvement. Encouraging and supporting the exchange of information and experience in country health programm~ng.

Reinforcing the skills of WHO Programme Coordinators and regional and field staff so that support to country health programming activities is effective.

26 Review WHO cooperation ~s being provided in organizing and carrying out health programming/planning exercises; in training in management and country health programming; and in developing further planning processes, structures and methods. Where cooperation is extended to include implementation of country health programming, attention is given to establishing a multisectoral advisory group and a small core technical working group. A methodology was developed under t~e intercountry health planning and management project (3.1.1) and finalized in early 1978. This was used in conducting the country health programming modules of planning and management courses. In 1979, the Health Manpower Development unit of the Regional Office developed a health manpower planning guide which is complementary to planning methodology developed earlier. In all the country health programming activities carried out during the biennium 1978-79, emphasis was placed on effective management of the programming process and on the necessity to produce simple, easy-to-understand, action-orientated documents which would serve as the basis for national medium-term programmes and programme budget proposals. This constituted a remarkable change from the orientation of the late 1960s and early 1970s, when emphasis was placed on methodology and the production of very comprehensive and detailed documents, and a large gap existed between national plans and national budgets. With acceptance of the goal of health for all by the year 2000, Member States have become more aware of of the need for country health programming and activities have increased. Country health programming, encouraged and supported by WHO staff, particularly health services planning and management staff (3.1.1), has been carried out and initiated in 11 countries or areas. With regard to training, country health programming was an essential module of the seven management training courses conducted in 1978-79 (2.2.1). WHO has also collaborated in planning and conducting a national course in country health programming, supported a number of fellowships to training institutions outside the Western Pacific Region, and sent representatives to attend three interregional meetings on country health programming. WHO Programme Coordinators The WHO Programme Coordinators at country level, who are included under this programme heading, constitute a key element in the structure and functions of the Organization in its programme of technical cooperation with Member States. The task of the WHO Programme Coordinator is~ to establish direct and permanent collaboration with the national health establishment;

to assist in the assessment of country health needs and resources and in the planning, implementation and evaluation of national health programmes, including those forming part of general development programmes; to ensure efficient planning and delivery of WHO's cooperation in relation to those programmes; to assist, as may be appropriate, the Regional Office and Headquarters with intercountry and interregional projects; to coordinate action and cooperate with country officers or representatives of other organizations and agencies, particularly those of the United Nations.

----------------------------------------------------------------·2.2.2 COUNTRY HEALTH PROGRA.'lMING

----------------------

-------------- -------------------ESTIMATED OBLIGATIONS 1980-81 Regular. bud ~ret Other sources Total 1982-83

-------------------------------Increase/(Decrease)

--------------- --------r-----·-·-·--·------------·--'T""---- --------1 Regular Other Total Regular budget sources ':>udgj£ - uss-___USJ _____u_,s,.,.$---+·-·----- us __ _ ---

~$--

Regional ........... . Country or area ..... Intercountry Total l 1)89 400 1 689 400 2 697 800 2 697 800 1 008 400

:::::======

1 689 400

=======-====

====::=====

2 697 800

2 697 800 ==::::::s:::==

1 008 400 ::::::::=====

____________ . ._______________._______ ....1--·-----------------------'------------

Programme: Information systems programme

No. 2.2 . .:

Objectives To promote the development of national health information management of national health programmes and subprogrammes; syste~s

and services for the planning and

to develop information syste~s that will enable WHO to support the planning and management of its collaborative rrogrammes with Member States, including coordination with bilateral and multilateral agencies for that purpose; to develop national capability further to improve the effectiveness and efficiency of national health information systems and services through the application, where appropriate, of computerized information processing technology. Approaches Promoting, through national and intercountry seminars and workshops, the application of the "information systems approach" to the development of efficient use- and user-orientated health information systems and subsystems for the planning and management of health programmes and subprogrammes. Developing and implementing an information system to support the management of WHO cooperation in the Western Pacific Region, at regional, country and project level, subject to overall compatibility with the global WHO information systems programme. Promoting interaction and interface between the WHO information system and national health information systems (or parts thereof) in Member States and in programmes in which WHO collaborates. Promoting and participating in training programmes aimed at strengthening the capability of national and WHO staff to develop and use such an information system. Providing methodological and technical support to national and WHO staff in the development and utilization of country, programme and project profiles as components of the WHO information system and in the establishment of appropriate updating and maintenance procedures.

Collaborating with Member States, on request, in formulating and conducting computer feasibility studies to identify appropriate data-processing and word-processing support for the national health information system and services. Review Under the WHO information system, profiles have been established for each programme and periodical reviews of programmes are being carried out, utilizing the profiles. Elements of the profiles were used for the preparation of medium-term programmes, and the evaluation elements of the profiles, updated appropriately, were used as a basis for the preparation of the Regional Director's report to the Regional Committee. Profiles for most of the country projects in which WHO is cooperating established as a basis for subsequent reporting. ~n

the Region have also been

With a view to furthering the development of the regional WHO information system, workshops were held in Suva, Fiji, in January 1977 and in May 1978, for the senior WHO staff stationed in countries or areas of the South Pacific. A third workshop was held in Port Moresby, Papua New Guinea, in January 1979. Five national staff, responsible for programmes in which WHO is collaborating, took part in that workshop with their WHO colleagues. The workshops facilitated the exchange of ideas and enabled national and WHO staff at country and regional level to comprehend the objectives, content and use of the regional information system. To assess the adequacy, timeliness and feasibility of "reporting by exception" as it applies at country level, four projects, in Fiji and Papua New Guinea, are taking part in an experiment over two reporting cycles during a period of one year. Studies are also in progress with a view to simplifying and rationalizing the different types of project documentation. A computer feasibility study to identify computer support for information processing activities in the Regional Office has been undertaken and an implementation programme formulated. Word processing facilities, already available for information processing, have been reviewed with a view to utilizing their potential to the full.

2.2.3

INFORMATION SYSTEMS

PROG~~

-------

------------ESTIMATED OBLIGATIONS

·Increase/(Decrease) Total US$ 55 500 Regular budget US$

1-----·-------- ---------.--1980-81 Regular budget

------------------·--f--- · - - - - - - - - - - us$ Other sources Total

1982-83

us$

Regular budget

us$

Other sources

us$

Regional ........... . Country or area ..... Intercountry Total 344 100 344 100 344 100 344 100

55 500

501 800 557 300

501 800 -----

157 700 -213 200

=======

========

=====:= -

557 300

=======

---------~-------------------------

Major

programme~

32 No. 2.3

External coordination for health and socioeconomic development Programme~

Collaboration with multilateral and bilateral programmes

2.3.2

Objectives To strengthen collaboration with the United Nations, agencies within the United Nations system and other organizations and institutions·, to participate actively in interagency coordination mechanisms; to provide support for countries in their coordination of national programmes geared to comprehensive socioeconomic development and the principles and goals of the New International Economic Order; to ensure the association of WHO in the Western Pacific Region with multilateral development programmes, funds and organizations; to follow up its participation in such activities; and to promote, enhance and coordinate collaboration with all other sources of support for health work being carried out in the developing countries. Approaches Establishing appropriate liaison procedures to facilitate contacts with international and regional funding agencies and the implementation of programmes. Collaborating with all contributors to regional activ1t1es through sectoral and feasibility studies, and in the identification of programmes and their execution, monitoring and evaluation. Review Joint activ1t1es with other agencies within the United Nations system and with other extrabudgetary funding agencies continues, with WHO act~ng as executing agency for projects supported by the United Nations Development Programme and the United Nations Fund for Population Activities, both country and intercountry. Collaboration with UNICEF is mainly in the areas of primary health care, the expanded programme on immunization and the diarrhoeal disease control programme. In several coun.tries or areas of the Region and in several programme areas, closer collaboration is being achieved with the International Bank for Reconstruction and Development (World Bank). The Regional Office for the Western Pacific has been made responsible for the overall coordination of WHO and Asian Development Bank activities which are increasing 1n fields such as environmental health, malaria and pharmaceuticals. Increased efforts are being made to secure extrabudgetary resources for the expanding programme of technical cooperation with countries.

2.3.2

COLLABORATION WITH MULTILATERAL AND BILATERAL PROGRAMMES

ESTIMATED OBLIGATIONS 1980-81 1982-83

Increase/(Decrease) Total US$ 268 200

Regular budget US$ Regional

Other sources US$

Total US$

Regular bu~get

US$ 268 200

Other sources US$

Regular budget US$ 268 200

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

Country or area Intercountry

........ Total =======

268 200

=======

Major programme: Research rromotion and development

~0. 2.~

Objectives To promote and collaborate in the development and coordination of biomedical and health services research; to promote the application of existing and emerging scientific knowledge to serve as the basis for the improvement of the health status of the people; to identify research priorities, to strengthen national research capabilities and to increase technical cooperation with and among research institutions so as to focus research programmes on the goal of health for all by the year 2000. Approaches Upgrading and supporting research institutions in fields relevant to WHO regional research programmes through the establishment or strengthening of medical research councils and analogous bodies. Developing multidisciplinary research programmes which make use of existing resources and encouraging cooperative efforts in research using a more mission-oriented approach. Strengthening communication through the exchange of research workers and through biomedical research information exchange so as to foster technical cooperation among developing countries in the field of research. Regularly convening the Western Pacific Advisory Committee on Medica] Research and its subcommittees in order to review programmes and make recommendations on regional research policy and priorities. Building up an information base of ongoing research in institutions in the Region. Promoting the rapid and effective application of existing and emerging scientific knowledge for the improvement of the health status of the people.

Stimulating countries to initiate research activities through research grants and research training grants. Strengthening the Institute for Medical Research, Malaysia, as a regional centre which will provide epidemiological, statistical, nutritional and immunological support to scientists working in the area of parasitic and other communicable diseases within the Region, as well as training in parasitic and infectious diseases related to modern advances in chemotherapy, immunodiagnosis, vector control and nutrition. Review In developing countries the lack of full-time research workers and of financial support for research is a serious constraint. National research councils have not yet been established in most Member States or have only recently been established, and research planning in relation to priority health problems is still at an embryonic stage. The policy of regional involvement in biomedical and health services research established by the World Health Assembly aims to rectify those deficiencies. The long-term aim is to achieve national self-reliance in health research of most relevance to solution of the major health problems of Member States, focused on the objective of health for all by the year 2000. From 1979, with endorsement from the WPACMR, approximately one half of the regional research promotion and development budget is being allocated to individual technical programmes, so that research activities become integral parts of those programmes of cooperation with Member States.

.35

2.4

RESEARCH

PRO~OTION

AND DEVELOPMENT

r-------------

-------ESTIMATED OBLIGATIONS 1980-81 Regular 1---~udg~t Other sources Total Regular budget 1982-83 Other sources Total lncrease/(Decrease)

us$

Regular bud&et

us$

Regional

............ ..... 100 000 1 249 900 64 200 64 200 100 000 1 314 100 885 600 885 600 (100 000) (364 300) ---(464 300)

Country or area Intercountry

........ Total

===========

1 349 900

============

===========

1 414 100

=========

885 600

========

=======

885 600

=========

Major programme: Regional Director's development programme

No. 2.5

As in previous years, the funds provided under this heading will be used for financing collaborative programmes with governments which could not be foreseen when the programme budget proposals were being developed.

2.5

REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular bud_get US$

............ ..... 643 600 643 600 643 600

Country or area Intercountry

........ Total

n5 300 775 300

775 300

131 700

========

=======

-------

643 600

=======

775 300

=======

131 700

Appropriation section: Development of comprehensive health services Major programme: Health services development Programme: Programme planning and general activities

No. 3

3.1

3.1.0

No separate objectives, approach or review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

3.1.0

--PROGR&\fME PLANNING AND GENERAL ACTIVITIES

I Total US$ Regular budget

ESTIMATED OBLIGATIONS 1980-81 Regular budget Other sources Total Regular budget US$ 1982-83 Other sources US$

,.....

Increase/(Decrease)

I i

us$

--1

I I

I ! I

Regional

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

I 184 700 461 200 645 900 184 700 461 200 645 900 519 200 ---519 200 =========== (184 700)

Country or area Intercountry

.....

........ Total

---======-===

519 200

58 000 (126 700)

=======

========

===:a:=-==

519 200

==:::r====

----

Programme~

No.

Health $ervices planning and management

3 .1.1

Objectives To promote the strengthening of national capacities for the planning and management of comprehensive health services. More specifically~

to strengthen national capacities for planning, management, financing, coordipation, and evaluation of comprehensive national health services; to increase national capacities and self-reliance in the development and design of the var1ous components of health services such as health care facilities; to collaborate in the preparation, execution and evaluation of health plans, programmes and development efforts in accordance with periodically revised or confirmed health policy. Approaches Collaborating in the development of responsive health care delivery systems, comprised of the four basic components, promotion, prevention, treatment and rehabilitation, highly supportive of primary health care while taking into account limitations in resources. This will include operational studies, activities leading to modifications in the design of health services and in the relationship between the various components of health services, and the development of guidelines, standards, and operating procedures. Since the expanded programme on immunization is more effectively implemented by means of an integrated approach, delivery through the health services planning and management programme will continue (4.1.5). Supporting country health programming, training in planning and management, health services research and information systems development (2.2.1, 2.2.2, 2.2.3, 3.1.6). Collaborating in the development of skills in health and hospital administration and in the repair and maintenance of equipment.

Review Cooperation is being extended (1) in~

improving hospital services, health statistics and health administration, including the restructuring of the rural health service delivery system in one country; in developing national health information systems, small-scale water supply systems and the expanded programme on immunization (4.1.5); training village sanitarians, aid-post orderlies, village health workers, professional sanitarians, nurses, senior and middle-level hospital administrators and technicians for the repair and maintenance of electromedical equipment; studies on the financing and cost-analysis of selected programmes and overall evaluation. supporting primary health care activities, country health programming, and training in planning and management.

(2)

(3) (4)

3. 1.1

HEALTH SERVICES PLANNING AND MANAGEMENT

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

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$

............ ..... 3 223 800 348 800 342 300 167 700 510 000 3 566 100 516 500 2 009 800 772 200 554 000 176 000 2 563 800 948 200 (1

-1

Country or area Intercountry

214 000) 423 400

........ Total

=========

3 572 600

=======

=========

4 082 600

=========

2 782 000

=======

730 000

=========

3 512 000

=========

(790 600)

44 Programme: Primary health care

No. 3.1.2

Objectives As the key approach in the strategy for attainment of health for all by the year 2000, the primary health care concept will be developed or intensified through collaboration in: the formulation of national policies, plans and programmes to ensure allocation of resources for the socially equitable coverage of essential health care; the implementation of primary health care in relation to technical knowledge, appropriate technology, supervision, logistic support, manpower development, referral mechanisms and the information system; the development of a collaborative network for the exchange of information and experience in primary health care among Member States. Approaches Collaborating ~n

the formulation of national policies and strategies for

pr~mary

health care.

Exchanging information on the development of primary health care programmes, and on training and technology. Conducting research, field studies, workshops and training courses on primary health care. Carrying out in-depth studies on certain specific problems or issues in primary health care, including the integration of traditional systems of medicine into present health care systems. Coordinating primary health care and rural development activities with national and international agencies. Integrating primary health care within national health care delivery systems various efforts to strengthen and improve such systems. ~n

coordination with

Review The programme is founded on the principle that achievement of the global objective of health for all by the year 2000 requires a sound government policy for the implementation of primary health care and practical strategies and plans using the primary health care approach. This will involve intersectoral collaboration for genuine health development in the broadest sense, i.e. a holistic approach, which will include the socioeconomic development of the community and improvement of the physical, mental and social well-being of its members. The stage has been reached where the primary health care philosophy has become an integral part of all WHO programmes of cooperation with Member States. This should be taken into account in any assessment of the impact of the primary health care programme. Many activities for the implementation of primary health care are mostly incorporated within individual technical programmes. Technical cooperation among developing countries (TCDC) will be necessary if Member States in the Region are to develop and implement sound strategies aimed at achieving health/2000 through primary health care. It is the objective of the programme to encourage such cooperation and to stimulate interest in, and secure support for, facilitating the exchange of information and experience among Member States so as to strengthen primary health care policy formulation, planning, programming, implementation, monitoring and management. As has been mentioned above, the development of primary health care in the Western Pacific Region has passed the promotional stage. A few governments have already declared their national policy; some are in the process of formulating implemention strategies. For example, in New Hebrides, Papua New Guinea and Solomon Islands, manpower has been developed for the delivery of primary health care, such as retrained aid-post orderlies, village health workers, and village sanitarians. Experience in some countries or. areas of the South Pacific has resulted in the initiation of primary health care. For example, in the Republic of Korea, the Government has used the Saemaul Undong (Community Development Movement). In Malaysia, the health services have been expanded to total coverage. The research and development project in Tacloban, Philippines, has contributed to the formulation of stra,tegies for the implementation of primary health care in the Philippines and could possibly influence other Member States. Tacloban was also the site of the Interregional Workshop on the Development of Health Teams in Rural Work, which was held in October 1979. In Suva, Fiji, the South Pacific Conference on Primary Health Care, including Diarrhoeal Disease Control, was held in August 1979, while in Kiribati, a national seminar on primary health care was held in November 1979.

Closer collaboration among Member States through the development of a network for the exchange of information and experience in primary health care is envisaged. In China, a training programme in primary health care has been initiated, with the support of UNDP, which is expected to lead to the designation of a network of activities in three rural areas as WHO collaborating centres in primary health care, eventually to be linked internationally with similar primary health care networks.

3. 1. 2 ~---------------

PRIMARY HEALTH CARE

1980:-81

ESTIMATED OBLIGATIONS 1982-83

Increase/(Decrease) Total Regular budget US$

Regular budget US$ Regional ..•.•. Country or area Intercountry .• .

Other sources US$

Total US$

Regular bud set

usi

Other sources

us$

uss

... .. . ..... .. . . . Total 505 800 457 900 963 700 zoa:::==

505 800 457 900 ---963 700 a====== •=•a===

1 067 600 371 800 1 439 400 ::a::::a:a:c:s:

20 000

1 087 600 371 800

561 800 (86 100)

20 000

1 459 400 ~:saw:s===

==-=====

475 700 ••••s=a

---------

Programme: Workers' health ~.

No. 1. ~

Objectives To promote the health of the working population, to control occupational health risks anc to prorr.cte the humanization of work. Approaches Cooperating in the formulation of policies, standards, guidelines and programme,s for protection against occupational hazards. Cooperating in the development of occupational health programmes and services. Trainin~ various categories of personnel engaged in occupational health activities, through the organization of serr.inars, workshops or national courses.

Developing methods for early detection of impaired health in workers. Promoting ergonomics and improvement of management-stsff'relationships. Collecting and disseminating information on specific occupational hazards and occupational health problems and means of solving them; and Collaborating with other international agencies in the area of occupational health, particularly with the International Labour Organisation. Review In 1978, the Regional Committee for the Western Pacific at its twenty-ninth session adopted resolution WPR/RC29.R14, which urged Member States to collaborate in occupational health activities and requested the Regional Director to intensity WHO's efforts towards such cooperation. In implementation of the resolution, visits were made by WHO staff and a consultant to Fiji, Philippines, Republic of Korea, Tonga and Trust Territory of the Pacific Islands to review occupational health problems, to make broad recommendations and to develop a programme of collaboration.

Collaboration in occupational health continues with Malaysia and a plan for the establishment of a national occupational health centre is progressing satisfactorily. Cooperation in further developing occupational health legislation and services has been provided to the Philippines and Samoa. In Singapore, WHO will act as executing agency, in association with the International Labour Organisation and with support from UNDP, in the development of an occupational safety and health institute.

3.1. 3

WORKERS' HEALTH

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

us$

............ ..... 161 900 185 300 347 200 213 600 10 000 161 900 =====:=

Country or area Intercountry

314 400

528 000 10 000

51 700 10 000

........ Total 185 300 347 200

223 600

314 400

=======

==-=====

=======

==•======

=======

538 000

=:a==·=

61 700

Programme: Care of the aged, disability prevention and rehabilitation

No. 3.1 .4

Objectives To promote and collaborate in the development of appropriate and adequate preparation for old age and effective and efficient systems of care for the elderly, including health promotion and prevention of disabilities and adverse processes; to collaborate in the development of policies, strategies and methods of intervention to reduce the incidence and severity of road traffic accidents, including appropriate coordinating mechanisms; to promote and collaborate in the development of activities, services and training to prevent all forms of disability or at least reduce their consequences. Approaches Conducting epidemiological studies to determine the nature, extent and magnitude of health and related problems of the elderly and the various conditioning factors affecting them, and especially sociocultural factors. Formulating policies and programmes to improve the health status of the elderly and developing appropriate technology for prevention, diagnosis, treatment and rehabilitation. Implementing training courses for health personnel, to develop positive attitudes towards the elderly and to strengthen the knowledge and skills necessary for them to function effectively in health care programmes for the elderly. Developing effective mechanisms for coordination among interested agencies. Identifying national pilot areas for epidemiological studies to develop effective programmes of education for the public, road users, health professionals and police officials with a view to preventit1g road traffic accidents.

Promoting the exchange of information. Promoting the concept of developing, expanding and improving rehabilitation units and activities in hospitals, health centres, leprosaria, etc. as well as community level care for the disabled. Promoting the inclusion of medical rehabilitation as a specific subject in the community planning and programming process. Collaborating with other international agencies engaged in rehabilitation such as Rehabilitation International, and the World Rehabilitation Fund, Inc. Directing technical cooperation with Member States tn the field of rehabilitation in such areas as gathering information, defining the nature, magnitude and extent of the problem, developing policies and implementing programmes, supporting studies and research, and supporting the development of health manpower. Review So far, the programme for care of the elderly has not received high priority. Programme activities are starting in 1980 with a visit by a consultant to selected countries in the Region to determine the nature and extent of the problem and to develop a programme of collaboration. A regional programme, within the framework of the WHO global programme on prevention of road traffic accidents, was established in 1978. As an initial step, information on road traffic accidents was collected from countries or areas of the Region. A consultant then visited selected countries to explore the deficiencies and strengths of the existing systems of information and to make recommendations thereon. In October 1979, a working group was convened to make recommendations for the development of policies, strategies and methods of intervention to reduce the incidence and severity of road traffic accidents in the Region. Programme acttvtttes include technical cooperation with the government organs responsible for rehabilitation in Lao People's Democratic Republic and the Philippines.

3.1.4

CARE OF THE AGED, DISABILITY PREVENTION AND REHABILITATION

ESTIMATED OBLIGATIONS 1980-81 1982-83

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

Regular budget US$ Regional

Other sources US$

Total US$

Regular budget US$

Other sources US$

............ ..... 27 000 27 000 27 000 298 000 32 000 298 000 32 000 298 000 5 000 303 000

Country or area Intercountry

........ Total

======

-------

------

27 000

-------

330 000

-------

330 000

=======

54 Programme: Appropriate technology for health

No. 3.1.5

(1)

Health laboratory technology

Objectives To cooperate in developing national health laboratory services and related technical activities; to cooperate in meeting the laboratory needs of curative and preventive health services with particular emphasis on the development of public health laboratory services and support for programmes on communicable diseases control and surveillance; to promote the development and adaptation of laboratory techniques, particularly simple, low-cost and effective techniques for basic laboratory work; to cooperate in the development of the manpower needed for laboratory services. Approaches Where development of a national health laboratory serv1ce is at the initial stage, advising on its further development and organization. Defining and implementing priority laboratory programme activities related to the needs at primary health care level. The public health aspects of laboratory work and close cooperation with the epidemiological services will be stressed. Standardizing supplies, equipment and procedures and introducing sound methods and national standards through regional or national courses. Where a health laboratory network is well developed, a quality control programme will be used as a tool to reveal weak points and introduce improvements. Introducing laboratory techniques relevant to local needs. Support will be given in preparing local laboratory procedure manuals or instructions and particularly in introducing tests which can be performed in small laboratories. Cooperating in the training of laboratory personnel at regional and national level.

Supporting technical cooperation among developing countries, particularly in the training of technical laboratory staff, the production and provision of reagents for laboratory work, the local production of simple equipment, quality control in health laboratory technology and standardization of laboratory methods. Review Most problems in the organization of health laboratories in the Region are related to: (a) unbalanced and inadequate development of the laboratory services in relation to expansion of the health services; (b) laboratory activities being geared essentially towards curative medicine while public health or community health activities are neglected; (c) the main centres being relatively overserved in comparison with those at the periphery. Intermediate and peripheral laboratory services are insufficiently developed in relation to other health services and their activities are largely unrelated to the basic health needs of communities in rural areas. The quality of laboratory technology is often questionable and comparability of results within laboratories is difficult, if not impossible. There is inadequate supervision and technical support from the central laboratories. There is a shortage of manpower, particularly at the periphery, and an urgent need for expansion of the training programmes for technical laboratory staff, adapted to local needs. Particular attention has therefore been given to strengthening laboratory support to primary health care in Fiji, Kiribati, Lao People's Democratic Republic, Papua New Guinea and VietNam. Staff at the intermediate level have also been trained, through courses for chiefs of provincial laboratories held in Hanoi, a regional course on laboratory diagnosis of most frequent pathogenic bacteria and mycological agents and a regional workshop on laboratory methods in the diagnosis of poliomyelitis and measles. (2) Radiological technology

Objectives To cooperate in improving and expanding the medical use of ionizing radiation and radionuclides, as well as in the protection of radiation workers and the population, including patients, against excessive exposure to ionizing radiation.

Approaches Cooperating in establishing and developing radiation health programmes suited to the needs and resources of various countries or areas. Collaborating in studies on design, planning, administration and evaluation of radiation health services and radiation health protection services. Training various categories of personnel in all aspects of the medical uses of ionizing radiation and radionuclides as well as radiation health protection services. Collaborating as appropriate in the maintenance and repair of facilities and equipment. Providing, in collaboration with the International Atomic Energy Agency, radiation dose measurement intercomparison services and personnel radiation monitoring services. Review Governments continue to show interest in developing and strengthening their radiological services. However, equipment and manpower continues to be unevenly distributed between urban and rural areas. Shortage of trained manpower, inadequate maintenance and repair of equipment, inadequate radiation protection and lack of adequate dosimetry, constitute the main problems. There are two secondary standard dosimetry laboratories (SSDL) in the Region, in the Philippines and Singapore. Australia, Japan and New Zealand have their own primary standard dosimetry laboratories. The two SSDLs belong to the global IAEA/WRO network. The IAEA/WHO postal dose intercomparison programme, covering institutions in eight countries or areas, and the radiation monitoring film badge service, covering institutions in four countries, continue. Inservice training in technical matters for the improvement of radiographical procedures in basic medical care and assessment of the need for further training in radiography continue to be provided to countries or areas of the South Pacific. Two regional training courses in radiation protection, supervision and inspection were successfully completed in 1978 and 1979.

Collaboration has been extended to the Philippines in the maintenance and repair of X-ray and other medical equipment while cooperation with the Republic of Korea, which came to a standstill in 1976, has resumed with the provision of a consultant in radiation dosimetry in 1978 and another consultant on radiation protection and doGimctry in 1979.

3.1. 5

APPROPRIATE TECHNOLOGY FOR HEALTH (HEALTH LABORATORY TECHNOLOGY)

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

............ ... " .... 623 700 208 000 831 700 49 400 49 400 673 100 208 000 881 100 314 000 129 800 443 800 11 000 11 000 325 000 129 800 454 800 (309 700) (

Country or area Intercountry

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

78 200)

(387 900)

========

======

=======

======== '--~.]

======

=======

3 .l. 5 APPROPRIATE TECHNOLOGY FOR HEALTH (RADIOLOGICAL TECHNOLOGY)

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget

us$

j I I

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

Country or area Intercountry

•

244 900 20 000 -264 900 =======

244 900 13 200 33 200 278 100

64 200 15 - 000 --

64 200 15 000 79 200 =======

(180 700) (

Got

---

000) 5-========

Total

------

13 200

=======

------

79 200

(185 700)

======

Programme: Health serv1ces research

No. 3.1.6

Objectives To enable Member States in the Region to develop and implement national health services research programmes as part of the health services development process, the results of which will be used to provide more efficient, effective, and equitable health services. More specifically: to develop national health services research programmes within the framework of government health development activities, including the identification of priorities for research through the planning process; to develop national capability to conduct the research activities identified in the programme; to develop a regional health services research structure to support and enhance national efforts. Approaches Implementing a series of national workshops on health serv1ces research. Organizing regional meetings on health services research manpower development and technical discussions on priority research areas. Strengthening institutions by providing direct support for research studies and by developing research capability through fellowships and training activities. Establishing a network of collaborating centres in the Region. Developing a regional health services information system to exchange knowledge on developments between national research workers.

Review The health services research programme in the Region has only recently been established and follows the creation, by the Western Pacific Advisory Committee on Medical Research (WPACMR) in 1976, of a task force on health services research. The task force met annually until 1979 when it was felt by WPACMR that its functions were changing and could better be fulfilled by a subcommittee. The title of the Task Force was therefore changed to Sub-Committee on Health Services Research. A landmark in development of the programme was the Working Group on Health Services Research, held in Manila in August 1978, which identified priorities for research, and formulated strategies and methods for the organization and development of the programme. However, before programme development activities initiated by the Task Force began, important operational studies had been conducted in Malaysia, Philippines and Republic of Korea. Initial efforts to establish a regional framework resulted in the designation of the Korea Health Development Institute, Seoul, as a WHO collaborating centre for research in health development. The Centre will act as national coordinating agency for health services research. Plans for collaborative activities have been prepared. As a result of growing interest in the programme, a number of studies are being supported by WHO and the number is expected to increase. To ensure that the studies conform to the objectives of the programme and and to national and WHO priorities, an effective flow of information between agencies, both national and international, is necessary. A regional inventory of health services research activities will be revised and expanded. WHO will continue to collaborate, upon request, in national operational research studies. It is also important to note that a number of individual programme areas for collaboration with Member States incorporate provisions for health services research, while a number, though not identifying them as such, reflect research activities in their plans of work.

--3.1. 6 HEALTH SERVICES RESEARCH

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

............ 6 0 ... 6

Country or area Intercountry

700 68 300 69 000 =======

700 68 300 69 000

118 000 160 800 278 800

. ..... "

Total

=======

======

========

::=======

=======

Major programme: Family health Programme: Maternal and child health

No. 3.2

3.2.1

To reduce maternal, perinatal, infant and childhood mortality and morbidity, to promote the physical and psychosocial development of children and adolescents and to promote reproductive health; to improve the coverage, efficiency and effectiveness of integrated family health care at all levels of the health system, in particular maternal and child health and family planning, in the context of comprehensive health services with emphasis on primary health care. More specifically: to collaborate in identifying prior~ttes in maternal and child health care in order to strengthen maternal and child health/family planning activities, with emphasis on improving coverage and effectiveness in the context of primary health care, including the managerial and referral aspects; to cooperate in the development of health manpower for the delivery of maternal and child health/family planning services at all levels, including traditional birth attendants; to collaborate in further development of the health information system as related to the efficient management of maternal and child health/family planning programmes; to encourage and support research in the area of maternal and child health and family planning with emphasis on the development and testing of approaches.

Determining the major health problems of mothers and children and identifying the priorities in maternal and child health care. Identifying and implementing modalities of service appropriate in different circumstances within the primary health care system. 63

Mobilizing and developing national resources to improve maternal and child health services, particularly to underserved communities. Supporting the training of national staff at different levels and providing consultants in specialized areas. Further strengthening cooperation with national staff and other agencies, particularly with UNICEF, UNFPA and the International Planned Parenthood Federation. Review 1979 was the International Year of the Child. Most countries or areas of the Region intensified their efforts to improve maternal and child health services and to determine priorities in maternal and child health care. The necessity to improve the information system was brought to the attention of participants in a regional seminar on indicators relevant to maternal and child health, held in Manila in December 1978. Growing interest in the medico-social problems of adolescents prompted the organization of two working groups; on the health needs of adolescents, held in March 1980, and on adolescent fertility management, to be held in November 1980. Activities connected with the high-risk approach in maternal and child health care are being implemented in a selected district of Peninsular Malaysia. Basic data and information have been collected and await further analysis. Other countries, such as China, Philippines and Republic of Korea, have also shown an interest in the study, and it is hoped to develop an appropriate approach in the context of primary health care. With a view to encouraging and supporting governments in the tra1n1ng of national staff, particularly the training of teachers, a maternal and child health/family planning teacher training project has been designed. Its objective is to promote relevant knowledge and appropriate technology to improve the care of mothers and children, particularly in underserved communities. The first course was conducted in the Western Highlands Province, Papua New Guinea, in October/November 1979. Attention was focused on infant and young child feeding during the WHO/UNICEF meeting on infant and young child feeding, held in October 1979 in conjunction with the International Year of the Child. There is a tendency, in some developing countries, to abandon breastfeeding. To combat the tendency, Hong Kong and the Philippines are proposing, with WHO support, to organize national workshops on breastfeeding in 1980.

Subjects for research reflect problems encountered in various countries or areas of the Region. They range from toxaemia in pregnancy and the incidence of congenital malformation, to the high prevalence of respiratory infections among causes of death in infants and small children and the role of infant nutrition 1n the outcome of diarrhoeal infections. The improvement of coverage with appropriate maternal and child health care activities continues to be a priority, with emphasis on the multidisciplinary approach to programme development and evaluation, particularly through the integration of family planning activities.

3.2.1

MATERNAL AND CHilD HEALTH

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

············· o e o o o G

Country or area Intercountry

220 200 144 000 364 200

8 891 100 579 600

9 111 300 723 600

136 200 129 800 266 000

2 387 900

2 524 100 717 600 3 241 700

( 84 000) (14 200) ( 98 200)

......... Total

587 800 2 975 700

========

==========

9 470 700

=========

9 834 900

=======

=========

=======

Programme: Nutrition

No.

3.2.2

Objectives To reduce the incidence of all forms of malnutrition and promote better nutrition of all individuals. More specifically: to collaborate in developing the health component of multisectoral food and nutrition policies and programmes; to promote the control of specific nutritional deficiencies such as vitamin A deficiency, anaemia and goitre; to collaborate with national and international bodies in carrying out the operational or basic research needed to implement the objectives of the programme, as well as to develop the regional action-oriented research and development programme 1n nutrition. Approaches Promoting the development of national expertise in nutr1t1on. The extent of this expertise will vary in accordance with available resources. It is envisaged that nutrition personnel will be primarily supportive, with service delivery being accomplished through regular line staff. Training of national staff through support of regional and national training programmes, national seminars and the provision of consultants in specialized areas. Developing integrated nutrition activities at the primary health care level. Supporting planning and coordination by encouraging the creation of a high-level national body, representing the different disciplines involved, able to give guidance to, and influence, the different professional ministries.

Continuing collaboration with other concerned agencies, particularly UNDP, UNICEF, the World Food Programme, FAO and the IBRD (World Bank), in view of the multisectoral nature of the problem. Review There has been evidence of small improvements 1n some areas and definite improvements in some of the services provided. Progress in the priority areas of the regional programme has been as follows: National food and nutrition eolicies There has been a noticeable upsurge of interest in this area and, increasingly, food and nutrition policies are being given specific attention in national development plans. Some evidence is emerging that, while it is possible to fonnulate such policies in outline at the national or macro level, it is often more effective to start specific planning at the micro level. This is particularly so where the relatively detailed data required for specific planning are not available. Joint efforts with FAO by collaborating in the provision of consultants have continued, as in Malaysia. Nutrition surveillance From the work of WHO staff and consultants and the reports of participants in a regional workshop on the subject, it has emerged that many of the measurements necessary for constructing indicators of nutritional status are being made at the periphery in most countries or areas. However, they are frequently not being compiled, analysed and utilized, although most countries or areas now have some indication of community nutritional status either from surveys or from health returns. Work continues on incorporating nutritional status indicators into routine health information reporting systems, with the object of providing more specific and continuous information for use in planning. Nutrition activities in primary health care The integration of nutrition into the line health services continues, but the need to integrate it with other health activities at the primary health care level is realized. A regional seminar emphasized how this integration should be effected. The identification of minimal nutrition input at the primary health care level and the development of a prototype manual followed. Further efforts will be concentrated at the national and community levels.

Nutrition training Regional training programmes, one on food and nutrition planning in collaboration with the Netherlands Universities Foundation for International Cooperation, and the other on community health (nutrition) in collaboration with the University of Queensland and the University of the Philippines, enhance the training facilities in the Region. The United Nations University is also conducting an advanced training programme on nutrition planning and implementation as a part of the World Hunger Programme. Through a total revision of the manual The Health Aspects of Food and Nutrition, the collaboration of consultants and staff, and the provision of fellowships, efforts continue, to upgrade the training in nutrition of those professionals who will be the leaders and trainers of health teams at different levels. In-country training of lower-level workers has improved in many countries and increased attention is being given to workers in primary health care. Action against specific deficiencies The vitamin A fortification of monosodium glutamate under experimental conditions having been shown to be effective in preventing xerophthalmia in one country, widespread trials on a commercial basis are now under way. Supplementation of pregnant women with iron continues but the problems associated with effective fortification have not yet been overcome. Iodized salt is being made available to an increasing number of people in endemic goitre areas but coverage is still inadequate. Childhood rickets has been observed in one country of the Region and plans are being made to control it. Nutrition research continues to receive attention and is being given increased emphasis with the initiation of an action-oriented research and development programme in nutrition.

3.2.2 ....._

NUTRITION

·ESTIMATED OBLIGATIONS

1980-81 Regular budget US$ Regional Other sources US$ Total Regular budget

1982-83 Other sources US$ Total US$

Increase/(Decrease) Regular budget US$

usT

uss

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

Country or area Intercountry

... ..

196 400 383 900 580 300 ===:=== ====:=::=

196 400 383 900

305 600 403 800 709 400 s~=====

305 600 403 800 =======

109 200 19 900 129 100 .,:.~~· ===::::s:::=

........ Total

=======

580 300

709 400 :=======

Programme: Health education

No. 3.2.4

Objectives To promote the health education of the public, with particular emphasis on the responsibility of the individual and active community involvement. More specifically: to collaborate in developing health education and information strategies and in establishing and strengthening health education services; to facilitate integration of health education 1n major health programmes and encourage intersectoral collaboration in health action; to promote health education in schools and for out-of-school youth; to stimulate development of health education manpower, including training of health education specialists and of health workers in health education; to strengthen communication and audiovisual support for health programmes; to encourage and promote behavioural research in health and health education. Approaches Promoting development of health education manpower, with emphasis on the preparation of medium-level health education workers, and the establishment of field practice areas in order to stress the desirability of combining classroom teaching with practical experience. Encouraging the inclusion of health education in the basic training of various categories of health worker, and promoting programmes for the inservice training of field level personnel in the community approach and health education. Supporting the development of specialization within health technology and behavioural research. edu~ation,

in areas such as media

Collaborating in the establishment and strengthening of national units for health education in the ministries of health and, wherever feasible, extending the network for professional leadership to the provincial and district levels. Encouraging behavioural research on sociocultural factors which influence health behaviour and community response to health services, with a view to identifying and developing the health education components of priority health programmes. Strengthening national capabilities tn the use of mass media in support of health programmes. Promoting health education in schools, with emphasis on designing curricula, developing teachers' guides and texts, and training teachers in school health education. Facilitating an integrated approach in health education, by encouraging multisectoral activities and interagency collaboration. Review The importance recognition of the participation, not therefore received of community involvement in health action was brought into sharp focus with the primary health care approach. Health education of the public to promote community only in the utilization of health services but also in their management and delivery, has continued support.

Emphasis is placed on strengthening the tratntng of health education specialists, particularly middle-level professionals. A development of major significance is the establishment of a postgraduate course in health education in Malaysia. A unique feature of this course is the emphasis given to combining classroom teaching with field training. Similar efforts are being made in Papua New Guinea, in reviewing and strengthening the diploma course for middle-level health educators conducted by the Health Education Institute. Cooperation has been extended to the Philippines in developing field study and demonstration areas for task-oriented training in health education. Another area of major emphasis in technical cooperation is the development of health education as an integral and vital component of all health programmes. Significant progress in that direction is being achieved by enlisting local spraymen selected by village councils in the decentralized antimalaria operation being carried out in Papua New Guinea. Cooperation has been provided in developing the health education component of malaria control programmes in Solomon Islands. In Kiribati, intensive activities have been

carried out in conjunction with environmental sanitation programmes. A team approach, utilizing health, community development, education and welfare workers, was encouraged and the involvement of community leaders and village councils further strengthened. Cooperation in incorporating health education in sanitation programmes has also been provided to Niue. Health education activities in the field of family health have been further developed and strengthened in seven countries or areas of the South Pacific. Emphasis is on creating a better understanding of the interrelatedness of nutritional status, infection control, environmental health, immunization and fertility regulation. Efforts have also been made to strengthen health education in programmes related to noncommunicable diseases, particularly the control of drug abuse and cardiovascular diseases and prevention of road traffic accidents. Another significant development is the growing recogn1t1on of the importance of the media, in combination with personal contacts and community organization efforts, in promoting public cooperation in health programmes. This aspect was reviewed in a workshop on the promotion of health information, held in Manila in March 1979. Technical support has been extended in reviewing and developing educational materials and radio programmes on health in Fiji, Papua New Guinea, Solomon Islands and Tonga. Communication strategies have been devised and audiovisual equipment supplied to Lao People's Democratic Republic. In coordination with the World Bank, plans have been formulated to strengthen media facilities and communication support for health programmes 1n Malaysia and the Philippines. Support is being given to the inclusion of health education in the school system. In Papua New Guinea, WHO is collaborating in developing health education curricula for teacher training colleges and secondary schools. Efforts in that direction have also been made in Solomon Islands. A major challenge in this field is ensuring that health teaching in schools reflects the health problems prevalent and the health education efforts in the community. A recent development is the growing interest in health behaviour research. Studies on psychosocial and cultural factors influencing community response to health services have been initiated in the Philippines and the Republic of Korea. Anthropological studies on human factors in the control of malaria and leprosy have been completed in Papua New Guinea. A similar study, to gather insight for the strengthening of health education in schistosomiasis control, is being undertaken in the Philippines.

3.2.4

HEALTH EDUCATION

-ESTIMATED OBLIGATIONS 1980-81 f--·

1982-83 Total Regular bud~et

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

Regular budget US$ Regional

Other sources

us$

Other sources US$

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

Country or area Intercountry

.....

230 500 305 400

175 600 271 800 --

60 000

235 600 271 800

(54 900) (33 600) (88 500)

........ Total

=======

535 900

========

=======

535 900

=======

447 400

60 000

507 400 =========

=======

Major programme: Mental health

~c.

Objectives To promote mental health, exemplified by work concerning the psychosocial development of the child and preservation of the protective aspects of traditional life styles and family relationships; to prevent and control mental and neurological disorders such as psychoses, neuroses, personality disorders, mental retardation and epilepsy; to alleviate psychosocial Approaches Encouraging epidewiologicaJ studies and psychosocial research on problems related to rrenta] health. Collaborating in the formulation and i~plementation proble~s

such as drug dependence and alcohol-related problems.

of mental health policies.

Organizing and strengthening an advisory or coordinating group on mental health. Establishing ~~0

collaborating centres for research and training in menta] health. info~ation

Encouraging the exchange of technical

on mental health.

Stimulating staff training in mental health. Review The importance of mental health within the overall context of public health has been recognized. There is also growing awareness that the application of knowledge and techniques in menta] health can greatly benefit other public health programme areas.

A regional coordinating group on the mental health programme was established in 1978 and the first meeting was convened in April 1979, to review the development and implementation of mental health activities in the Region. The role of WHO collaborating centres in the Region was underlined and the scope and role of national coordinating groups in relation to the regional coordinating group analysed. As a result of keen awareness of the increasing problems arising from alcohol consumption, a survey was

conducted on alcohol consumption and related problems. In the area of mental health teaching, cooperation is being pursued with Member States in the development of mental health curricula at the graduate and postgraduate levels of medical education. Efforts to control and prevent drug abuse continue, in collaboration with Member States, and a working group on the application of laboratory methods in the surveillance/epidemiology of drug dependence was held in Manila in November 1978. To seek out strategies for extending mental health care, research on the integration of mental health 1n general health care has started in the Philippines and is making good progress.

3.3

MENTAL HEALTH

ESTIMATED OBLIGATIONS 1980-81 Regular bud~et

1982-83 Total Regular bud~et

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

us$

Other sources US$

us$

Other sources

us$

Regional

......

Country or area Intercountry

oil

....

148 600 275 800 424 400 56 600 56 600

148 600 332 400 481 000

389 400 221 300 610 700

389 400 221 300

240 800 (54 500) 186 300

........ Total

610 700

========

=====:::z

=======

=========

========

=========

=======

Major programme: Prophylactic, diagnostic and therapeutic substances Programme: Programme planning and general activities

No.

3.4

3.4.0

No separate objecttves, approach or review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

,--------------------------------------3.4.0

PROGRAMME PLANNING AND GENERAL ACTIVITIES

ESTIMATED OBLIGATIONS 1980-81 1982-83

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

Regular budget US$ Regional ........... . Country or area ..... Intercountry Total 103 00 0 103 00 0

Other sources US$

Total US$

Regular bud~et

us$

Other sources US$

103 000

(103 000)

====== =

========

======= -

103 000

(103 000)

=======

========

=======

Programme: Drug policies and management

No. ?.4.1

Objectives To collaborate in formulating national policies for the production, distribution, utilization and control of safe and efficacious drugs; to collaborate in the development and establishment of national, regional or subregional services needed for the implementation of those policies. Approaches Exchanging information on the drug policies and legislation for government regulatory control existing in different countries or areas. Collaborating in formulating national drug policies for production, distribution, control and management, including establishment of national lists of essential drugs. Collaborating in programming, planning and organizing the production or procurement of drugs. Undertaking feasibility studies on procurement, production and distribution of drugs for the national health needs. Promoting improved utilization of locally available resources, especially medicinal plants. Conducting drug utilization studies to improve the rational utilization of drugs at all levels of health care. Review Countries or areas of the Region are confronted with rapidly rising costs in the prov1s1on of pharmaceuticals for health care. There are problems of logistics in the distribution of drugs in some countries, particularly to remote rural areas. There are also problems associated with drug production and importation as well as with monitoring, quality control, and product registration and certification.

A working group on the regional aspects of drug policies and management was held in Manila in March 1978, during which a programme of action for technical cooperation with and among countries was formulated. A survey of the drug policies and management situation in five South Pacific countries or areas and a study of drug utilization in Papua New Guinea were carried out from July to September 1978. The two studies provided the technical input to the Meeting on Technical Cooperation among South Pacific Countries/Areas in Pharmaceutical Supplies, jointly sponsored with the South Pacific Bureau for Economic Cooperation in Suva, Fiji, in December 1978. The meeting adopted a list of essential drugs for use in the South Pacific and recommended a programme for the establishment of a South Pacific pharmaceutical service (SPPS). Members of a task force visited most of the South Pacific countries or areas from February to April 1979 and prepared a report outlining the various options for the four proposed components of the SPPS; namely, a joint purchasing service, a warehousing arrangement, a quality assurance programme and a drug information service. A working group, comprising senior government officials from the ~inistries of Health, Finance and Planning of the South Pacific countries/areas, examined and discussed the Task Force report in detail at a meeting in Auckland, New Zealand, in August 1979. The report of the Working Group served as the technical input to the Conference of Ministers of Health of the South Pacific Countries/Areas on Technical Cooperation in Pharmaceutical Supplies, held in Manila in November 1979. At the Ministerial Conference, 12 countries or areas of the South Pacific adopted a declaration of intent calling for the establishment of the SPPS in the shortest possible time. A more detailed examination of the most appropriate locations for the joint purchasing service and the warehouse, or warehouses, including the financial aspects, is being carried out by a study mission. Collaboration in drug policies and management has been extended to the Philippines in strengthening the inspectorate of the food and drug administration and to Kiribati in traditional medicine and medicinal plants.

------3 . 4.1

-----ESTIMATED OBLIGATIONS

DRUG POLICIES AND MANAGEMENT

1980-81 Regular budget Other sources

-----Total Regular bud~et

1982-83 Other sources Total

Increase/(Decrease) Regular budget US$

us$

US$

us$

Regional ........... . Country or area ..... Intercountry Total 1 059 400 112 400 660 70 0 660 70 0 1 059 400 773 100 131 600 140 800 523 700 131 600 664 500 --

(927 800) 28 400 (899 400)

====-:-====

1 171 800

::-=========

1 832 500

========

272 400

======= -

523 700

=======

796 100

=======

Programme: Pharmaceuticals and biologicals

No. 3.4.2

-----------------------------(l) Pharmaceuticals Objectives To collaborate tn establishing national lists of essential drugs, and specifications if necessary; to establish and improve international requirements and standards for the quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances. Approaches Establishing national lists of essential drugs within the framework of national drug policies. Programming, planning and organizing the production of pharmaceuticals. Developing the services required for drug quality control. Review As mentioned under 3.4.1 Drug policies and management, a list of essential drugs for use tn the South Pacific has been established. Two subregional workshops on drug quality control and management supported by DANIOA, were organized one in Suva, Fiji, in December 1979 and the other in Kuala Lumpur, Malaysia, in February-March 1980. Following the first meeting of the ASEAN countries on drug legislation, evaluation and quality assurance held in Jakarta, Indonesia in November 1979 an ASEAN task force on pharmaceuticals has been convened to examine priority areas for technical cooperation. The report of the task force will be discussed at a second meeting on technical cooperation among ASEAN countries on pharmaceuticals scheduled to be held in August 1980 in Manila. Collat)oration has been extended to Lao People's Democratic Republic in the establishment of a national pharmaceutical service in the Ministry of Health and to Viet Nam in the provision of supplies and equipment. 83

(2)

Biolo~icals

Objectives To provide support to programmes for the control of communicable diseases through vaccine production; to promote the establishment of vaccine control and laboratories for vaccine control; to cooperate in the development of the manpower needed for the production and control of biologicals. Approaches Establishing bottling, capping and labelling facilities and modern laboratory methods for processing imported bulk vaccines. Improving existing production methods and reducing the import of bulk vaccLnes as local technical capabilities and production increase. Introducing or further developing the quality control of vaccines for both imported and locally produced vaccines. Supporting the development of national control laboratories for vaccines. Undertaking the training, refresher training and specialization of scientific and technical personnel through short courses or individually arranged programmes. Review An insufficient quantity of vaccine and products for immunization is produced in the Region to meet the needs of developing countries or areas at reasonable cost. This applies particularly to those vaccines needed for the WHO Expanded Programme on Immunization and results in vaccine being imported from overseas at high cost or in reliance on donations and similar kinds of support, which obviously cannot be expected to last forever. Further cooperation is needed in establishing and improving vaccine production facilities Ln several countries of the Region, with a view to ultimately developing a regional vaccine production and distribution centre.

There is a lack of organization for proper quality control in some countries or areas and this poses a great problem, particularly in the countries which produce vaccine. A regional network of control laboratories will have to be established to assist in the control of vaccines in countries where the establishment of such a facility is not feasible. There is a shortage of adequately trained staff for both production and control. Some progress has been made however. The Serum and Vaccine Laboratories, Alabang, Philippines continue to receive support from the Government of the Netherlands. A WHO Associate Expert from the Rijks Instituut voor de Volksgezonheid, Bilthoven is collaborating at Alabang in the completion of facilities for large-scale DPT vaccine production. BCG vaccine, produced at Alabang, has been tested for potency and found to be of a satisfactory standard.

.---·

3.4.2

----

-----

----

PHARMACEUTICALS AND BIOLOGICALS

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

us$

............ •••• It

Country or area Intercountry

343 200 53 400 --396 600

130 600

473 800

545 600 15 000 560 600

545 600 15 000 560 600 =======

202 400 (38 400) 164 000

........ Total

53 400 130 600 527 200

---

=========

========

=========

========

=========

======== ·-

Appropriation section: Disease prevention and control Major programme: Communicable disease prevention and control Programme: Programme planning and general activities

No.

4.1

4.1.0

No separate objectives. approach or review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

4.1.0 PROG~~ME

PLANNING AND GENERAL ACTI VI TIES

----ESTIMATED OBLIGATIONS 1980-81 1982-83 Total Regular bud et 0 ther so urces

------------Regular budget US$ Regional ........... . Country or area ..... Intercountry Total 146 600 352 200 498 800 146 f>OO 352 200 498 800 389 400 389 400 Other sources US$

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

----US-.$~----+---~US~$~-------

us-r---

(146 600) 389 400 37 200 (109 400)

========

====-====

::======

=========

== ======

389 400 ====:r::=

=======

--L---------~------------------------~~--------

Programme: Epidemiological surveillance

No. 4.1.1

To strengthen national surveillance of communica~le diseases of major public health importance and to provide prompt and effective cooperation in emergencies. Approaches collabo~ating

Meeting national needs by promoting the establishment of epidemiological services and by in the improvement of those already existing.

Supporting the training, parttcularly the refresher training, 1n epidemiology of health personnel at all levels. Promoting improvement in the quality of ongoing surveillance, inter alia by encouraging national authorities to include narrative sections in statistical reports on communicable diseases and to develop close liaison with supporting laboratory services. Collaborating in activities directed at the management of emergenctes tn relation to communicable diseases. Review Most significant has been the newly emergtng active participation of China and Viet Nam in the surveillance of communicable diseases. Only a few countries of the Region have active epidemiological surveillance programmes and the exchange of experience leaves much to be desired. Although some health administrations appreciate the importance of having trained epidemiologists, such positions are often not sufficiently attractive, and there may be frequent changes in staffing. Only rarely does a country have a sufficient number of epidemiologists to implement a programme. 89

In most countries or areas of the Region few opportunities exist for refresher tra~nLng in epidemiology for medical officers or allied health service staff. In response to this situation and with extrabudgetary resources, WHO is collaborating with countries of the South Pacific and with Papua New Guinea in the strengthening of epidemiological services. Several training courses in epidemiological surveillance for allied health services staff have been given in areas of the South Pacific, as well as one for medical officers. WHO has been called upon to collaborate with countries or areas of the South Pacific in emergencies arising from outbreaks of dengue fever and Ross River fever. Collaboration has also been extended to Malaysia and the Philippines in taking precautionary measures against outbreaks of disease resulting from population movement.

-4.1.1 EPIDEMIOLOGICAL SURVEILLANCE

ESTIMATED OBLIGATIONS 1---·

1980-81 Regular budget Other sources

-Total

1982-83 Regular budget Other sources Total US$

Increase/(Decrease) Regular budget US$

usr--

us$

Regional

.....

"."

•••••

Country or area Intercountry

....

220 600 405 900 626 500

160 500 157 300

381 100 563 200 944 300

339 300

64 000 73 000 137 000

403 300 573 600 976 900 =======

118 700

........ Total

500 600

94 700 213 400

========

=======

317 800

========

=======

839 900

==========

=======

92 Programme: Malaria and other parasitic diseases

No.

4.1.2

(1)

Malaria

Objective To cooperate in the intensified malaria action programme of control; where feasible, 1n the eradication of malaria; and in preventing reestablishment of the disease 1n countries or areas where it has been eradicated or establishment where it has never been endemic. Approaches Providing technical cooperation in the planning, implementation and/or evaluation of the antimalaria programme, particularly where malaria continues to be a major health and socioeconomic problem, such as in remote rural areas, and where the malaria manpower situation is most precarious. Promoting and organizing group educational activities, with a view to enhancing and updating the technical expertise of professional and senior technical staff of the antimalaria services at national level. In coordination with existing regional training institutions, organizing training at subregional or regional level, Providing orientation on the socioeconomic implications and the control of malaria for staff of the general health services and others engaged in rural development, in order to strengthen intra- and inter-sectoral coordination. Cooperating in the promotion of primary health care through active community participation 1n antimalaria operations, particularly in remote rural areas. Promoting cooperation in malaria research activities, in particular the development and implementation of applied field research under the Special Programme for Research and Training in Tropical Diseases or regional research programmes, with a view to solving technical or operational problems of immediate relevance to the progress of the national, subregional or regional programme.

Review In countries or areas where malaria is no longer endemic, i.e. Australia, Brunei, Hong Kong, Japan, Macao and Singapore, the malaria-free status is, in general, being maintained. Staff responsible for the malaria vigilance operations continue to participate in intercountry malaria meetings. Among the ten countries where malaria is still endemit:, the risk is limited in the Republic of Korea (Plasmodium vivax only), while considerable progress is being made in China, Malaysia, and the northern provinces of Viet Nam. In those three countries, vertical programmes of technical direction and guidance have been harmoniously linked with integrated services at the periphery. Malaria remains a major health problem in Democratic Kampuchea, Lao People's Democratic Republic, Papua New Guinea, Solomon Islands, and 1.n parts of the Philippines and Viet Nam, for mainly administrative and/or operational reasons. Continued attention is being paid to development of the manpower required at higher echelons of the antimalaria organization and to the orientation in malaria of general health services staff. Alternative operational approaches for attaining better coverage in more remote rural areas are being promoted: a study of active community participation in the application of antimalaria measures has been initiated in Papua New Guinea. Regional collaborative studies on the occurrence of multi-drug resistant strains of P. falciparum and the effectiveness of alternative drugs or combinations of drugs have also been initiated. A comprehensive appraisal of the situation in the Region was undertaken in September 1979 with the cooperation of national programme directors. The progress achieved, and the technical, operational and administrative impediments to progress, were identified, including training requirements, as well as priority areas for applied field research. The medium-term strategy and approaches are based on the findings of this appraisal. (2) Objective To provide technical support to, and cooperate with, Member States in the prevention and progressive control of major parasitic diseases, particularly schistosomiasis, filariasis, clonorchiasis, paragonimiasis and other helminthic infections. Approaches Collaborating in assessing the current extent and seriousness of the problem. Promoting, and cooperating in carrying out, research in parasitic diseases which will lead to more effective means of control. 93 Other parasitic diseases

Providing technical guidance in the planning and implementation of more effective control programmes. Cooperating in the monitoring and evaluation of the impact of large-scale rural development programmes on prevalent parasitic diseases. Cooperating in the preparation and training of manpower in parasitic diseases research and control. Emphasizing the serious need for health education and community participation in all countries or areas where parasitic diseases are a major public health problem. Review Schistosomiasis While schistosomiasis has been successfully controlled in Japan, it continues to be a major public health problem in the Philippines, owing to its complex epidemiology and strictly rural distribution. More than half a million cases exist in 130 municipalities in 22 provinces and the economic loss due to the disease is estimated at ~230 millionl annually. Further studies have been carried out on the epidemiology and transmission dynamics of the disease, including human-water contact activities and the cost-effectiveness of various control measures. Regular meetings of a multidisciplinary working group and the regional steering committee are held to encourage, pursue and evaluate such research. The training of research workers and field personnel is a continuing activity. The presence of Schistosoma japonicum-type infection among the aborigines (Orang Asli) of Malaysia has been reported. Filariasis It is estimated that close to 10 million people in the Western Pacific Region are suffering from filariasis due to Brugia malayi and Wuchereria bancrofti. Both species are prevalent in China, Malaysia, Philippines and the north of Viet Nam. W. bancrofti is responsible for filarial infections in the South Pacific, Papua New Guinea and the south of Viet Nam. In the Republic of Korea, B. malayi is the species present.

lus$1.00

= 7.40

Pesos.

A substantial reduction in the prevalence of filarial infections has been achieved through mass drug administration and limited vector and environmental control in Samoa. Further studies are under way on the following: development of simple but accurate diagnostic tests, including immunological methods to determine prevalence and intensity of infection; host-parasite relationships, especially the dynamics of transmission, bionomics and ecology of the insect vectors, and chemical and biological control directed against the vectors; the role of environmental sanitation and effective health education measures, including community participation. Baseline epidemiological and entomological information on bancrofti has been collected and newer strategies are currently being applied to control the remaining low level of parasitaemia among the island population. These problems were discussed during the meeting of the joint WPRO/SEARO Working Group on Brugian Filariasis, held in Kuala Lumpur, Malaysia, in June 1979. Other parasitic diseases Among other parasitic diseases prevalent in the Western Pacific Region, on which research is being supported, are paragonimiasis, clonorchiasis and other helminthic infections, notably ascariasis and ankylostomiasis. Habits related to eating raw fish and crabs, promiscuous spitting and poor waste disposal are important factors in the monitoring of such trematode infections, whereas soil-transmitted helminths are prevalent in countries where human waste is used as fertilizer and promiscuous defecation is a common practice. It is felt that information on the precise status of these infections, on new or improved immunodiagnostic methods, on health education measures and on new chemotherapeutic agents, is needed to launch effective control programmes. Two WHO collaborating centres, at the Institute of Tropical Medicine, Beijing, and the Institute of Tropical Medicine, Yonsei University, Seoul, have been designated to undertake the above-mentioned research activities.

4.1. 2

MALARIA AND OTHER PARASITIC DISEASES

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

I 0 0 ...........

Country or area Intercountry

606 200 913 200

251 800 417 200 669 000

858 000 1 330 400 2 188 400

977 600 1 059 400

860 000

1 837 600

371 400 146 200

0."

.....

1 059 400

Total

==========

1 519 400

========

============

=========

2 037 000

=======

860 000

=========

2 897 000

=======

517 600

Progranune: Bacterial, viral and mycotic diseases

No. 4.1. 3

(1)

Diarrhoeal diseases, including

ch~lera

To reduce mortality and morbidity from acute diarrhoeal diseases, particularly in children under five years of age, priority being given to countries with an infant mortality rate of over 60 per thousand. App-roaches Promoting a community approach to control measures. Implementing preventive and control measures on an integrated basis through primary health care activities. Employing control measures against the diarrhoeal diseases through improvement of maternal and child care practices, health education, basic sanitation, oral rehydration, epidemiological surveillance and research. Carrying out programme activities through the collaboration of WHO Programme Coordinators and field staff, particularly those in health services development projects. Review The programme is now developing rapidly and has gained wide acceptance in the Region. Promotional activities have included a national workshop held in the Philippines in 1978, supported by WHO and UNICEF, which paved the way for the establishment of a study or pilot area. Country visits were made by a WHO consultant in 1978 and 1979 for the purpose of preparing a regional programme. The consultant's work was used as a basis for the Regional Planning Meeting on Diarrhoeal Diseases Control, held in July 1979 in Manila. Several countries have already developed their own diarrhoeal diseases control programme, notably Papua New Guinea and the Philippines.

To promote and support the research component of the project, the Western Pacific Advisory Committee on Medical Research has created a Sub-Committee on Diarrhoeal Diseases, which met Ln April 1980. At the thirtieth session of the Regional Committee for the Western PacLfic in 1979, diarrhoeal diseases control was an item on the agenda, indicating the sustained interest in the subject. (2) Acute respiratory infections

To reduce mortality, particularly of Approaches

infa~ts

and children, from acute respiratory infections.

Obtaining agreement on terminology and criteria for the diagnosis of various acute respiratory infection syndromes. Developing a network of acute respiratory infection units covering all countries or areas of the Region, to monitor, investigate and care for acute respiratory infections in defined populations, using standardized descriptive and technical methodology. Establishing a rational basis for the management and control of acute respiratory infections, including controlled evaluation of the effects of vaccine, where appropriate. Establishing a standardized data recording and reporting system for acute respiratory infections. Strengthening the regional advisory panel on acute respiratory infections. Encouraging the creation of national committees to coordinate control activities Ln acute respiratory infections. Review Activities in the field of acute respiratory infections have developed since a consultant visited Fiji, Papua New Guinea and Philippines from December 1977 to January 1978 to assess the problem and to make proposals for the development of a programme.

After a general review of the consultant's proposals by the Western Pacific Advisory Committee on Medical Research in 1978 implementation details were recommended by the Task Force on Communicable Diseases (acute respiratory infections) in September 1978. In January 1979, a working group on acute respiratory infections met in Goroka, Papua New Guinea and produced a report on sentinel unit methodology which formed the basis for the activities of an acute respiratory infections unit established shortly afterwards in collaboration with the Institute of Medical Research, Goroka. At the thirtieth session of the Regional Committee for the Western Pacific in October 1979, a technical presentation was given on acute respiratory infections, and the representatives of several Member States expressed interest in collaborating in the programme. (3) Objective To reduce the mortality, prevalence, incidence and transmission of tuberculosis areas of the Region. Approaches Controlling tuberculosis by simple, economical, acceptable and effective methods, applied through the general health services at national, intermediate and peripheral levels utilizing, where applicable, the primary health care approach. These methods are: (a) (b) maintenance of a high level of protection against tuberculosis through extensive application of potent BCG vaccine to susceptible populations; elimination of the source of infection by finding infectious cases through the simple bacteriological examination of patients complaining of respiratory symptoms, and rendering them non-infectious as quickly as possible through effective chemotherapy, mainly applied on an ambulatory basis. ~n

Tuberculosis

all countries or

Selecting, according to the epidemiological picture of the disease in the community and subject to available resources, priority population groups for the application of control measures. 99

100

Training specialized and general personnel, particularly auxiliaries, in general principles and simple techniques. Promoting operational research on the application of control methods suitable to the national health service system and prevailing epidemiological conditions. Review Countries or areas with both the highest and the lowest tuberculosis mortality and morbidity in the world are situated in the Western Pacific Region. Because of this vast contrast, the control measures to be adopted must vary. To establish appropriate control measures for specific population groups, to set targets for field activities and to evaluate the impact of tuberculosis control programmes, three prevalence surveys every five years have been conducted in the Republic of Korea. Single prevalence surveys have also been conducted in American Samoa, Malaysia, Samoa and Singapore. Almost all countries or areas have established national tuberculosis programmes, many of which have become well integrated into the general health services, applying WHO-recommended procedures and covering the whole population. However, the quality of many of the services still needs improving through intensified supervision and the training of health workers at various levels and of different categories. The WHO regional tuberculosis control team collaborates in the evaluation of national control programmes and in the training of health workers of various categories. Collaboration in the development of national tuberculosis programmes is also extended by WHO staff assigned to country projects. In collaboration with the Government of Japan, a course on tuberculosis has been organized at the Research Institute of Tuberculosis, Tokyo, every year since 1966. To ensure the constant supply of stable BCG vaccine of standard quality, a regional freeze-dried RCG vaccine production laboratory was established in 1975 with the cooperation of UNICEF and WHO at the Serum and Vaccine Laboratories, Alabang, Philippines. With the cooperation of WHO, studies are being carried out on problems encountered in the field by the national tuberculosis programmes of Japan, Philippines and Republic of Korea.

(4) Objective

Leprosy

To reduce the morbidity of leprosy as well as the heavy toll in disability associated with the disease, by applying available knowledge of public health principles through organized control services. Approaches Organizing the detection of hidden cases in the community by trained health workers, with laboratory support within the framework of the health network. Providing regular chemotherapy for all detected cases, particularly infectious cases, mainly on an ambulatory basis under the close supervision of workers in the health centres at the periphery. Providing services for the prevention and treatment of disabilities associated with the disease, through the existing health services. Establishing leprosy registers to facilitate the superv~s~on of domiciliary treatment, follow-up, and surveillance of patients under observation and household contacts. Imparting up-to-date knowledge on leprosy to the public and to health workers. Review Problems relating to leprosy and approaches for controlling it differ markedly within the Region. From information available, it appears that the disease remains moderately prevalent in Lao People's Democratic Republic, Malaysia, Papua New Guinea, Philippines, Republic of Korea, Viet Nam and countries or areas of the South Pacific. A review of annual notifications of new cases over the past decade reveals that there has been a declining trend in incidence in many parts of the Region where leprosy remains endemic. Nevertheless, it is estimated that less than half the cases in existence have been discovered. Regularity of attendance for treatment has generally not reached the accepted standards. Integration of leprosy control activities into the general health services is considered the best approach to the problem. This has not yet been achieved in many countries or areas of the Region because health workers and health administrators are insufficiently knowledgeable on modern approaches to leprosy control, because of operational problems in supervising medication, and because of the persistent stigma attached to the disease. Wl

102

WHO has cooperated in control activities in Lao People's Democratic Republic, Papua New Guinea and the Republic of Korea, as well as in the South Pacific area. The South Pacific Leprosy Training Centre, jointly established by the Government of Fiji, the New Zealand Leprosy Trust Board and WHO, and situated at the P.J. Twomey Memorial Hospital, Suva, became operative in 1978. The main objective of the Centre is to train workers of various categories and levels from countries or areas of the South Pacific, including Papua New Guinea. Special assistance was provided to Viet Nam from contributions made by the Japan Shipbuilding Industry Foundation, the Government of Switzerland, Amici dei Lebbrosi and the Damien Foundation. Through the WHO Voluntary Fund for Health Promotion, assistance has also been provided for leprosy control in general by voluntary agencies, including the Japan Shipbuilding Industry Foundation, the German Leprosy Relief Association, the Military Order of Malta, and the New Zealand Leprosy Trust Board. (5) Sexually transmitted diseases

Objectives To strengthen the control of sexually transmitted diseases; to develop an epidemiological information system and effective approaches and control techniques. Approaches Intensifying surveillance, on which definition of the problem depends, and which therefore has high priority. Promoting the exchange of information on the results of surveillance and on the treatment of sexually transmitted diseases. Promoting the development of standard treatment schedules for N. gonorrhoeae. Improving the availability of diagnostic and therapeutic services to the population at large. special cases, coordination will be established between developing countries facing serious sexually transmitted diseases problems and possible donors of the necessary supplies and equipment. Review The incidence of beta-lactamase-producing gonococci has significantly increased in several countries, in some without the introduction of vigorous control operations. In

Syphilis has been found to be more widely disseminated in the South Pacific area than was previously suspected. An intercountry workshop and tra~n~ng course on sexually transmitted diseases was organized in Fiji, which gave impetus to programme development. Collaboration with Papua New Guinea has focused on developing a comprehensive training programme for workers involved in the control of sexually transmitted diseases. Cooperation has also been provided to Fiji, Malaysia, Philippines, Republic of Korea and Viet Nam. A national programme has been formulated in the Philippines but there are serious budgetary constraints to expansion of activities to the periphery. Extra~udgetary resources are being sought. Viet Nam has developed a rigorous control programme which focuses on syphilis. (6) Ob ective To control and prevent zoonoses and related food-borne infections as well as intoxications. Approaches Identifying and assessing the veterinary public health problems which should be given priority. Promoting, developing and implementing practical programmes to control zoonoses such as rabies, plague, leptospirosis, brucellosis and salmonellosis. Promoting the organization of veterinary public health services, including surveillance. Collaborating in the control of emergency situations such as outbreaks of plague or brucellosis. Promoting research. Zoonoses and related food-borne diseases

103

Review Leptospirosis Leptospirosis is of growing concern in many areas of the Region. A consultation is being planned, in a country of the South Pacific, to develop a strategy for the surveillance and control of the disease. Rabies The increasing dog population and the limited supply of vaccines are major factors contributing to problem of rabies in the Philippines. Cases of rabies have been reported in Lao People's Democratic Republic, Republic of Korea, and Viet Nam. No cases have been reported from Australia, Fiji, French Polynesia, Guam, Japan, Malaysia, New Zealand, Papua New Guinea and Samoa. (7) Other bacterial, viral and mycotic diseases

Objectives To prevent and control bacterial, viral and mycotic diseases of public health significance, other than those specified above. Approaches Exercising constant vigilance in detecting the appearance, or monitoring the development, of such diseases and providing prompt and effective assistance in emergencies. Promoting training in their surveillance and control. Collecting and interpreting data on such diseases to evaluate their public health significance. Developing and promoting the use of effective control measures for any disease or disease complex so identified.

Review Arboviruses Dengue fever/dengue haemorrhagic fever was reviewed by the Technical Advisory Committee which met in December 1978. On that occasion preliminary discussions were held on the second editions of the guides for surveillance, treatment and control which are now available. Several research proposals were supported. The problem of dengue haemorrhagic fever is causing concern in China, Malaysia, Philippines, Singapore, Viet Nam and some countries or areas of the South Pacific. Japanese encephalitis B is apparently spreading in China and vaccination programmes are being carried out there, as well as in Japan and Viet Nam. Various vaccines are being used and experience has to be exchanged on their various merits. Mite-borne typhus is widespread but few efforts are being directed towards surveillance except at the Institute for Medical Research, Kuala Lumpur. Ross River fever, originally found in Australia, has now reached Fiji, where there was an outbreak 1979. ~n

Haemorrhagic fever with renal syndrome, originally found in the Republic of Korea, has now been recognized in China and Japan. It is also seen in countries outside the Region. The etiological agents were isolated in the Republic of Korea but this could not be achieved elsewhere. Hepatitis The interregional seminar on viral hepatitis, held in Kuala Lumpur in November-December 1977, was followed by a training course for senior laboratory technicians in Tokyo, Japan, in 1978. Influenza The participation of China in the global surveillance system has added an area of great importance. Epidemic meningitis Few countries consider this disease a priority for control, although in 9 out of 24 countries it was reported as being among the 10 leading causes of death. 105

106

"Pig-bel" (enteritis necroticans) is a disease of children in Papua New Guinea which is frequently serious. It is caused by C. welchii, which becomes invasive under certain circumstances. A vaccine is being used. Mycotic diseases are characterized mostly by the prevalence of fungal skin diseases and the significant use of health facilities by affected patients. Nevertheless, little importance is given to these diseases by most public health authorities.

4.1.3

BACTERIAL, VIRAL AND MYCOTIC DISEASES

ESTIMATED OBLIGATIONS 1980-81 Regular budget Other sources US$ Total Regular budget 1982-83 Other sources Total Increase/(Decrease) Regular budget US$

us$

uS$

Regional ........... . Country or area ..... Intercountry Total 262 600 392 800

655 400 1 584 000

381 300 1 090 100 64 000

381 300 1 154 100

118 700 498 300 617 000 ========

591 800

992 200

=======

854 !tOO

==========

1 385 000

=========

2 239 400

==========

1 471 400

======

64 000

==========

1 535 400

---..-&...---------------------

107

108

Programme: Expanded programme on immunization

No. 4.1.5

Objectives To reduce morbidity and mortality from the six target diseases, diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis and measles, by providing immunization against them for every child in the Region by 1990; to promote national self-reliance in the delivery of immunization services within the context of the comprehensive health services; to ensure that national programmes are supported by proper vaccine quality control and adequate vaccine supplies. Approaches Fostering the development of national plans for expanded immunization programmes with appropriate budgetary allocations. Developing the national training courses required to support implementation of the programme. Collaborating in solving cold chain problems. Establishing a regional system for the procurement, distribution and quality control of vaccines. Developing mechanisms for surveillance of the six diseases, for reporting by immunization services and for the regular monitoring and evaluation of national immunization programmes. Review The following are the most significant events which have taken place in the Region. Policy changes On the firm assumption that even countries with good immunization services desire further improvement, it has been decided that inclusion in the programme should not be restricted to countries with poor

immunization services. It is of course understood that the nature and direction of collaboration with WHO will vary according to the level of development of the immunization services. Operational responsibility for the WHO programme of cooperation is within the communicable disease prevention and control and health services development programmes. This was effected in 1978, in keeping with the integrated approach to immunization services which has been adjudged most suitable for most Member States of the Region. At present WHO is most involved in the national immunization programmes of Papua New Guinea, Philippines, Viet Nam and countries or areas of the South Pacific. A fruitful exchange has commenced with China. In other countries of the Region, WHO cooperation is focused on evaluation, training and cold chain development. The Region ~s not yet self sufficient in vaccine production. WHO, UNICEF and other agencies are working with countries to develop national capability. In the meantime, many countries purchase vaccine, or have vaccine supplied through UNICEF, from outside the Region. Efforts are being made to strengthen the distribution systems for vaccine through a regional or subregional bulk store and supply project, which it is hoped will become part of the planned South Pacific Pharmaceutical Service (3.4.1).

1Q9

110

4. 1. 5

EXPA.."mED PROGRA.'IME ON DOOJNIZATION

ESTIMATED OBLIGATIONS

1980-81 Regula'!:' budget Other Total Regular

1982-83 Other Total

IIncr~ase/(Decrease) Regular budget

us$

source_s·-------~~---+--~S ~t_______ s_ou~r~cre_s__·----~~ usrus$ us$ us$ us~

us$-

Regional ........... . Country or area ..... Intercountry Total 35 300

35 300 275 900 275 900 1 294 500

277 900 363 800 641 700

277 900 363 800

242 600 (654 800) (412 200)

1 018 600

==========

1 053 900

==========

1 329 800

===-====

=======

641 700

========

=======

--------~------------------~

Programme: Prevention of blindness

No. 4.1.7

Objectives To prevent blindness, from xerophthalmia and trachoma in particular; to promote the adequate provision of eye care for all. Approaches Collaborating in the collection of relevant national statistics for the identification of priorities and the formulation of national plans and programmes for the prevention of blindness. Collaborating in the development and strengthening of comprehensive eye care with adequate provision for referral, supervision and integration with general health services. Promoting the training of different categories of professionals and auxiliaries. Review The hi-regional working group which met in Manila in April 1979 drew attention to the lack and inadequacy of data on which preventive programmes in most countries or areas of the Region could be based. The working group urged increased effort on the part of national authorities and recommended that immediate action should be taken to formulate and implement prevention of blindness programmes, in partnership with WHO if no such programme had been formulated. National programmes will frequently start with the establishment of pilot programmes to ensure that (a) resources are diffused effectively; (b) in-service training, restricted to staff of one region, may be undertaken rapidly; (c) the programme is tested, and modified where necessary, before it is extended to other regions; and, additionally (d) the pilot region will provide a training ground for staff of other regions. WHO will cooperate in such pilot programmes, particularly in the training of primary health care personnel. The initiation of eye-care programmes will be greatly assisted by the formation of national advisory committees on the prevention of blindness. 111

112

Australia, Japan, New Zealand and Singapore already have effective national programmes, while China, Fiji, Malaysia, Philippines and Viet Nam are implementing programme components. It is also known that trachoma is prevalent in Papua New Guinea and there is a high incidence of cataract in Marshall Islands. The Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, has been designated a WHO collaborating centre for the prevention of blindness. While better data are required from all developing countries, the problem of xerophthalmia will receive special attention in the area of research.

4.1. 7

PREVENTION OF BLINDNESS

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional ••••• 0.

1982-83 Total US$ Regular budget US$ Other sources US$ Total US$

Increase/(Decrease) Regular budget US$

Other sources US$

(>.It

••

Country or area Intercountry

..... 0 • 0 • " •

150 000 77 700

150 000 77 700 227 700

76 200

(73 800)

Total

150 000

=======

77 700 ======

========

======

76 200

·======

76 200

(73 800)

=======

Ill

114

Programme: Vector biology and control

No. 4.1.8

Objective To reduce vector and pest distribution and abundance, priority being given to the control of those vectors and animal reservoirs responsible for the transmission of vector-borne diseases of major public health importance. Aperoaches Promoting environmental sanitation, health education, community participation, primary health care concepts, biological control and the selective use of safe insecticides in order to reduce vector and rodent populations. Encouraging expanded operational activities in vector surveillance and control through tra~n~ng activities, technical visits to countries most in need, and research activities leading to improved vector control measures. Review The vector biology and control programme is oriented to tratntng, in the form of fellowships, or cooperation in intercountry and national training courses. From the budgetary point of view, funds for the programme appear to be limited, because most of the activities overlap with other programme areas, such as communicable disease prevention and control, malaria and other parasitic diseases, and research promotion and development. As there is a shortage of trained staff in vector surveillance and control, one of the major approaches in the programme is to cooperate in establishing national vector control units, and also to train health inspectors and related staff in the application of the concepts of primary health care through community participation in vector control. The programme relies on a multidisciplinary approach in the control of malaria, filariasis, dengue haemorrhagic fever and other vector-borne diseases.

4.1.8

VECTOR BIOLOGY AND CONTROL

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

•••••

<i>

•••••

Country or area Intercountry

•

83 200 159 300 242 500 121 900 121 900 ========

83 200 281 200

89 800 196 800

6 600 37 500 44 100

........ Total

=======

364 400

=======

286 600

=======

========

286 600

=======

115

116 Major programme: Noncommunicable disease prevention and control Programme: Programme planning and general activities No.

4.2

4.2.0

No separate objectives, approach and review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

---4. 2.0

---

------

------------ ---------

PROGRAMME PLANNING AND GENERAL ACTIVITIES

ESTIMATED OBLIGATIONS

-1982-83

·-

1980-81 Regular -·budget US$ Regional .... Other sources US$ Total Regular budget

Increase/(Decrease) Total

usr

--- us$

Other sources

usi

----

US$

Regular budget US$

•

••

...

Country or ar ea Intercountry

...... "

133 700 115 300 249 000 =======

133 700 115 300 129 800 129 800 129 800 129 800 =======

( 133 700)

..... .. Total

--===:===

14 500 ( 119 200)

:======

249 000

=======

L--------

117

Programme: Cancer

No. 4.2.1

Objective To promote the prevention and control of cancer. Approaches Promoting the establishment of national cancer registries, based on WHO standard guidelines, to obtain information on the pattern of cancer morbidity in the community. Promoting the esta~lishment

of effective control services within the national health organization.

Introducing, on the basis of up-to-date knowledge, effective detection and treatment methods applicable to a wide sector of the population. Collecting and disseminating information on new developments in cancer, with particular reference to epidemiology, the role of environmental factors 1n the development of the disease, and new methods of diagnosis and treatment. Cooperating in the training of health workers, at various levels and of various categories, involved in control programmes. Promoting epidemiological and operational research to discover effective methods for the prevention and control of cancer. Review

WHO is cooperating in the development of cancer control services in accordance with public health principles, emphasis being placed on the inclusion of such services in the national health structure at an early stage. Collaboration has started with the Republic of Korea in developing a comprehensive cancer control programme.

A working group on the organization of comprehensive cancer control programmes, held in October 1979, stressed the need for national plans for cancer control. Such plans would help to avoid unnecessary duplication of effort and lead to a more rational use of resources. Planning priority should be given, especially in developing countries, to cancers that are common and to those for which practical control measures exist. Cancer control should be integrated within the general health services, utilizing primary health care; community participation in the cancer control programme is essential.

119

120

-4.2.1 CANCER

ESTIMATED OBLIGATIONS

-· 1980-81 Regular budget US$ Regional ..... . . . Country or area Intercountry .. Other sources US$

Total US$ Regular budget

1982-83 Other sources US$ Total US$

Increase/(Decrease) Regular budget US$

us$

... . 0.

....

196 300 27 000 223 300

196 300 27 000

166 000 46 000 212 000

166 000 46 000 212 000 ======= ::2:::::::::::=

(30 300) 19 000 (ll 300) ==:::=::::::

.... . . Total

========

=======

223 300

=========

Programme: Cardiovascular diseases

No.

4.2.2

Objective To cooperate 1n promoting the prevention and control of diseases of the cardiovascular system. Approaches Promoting epidemiological surveys on the size and nature of the cardiovascular conditions existing tn the community in order to establish strategies for control programmes. Promoting the organization of control services within the framework of national health structures. Collecting and disseminating information evolving from research studies conducted at the WHO collaborating centres. Assisting in the training of personnel involved in control activities. Promoting exchanges of experience among national experts engaged in cardiovascular disease prevention, diagnosis and treatment. Review Rheumatic fever and rheumatic heart disease registers have been established in Fiji, in Wairoa, a high risk area of New Zealand, and in Philippines, Singapore and Tonga. A community-based control project for rheumatic heart disease was established, with the participation of general health workers, in Pangasinan Province, Philippines, in 1977. The project has shown that primary health care workers can contribute to the discovery of rheumatic fever and rheumatic heart disease by recognizing early symptoms, listening to heart murmur and referring patients to doctors. Reports have indicated a great variety of blood pressure patterns in the populations of different countries. Data need to be obtained from selected samples as a means of defining the problem of hypertension and determining the frequency of its complications, so that appropriate control measures mwy eventually be adopted for wider application. In the Republic of Korea, WHO has collaborated in the coordination of various research activities on hypertension.

121

122

Apparently the extent of ischaemic heart disease varies in the Region. Studies should be carried out among selected populations in areas where the problem appears to be increasing, to define the pattern of such disease and the coronary risk factors involved. In 1980, WHO is collaborating with the Government of Fiji in conducting a population survey on the prevalence of cardiovascular and metabolic diseases, to determine the risk factors, for the control of which an intervention programme will have to be established. Risk factors for hypertension and ischaemic heart disease are related to dietary habits and life style and preventing them is beyond the capability of the conventional medical services. A multidisciplinary approach and active community participation are needed. A regional training course on the epidemiology and community control of cardiovascular disease was held in Wellington in 1978. A similar course will be held in Singapore in 1980 and another is proposed for 1982 (see page 348).

----------- - - 4.2.2 CARDIOVASCULAR DISEASES

-----------1980-81 Regular budget Other sources

-----------------------------------------------------------ESTIMATED OBLIGATIONS 1982-83 Total Regular budget Other sources Total Increase/(Decrease) Regular budget

1------------- -------.,-------------------------r-------------1 r--------------------------+------------

I I

us$

usr------usi

us$

Regional ........... . Country or area ..... Intercountry Total 73 200 34 100 107 300 73 200 34 100 107 300 168 100 50 200 218 300 168 100 50 200 94 900 16 100 111 000

========

=======

218 300

=======

-------

~--------------------------------~

----------------

123

124 Programme: Oral health

No. 4.2.3

Objectives To increase coverage of the population by oral health services; to improve the education of profess:onal and auxiliary dental staff and the public; to utilize more effective techniques for the prevention and control of oral disorders. Approaches Implementing widely the training and use of oral health workers within the context of primary health care. Producing teaching packages and self-instructional material for oral health care personnel, establishing learning resources loci and organizing meetings of heads of dental schools and directors of schools for dental auxiliaries. Conducting oral health seminars, under the intercountry programme, to monitor, evaluate and transfer appropriate technology for preventive dentistry programmes and dental disease control programmes. Promoting the use of flouride for the prevention of dental caries. Encouraging the establishment of national central oral health education units and selecting successful national oral health education activities for the dissemination of techniques and exchange of information. Carrying out research in priority areas of oral health. Review Monitoring of countries or areas in the Western Pacific Region has shown that the majority have implemented dental caries preventive programmes using fluorides (either topically or through water fluoridation), while school toothbrushing programmes for oral health continue, with greater emphasis on home care. There is general awareness of the need to develop techniques for the dental health education of the public and continuing education programmes for oral health personnel.

In collaboration with national staff, a research programme has been mounted in Samoa and Tonga to study the evolution of periodontal diseases. The study will be extended to the Republic of Korea. The findings should prove beneficial in controlling periodontal disease in the Region. Promotion of the use of flourides in drinking wRtP.r continues to be a major activity for reducing the prevalence of dental caries. The third WHO regional course in public health dentistry, held in 1979, was a useful medium for acquainting dentists and dental auxiliaries from seventeen countries or areas in the Region with the objectives, targets and activities of the medium-term oral health programme. Greater involvement of Member States in the development of the oral health component of primary health care was effected through participation in the course which, through the use of consultants and temporary advisers, gave full expression to the principle of technical cooperation among developing countries.

125

126

··4.2.3 ORAL HEALTH

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

............ It ..

Country or area Intercountry

213 400 194 300 407 700

213 400 194 300 407 700 =======

152 600 254 600 407 200

152 600 254 600

( 60 800) 60 300 (

•••

••••

Total

:::::s======

========

=======

407 200

500) ======

=======

Programme: Other noncommunicable diseases

No.

4.2.4

Metabolic diseases Objective To reduce the morbidity of metabolic diseases, particularly diabetes mellitus and gout. Approaches Promoting epidemiological surveys on the extent and nature of diabetes mellitus and gout 1n the community in order to establish appropriate control programmes for those disorders. Promoting the organization of control services within the national health structure with particular reference to the prevention of metabolic diseases. Cooperating in the training of personnel involved 1n control activities. Promoting exchanges of experience among national experts engaged in the prevention, diagnosis and treatment of metabolic diseases. Review Diabetes 1s a major health problem among Micronesian and Polynesian people in the South Pacific area. Obesity, one of the risk factors of diabetes, has become more prevalent due to changes in life style and dietary habits. Gout is prevalant in French Polynesia and Nauru. Control of the diet has been recommended, together with promotion of physical exercise through educational campaigns, particularly among schoolchildren and young adults, and regulation of food imports. It will be necessary to conduct epidemiological studies on the prevalence of diabetes and gout and the risk factors involved, as well as an operational study to ascertain effective control methods. A WHO/SPC meeting on metabolic diseases was held in Nauru in 1978 to discuss problems and control measures. Technical cooperation has been extended to French Polynesia, Samoa and Tonga.

127

128

In a survey on metabolic and cardiovascular diseases, conducted in Samoa, a marked difference in the prevalence of diabetes, obesity and hypertension has been found between the urban Upolu and the rural Upolu and Savaii population. A similar survey has been conducted among the Fijian and Indian population groups in Fiji to establish an epidemiological profile, including the prevalence of risk factors. The results of the survey will be used to plan a metabolic and cardiovascular diseases control programme.

-4.2.4 '

OTHER NONCOMMUNICABLE DISEASES

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

v .:.

•

Country or area Intercountry

.... 0 • 0

150 000 9 000 159 000

3 000 35 000 38 000

(147 000) 26 000 (121 000) =======

ell

......

Total

=======

=:::z====

=======

===a====

129

130

Appropriation sectton: Promotion of environmental health Major programme: Promotion of environmental health Programme: Programme planning and general activities

No. 5

5.1

5.1.0

No separate objectives, approach or review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

5.1.0

PROGRAMME PLANNING AND GENERAL ACTIVITIES

ESTIMATED OBLIGATIONS 1980-81 1982-83

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

Regular budget US$ Regional ......

Other sources US$

Total US$

Regular budget US$

Other sources US$

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

Country or area Intercountry

.....

30 000 230 600 260 600 =======

30 000 230 600 260 600 259 600 259 600 259 600 259 600 =======

(30 000) 29 000 ( 1 000)

.......... Total

=======

131

132

Programme: Environmental health planning and management

No. 5.1.1

Objective To support the work of Member States 1n promoting and developing environmental planning and management. Approaches Cooperating in the analysis and development of national policies, plans and programmes dealing with environmental, social, economic and health issues, with particular emphasis on planning and programming for the International Drinking-Water Supply and Sanitation Decade. Ensuring the continuation and expansion of the programme of work for the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS), to include the provision of technical cooperation, specialized environmental planning expertise, and education services; development of a regional information centre; and promotion of appropriate technology. Cooperating in, and promoting, research and studies to elaborate the health effects of environmental factors and to identify appropriate management and control technology for health-related factors. Cooperating in and promoting improved information collection and transfer. Cooperating in the analysis of environmental health manpower needs, curriculum development, and training. Organizing and sponsoring regional meetings, workshops and short courses for environmental health manpower development. Review The programme provides technical and organizational support for overall environmental planning and programme development in Member States. Improvements in this sector are of major.importance for the achievement of health for all by the year 2000. Urgent problems result from uncontrolled urban development

and industrialization, a critical need for coordination and cooperation among competing agencies at all levels, and shortages of experienced technical staff for environmental planning and pollution control. The continued expansion of the comprehensive programme of work of PEPAS, in conjunction with cooperation in maintaining national environmental health services at previous or higher levels, is contributing to progress. Technical cooperation by PEPAS has contributed to the strengthening of institutional capabilities for environmental programmes in four countries. Educational activities in pre-investment planning, diarrhoeal disease prevention, pollution control, food safety and water quality control have taken place. In addition, cooperation has been provided to more than eight countries or areas in preparatory activities in support of the International Drinking-Water Supply and Sanitation Decade.

133

134

5. 1.1

ENVIRONMENTAL HEALTH PLANNING AND MANAGEMENT

------,-----------ESTIMATED OBLIGATIONS

---------------------------------.------------1980-81 Regular budget

----------------Total US$ Regular budget

1982-83

Increase/(Decrease) Regular budget US$

us$

Other sources

us$

Other sources us$ ___

Total

us$

Regional ........... . Country or area ..... Intercountry Total 347 800 772 000 1 119 800

569 400

917 200 772 000

491 700 963 000 1 454 700

354 600

846 300 963 000

143 900 191 000 334 900

====::=====

=======

569 400

=========

1 689 200

354 600

===========

=========

1 809 300

=======

Programme: Basic sanitary measures

No. 5.1.2

Objective To support the work of Member States in promoting and developing basic sanitary measures, which will contribute to the control of disease, pollution and nuisance and lead to improvement in the quality of life. Approach Supporting WHO activities during the International Drinking-Water Supply and Sanitation Decade since basic sanitary measures provide the key to the environmental health programme. Intensifying cooperation in the areas of institutional development, project formulation and implementation, and securing external f ial resources for water supply and sanitation programmes. Cooperating in the planning of human settlements. Endeavouring to identify and obtain external funding for the programme. Review In most countries services will have to and Sanitation Decade achieving the overall or areas of the Region, existing programmes to provide water supply and sanitary be considerably accelerated if the goals of the International Drinking-Water Supply are to be achieved. The Decade, in turn, is a vital component of the strategy for goal of health for all by the year 2000.

Major problems in this sector include: financial limitations at national and local levels; lack of trained manpower; lack of effective infrastructural support for accelerated sector development; lack of clear national priorities translated into effective policies and programmes; and lack of basic data on existing conditions and resource potentials. Over the past ten years, considerable progress in sector development has been achieved in Malaysia an~ the Republic of Korea. With continuing cooperation from WHO at least five other Member States of the Region are making good progress towards decade objectives.

135

136

5.1. 2

BASIC SANITARY MEASURES

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total Increase/(Decrease) Regular budget US$

us$

I $> ....

...

Country or area Intercountry

..... "

291 600 257 500 549 100

886 200 224 400 1 110 600

1 177 800 481 900 1 659 700

450 900 257 000 707 900

719 100 44 500 763 600 =======

1 170 000 301 500 1 471 500 (

159 300 500) 158 800

........ Total

=======

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

=========

=======

=========

=======

Programme: Recognition and control of environmental hazards

No. 5.1.3

Objective To support the work of Member States 1n promoting and developing programmes for the recognition and control of environmental hazards. Approaches Cooperating in analysing pollution problems, establishing systems to detect and monitor hazards and pollutants in the environment, and exchanging information. Developing institutions, standards, and programmes to control hazards and problems of the environment. Developing appropriate technology. Review Air pollution, already a serious problem in most large urban areas, challenge in 1982-83, since effective control programmes have yet to be discharge of nutrient-laden, hazardous or toxic wastes into the aquatic widespread problem, potentially affecting food production and health in management and disposal also pose major problems. is expected to provide a major adopted in most countries. The ecosystem is a particularly many Member States. Solid waste

In the area of water pollution, the efforts of the International Drinking-Water Supply and Sanitation Decade in the provision of sanitary measures will contribute to the control of environmental hazards. WHO technical cooperation in this field is expected to increase, and extrabudgetary funds will be needed for some activities. Many of the activities will be conducted through the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS), which has region-wide coordination responsib~lities for environmental monitoring systems and provides specialized technical cooperation in the detection, analysis, assessment, and control of environmental hazards of all types.

137

138

5 .1. 3

RECOGNITION

~~D

CONTROL OF ENVIRONMENTAL HAZARDS

-ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources Total US$ Regular buc;!g_et US$ 1982-83 Other sources US$ Total US$

--Increase/(Decrease) Regular budget US$

us$

............ 0 .. "' .. 0

Country or area Intercountry

487 500

580 200

92 700

....

••••

--487 500 =======

Total

487 500

=======

580 200

========

=======

580 200

92 700

======

Programme~

No. 5.1.4

Food safety

Objective To support the work of Member States in promoting and developing food safety programmes. Approaches Developing manpower, including the provision of fellowships and the group training of sanitary inspectors. Programme planning, project development and evaluation. Collaborating 1n the improvement of legislation and developing frameworks for organization and administration. Upgrading the analytical capabilities of surveillance laboratories. Collaborating in strengthening rules and regulations for monitoring and control. Review Control of food safety is a basic requirement in support of health for all by the year 2000, and is of great concern to countries which either import or export food. In the past, WHO has provided support 1n manpower development by conducting working groups on food safety and hygiene and by supporting group training for food inspectors and food handlers. In addition, technical cooperation has been provided in the upgrading of legislation and rules and regulations. A working group on food hygiene and safety was held at the Western Pacific Regional Centre for the Promotion of Environmental Planning and Applied Studies (PEPAS) in October 1979. A condition causing problems in the Region is ciguatera (fish poisoning), for which prevention and control measures are being studied.

140

-5.1.4

FOOD SAFETY -"-----

ESTIMATED OBLIGATIONS '---•

1980-81

1982-83

Increase/(Decrease) Total US$ Regular budget

Regular budget US$ Regional ...

Other sources US$

Total

usl

Regular budget US$

Other sources US$

us$

......

Country or a rea ......... Intercountry

53 000 9 700

53 000

135 100 25 000 160 100 =:=====

135 100 25 000

82 100

.......... Total

9 700 62 700

15 300 97 400

======

62 700

=======

======= -~

=======

===:===

160 100

======

Appropriation section: Health manpower development Major programme: Health manpower development Programme: Programme planning and general activities

No.

6.1

6.1.0

No separate objectives, approach or review are given for this part of the major programme, as all activities are shown under the specific programme headings which follow.

142

6.1.0

PROGRAMME PLANNING AND GENERAL ACTIVITIES

ESTDtATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total /

Increase/(Decrease) Regular budget US$

US$

............ ..... 102 800 318 800 421 600 102 800 318 800 421 600

Country or area Intercountry

I 375 100 375 100 375 100 375 100 ======= =======

I I I I I I I

(102 800) 56 300 ( 46 500) =======

........ Total

=======

Programme: Health manpower planning and management

No. 6.1.1

Objectives To promote and cooperate in the formulation of policies and facilities for the continuing education of health workers; to promote and cooperate in establishing mechanisms for closer collaboration between national agencies responsible for training health personnel and those responsible for the delivery of health care, in order to ensure greater relevance in the development of health manpower, Approaches Encouraging the integration of health manpower planning development planning. ~n

the overall process of socioeconomic

Promoting the integration of activities for planning, production and management of health manpower, stressing in particular collaboration between agencies responsible for the training of health personnel and those responsible for the health services. Promoting career development and continuing education for all categories of health personnel. Preparing, field testing and revising guidelines and manuals on the analysis and formulation of health manpower policies, planning and management. Collaborating with other technical programmes in the formulation and implementation of strategies for achieving health for all by the year 2000, particularly in relation to the use of innovative health personnel and a rational approach to the use of health teams in health care delivery.

144

Review Health manpower planning and management has attracted the attention of Member States to an increasing extent. Some activities were carried out in 1977-78 and since then manpower studies have been started in Guam and the Republic of Korea, both in 1979, while others are planned in Malaysia and the Philippines. It is envisaged that these activities will lead to additional studies, eventually including all categories of health manpower and covering all aspects of the health manpower process. During the thirtieth session of the Regional Committee for the Western Pacific, special emphasis was placed on the integration of activities related to health service delivery and health manpower development. The topic had been widely debated at the Bi-regional Seminar on Education and Health Care, held in 1978, and at the Meeting of Deans of Medical Schools, held in Manila in 1979. The results of testing in the field the guidelines prepared for incorporating the health manpower development process within country health programmes and national health plans, which were prepared in 1979, will lead to modifications in the guidelines, resulting in their greater accessibility to all levels of health worker not only to professional planners in the health agencies. Countries have been slow in committing themselves to continuing education for health workers although, in many, the professional associations are taking the lead in promoting attendance at continuing education programmes which are being offered in increasing numbers.

6.1. 1

HEALTH MANPOWER PLANNING AND MANAGEMENT

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

Country or area Intercountry

..... 0 Cl 0 0 0 0

215 900 94 000 309 900 :::======

215 900 94 000 309 900

159 000 60 000 219 000

10 000

169 000 60 000

(56 900) (34 000) (90 900)

Total

=-======

=======

======

10 000

229 000

========

=-======

145

M6 Programme: Promotion of training No.

6.1.2

Objectives To promote and cooperate in the production of adequate numbers and appropriately trained categories of health personnel and in the development of health teams, which will include auxiliaries and aids, to deliver services to entire populations; to promote the application of task-oriented teaching approaches, especially for health workers at the middle and lower levels. Approaches Promoting the development of selection policies and the tapping of new sources of health manpower within the community, including the establishment of new institutions for production of health manpower. Refining the existing WHO fellowship programme to stress particularly the role of countries, both sending and host, in ensuring the relevance of the training programmes being requested and the proper utilization of fellows upon return to their own country. Review After several years during which act~v~t~es were minimal, there has been a renewed interest in nursing in the Region. Through a special contractual arrangement which commenced in 1979 with Armidale College of Advanced Education, six national nurses in Solomon Islands will pursue external studies for the Diploma in Nursing Education. Teaching t~ams from the College will be responsible for the programme and will hold six residential schools over a two-year period, five in Solomon Islands and one at Armidale followed by active teaching in selected schools of nursing. Revisions to nursing curricula have been undertaken in Guam and the Republic of Korea. Cooperation is also being extended to Cook Islands, New Hebrides and Papua New Guinea in this field.

The Conference on Regional Cooperation in the WHO Fellowship Programme, held in 1979, created renewed interest and resulted in a series of recommendations and commitments to making the fellowship programme more effective, thus reflecting the importance attached to this activity as a means of developing national health manpower. Intercountry meetings will be held from time to time to maintain the interest of governments as well as to review the administrative aspects of the fellowship programme. Fellowships for Chinese nationals have been an important component of the overall collaboration. In Viet Nam, collaboration extends to strengthening the curricula Epidemiology, Hanoi and the Institute of Hygiene, Ho Chi Minh City as training institutions. Cooperation is being given to the Fiji School in the training of medical assistants, and to Papua New Guinea, Trust Tonga in developing task-oriented training programmes. of the Institute of Hygiene and equal parties in the network of of Medicine (paediatrics) and to Tonga Territory of the Pacific Islands and

The use of modular instruction is being pursued, especially in nursing and midwifery education. National workshops on the same topic were held in Papua New Guinea and the Philippines, and one is planned for Malaysia in 1980. A consultant in 1979 drew up details for the operation of a modular bank for the Region, based in the Philippines. A modular approach is also being used for assistant health inspector training in Samoa and is expected to be used widely in the Pacific.

147

148

6.1. 2 PROMOTION OF TRAINING

-ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

Regional

............ "

Country or area ...... Intercountry

3 285 900 331 200

1 200 000

4 485 900 331 200

6 526 200 161 000

3 240 300 (170 200)

........ Total

=s•======

3 617 100

1 200 000 ====::ua===

=========

4 817 100

==:a=======

6 687 200

=======

=========

6 687 200

=========

3 070 100

Progrannne: Educational development and support

No. 6. 1. 3

~~iectives

To promote and cooperate in the application of educational planning to the formulation of relevant curricula for health personnel; to promote and cooperate in the development of resource material 1n national languages for training health workers; to promote and cooperate in the establishment of institutions for the preparation of teachers of health personnel and the formulation of policies which require the adequate preparation of such personnel; Approaches Developing courses for health personnel, and encouraging and part1c1pating in the application of sound educational planning, especially the use of competency-based, problem-oriented approaches to curriculum development. Promoting the development and use of evaluation mechanisms for all types of educational activity. Identifying, and promoting the use of, innovative methods and media for the education and training of health workers. Promoting and collaborating in the development of teacher training programmes, whether formal or informal, including the establishment of educational development and research units in national institutions or national centres. Review The Regional Teacher Training Centre for Health Personnel remains an active component of the educational development and support programme. A national teacher training centre for allied health professionals is being established in Malaysia. It will be the third national centre after those in the Philippines and the Republic of Korea. 149

150

Experience is being gained in the use of a competency-based approach through collaboration in the training of medical assistants in Tonga (6.1.2) and health inspectors in Malaysia. These developments require the appropriate preparation of teachers before they can take full advantage of the potential of each approach. Opportunities for such training are available but there is no possibility in the Region for those teachers who do not possess a university degree to attain a formal qualification in educational technology. In response to the thrust towards primary health care, appropriate technology for the training of primary health care workers, who are often of low educational achievement, remains to be developed and applied. Collaboration with the global health manpower development programme continues, with field testing of innovative learning materials such as diagnostic flowcharts and other manuals.

6.1.3

EDUCATIONAL DEVELOPMENT AND SUPPORT

ESTIMATED OBLIGATIONS

r--------------------------- --------------~------------------------------------T----------1980-81 1982-83 Increase/(Decrease) r---------------------------------------r---------------·--------------------+r-·-----~us~$r-·-------=us~$r-----·---u~s~$~--+----·--u~s~$-------

Regular budget

Other sources

Total

Regular budget

Other sources

Total

us$

Regular budget

us$

---1

Regional ........... . Country or area ..... Intercountry Total 960 400 296 600 1 257 000 155 000 155 000 960 400 451 600 394 900 458 300 853 200 394 900 458 300 853 200 =======

(565 500) 161 700 (403 800)

=========

========

=========

1 412 000

=======

========

~-----------------------~-------·--------------------------------~-----------------------------------~

151

Appropriation section: Health information Major programme: Health information Programme: Health statistics:

No.

7.1

7.1.1

Objectives To develop and strengthen health information systems and services, including health statistics, to support the planning and management of health programmes and subprogrammes; to strengthen national capability in the application of statistical and mathematical methodology 1n research and in designing and conducting specific studies and investigations in health programmes; to promote the development of appropriate procedures and mechanisms for the effective and efficient collection, compilation, analysis and interpretation of statistical data, including "lay reporting" of morbidity and mortality, as appropriate; to improve statistical standards, definitions, classifications and procedures for comparisons over time and comparisons over space; to develop national capability in the tra1n1ng of all categories of health personnel in vital, health and hospital stati~tics, and in the upgrading of medical records; to collaborate in the development of relevant, specific and sensitive health and health-related indicators in the context of health for all by the year 2000; to collect and disseminate health statistical data and information from Member States.

Approaches Cooperating in the formulation of socially relevant and operationally realistic health information policies. Collaborating in the development and implementation of health information systems, including health statistical services. Applying the technical cooperation among developing countries approach in furthering collaboration in the development of procedures for "lay reporting" of morbidity and mortality and in the application of appropriate methods for collection, processing and analysis of statistical data, including utilization of available sources of data on the health situation. Promoting standardization in the collection of morbidity and mortality data, including implementation of the Ninth Revision of the International Classification of Diseases. Conducting national and intercountry courses for training in health and hospital statistics, including medical records. Supporting basic and applied research in health statistics through collaborating centres and other competent national and international bodies. Review Health statistical activities in the Region are being reoriented and expanded to support the development of information systems to satisfy the technical and managerial information requirements of health programmes and subprogrammes. Health management information system (HMIS) development projects have been initiated in Malaysia, Papua New Guinea, Philippines, and Republic of Korea. On the basis of the experience gained so far, guidelines for the development of HMIS were reviewed by a regional workshop on the national health information system, held in Kuala Lumpur in June 1980. National and intercountry workshops to facilitate the development, testing and implementation of health information systems are taking place. Activities related to the development of health statistical services to support the managerial functions of health services programmes, form integral components of the health services development, research

153

154

promotion and development and tuberculosis control programmes. Effective recording and reporting procedures for a leprosy management information subsystem have been developed under the intercountry leprosy control advisory services, South Pacific project. Intercountry meetings provide an effective vehicle for promoting the development of user-oriented information systems as part of relevant health, health-related and health services programme activities. In some programme areas, reorientation of health statistics activities towards the development of user-oriented information subsystems are being promoted. Projects for development and/or improvement of medical records services have been undertaken in Malaysia, Papua New Guinea, Philippines, Republic of Korea and Solomon Islands. Activities are also commencing further to develop the health statistical services in China. Every effort is made, where appropriate and feasible, to integrate the health statistical services in overall socioeconomic and demographic data/information systems and services. To contribute to the standardized recording and reporting of morbidity and mortality statistics and to facilitate implementation of the Ninth Revision of the International Classification of Diseases (ICD-9), training courses have been conducted to reorientate trained coding supervisors and senior coders. Projects to develop procedures for the "lay reporting" of morbidity and mortality statistics, initiated 1n Fiji, Papua New Guinea and Tonga, will be extended to other countries as appropriate. At the regional seminar on indicators relevant to maternal and child health, held in Manila in December 1979, a minimum set of operational, performance and impact indicators, together with sources for their generation, were identified and generation procedures formulated. In collaboration with the Government of Malaysia and the South-East Asia Medical Information Centre (SEAMIC) of the International Medical Foundation of Japan, a workshop on operational, performance and impact indicators relevant to community health was held in Kuala Lumpur in February 1979. Responses to questionnaires for the World Health Statistics Annual were received from about 70% of the countries or areas of the Region. An effective procedure for updating the country health information profiles (CHIP), established for 30 out of 32 countries or areas in the Region, has been introduced and annual updating of the profiles has become a routine activity. Taking advantage of information collected from Member States, a sharable data-base in the form of a data bank of socioeconomic and health indicators has been established, with procedures for annual updating and maintenance, to facilitate the study of regional health trends and projections in the context of health for all by the year 2000. An epidemiological data-base with procedures for monthly updating, using periodical epidemiological reports submitted by Member States of the Region, has been established and selective but consolidated periodical reports prepared and disseminated to relevant staff in Member States.

7 .1. 1

HEALTH STATISTICS

ESTIMATED OBLIGATIONS 1980-81 1982-83

Increase/(Decrease) Total us$ 148 400 117 000 252 600

Regular budget us$ Regional

Other sources us$

Total usT

Regular budget US$ 148 400

Other sources us$

Regular budget us$ 148 400 49 100 252 600 450 100

Country or area

.....

67 900

117 000 252 600

Intercountry .............. Total 67 900 67 900

518 000 =======

=======

518 000

=======

155

Programme: WHO publications and documents

No. 7.1.2

Objectives To provide the medical and public health profession with information on the various fields in which the Organization is interested; to provide - within the limits of available resources - such editorial and translation services as may be needed in the preparation of documentation; to cooperate in the production and distribution of documents; and to centralize the collection of material for reports required by Headquarters. Approaches Disseminating information on WHO publications as widely as possible. Encouraging the translation and distribution of WHO publications in languages other than the working languages of the Organization. Editing and translating into English and French, as appropriate, material on technical subjects, including documents prepared for or resulting from the sessions of the Regional Committee; and working papers and reports of conferences, seminars, working groups and other meetings. Providing a conference records service at sessions of the Regional Committee and meetings of the WHO Programme Coordinators. Review A special scheme for the distribution and sale of WHO publications to health workers and institutions exists in the Regional Office. This enables interested persons to pay for WHO publications in their local currency. For some countries, special reductions are made if publications are ordered in bulk. All persons who have expressed interest, at any time, in obtaining publications in a special field are advised about forthcoming publications in that field. Rights continue to be granted to national institutions for the translation and distribution of WHO publications in other languages, particularly Japanese.

7 .1. 2

WHO PUBLICATIONS AND DOCUMENTS ..,.,,ca.-

ESTIMATED OBLIGATIONS

1980-81 Regular budget US$ Regional Other sou.rces US$ Total US$ Regular budget US$

1982-83 Other sources US$ Total US$

Increase/(Decrease) Regular budget US$

...

•

416 200

417 500

1 300

Country or area Intercountry

••••

••

•••••

Total

416 200 :::a:a:a:===

416 200

417 500

========

===•===

:a:a:a====

417 500 =•=:a=:a:a

·=====

1 300

157

Programme: Health legislation

No. 7.1.3

Objectives To collaborate in developing legislation to support the health system; to collaborate in the implementation of health legislation. Approaches Meeting information needs including dissemination of the International Digest of Health Legislation. Providing cooperation in developing and drafting specific health legislation as well as in its implementation. Review As part of global programme development, a consultant visited Malaysia, Philippines, and Singapore in June 1978 to review the situation with respect to health legislation, to assess needs and to recommend further development. Collaboration bas been extended to New Hebrides in developing and drafting legislation covering various subjects, including registration of medical and allied health personnel, quarantine, treatment of mental diseases, and control of drugs and pesticides, dairies and slaughterhouses, burial and cremation.

7 .1. 3

HEALTH LEGISLATION

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ Regular budget US$ 1982-83 Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

•••

••

Country or area Intercountry

..... 0 .... 0 0

20 000

••

Total

20 000

20 000 ======

======:a

=========

=======

::::a===

========

:=====

159

160

Programme: Health literature services

No. 7.1.4

Objectives To collaborate in improving the transfer of relevant information through the development of health literature services, as part of national health information systems for the planning, management and evaluation of national health programmes, and in the training of appropriate personnel; to promote and develop a biomedical information system, including the establishment of a regional biomedical information centre and a network of subcentres and libraries to serve national health information objectives. Approaches Promoting, through intercountry and national seminars and workshops, development of relevance-based libraries and literature services. Collaborating in the establishment of health literature for the intra-country exchange of relevant information. serv~ces

and

the development of procedures

Applying the technical cooperation among developing countries approach to facilitate the development of a network of biomedical information centres and subcentres for the international exchange of information. Contributing to studies on the desirability and feasibility of developing a health-related information system (HERIS) that will meet the needs of developing countries for ready access to health-related information of direct and practical use in solving their health problems. Review A small library at the Regional Office, primarily to provide support to WHO staff in their programmes of cooperation with Member States, has been functioning since 1951. Following decentralization of research promotion, development and coordination functions to the regional offices, a feasibility study for a biomedical research information exchange system in the Western Pacific Region was undertaken in 1978. A survey of selected medical and health-related libraries in relation to

their possible participation in the system was carried out. A working group of librarians was held in Manila in November 1978 and a framework for the development of biomedical research information formulated. Collaborative activities in health literature services have been undertaken in Fiji and the Republic of Korea and a survey of medical and health-related periodicals published in countries or areas of the Western Pacific Region is being undertaken. Collaboration is being extended to China 1n the establishment of a biomedical information centre and a network of subcentres and libraries. Libraries in the Western Pacific Region are benefiting from the WHO/United States National Library of Medicine agreement for the supply of MEDLARS searches and photocopies to developing countries which was made effective in October 1979 and will run for an experimental period of one year.

161

162

7.1.4

HEALTH LITERATURE SERVICES

ESTIMATED OBLIGATIONS 1980-81 1982-83

Increase/(Decrease) Total US$ 36 500 70 000 10 000

Regular budget US$ Regional Country or area .... Intercountry

Other sources

Total US$ 32 100

us$

Regular budget US$ 36 500 70 000

Other sources US$

Regular budget US$ 4 400 70 000 (10 000) 64 400 ms~===

32 100

. Tot a 1

20 000 52 100 ====== =======

20 000

10 000

==::::====

52 100

=======

116 500

=======

116 500 ;::::::::::=:::=:::

Prograrrnne: Health information of the public

No. 7. 1. 5

Objectives To make the Organization, its work, and the concept of health for all by the year 2000, better known and understood by the people of all countries or areas 1n the Region; to inform the people of the countries or areas 1n the Region on matters of health. Approaches Producing and distributing information material on WHO and on health subjects for the mass media networks, health departments and other government agencies, educational institutions, professional and civic associations, the medical profession and interested individuals in the Region. Organizing and facilitating news coverage of WHO educational meetings, field activities and health subjects by the press, radio and television stations in the Region. Giving lectures and talks to students, professionals, civic associations and other groups, and dealing with individual enquiries on health subjects and on the work of WHO. Stimulating other agencies and national institutions to produce information material on health subjects. Promoting ways of strengthening health reporting 1n the national media serv1ces through regional workshops. Review The WHO information service has achieved a strong measure of credibility. WHO news releases are considered authoritative, technically correct, factual and unbiased. WHO news releases have also become an important source of information on WHO activities for educational institutions, health agencies/professional associations and other international organizations.

163

,;wo information· activities, also encourage factual reporting on healith :action for health.

•and·~

st±urillate; iddividuUpposii..tive

"The first,-WHO/UNICEF- Regional. Workshop on the' Promotion of'Healrt:h.~ Information· ·was hHdi 1in:"J.Ma·rhhll979. It, was attended by 33 health. educators, information officers and hea'l.:th officials conce:rnedr.-rwliJchtlthe dissemination of information on health in 16 countries-or areas.

-7. 1. 5 HEALTH INFORMATION OF THE PUBLIC

-ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional 126 400 Other sources US$ Total US$ 126 400 Regular budget US$ 155 700 1982-83 Other sources US$ Total US$ 155 700 Increase/(Decrease) Regular budget US$ 29 300

Country or area Intercountry

..... 17 500 143 900 17 500

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

60 800 216 500

43 300 72 600

143 900

========

=========

====z==

=======

======

165

166

Appropriation section: General services and support programmes Major programme: General services and support programmes

No. 8

8.1

Objective To provide support services at all levels in the planning, preparation and implementation of the regional programme of cooperation. This major programme covers all staff services, i.e. staff development and training, personnel, supplies, conferences, office and building services, budget, finance and accounts.

8.1.0

--ESTIMATED OBLIGATIONS

PROGRAMME PLANNING AND GENERAL ACTIVITIES

1980-81

1982-83

Increase/(Decrease) Total US$ 379 400

Regula r budget

us$

Other sources

Total US$ 290 600

Regular

usr-

bud~et

us$

Other sources

usr--

Regular budg$£_ _ _

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

290 600

379 400

88 800

----

=====

290 600 ::

290 600 ======= =======

379 400 =======

=======

379 400

88 800

========

======

167

168 Programme: Staff development and training

No. 8.1.1

Objectives To strengthen the Organization's capacity to respond to the changing needs of countries in their efforts to attain health for all by the year 2v00; to strengthen the technical and managerial capacities and skills of WHO staff Ln the Western Pacific Region at all levels. Approaches Providing briefing and orientation to staff at all levels on the Organization's new policies and directions. Strengthening the ability of staff to form, and work in, multidisciplinary teams for problem-solving, planning and evaluation. Training in managerial processes and skills for health development. Training in, and updating of, the technical and administrative knowledge and skills of staff at all levels. Encouraging the involvement of national staff in these training programmes as appropriate. Review In 1978, a comprehensive regional medium-term programme for staff development and training was formulated, with the above-mentioned principal objectives. Because of recruitment difficulties, it was not possible to begin implementing the programme until January 1980, when a programme manager was finally appointed. Priority areas are, (1) orientation and training of WHO and national staff in the Organization's new policies and directions; (2) developing teambuilding programmes to increase the staff's skills for working in multidisciplinary groups; and (3) upgrading the staff's managerial and administrative skills and knowledge.

I 1980-81 Regular budget US$ Regional

8.1.1

STAFF DEVELOPMENT AND TRAINING

ESTIMATED OBLIGATIONS 1982-83 Total US$ Regular budget US$ Other sources US$ Total US$ Increase/(Decrease) Regular budget US$

Other sources US$

••••

••

•

Country or area Intercountry

••

•

•••••••

24 000 24 000

24 000

288 800

264 800

Total

=======

::a:s=====

24 000

====:a=

·=======

288 800

===·===

288 800 ::c::::::s:a:

========

264 800

169

170 Programme: Personnel No. 8.1.2

Objectives To provide personnel management services in respect of general service and professional category staff in the areas of recruitment, contract administration, reassignment, post classification, termination, appeals and staff relations; to conduct, in relation to the conditions of service of general service staff, salary surveys in coordination with the local offices of the organizations belonging to the common system of the United Nations, in order to determine uniform pay scales, allowances and other benefits as appropriate.

8.1. 2

PERSONNEL

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional 224 500 Other sources US$ Total US$ 224 500 Regular bud_get US$ 300 400 1982-83 Other sources US$ Total US$ 300 400 Increase/(Decrease) Regular budget US$ 75 900

••

•

••••

Country or area Intercountry

111

•

........ Total 224 500 224 500 •=:a====

=======

300 400

15 900 ==::===

=========

•=:.z:::::::::a

171

172 Programme: Supplies

No. 8.1.3

Objective To provide procurement and related supply services at the Regional Office, directly and through Headquarters. Procurement activities are carried for all sources of funds, including extrabudgetary and reimbursable funds. In addition, office supplies and equipment are procured for use in the Regional Office and in the offices of the WHO Programme Coordinators.

-8.1.3 "' -~·---

---

SUPPLIES

_.,..,

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ Total US$ 102 800 Regular budget US$ 144 800

1982-83 Other sources US$ Total US$ 144 800

Increase/(Decrease) Regular budget US$ 42 000

....... " ......

102 800

Country or area Intercountry

..... -

.......... Total

---144 800

=-··--

=======

102 800

=======

102 800

144 800 =======

42 000

=======

======

173

174

Programme: Conference, office and building servLces

No. 8.1.4

Objectives To arrange for and assist in the provision of physical facilities for WHO meetings, courses and seminars, including interpretation facilities wherever necessary; to provide services in connexion with mail dispatch, internal distribution of communications, messengerial and security functions; to provide facilities for the internal reproduction of documents and reports and photocopying services; to provide building and maintenance services. This includes the maintenance and improvement of the premises, and the requisition and maintenance of interpretation, audio-visual and other electrical equipment; to provide records management services, maintenance of central files in the registry, and provision of reference and archive services; to provide travel and transportation services for staff, consultants and other official visitors; and facilities for arranging transportation of personal effects and customs clearance.

! I

8.1.4 ~~

CONFERENCE, OFFICE AND BUILDING SERVICES

-"'·-~·

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional Other sources US$ 223 000 Total US$ 1 698 700

1982-83 Regular budget US$ 1 572 600

Increase/(Decrease) Total US$ 2 098 600 Regular budget US$ 96 900

Other sources US$ 526 000

I ! I

I !

............ "

1 475 700

Country or area Intercountry

.....

........ Total

=========

1 475 700

=======

223 000

=========

1 698 700

=========

1 572 600

=======

526 000

=========

2 098 600

96 900

=======

175

176 Programme: Budget

No. 8.1.5

Objectives To provide services in respect of the budgetary aspects of the planning, preparation and implementation of the Organization's programme under all sources of funds, including finalization of the programme budget for the biennium 1982-83 and monitoring and control of the financial implementation of the programme budget for 1980-81 within the allocations available under various sources of funds; to provide support to the Regional Programme Committee in the periodical rev1ew of the budgetary situation, re-programming of provisions and performance evaluation.

8.1. 5

BUDGET

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional 183 300 Other sources US$ 16 000 Total US$ 199 300 Regular budget US$ 286 600 1982-83 Other sources US$ 18 900 Total US$ 305 500 Increase/(Decrease) Regular budget US$ 103 300

•

......

•

Country or area Intercountry

...

........ Total

183 300 =======

16 000

199 300

286 600

18 900

305 500

=======

========

=======

103 300

=======

177

178

Programme: Finance and accounts

No. 8.1.6

Objective To provide support services in the area of finance and accounts in respect of the regular budget and all extrabudgetary funds, including the receipt and disbursement of funds, settlement of claims and suppliers' invoices, maintenance of accounts, and preparation of financial reports.

8.1.6

FINANCE AND ACCOUNTS

ESTIMATED OBLIGATIONS 1980-81 Regular budget US$ Regional 212 200 Other sources US$ Total US$ 212 200

1982-83 Regular budget US$ 187 800 Other sources US$ Total US$ 187 800

Increase/(Decrease) Regular budget US$ (24 400)

<>_,.Go<>

0:.

Country or area Intercountry

...

........ Total 212 200

========

=======

212 200

========

=======

187 800

(24 400)

=======

========

======

179/180

INFORMATION ANNEXES

182

CONTENTS

Technical cooperation with and services to governments ANNEX I ANNEX II

183 187

Regional Committee and Regional Office Country or area programmes

American Samoa Australia China Cook Islands Democratic Kampuchea Fiji ......•....• French Polynesia Guam Hong Kong Japan Kiribati Lao People 1 s Democratic Republic Macao ...•.. Malaysia New Hebrides New Zealand Niue ....... .

...

191 195 197 205 211 212 218 224 227

Papua New Guinea Philippines Republic of Korea Samoa Singapore •••••• Solomon Islands Tokelau Tonga Trust Territory of the Pacific Islands Tuvalu Viet Nam

230 233 239 245 247 257 263 266 269 277

• • • • • • • w .,

•

••••••

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

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

287 293 301 306 312 315 321 327 331 341

ANNEX III -

Intercountry progr aunne ........................................................... .

TECHNICAL COOPERATION WITH AND SERVICES TO GOVERNMENTS

Major programme/programme Regular budget US$

1980-81 Other sources

----1982-83 Tot a 1 Regular budget US$ Other sources Total

-Increase/ (Decrease) Regular budget US$

us$

American Samoa .....••...••••...••..... Australia .•.....••.......•..••.....•.. China ...•.•..........•.•...•...••..... Cook Islands ....•.........•........... Democratic Kampuchea ......•........... Fiji ..••..• , . , , , ••. , . , , , ..• , .. , . , , .. , , French Polynesia .................... .. ..... Guam .. , •........ , •...••.••• , . , ..•... , . Hong Kong .... , , .....•.•... , .......... . ...... Japan •.. , ......•..••..... , .••.....•... . . Kiribati ••.....• , •...•........•...... Lao People's Democratic Republic Macao •...•.•..••..••.....•...••...... Malaysia . , .. , .....• , ...........•..... ... ' New Hebrides ......•.........•.. , ..... ...... New Zealand Niue Papua New Guinea ••.•...• , •.• , .....•.. Philippines ..• , ..•••... , ••.• , • , •..... Republic of Korea ................... . Samoa .••.•...• , ..... , •... , .......... . Singapore .. , , .. , , , .....•... , .... , ... . Solomon Islands , •••••••...•••.••.... , Tokelau •...•...•••.• , •....•.......... Tonga .• , •..•••...... , .•...••••..• , ... . Trust Territory of the Pacific Islands ..... Tuvalu ••...••••••...•••...•.•...•• , .. Viet Nam .•.••••...•••••.•.....•••••••. Intercountry programmes (Including Regional Advisers) ..•.••... • 0 •••• ~

...... ...... ...... ...... ...... • •• 0 ••

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

100 100 600 253 1 000 772 60 66 110 68 262 1 517

••

•

000 000 000 500 000 300 000 000 000 000 000 300 300 400 000 000 400 800 300 400 900 400 600 000 000 800

6 791 700 138 300 172 600

72 100 181 300 559 000 378 300 39 1 368 1 371 14 246 185 644 300 100 500 800 300 300 600

100 100 7 391 391 1 000 944 60 66 110 68 334 1 698 926 60 99 061 13 5 470 633 505 193

000 000 700 800 000 900 000 000 000 000 100 600 700 000 300 500 300 100 700 200 000 700 000 600 000

1 1

1 059 548 60 60 1 693 1 763 1 455 387 319 548

1 618 300

3 3 1 1

1 1 1

416 207 52 3 668

310 100 25 600 561 200 4 031 900

726 207 77 4 230

115 000 100 000 198 900 44 7 300 500 000 944 800 70 000 80 000 110 000 100 000 54 7 300 267 700 50 000 12 7 500 794 600 60 000 50 000 889 700 624 900 498 000 694 600 415 700 744 600 10 000 54 7 300 64 7 300 75 000 333 600

2 70 000 6 600

90 000 716 000 163 300 453 000 11 000 864 800 1 072 800

1 1 2 2 1 1

230 000 314 400 906 600 340 000 90 000 26 500

3 1 469 000

115 100 198 517 500 951 70 80 110 100 637 983 50 290 24 7 60 61 754 697 498 924 730 651 10 887 737 101 333

000 000 900 300 000 400 000 000 000 000 300 700 000 800 600 000 000 500 700 000 600 100 200 000 300 300 500 600

15 000 900 800 000) 500 000 000 000 300 600) 000 200 200 000) 300 900) 700 200 800

1 598 193 ( 500 172 10 14

(

32 285 249 50 68 246 -

( (

(

10 196 138 42 307 95 196 10 130 440 23 335

zoo

000 700 300 000 200)

l l 797 800

15 829 700 46 039 200

13 168 700 33 212 500

14 637 700 40 036 500

1 370 900

Total

28 94 7 200

============

==========

17 092 000

==========

6 824 000

==========

4 265 300

183/184

ANNEX I REGIONAL COMMITTEE AND REGIONAL OFFICE

REGIONAL COMMITTEE

---Estimated obligations 1980-81 1982-83

Regional Committee for the Western Pacific

us$

Sources of funds RB

131 000

280 000

REGIONAL OFFICE !iajor programme/programme

Man-years/months 1980-81 1982-83

Estimated obligations 1980-81 1982-83

Source of funds

us$

2. l 2.2

Executive management

••••••••••

•••••••••

•••••••••••••••

6/00

8/00

241 800

334 900

General programme development and management 2. 2. l 2. 2. 3 General programme development Information systems programme 0 ••••• 0 •••••••••••••

28/00

•••

••••••

•••••••••

-28/00

30/00 6/00 36/00

611 200

988 200 55 500 l 043 700

RB RB

611 200

2.3

External coordination for health and socioeconomic development 2.3.2 Collaboration with multilateral and bilateral programmes •••••••••• 0

•••••••••••••

••

-18/00 4/00 4/00 26/00

10/00

268 200

7. 1

Health information 7. l.l 7 .l. 2 7 .1.4 7 .l. 5 Health statistics WHO publications and documents Health literature services Health information of the public ••••••••• 0 ••••••• 0 •••••••••• 0 •••

•

•••••••••

••••••••

•

••

••••

••

•••

••

••••

•••••••••

4/00 18/00 4/00 4/00 30/00

416 200 32 100 126 400 574 700

148 417 36 155

400 500 500 700

RB RB RB RB

758 100

187

188

REGIONAL OFFICE Major programme/programme

Man-years/months 1980-81 1982-83

Estimated obligations 1980-81 US$ 1982-83 US$

Source of funds

8.1

General services and support programmes 8.1.0 8.1.2 8.1. 3 8.1.4 8.1.5 8.1.6 Programme planning and general activities Personnel Supplies Conference, office and building services Budget

........ ........................................ .......................................... ......... ........ ,. ~

8/00 14/00 8/00 (94/00 ( (

10/00 16/00 10/00 92/00 18/00 2/00 22/00 170/00 254/00 252/00 2/00

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

•

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

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

Finance and accounts

............................. Total - REGIONAL OFFICE of which: Regular budget Other sources

(14/00 ( 2/00 22/00 162/00 222/00 220/00 2/00

290 224 102 1 475 23 200 183 16 212

600 500 800 700 000 000 300 000 200

379 300 144 1 572 26 500 286 18 187

400 400 800 600 000 000 600 900 800

RB RB RB

RB FP AS RB

FP RB

2 728 100 4 155 800 3 916 800 239 000

3 416 500 5 821 400 5 276 500 544 900

ANNEX II

COUNTRY OR AREA

PROG~~ES

AMERICAN SAMOA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The American Samoa plan for health defines the overall health status goals as follows: (1)

every individual in American Samoa should have the knowledge and the capacity to enable him to improve his own health, to maintain a high level of good health and to protect himself from illness, injury, disability, and premature death through accepting appropriate self-responsibility and taking action for personal and community well-being; the infant mortality rate for American Samoa should not exceed an average of 16 per 1000 live births for any consecutive three year period and should not exceed 20 per 1000 for any individual year; life expectancy at birth and at age 45 1n American Samoa should not be more than S% below the national average for the United States of America; the average crude birth rate for American Samoa should be no greater than 25 live births per 1000 population.

(2)

(3) (4)

To guide the future development of health services, the overall health system goal 1s defined as follows: The organization and operation of a system of high quality health services for the Territory of American Samoa, efficiently provided, either directly or through cooperative arrangements, in such a manner, in such numbers, and in such locations, as to ensure the most effective utilization of territorial health resources in meeting the public need for such services, by: providing health services which have been determined by accepted criteria to be both needed and appropriate; providing health services which are reasonably accessible to those who need them at a time and location appropriate to the need;

191

192

AMERICAN SAMOA (continued) providing health services which are organized and interrelated so as to bring the consumer into contact with the appropriate services as the need arises; providing health services which are designed and delivered in a manner which promotes mutual respect between the consumer and the provider and enhances the acceptability of the services provided; ensuring that health services are provided by health personnel performing at levels above minimum standards for the Territory, as determined by peer providers and consumer representatives; providing health services at the least cost consonant with adequate quality, accessibility, and acceptability. In an attempt to facilitate a more direct approach to assessing the health status of the population, eight areas of health concern are identified, listed by priority as follows: First priority (1) (2) (3) (4) infectious and communicable diseases; birth, growth, and development; chronic diseases; accidents and trauma;

Second priority (5) (6) (7) (8) dental health; nutrition; mental health and social adaptation; handicapping conditions.

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health manpower development Promotion of training WHO cooperation will continue to take the form of fellowships for undergraduate study in health courses not available locally, to permit existing health staff to undergo further training abroad, and to provide national staff with opportunities to participate in intercountry group educational activities.

193

194

AMERICAN SA!otOA Regular budget US$

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83

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

-----

Other Sources Source of funds US$

~ajor

programme/programme

6. l

Health maneower develoement 6.1. 2

Promotion of training Total A.~ERICAN

100 000

ll5 000

115 000 :::s======

15 000 15 000 ==:::::===::=

SAMOA

==========

100 000

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

=========

100 000

=========-=

115 000

.:===:===-:=

115 000

AUSTRALIA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Australia is a federation of states and territories: New South Wales, Victoria, Queensland, South Australia, Western Australia, Tasmania and the Northern Territory. The Australian Capital Territory is the seat of the Commonwealth Government. The Commonwealth has limited direct involvement in the provision of health care services. The primary responsibility for the provision of health services is vested in the various State Governments and the Government of the Northern Territory. In the Australian Capital Territory, the responsibility lies with a statutory authority, the Capital Territory Health Commission. Before the Constitution was amended in 1946, the only health function of the Commonwealth Department of Health was in relation to quarantine. Consequent upon this amendment, the Commonwealth Government was given powers to make laws with respect to pharmaceutical, hospital and sickness benefits and medical and dental services. The Commonwealth Government also has used its powers under section 96 of the Constitution to make grants to the States for health purposes. In addition, the Co~~onwealth Government gives financial assistance to certain organizations concerned with public health matters. The Commonwealth plays a significant role through its financial support of these services in such areas as the supervision of private health insurance, and the financial support of hospitals and other services. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health manpower development Promotion of training The provision of health manpower and tra~n~ng in Australia is a complex process extending over a number of different interests and authorities: hospitals, universities, other educational institutions, registration authorities, professional associations and State and local governments. The provision of the fellowship programme affords Australia the opportunity of training selected health personnel in specific fields in which training is not available within the country. The Government will continue to collaborate actively with the World Health Organization and the countries or areas of the Pacific ~n various health development programmes, including training and medical research. Since the WHO fellowship programme is a vital aspect of the overall health services development programme for countries of the Pacific, Australia is most willing to share again in this collaborative activity for the 1982-83 biennium.

195

196

AUSTRALIA Regular budget US$ 6.1 Health maneower develoement 6.1. 2 Promotion of training Total - AUSTRALIA 100 000 100 000 ===:=::::ssss:

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

100 000 100 000 s=ss:::as=s= ::&::::::I:S.:SS-::t=:

100 000 100 000 ====s==== :=======s::=

100 000 100 000 =-==:=-=:~~=::.:=-

=====::===

CHINA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The medical and health serv1ces constitute important components of the national development programme of China. Activities need to be enhanced, strengthened and developed as rapidly as possible to meet the needs of modernization and reconstruction. In the effort to modernize the medical and health services, the principles of (1) providing medical services to the workers, peasants and soldiers; (2) emphasizing prevention; (3) integrating traditional Chinese and western medicine; and (4) integrating health activities among the masses, will continue to be followed, in order to strengthen primary health care and improve the health of the people. In the continuing expansion and development of technical cooperation with WHO and with other countries, for the purpose of effectively developing the medical and health services, emphasis will be placed on self-reliance. The following objectives have been established in this context: (1)

to strengthen the rural health services and health care for 800 million peasants, in particular to strengthen or reorganize one-third of the prefectural health services, the training of barefoot doctors, the cooperative medical services, and health care in cities, factories and mines; to strengthen the prophylactic health services and control the incidence of diseases seriously endangering the health of the people; develop the patriotic health movement and mass campaigns and scientific work for eradication of the four pests; and develop safe water and night soil disposal facilities; to accelerate the integration of traditional Chinese and western medicine through research on traditional medicine and medicaments; to strengthen family planning and maternal and child health care; to train scientific and technical staff, as well as administrative personnel, in medicine and health care so as to form a large contingent of medical and scientific workers; to increase the administrative ability and work efficiency of the medical and health agencies at various levels. 197

(2)

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

198

CHINA (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Primary health care A basic health network has been established throughout China, but the technical level and quality of primary health care services need to be improved. In the national health programme, emphasis will continue to be placed on the organization of rural primary health care to improve health services for the 800 million peasants. It is planned that, by 1985, primary health care centres will have been strengthened in one-third of the prefectures (about 700) throughout the country. This will include facilities for prophylactic health care, maternal and child health care, medical care, and training for barefoot doctors and intermediate level health workers. During the period 1982-83, in cooperation with WHO and UNDP, three primary health care collaborating centres will be established and strengthened at Conghua County, Guangdong Province, Jiading County in Shanghai, and Yexian, Yantai, Shandong Province. Multilateral and bilateral support will be secured to strengthen primary health care centres in 30-50 selected prefectures so that they may be used as demonstration centres and some for international cooperation. Abundant experience has been accumulated in the area of Chinese traditional medicine and drugs, which have contributed significantly to the health of the people. The national health programme calls for the continuation and development of the country's medical heritage and for strengthening the work of integrating the Chinese and western systems of medicine. In cooperation with WHO and UNDP, research on traditional medicine will be enhanced and support provided to training centres which may also serve as centres for the international exchange of knowledge. Workers' health The goal of the national programme 1s to improve conditions for the workers and effectively to control occupational diseases and the effects of toxic substances. WHO will collaborate in training specialists and in developing criteria for health standards. Appropriate technology for health (Health laboratory technology) establishing a laboratory animal centre. Family health Maternal and child health Maternal and child health and family planning are important components of the national development programme. It is planned that, by 1985, the natural growth rate of the population will be reduced to below 10 per thousand. As the Government proposes one child for each Cooperation will be extended in

couple, maternal and child health will become especially important. Extensive cooperation activities in scientific research, training of personnel and action programmes will be carried out in conjunction with WHO, UNDP, UNFPA and UNICEF. Nutrition WHO and UNICEF will provide cooperation tn the field of scientific research and the training of personnel. Mental health In cooperation with WHO, centres for mental health will be established and strengthened in Beijing and Shanghai, specialists in psychiatry (including doctors and teachers) will be trained, and epidemiological surveys and the community control of mental diseases carried out. Prophylactic, diagnostic and therapeutic substances Pharmaceuticals and biologicals Emphasis, in the national health programme, will be placed on further development of the pharmaceutical industry. Studies will be made to expand production of prophylactic, diagnostic and therapeutic substances. Quality control and standardization of drugs will be enforced to meet the needs of modernization, especially for the vast rural primary health care services. In cooperation with WHO and UNDP, an experimental centre for clinical diagnostic reagents will be established in Shanghai. The Institute of Materia Medica of the Chinese Academy of Medical Sciences and the Institute of Chinese Drugs of the Academy of Traditional Chinese Medicine will be strengthened. Further training will be provided to Chinese experts in such disciplines as pharmacy and clinical pharmacology. With support from WHO, the research institutions for biological products in Beijing, Shanghai and Kunming will serve as centres carry out collaborative research. Communicable disease prevention and control Epidemiological surveillance In cooperation with WHO, the surveillance of communicable and epidemic diseases will be developed, the information system will be improved and professional staff trained.

199

200 CHINA (continued) Malaria and other earasitic diseases Malaria, schistosomiasis and filariasis continue to be the main diseases endangering the health of the population in certain areas. The national programme provides for the eradication or control of those diseases by 1985. WHO will continue to give support to the existing centres in China for the development of collaborative research and the training of personnel. Bacterial, viral and mycotic diseases WHO will collaborate in the prevention and control of such diseases as influenza, hepatitis, haemorrhagic fever, epidemic encephalitis and tuberculosis as well as diarrhoeal diseases. Collaborating centres will be designated, information and bacterial strains exchanged and scientific research workers trained. Expanded programme on immunization A programme of cooperation will be developed with WHO and UNICEF for the implementation of an immunization programme. Activities will be aimed at improvement in the processes for the production of vaccines and in their quality, the introduction of techniques for freeze-drying and further development of the refrigeration and transportation system, to meet the immediate needs of the primary health services for infectious disease prevention. Seecial Pro~ramme for Research and Training in Tropical Diseases Collaboration will continue and be strengthened in scientific research on malaria, schistosomiasis, filariasis and leprosy, and in the training of personnel in those fields. The Government will also take part actively in Special Programme activities for research and training in tropical disease control. Prevention of blindness trachoma. Collaboration will continue in research on the prev~ntion

and control of

Vector biology and control Though China has some experience 1n control of the four pests (rats, mosquitos, flies and bedbugs), it is also necessary to learn about new techniques and methods for vector control from other countries. This will be achieved through exchanges of visits between scientists and through study tours. Noncommunicable disease prevention and control Cancer Morbidity from these two diseases has increased and they have already Cardiovascular diseases become major causes of death. The programme of cooperation between China and WHO w{ll include the establishment and strengthening of centres in Beijing, Shanghai and Guangzhou, epidemiological surveys, mass prevention and treatment, collaborative research and scientific training. Experience from major research activities in China will be available for the international exchange of information.

Oral health With support anticipated from UNDP, WHO will cooperate in strengthening the oral health centre established in Beijing. Promotion of environmental health Recognition and control of environmental hazards With the development of industry, pollution of the atmosphere and of water has become a major problem of national concern. In accordance with the national environmental protection policy, measures have been taken to prevent and control such pollution. China has also participated in global atmospheric surveillance. WHO, with UNDP, will cooperate in pollution surveys, in the establishment of an atmosphere and water monitoring system, 1n training professional staff, and in establishing standards 1n relation to pollution. Food safety WHO and UNDP will continue to cooperate 1n strengthening the natioal food safety monitoring centre and in training professional staff. Health manpower development Promotion of training To meet the requirements of the programme for modernization of the medical and health services and for the development of rural primary health care services, the training of intermediate and higher levels of health personnel, through continuing professional education and visits abroad, will have priority within the national health programme. WHO and UNDP will cooperate in this endeavour. Cooperation will also be extended in training experts in immunology, a recently established discipline in China, with a view to strengthening research centres in Beijing and Shanghai. Educational development and support medical education demonstration centre. Health information Health literature services centre and network. Cooperation will be extended in establishing a biomedical information WHO and UNDP will cooperate in establishing a national higher

201

202

CHINA Regular budget US$ 2.2 General 2.2.2 ero~ramme

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

develoement

Country health programming (Cost of WHO Programme Coordinator's office, Beijing, China 100 000 100 000

198 900

198 900 (100 000)

2.4 3.1

Research eromotion and develoement Health services develoement 3 .1. 2 Primary health care 3.1. 3 Workers' health 3 .1. 5 Appropriate technology for health (Health laboratory technology)

280 000 30 000

70 000

3.2

Famil:r; health 3.2.1 3.2.2 Maternal and child health Nutrition 20 000 20 000 5 185 700 FP 5 185 700 10 000 20 000 70 000 10 000 20 000 70 000 10 000 20 000 50 000

3.3 3.4

Mental health Proeh:tlactic 1 diasnostic and theraeeutic substances 3.4.0 3.4.2 Programme planning and general activities Pharmaceuticals and biologicals

75 000

75 000 210 000 210 000

(75 000) 210 000

CHINA Regular budget US$ 4.1 Communicable disease and control 4.1.1 ~revention

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

Epidemiological surveillance

40 000 70 000 70 000 30 000 10 000

4.1. 2 Malaria and other parasitic diseases 4.1.3 4.1. 5 4.1.8 4.2 Bacterial, viral and mycotic diseases Expanded programme on immunization Vector biology and control

Noncommunicable disease prevention and control 4.2.0 4.2.1 4.2.2 Programme planning and general activities Cancer Cardiovascular diseases 50 000 50 000 70 000 70 000 70 000 70 000 (50 000) 70 000 70 000

5.1

Promotion of environmental health 5.1.0 5.1.1 5.1.3 5.1.4 Programme planning and general activities Environmental health planning and management Recognition and control of environmental hazards Food safety 30 000 406 000 DP 30 000 406 000 30 000 40 000 30 000 40 000 30 000 40 000 (30 000)

203

204

CHINA Regular budget US$ 6.1 Health 6.1.2 6.1.3 7.1 man~ower

1980-81 Other Sources Source of funds US$ Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

usl

development 300 000 1 200 000 DP 1 500 000 740 000 70 000 740 000 70 000 440 000 70 000

Promotion of training Educational development and support

Health information 7 .1.1 7 .1.4 Health statistics Health literature services Total - CHINA 25 000 25 000 70 000 70 000 (25 000) 70 000

=========

600 000

===========

6 791 700

=========

7 391 700

=========

2 198 900

==========

2 198 900

=========

1 598 900

COOK ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Although the national public investment plan has yet to be finalized, the Ministry of Health has been engaged in extensive evaluation of the services provided by the health services at various levels. The evaluation process revealed the need to reorganize the Ministry and to reformulate its objectives, with the aim of attaining the goal of health for all by the year 2000. The principal aim, in national health development, is to provide the best possible comprehensive health service, both preventive and curative, for every individual residing in Cook Islands and to ensure that free medical and health care is made available to the entire population. In the reorganization plan, the objectives of the health services are more detailed, as follows: (1) to ensure the provision and maintenance of effective hospital services throughout Cook Islands and to provide the highest quality of service for the diagnosis of disease and the restoration of health for all people living in Cook Islands; to provide and maintain an effective public health programme for the prevention and control of diseases within Cook Islands and to ensure the adequate protection of the environment against unnecessary pollution by noxious agents; to ensure the provision and maintenance of an effective nursing service, in both outpatient and inpatient care, to every individual residing in Cook Islands; to provide the highest possible level of dental health to all inhabitants of Cook Islands through the application of appropriate curative, preventive and other dental public health measures; to provide adequate facilities, equipment and trained manpower on all islands of the group for the purpose of ensuring the effective delivery of health services on each island; to encourage and promote those health and allied research programmes that have practical application and benefits for the people of Cook Islands.

(2)

(3) (4)

(5) (6)

The hinistry of Health is accordingly being reorganized into five divisions under the Minister of Health and the Director-General of Health, namely Hospital and Clinical Services, Public Health, Nursing Services, Dental Services and Central Health Administration. 205

206

COOK ISLANDS (continued) To comply with the overall goal of health for all, much emphasis is being placed on the development of the outer island health services. Suitably trained staff will be provided, to deliver preventive and curative services. Supervisory services will be strengthened by more frequent visits of the technical staff of the Ministry. The system of communication with the outer islands has been much improved by the installation of a radio-telephone network and by the construction of an increased number of air strips on the outer islands. The development of front-line health care delivery will form an integral part of the community development scheme. At community level, the 160 child welfare committees throughout the islands have been playing an important role in promoting community participation in health activities. Their potential will be further developed by training key members in basic health knowledge so that local communities may take more initiative in improving the health status and the quality of life. Per capita health expenditure attained NZ$75 in 1978-79.1 The health budget represents about 13% of the total national budget. An effort is being made to increase the allocation of funds for the development of health services on the outer islands, particularly for the primary health care, rural water supply and rural sanitation programmes.

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Primary health care A national seminar on primary health care will be conducted in 1981. In 1982-83, follow-up meetings on primary health care at the district level will be conducted and action plans formulated. Emphasis will be placed on community participation and intersectoral cooperation. Group training activities will be undertaken for members of the child welfare committees, who will collaborate with peripheral health workers to develop primary health care activities. WHO will collaborate in developing the primary health care programme.

lus$1

= NZ$1.05.

Family health Maternal and child health Emphasis will be placed on the further development of antenatal, natal and postnatal services, child health care, school health, nutrition and family planning, especially on the outer islands. It is envisaged that UNFPA will be requested to extend the family health project up to the end of 1984. The primary health care approach will be emphasized in developing the family health programme at community level. Health education The programme will be further developed, with the Ministries of Health and Education working in close collaboration. A health education unit will be established. The major effort of the health education programme will, with WHO cooperation, focus on support for the development of primary health care, family health and rural sanitation. Communicable disease prevention and control Malaria and other parasitic diseases Filariasis continues to be a disease of public health importance and WHO will cooperate in activities for its control. Bacterial, viral and mycotic diseases With the participation of WHO, major attention will be paid to the prevention and control of diarrhoeal diseases, tuberculosis, leprosy and sexually transmitted diseases. Expanded programme on immunization Immunization coverage has been high but the cold chain and transport facilities.require further improvement to ensure that the eligible population groups are immunized with potent vaccines. WHO will cooperate in improving the cold chain and UNICEF will be requested to provide the vaccines required. Noncommunicable disease prevention and control Cardiovascular diseases The incidence of cardiovascular and metabolic diseases has shown an increasing trend during recent years. The Government will arrange with bilateral or other aid agencies to conduct an epidemiological survey in 1980-81 to define the magnitude of the problem. Follow-up control activities will be developed, with WHO cooperation, in 1982-83.

207

COOK ISLANDS (continued) Promotion of environmental health Basic sanitary measures The development of a sewerage system on Rarotonga, and water supply and latrine programmes on the outer islands, will continue. To support primary health care activities at the periphery, more assistant health inspectors will be needed. Legislation on environmental health requires review and revision. WHO will continue to collaborate in the development of the programme. Continued UNDP participation in the programme is also envisaged. Health manpower development Promotion of training Shortage of health manpower is still a critical constraint in the development of the health services. Programmes for the local training of auxiliary staff and the in-service training of health personnel at the periphery will be reorientated in line with the development of primary health care. WHO will continue to provide fellowships for undergraduate and postgraduate studies in health courses which are not available locally.

COOK ISLANDS Regular budget

1980-81

---Regular budget

1982-83 Other Sources

Increase/ (Decrease)

Other Sources Source of funds Total US$

Major programme/programme

us$ 2.2 General 2ro~ramme development and mana~ement 2.2.2 Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

Source of fund_~ US$

Total

Regular budget US$

US$

--us$ ___ ,.

23 500

47 300

23 800

3.1

Health services develo2ment 3. 1. 2 Primary health care 17 000 17 000 20 000 20 000 3 000

3.2

Famil! health 3.2.1 3.2.4 Maternal and child health Health education 4 000 68 200 FP 68 200 4 000 20 000 40 000 FP 40 000 20 000 16 000

4.1

Commun ical:> le disease 2revention and control 4.1. 2 4.1. 3 4.1. 5 Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization 10 600 9 100 5 300 10 600 9 100 5 300 5 000 6 000 3 000 5 000 6 000 3 000 (5 600) (3

100)

(2 300)

4.2

Noncommunicable disease 2revention and control 4.2.2 Cardiovascular diseases 17 200 17 200 3 000 3 000 (14 200)

209

210

COOK ISLANDS Regular hudget US$ 5.1 Promotion of environmental health 5. l. 2 6.1 Basic sanitary measures 26 000

1980-81 Other Sources Source of funds US$ Total US$ Regular hudget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular hudget US$

Major programme/programme

70 100

96 100

200 000

30 000

230 000

174 000

Health maneower develoement 6.1. 2 Promotion of training 137 600 137 600 143 000 143 000 5 400

7.1

Health information 7. l. l Health statistics Total - COOK ISLANDS 3 200 ---3 200 (3 200)

=========

253 500

=========

138 300

=========

391 800

=========

447 300

=========

70 000

=========

517 300

=========

193 800

r-·

- -------DEMOCRATIC KA~PUCHEA

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

3. 1

Health services development 3. 1.1 Health services planning and management Total 1 000 000

- DEMOCRATIC KA.'fPUCHEA

---===-=======

1 000 000

500 000

(500 000)

=========

1 000 000

=========

l 000 000

=====:::===

500 000

-=========

=========

500 000

===========

(500 000)

211

212

FIJI NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The national health policy of Fiji reflects the national development goal of equitable economic and social growth for all its people. The emphasis of the health policy on developing the individual in the rural community is bringing the goal of health for all by the year 2000 to the forefront as a national concern. The Ministry of Health's objectives, as set out in the national development plan, are; (1) (2) (3) to promote the physical, mental and social well-being of the nation; to protect Fiji's young and old from illness; to provide adequate clinical facilities and staff to satisfy the medical and dental needs of the rural and the ~rban population; and to promote a better standard of living through reducing the birth rate.

The fundamental strategy for achieving those health objectives is clearly to focus on the principles embodied in primary health care. The specific principles guiding primary health care development include the following: (1) (2) (3) full utilization of local resources and expertise in planning and implementing health programmes; health programmes to have their roots in the community, based on the cultural, political, social, educational and economic situation; equitable distribution of the health services provided at different levels and proper utilization of human, financial and material resources. Health planning to be the responsibility of health workers as well as staff from other social services; primary health care to be the priority concern in national health planning, with research and development as inseparable components.

(4)

The priority health service objectives within the national health plan are: to make available the necessary manpower to staff the health facilities; to improve the quality and quantity of the health services; and to develop improved programmes to deal with the emerging health problems of mental illness and diseases related to the environment.

Fiji has emerged from the application of one strategy, the main emphasis of which was on coverage by the ba'sic health services, and embarked on another aimed at health development of the community, to enable each member to live a socially and economically productive life. The objective of health for all clearly requires a strategy which focuses on developing the individual and the community. To that end, various promotive efforts have been organized at village level, with community and ministerial participation. In addition, every opportunity will be taken to sensitize communities, health workers and politicians to the goal of health for all and to strategies to achieve that end. As each stage of the process develops, it will be possible to see more and more tangible benefits accruing to the population as a whole. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management To meet the need for improved planning and delivery of the health services as they develop and expand, staff, particularly at supervisory level, will require specialized training in administration and management. WHO will participate in the organization of some in-service training courses and advantage will be taken of other specialized courses that become available from time to time. Primary health care Primary health care must develop from within the community and not be transplanted from another situation. Very satisfactory results have already been achieved in Fiji. Through the promotive efforts of the Ministry of Health in some parts of the country in collaboration with WHQ, communities no longer require Ministry staff to provide advice on primary health care. The people th~selves have modified health teachings and methods to develop technology appropriate to their own needs. The present promotive efforts will continue. In the 1982-83 biennium emphasis will be placed on cooperating with communities in solving specific problems for which the resources required are beyond their means. The Ministry, in collaboration with WHO, will support primary health care development by providing resources to meet those needs. Appropriate technology for health (Health laboratory technology) The objectives of laboratory service are to extend laboratory and technical support for clinical and public activities, to provide technical support to blood banks, and to provide support in health research. WHO collaboration will continue in this programme with special emphasis on the peripheral laboratory services. the health health services needs of the

213

214 FIJI (continued) Family health Nutrition Malnutrition has been isolated as a matter for national concern. Special efforts have been made to improve the nutrition education programmes of public ins"titutions. In addition, a supplementary feeding programme is available to the population groups most vulnerable to nutritional disorders. WHO collaboration will further the national programme by supplying current information on nutritional issues, and providing training to improve the knowledge of local health workers. Mental health This priority programme stresses the need to develop local capability to manage cases of mental illness outside the hospital. The immediate need is to expand mental health'services by training more professional staff to improve their capabilities. In addition, as a preventive measure, it is necessary to promote public awareness of the increasing mental health problems and to create a community environment that is supportive of those who need help. WHO collaboration in this programme will concentrate on the training of local staff. Communicable disease prevention and control Epidemiological surveillance Dengue and other arboviral diseases have become more serious as public health problems, and filariasis continues to cause concern. Enteritis and other diarrhoeal conditions constitute a leading cause of mortality. Leptospirosis and sexually transmitted diseases are also major health problems. The objective of the epidemiological surveillance programme. is .to reduce the prevalence of communicable diseases to a low level and to be prepared against outbreaks, especially those of arboviral ortgtn. WHO collaboration will be provided in controlling communicable diseases. Emphasis will be on the training of health personnel, improvement of epidemiological surveillance, preparedness against epidemics of communicable diseases, and provision of specialized· advice as deemed necessary. Noncommunicable disease prevention and control Cardiovascular diseases Cardiovascular disease is a major cause of mortality and a leading reason for hospital admission. Metabolic diseases, including diabetes, are becoming an increasing problem. V.iiO will collaborate in enabling workers to acquire additional skills and in periodically assessing specific areas of concern in the various services. A large cardiovascular/metabolic disease survey will be carried out in 1980. Following the survey, WHO will collaborate in developing programmes to address the defined problem areas.

Promotion of environmental health Basic sanitary measures The lack of a safe water supply in rural areas continues to be a maJor public health concern. The establishment of new industries demands that attention be given to pollution. The objectives of the environmental health programm~ are to improve basic environmental health facilities, promote safety in industrial establishments, and regulate industrial waste. With the expected support of UNDP and other agencies, WHO will collaborate developing pollution control and waste management. Health manpower development Promotion of training The national health plan stresses the need to upgrade technical skills within the many support services required to maintain the health delivery system. The plan also places stress on sensitizing technical and supervisory staff to the need to improve their management capabilities. WHO will collaborate in the achievement of those health manpower goals. Inadequate coverage of the population by skilled professional staff is partly a result of the insufficient number of health workers produced in the country. The objective, as stated in the national health plan, is to provide the manpower necessary for the different health programmes in as efficient a manner as possible. In Fiji, the key institutions for the production of health manpower are the School of Nursing and the School of Medicine. These institutions offer a variety of courses - national and international - in professional and technical fields. WHO will continue to collaborate in supporting the Fiji School of Medicine and in upgrading the technical skills of health workers in general. ~n

activities aimed at

215

216

FIJI Regular budget US$ 2.2 General ~ro~ramme and mana~ement 2.2.2 develo~ment

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

Country health programming (Cost of WHO Programme Coordinator's office, Suva, Fiji Less: Costs attributed to other countries and areas of responsibilities)

295 600

567 800

(240 300) 55 300 55 300

(473 000) 94 800 94 800 39 500

3.1

Health services develoement 3 .1.1 3.1. 2 Health services planning and management Primary health care 30 000 30 000 60 000 50 000 60 000 50 000 60 000 20 000

3 .1. 5 Appropriate technology for health (Health laboratory technology) 3.2 Famill health 3.2.1 3.2.2 3.3 Maternal and child health Nutrition

120 000

20 000

(100 000)

43 400 25 000 25 000

43 400 25 000 25 000 25 000 90 000 25 000 90 000 65 000

Mental health

FIJI Regular budget US$ 4.1 Communicable disease erevention and control 4.1.1 4.2 Epidemiological surveillance 25 000 25 000 35 000 35 000 1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$ 1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

10 000

Noncommunicable disease 12revention and control 4.2.0 4.2.2 Programme planning and general activities Cardiovascular diseases 25 000 25 000 20 000 20 000 (25 000) 20 000

5.1

Promotion of environmental health 5 .1. 2 Basic sanitary measures 48 000 129 200 DP 177 200 50 000 6 600 DP 56 600 2 000

6.1

Health man12ower develo12ment 6.1.2 6.1.3 Promotion of training Educational development and support Total - FIJI 119 000 300 000 772 300 ======~==

119 000 300 000

500 000

381 000 (300 000)

=========

172 600

=========

944 900

=========

944 800

=========

6 600

=========

951 400

=========

172 500

217

218 FRENCH POLYNESIA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL In line with the social target of WHO Member States, attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life, the Territo~y undertook to adjust its health policy by assigning objectives to the services responsible for health and social development. Public health protection Efforts undertaken in previous years to support preventive medicine and health education, which led to the establishment of a health education unit under the Directorate of Public Health which participates in all health activities, will be pursued. The various programmes established for the services responsible for prevention (territorial and public health, dental health, school health, maternal and child health) have been adequately implemented, especially on the islands of Tahiti and Moorea. Most of those services, while carrying out the activities assigned to them, are facing problems in expanding at the periphery because of the scattered population inhabiting a large number of islands, islets and secondary atolls. The dental health unit is the best organized, with its fixed structure and its mobile teams. As the Territory is divided into a number of medical districts corresponding to the different archipelagos, activities, developed at central level by individual services and integrated by the teams at the periphery, need strengthening. The different programmes (general and public health, school health, maternal and child health and health education) should develop substructures at district level to extend their objectives, integrated with primary health care activities, to village and valley communities. Most of the population is adequately covered by medical care. This is due to the considerable means of the Papeete General Hospital which, with the wide range of equipment and specialists at its disposal, can face most health problems, referring only a few cases outside the Territory for specific or costly treatment. Within the Territory, a large number of cases are transported, by sea or by air, to the General Hospital. On the main island, where the population is relatively dense, medical care from both the public and the private sector is adequate. At the periphery, on remote archipelagos with case-detection and screening services, the structure needs to be reinforced to carry out therapeutic activities and additional health centres need to be established. Health education and preventive measures should eventually minimize the necessity to refer cases to the main island.

On a particularly characteristic archipelago, the Tuamotu-Gambier, with a population unevenly distributed over some 100 islands scattered over a wide area, a pilot experiment is now under way in the context of primary health care development. It involves community health workers recruited at very low level, whose training and supervision is entrusted to a medical team using the means of commu~ication and liaison made necessary by the situation (radio, vertical take-off planes, boats). Staff training The Territorial School of Nurses, which prepares to the State Nurse Diploma and is under the Directorate of Public Health, is the only School offering a national degree. Qualified nurses have been strengthening the work force of the health services since 1967. A further training programme, supported by the Ministry of Health, allows staff who qualified before 1967 to take the State Diploma after a period of one year. The School also trains, in 18 months, public health auxiliary workers, such as auxiliary nurses for the health services, technical assistants for general and dental health, assistant laboratory workers, assistant X-ray operators and assistant health educators. The Territory remains dependent on France for the training of professional staff: medical officers, pharmacists, midwives, technicians, laboratory workers, X-ray operators, sanitary engineers, health inspectors, supervisory teaching staff, children's nurses, assistant anaesthetists. There is no plan, in view of the size of French Polynesia, to train university level professional staff locally. The increasing need for public health personnel of quality nevertheless poses a problem. The establishment, in Papeete, of a health-related institute, based on the existing nursing school, technically and financially supported by a French university, would allow for the partial training - in one or two years initially - of the intermediate professional staff necessary for the development of health activities. An additional year of training in France would remain necessary in order to reach degree level but the present three-year absence from the Territory would be avoided and the necessary support would be provided to health activities for development. From 1980, admissions to the School for the State Nurse Diploma course were increased from 10 or 12 to 20. A further increase planned for the next few years should accelerate the strengthening of manpower. Great emphasis is placed on gradually tra1n1ng the most qualified staff to improve health activities at community level. Such is the orientation of efforts in the training of community health workers in the Tuamotu-Gambier archipelago, an experience the Territory is willing to share with WHO and with other countries or areas of the Region. 219

220

FRENCH POLYNESIA (continued) TECHNICAL COOPERATION PROG~MME

FOR HEALTH DEVELOPMENT

Health services development Primary health care Primary health care delivery requires adjustment in French Polynesia because of its geographical structure. The population is scattered throughout numerous and distant atolls of uneven size, such as in the Tuamotu archipelago, or is gathered in secluded valleys, not easily accessible, such as in the upper islands of the Marquesas archipelago. In the Tuamotu Gambier, staff selected by the communities of each atoll have been given responsibility for first-aid stations, after an initial training period in general health problems, basic obstetrics and first-aid, and after daily radio communication has been established between each station and the medical centre. Supervision is carried out by a medical team through periodical visits. It has been decided to improve the training of this category of personnel in order to produce health workers who have definite status in their own communities, and who are integrated into the health services. In Papeete, 15 such workers are undergoing eight weeks training, carried out in French and in the local language, emphasis being placed on health education, improvement of hygiene, the environment, behaviour and nutrition, and the detection and surveillance of prevailing diseases. The pilot training will be followed up in the field by the medical team responsible for the district. It will be extended gradually to the whole of the archipelago and to other districts in the Territory. WHO collaboration in the development of training programmes for this category of field staff could provide valuable experience to the training team as well as the supervision team. Experience gained from the experiment could be shared with neighbouring countries and territories willing to undertake similar activities. Family health Maternal and child health Activities in this field, in which WHO is collaborating in 1980 and 1981, are aimed at the establishment of a new central unit for maternal and child health and staff training at all levels, as well as decentralization. Emphasis will be placed on decentralization of maternal and child health activities, together with the integration of maternal and child health and family planning activities at primary health care level. Nutrition Observations made in the different archipelagos on the role of nutrition in health which is misunderstood - obesity rates, high blood pressure and diabetes, indicate that activities othe~ than curative treatment and case-detection (which are already carried out satisfactorily) are required from the health services, such as preventive measures based on better education of the people. Realization of the problem, together with collaboration from WHO and consultation based on observations made in the field, are expected to help in defining an action programme.

Health education Activities, started in this field in 1979 with staff training and the establishment of a unit, will have to be further strengthened with a view to decentralization, in order to launch programmes adapted to the prevailing situation in the different districts. Communicable disease prevention and control Epidemiological surveillance There has been continuous collaboration in this field from WHO. Filariasis is now under control but leprosy still poses a considerable problem and viral infections, such as influenza, dengue fever and other diseases, are definite threats. Yellow fever, which could be transmitted by Aedes aegypti, is also a threat. Malaria and other parasitic diseases The possible establishment of a public health laboratory, which is becoming increasingly necessary, and the fact that it could be supported by the existing Institute of Medical Research, make it possible to envisage technical collaboration for a better knowledge of the so-called tropical diseases. Vector biology and control Great importance, justified by the reality of the risk, 1s given to the continuation of studies on vector biology and control. Noncommunicable disease prevention and control Cancer Collaboration with neighbouring countries in the exchange of information on cancer is deemed desirable, together with the establishment of relations on specific technical aspects (for special treatment) with a particular country in the Region. Cardiovascular diseases The economic and social consequences of cardiovascular diseases explain the concern felt and the efforts that will be devoted to the improvement of early case-detection and prevention. Promotion of environmental health Basic sanitary measures Activities will be developed in medical districts and followed up at periurban level and on the islands, to improve environmental health at the primary health care level. Food safety Food safety, and surveillance of food industries, shops and markets, which is the concern of the public health service, is adequate in the district capital towns. It must be reinforced at the periphery where routine control has not been undertaken in view of the fact that the population is scattered over the islands.

221

222

FRENCH POLYNESIA (continued) Health manpower development Promotion of training Great importance is given to the promotion of tra1n1ng as defined in the development strategy. Problems caused by the necessity to send staff abroad for training are surmountable, as is testified by the increasing number taking part in development activities. Nevertheless, if training for certain specific categories were to be available locally, an even larger number.of candidates would be motivated. The upgrading of training is definitely a complex problem and this is why assistance from a French university is envisaged, together with a programme adapted to the regional situation. Consultation from WHO could be useful. Health information Health statistics After the cooperation extended in 1980-81 towards the establishment, under the Directorate of Public Health, of a medical statistics collection and treatment unit adapted to the size of French Polynesia, and in view of its relative isolation, the present relations with WHO will be maintained for the exchange of data and for developing a nomenclature for lay reporting. Health legislation French Polynesia will soon have definite requirements in the field of public health which cannot be referred systematically to French legislation, which is often not adapted to specific local conditions.

r-· FRE~CH

POLYNESIA Regular budget

---1980-81 Other Sources Source of funds Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total

f-· ~ajor

Increase/ (D~£!~~Regular budget

programme/programme

us$ 3.1 Health services develoement

us$

----usr

us$

us$___

3 .1. 2 3.2

Primary health care

5 000

Family health

3. 2.1 3. 2. 2 4. 1

Maternal and child health Nutrition

5 000 5 000

5 000

5 000 5 000

5 000

Communicable disease erevention and control

4. 1.1 4.1. 8 5. 1

Epidemiological surveillance Vector biology and control

5 000 5 000

Promotion of environmental health 5.1. 2

Basic sanitary measures

5 000

6.1

Health maneower development

5. l. 2 7.1

Promotion of training

60 000

30 000

(30 000)

Health information

7 .1.1

Health statistics

5 000 5 000

s s

000 000

5 000 5 000

7 .1. 3 Health legislation Total - FRENCH POLYNESIA

=========

60 000

==========

=========

60 000

70 000

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

=========

70 000

=========

10 000

223

224

GUAM

NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL While Guam may generally be considered to be well advanced in the delivery of health care to its citizens, in comparison with many other areas of the Pacific Basin, certain gaps and deficiencies still exist in the delivery of available health care resources, and some health problems have not yet been resolved by the application of those resources. To help ensure that all the residents of Guam are able to attain a level of health that will permit them to lead a socially and economically productive life, health development goals will emphasize the following strategies: (l) cooperating with WHO in achieving its goals for international health, by promoting the concept of health care delivery and services as an integral part of the overall economic development of the community; encouraging the distribution of health care resources to make primary health care readily accessible to residents of all areas of Guam; facilitating health manpower development, through tra1n1ng additional health professionals to meet the needs of an expanding population and improving the skills of existing health professionals to meet the challenge and opportunity provided by increasingly complex health technology; preserving the environment of island residents from the combined effects of increased population pressures and from the damage wrought by the polluting effluents of modern society; eliminating infectious diseases for which efficacious vaccines are available; reducing the incidence of other infections through the appropriate application of available medical knowledge and resources; investigating the disease problems of particular significance to Guam; improving health education among all levels of the population to promote the development of healthy individuals and minimize the occurrence of preventable chronic disease.

(2) (3)

(4) (5) (6) (7) (8)

TECHNICAL COOPERATION

PROG~~

FOR HEALTH DEVELOPMENT

Health manpower development Promotion of trainin& The health manpower needs of Guam continue to reflect the concern to provide increased technical support for a population whose health demands are increasing as its socioeconomic position improves. As the demands for health services increase in proportion, the key strategy in health manpower planning will be the development of middle management skills, so that the health services may increase the level of technical support while containing the overall health system costs. WHO collaboration in the health manpower plan to achieve that goal will take the form of fellowships for selected health personnel. Priority areas will include primary health care and supporting services such as nursing, communicable disease control, environmental health and laboratory services. The expanding level of services creates a unique demand for personnel with specialized skills. The strategy to meet that need is to use consultants who can provide a critical service and at the same time upgrade, the skill of selected staff through practical training sessions. Such technical support will be particularly needed for special problems in paediatrics. There remain other specialized needs, such as the development of additional public health laboratory services, a priority, since other programmes and the private medical community require the support of the laboratory. It is anticipated that selected personnel will have to be sent out of Guam for training. The expansion of laboratory services is planned in phases over the programming period. Each phase will require skills that can be acquired through a specific training programme. WHO collaboration will assist in meeting national health service objectives through health manpower development. Continued participation in the seminars and tra1n1ng courses sponsored by WHO will enable Guam to train health personnel who will be able to contribute more effectively to the development of its health services as well as the achievement of the international goals of the Organization.

225

226

GUAJ-1 Regular budget

1980-81 Other Sources Source of funds Total Regular budget

1982-83 Other Sources Source of funds Total

Increase/ (Decrease) Regular budget

Major programme/programme

US$ 6.1 Health maneower 6.1. 2 develo~ent

US$

Promotion of training Total - GUAM

66 000

66 000 66 000 ===~==:==

80 000

80 000 ----80 000

14 000 14 000 ::::::c::~as:=rss

======:.==-

66 000

=======s=

==::======

80 000

===::::===-:=

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

HONG KONG NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The health development strategy is embodied in a White Paper on "The further development of medical and health services in Hong Kong". The objectives of the ten-year medical development programme are to: (1) (2) (3) (4) (5) (6) (7) (8) (9) build new hospitals and clinics to meet expected population growth; provide more specialist treatment for psychiatric cases and the elderly; relieve overcrowding in government hospitals and secure greater use of beds in government-assisted hospitals; improve and expand the health services, particularly those for family health and industrial health; establish and further expand the central health education unit; establish a community nursing service; further develop the medical treatment of drug addiction; introduce a school dental care service; establish a dental school to train dentists locally.

In addition, the White Paper on "Integrating the disabled into the community: A united effort" sets out the Government's proposals for further development of rehabilitation services. The policy objective is to provide such comprehensive rehabilitation services as are necessary to enable disabled persons to develop their physical, mental and social capabilities to the fullest extent their disabilities permit. The specific areas for further development include prevention and early diagnosis, medical treatment, medical rehabilitation services, education and training, and social rehabilitation services.

227

228 HONG KONG (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health manpower development Promotion of training The programme described above, covering a wide range of medical and health services, will necessarily require a considerable number of medical and health staff. Although local training facilities for doctors, nurses and paramedical personnel are being established, there is still a great need for the staff of the medical and health services to obtain, through the WHO fellowship and other programmes, the training and experience not available locally in such fields as planning and management, care of the aged, disability prevention and rehabilitation, health education, communicable disease prevention and control, industrial health, dental health, family health and nursing education. All such training is aimed at further development of the medical and health services as set out in the medical development programme.

HONG KONG Regular budget US$ 6.1 Health man2ower development 6 .1. 2 Pro:notion of training Total 110 000 110 000

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Dec~~~

Major progra11Ullelprogra11Ulle

Regular budget

ugr----

110 000 110 000

HONG KONG

=========

229

230 JAPAN NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Japan is enjoying a high level of economic growth after strenuous efforts towards rapid industrial expansion and development since the end of the Second World War. Parallel with economic growth, the implementation of various health measures, such as the qualitative improvement of medical and health personnel, expansion of medical care facilities, institution of a comprehensive medical insurance scheme, control of communicable diseases, improvement of general environmental sanitation and nutrition, and the quality control of pharmaceuticals, have made tt possible to achieve a remarkable improvement in the nation's health. This has been clearly reflected in decreased mortality, contributing to prolonged life-expectancy. The main causes of death have also changed from the communicable diseases to the chronic degenerative diseases, such as cerebra-cardiovascular diseases and malignant neoplasms. However, the high rate of economic growth and rapid industrialization have created a new problem, that of environmental pollution through deterioration of the living environment. The general improvement in the health of the nation, which has affected life expectancy, has caused a change in emphasis within the health services towards the health and welfare of elderly people. Other newly emerging health problems require priority government programmes, as follows: prevention and control of cerebra-cardiovascular and geriatric diseases; surveillance of certain communicable diseases transmitted through international traffic; prevention of congenital anomalies; drug safety measures; research on, and control of, certain specific diseases of an intractable nature, such as subacute myelo-optico-neuropathy (SMON), and diseases due to environmental pollution; promotion of mental health; and development of health manpower. To be ready to deal with these new problems it will be necessary to expand and improve programmes for the training of health personnel, within the system available in the country and also abroad. With a view to achieving the country's overall objective of health for all by the year 2000, the following areas will receive priority: (1) (2) (3) (4) health manpower development; control of degenerative diseases such as cerebra-cardiovascular diseases and cancer; control of environmental hazards; promotion of the health of the people;

(5) (6)

promotion of the international exchange of health information; health administration planning. PROG~~

TECHNICAL COOPERATION

FOR HEALTH DEVELOPMENT

Health manpower development Promotion of training WHO will continue to collaborate in the training of health personnel, particularly postgraduate training and training aimed at developing the community water supply programme, improving the chemical safety administration by studying how to evaluate the effect of chemicals on health, and developing the community health services towards the provision of primary health care. In the context of technical cooperation among all countries, whether developed or developing, Japan has collaborated in the field of health under bilateral and multilateral programmes. Many WHO fellows from abroad have been given the opportunity to study in Japan, and consultants from Japan have carried out assignments abroad. To collaborate with developing countries in the most appropriate and effective manner, it is essential to be aware of the prevailing health situation in those countries, the problems and the health needs.

232

JAPAN

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$

-Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

-Major programme/programme

Increase/ (Decrease) Regular budget US$

6.1

Health maneower develoement 6.1.2 Promotion of training Total - JAPAN 68 000 ---68 000 ======-==s= :::::::::::

68 000

100 000 100 000 ::=======:s=

100 000

32 000 32 000 ===:=:===

·========

68 000

=====::===

100 000 ====:~:=====

KIRIBATI NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The principle guiding national health development is that major improvements in the health of the community can be achieved through improvements in the environment and in the health aspects of daily living. Increased awareness of the health implications of common activities will improve health and also make people more receptive to suggestions for further improved practices. In the light of this understanding of health and the community, the fourth national development plan, 1979-82, outlines the following basic aims for the health sector: (1) (2) to help each community to become more aware of the physical and social factors in its environment that cause poor health and to assist it in developing appropriate solutions; to improve the quality of the basic health services available at present.

The national development plan sets out the objectives of the health services in more detail, taking into consideration some of the existing problems. The objectives are principally the following: (1) (2) (3) (4) (5) (6) to prevent the outbreak of another cholera epidemic by providing all households with access to a protected drinking water supply and a sanitary latrine; to protect nutrition and to prevent malnutrition over the long term; to assist parents in the planning of their families by offering services appropriate to the desires of each community and to give assistance with any problems that may arise; to provide appropriate care for individuals who suffer from mental illness; to maintain curative services at a level appropriate to the economic circumstances of the country; to develop and initiate pilot projects which aim at establishing the use of traditional medicine in the basic health services.

233

234

KIRIBATI (continued) In accordance with the policy of decentralization of government services, the Ministry of Health and Community Affairs has started to establish five district health offices, each of which will be staffed by one district medical officer, one principal nursing officer and one assistant health inspector. When the district health offices are fully established by the end of 1980, better supervisory services will be provided for the health staff at the island and village levels. The network of basic health services is now accessible to the vast majority of the population. The next step in the improvement of the people's health is to assist local communities towards a basic understanding of those factors in the environment that cause poor health. This primary health care approach will be carried out by providing the local community with skills and knowledge to enable it to mobilize resources to solve its own problems. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management Major attention will be paid to the development of rural health services using the primary health care approach. In accordance with the policy of decentralization of government services, health manpower requirements will be reviewed and health manpower deployment and development plans formulated. To increase the efficiency of the health services, a continuous input of managerial skills and local training in management will be required. WHO will participate in activities for the development of health services planning and management. Primary health care The National Seminar on Primary Health Care, held in Tarawa in November 1979, provided a sound foundation for the development of primary health care. Major areas to be developed with WHO collaboration will be closer coordination between the various sectors in contributing towards health programmes, further development of the potentials of community organizations to contribute to a community-based primary health care programme, and development of health manpower as required by the primary health care programme. Appropriate technology for health (Health laboratory technology) With cooperation from WHO, health laboratory services will be further developed by improving laboratory technology, providing laboratory equipment, training laboratory technicians both locally and overseas, and improving the management aspects of laboratory services. Major emphasis will be placed on supporting the development of primary health care.

Family health Maternal and child health The family health programme, with the major components of antenatal, natal and postnatal services, child care and family planning, will be expanded and further developed. The primary health care approach will be emphasized in the implementation of the programme at the community level. I t is envisaged that UNFPA will be requested to extend the family health project until the end of 1984, with WHO serving as executing agency. Nutrition Malnutrition is a problem in some isolated areas. The Government is seriously considering requesting the the World Food Programme to assist in the supply of milk powder and biscuits for supplementary feeding programmes in schools. With WHO cooperation nutrition surveys will be carried out. Health education There is still a need to improve and upgrade the health education services, particularly in relation to basic sanitation. Government efforts in training and service activities will continue to be supported by WHO collaboration. Communicable disease prevention and control Bacterial, viral and mycotic diseases Among the communicable diseases, major attention will be paid to preventing the recurrence of cholera, the surveillance and control of diarrhoeal diseases, the control of sexually transmitted diseases, and the control of tuberculosis, leprosy and parasitic diseases. Expanded programme on immunization Continuous efforts will be made to improve the immunization programme for childhood diseases. With WHO cooperation, particular attention will be paid to improving the cold chain and to widening the coverage of the eligible population by potent vaccines. UNICEF will be requested to provide the vaccines required. Noncommunicable disease prevention and control Other noncommunicable diseases The Government is negotiating with the Australian Development Assistance Bureau and the South Pacific Commission for support of a survey on metabolic diseases, possibly including cardiovascular diseases. 235

236 KIRIBATI (continued) Promotion of environmental health Basic sanitary measures The programme for the development of a safe water supply and waste disposal facilities will be continued, particularly stage III of phase III of the water supply programme (medium and large-scale water supply schemes) and the water-seal latrine programme. The Government intends to request the services of an associate expert to assist with the stage III water and rural sanitation programme and the inservice training of assistant health inspectors. WHO will continue to collaborate ~n developing the basic sanitation programme. Health manpower development Promotion of training There is still an acute shortage of health manpower, especially medical officers and nursing and sanitation staff. As long as it remains necessary to employ expatriate medical officers, the fellowship programme for overseas training will be required. Fellowships for the basic training of health inspectors and for the postbasic training of nurses will also be required. The local training of medical assistants, maternal and child health aides and sanitation aides will continue. WHO will continue to cooperate in developing health manpower under this programme. Health information Health statistics To develop a sound health information system, hospital records, health records and the health reporting system will require further improvement. In addition, in conjunction with the development of primary health care, a lay reporting system will be developed. WHO will collaborate in the development of the health information system.

KIRI B.o\TI

1980-81

1982-83

---------------Major programme/programme

-------- -----------·...--Regular budget Other Sources ~-----~--------

Regu 1ar budget Other

-Sourc·~s

Increase/ (Decrease) Total US$ Regular budget

----usr-2.2 General programme development and management 2.2.2 Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

us$

Source of funds

Total

-----m--

Source ,_of funds

\JS$-

24 000

47 300

23 300

3.1

Health services development 3.1.1 3.1.2 3.1.5 Health services planning and management Primary health care Appropriate technology for health (Health laboratory technology) 13 000

114 000

114 000 20 000

114 000 7 000

13 000

20 0 00

114 000

3.2

Family health 3.2.1 3.2.4 Maternal and child health Health education 18 000 72 100

72 100

90 000 20 0 00

90 000 20 000 2 000

18 000

4.1

Communicable disease prevention and control 4.1.3 4.1.5 Bacterial, viral and mycotic diseases Expanded programme on immunization 15 000 10 000 15 000 10 000 10 0 00 10 000 (15 000)

237

238

KIRIBATI Regular budget

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

uss 5.1 Promotion of environmental health 5.1.2 6.1 Health 6.1. 2 Basic sanitary measures man~ower develo~ment

50 000

Promotion of training Total - KIRIBATI

132 000

132 000 72 100

172 000

172 000 90 000 :112===:~===

40 000 285 300

==========

262 000

============

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

334 100

==========

547 300

==========

637 300

=========

LAO PEOPLE'S DEMOCRATIC REPUBLIC NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL In accordance with the country health programme, revised in 1977, the main objectives of the national policy for health for all are as follows: (1) (2) (3) ( 4) (5) (~)

strengthening of health services management; promotion of community interest and participation; protection of the population against communicable diseases; improvement of en vi ronmenta 1 sanitation; promotion of health education in the community; development of health manpower according to the needs and possibilities of the country; promotion of research in traditional medicine and its integration into the health services; rehabilitation of the physically handicapped; production, control and distribution of essential drugs and biologicals; strengthening of mental health services; strengthening of interministerial cooperation.

(7) (8) (9) (10) (11)

The main national health strategies are as follows: (1) (2) involving the community in the management of health programmes, respecting local cultures, traditions and values; making effective and efficient primary health care services accessible to all, including the possibility of referral to higher levels when necessary;

239

240

LAO PEOPLE'S DEMOCRATIC REPUBLIC (continued) (3)

emphasizing preventive and promotive health and, where feasible, the outpatient management of cases; realistically adapting health facilities, their staffing and their reporting procedures to the socioeconomic conditions of the co~try; integrating and regionalizing, as far as possible, the administration and :ielivery of health care; coordinating external aid to maximize its impact on the health situation; investigating the effectiveness of traditional medicine; ·and how it can be utilized if proved effective; relating the training of health staff to the needs and possibili~ies

(4) (5) (6) (7) (8)

of the country.

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT WHO technical cooperation wilt concentrate on three major areas: (1) (2) (3)

development of the health services, mainly through primary health care; prevention and control of endemic diseases, mainly malaria; -~

health manpower development, mainly

~~~

training of medical staff. \

Health services development In accordance with the country health programme, the Government will continue to: (1)

strengthen the administration of the health services, to permit an effective approach to the solution of national health problems; establish a national health network at the village, commune and district. level, fully · integrated with general community development and providing for the active participation of the people and health or administrative committees at all levels; rebuild or renovate its health facilities, including the provincial or district hospitals, the School of Medicine, the Central Laboratory and the Orthopaedic Centre.

(2)

(3)

WHO cooperation wi 11 continue to focus on the following areas; (1)

planning and management of health services; development of primary health care activities within two demonstration areas, mainly for research and application at the national level; balanced development of the distri'ct laboratory services; rehabilitation of the physically handicapped, services being extended to the northern and southern regions of the country; development of health education and mental health as part of the primary health care services.

(2) (3) (4) (5)

As in previous years, an important contribution will be expected from UNDP and UNICEF, mainly in the field of primary health care.

Prophylactic, diagnostic and therapeutic substances After completion of the feasibility study on the establishment of a -national pharmaceutical industry, extrabudgetary resources will be sought for financing it. Communicable disease prevention and control The Government intends to; (1)

expand its antimalaria activities to two other provinces, 1n addition to those alreadx.covered;

... ~

( 2)

develop immunization programme activities in the districts and communes already covered by the primary health care network; gradually integrate tuberculosis and leprosy control services into the basic health services.

(3)

WHO cooperation will focus mainly on training, on applied field research act1v1t1es in the area of malaria, and on the provision of technical services for the prevention and control of other communicable diseases. As in previous years, an important contribution is expected from UNDP and UNICEF, mainly for the expanded programme on immunization and the malaria control programme.

241

242

LAO PEOPLE'S DEMOCRATIC REPUBLIC (continued) Promotion of environmental health Through the health services development programme which integrates activities for the delivery of primary health care, WHO will, in conjunction with UNDP and UNICEF, cooperate in providing safe drinking water and sanitary facilities for the population before 1990. Health manpower development In recent years, shortage of qualified staff has adversely affected the development of health services, at a time when the country has urgently needed an increased number of competent staff for its rehabilitation. Although the Ministry of Health has sufficient teaching staff at its disposal for the tra~n~ng of low- and middle-level personnel, it will have to rely on external aid for the training of physicians. Health personnel will be trained locally, rather than abroad, so that they remain in contact with national conditions and problems. WHO will cooperate ~n health manpower planning and management, as in the financing of contractual services for the School of Medicine. UNDP is also expected to contribute to health manpower planning and management.

LAO PEOPLE'S DEMOCRATIC REPUBLIC Regular budget US$ 2.2 General 2ro~ramme develo2ment and mana~ement 2.2.2 Country health programming (Costs of WHO Programme Coordinator's office, Vientiane, Lao People's Democratic Republic)

---1980-81 1982-83

·Other Sources Source of funds US$ Total US$ Major programme/programme Regular budget US$ Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

252 300

267 700

15 400

3.1

Health services develoEment 3.1.1 3. 1. 2 3.1.4 Health services planning and management Primary health care Care of the aged, disability prevention and rehabilitation Appropriate technology for health (Health laboratory technology) (Radiological technology) 3.1.6 Health services research 233 000 296 000 150 600 DP 383 600 296 000 157 000 306 000 DP 463 000 (76 000) (296 000)

112 000

3.1.5

102 700 125 400 700 VG

102 700 125 400 700

20 000

(82 700) (125 400)

3.2

Family health 3.2.2 3.2.4 Nutrition Health education 19 400 19 400 14 800 19 400 19 400 14 800 5 000 5 000 5 000 5 000 (19 400) (14 400) (9 800)

3.3

Mental health

243

244

LAO PEOPLE'S DEMOCRATIC REPUBLIC Regular budget US$ 3.4 Proph;z:lactic, dia~ostic and therapeutic substances 3.4.1 4.1 Drug policies and management 189 200

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

189 200

(189 200)

Communicable disease Erevention and control 4.1.1 Epidemiological surveillance 53 000 9 700 24 100 30 000 53 000 112 000 146 000 10 000 400 000 DP 112 000 546 000 10 000 59 000 136 300 (14 100)

4.1. 2 Malaria and other parasitic diseases 4. 1. 3 4.2 Bacterial, viral and mycotic diseases

39 700 24 100

Noncommunicable disease prevention and control 4.2.3 Oral health 9 400 9 400 (9 400)

5.1

Promotion of environmental health 5 .1. 1 5 .1. 3 Environmental health planning and management Recognition and control of environmental hazards 19 400 14 800 19 400 14 800 (19 400) (14 800)

6.1

Health manEower development 6.1.1 6.1. 2 Health manpower planning and management Promotion of training Total -LAO PEOPLE'S DEMOCRATIC REPUBLIC 38 200 96 500 1 517 300 :::=;:=:::===== 38 200 96 500 433 000 10 000 DP 10 000 433 000 (38 200) 336 500

=========

181 300

=========

1 698 600

=========

1 267 700

=========

716 000

=========

1 983 700

=========

(249 600)

MACAO NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The main emphasis of the national policy and strategy for health for all is on controlling the prevailing health problems, such as tuberculosis and drug abuse, and monitoring diseases which affect the world but do not exist, or have a very low incidence rate, in Macao. The health policy aims at achieving a satisfactory equilibrium between curative medicine for individuals, ensuring that the maximum number of people have access to ordinary medical, surgical and obstetrical care, and mass preventive medicine, which requires further development efforts through the extension and establishment of the necessary services for promotion of environmental health, maternal and child health and health education. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT It is planned that by 1982-83 a rehabilitation centre for the physically handicapped will have been established. Control activities will be undertaken against pollution, smoking and traffic accidents (a seminar is to be held in Macao in 1982) and a study on nutrition carried out. WHO cooperation will be extended in nutrition activities, in the control of drug abuse and pollution and in the training of intermediate and auxiliary health workers, lack of health personnel being the main constraint in the field of health in Macao.

245

246

!-!ACAO Regular budget US$ 3.2

1980-81 Other Sources Source of funds US$ Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

usf

Family health 3.2.2 Nutrition 5 000 5 000 5 000 5 000 5 000 5 000

3.3 5. l

Mental health Promotion of environmental health 5. l. 3 Recognition and control of environmental hazards

5 000

6.1

Health maneower develoement 6.1. 2

Promotion of training Total - MACAO

---======:s== s=====s== =========

35 000

35 000 :=:==s-==::=:a::~:

35 000 50 000 :::======:~~=-=

=========

50 000

·=====:a::::

50 000

MALAYSIA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Introduction The Ministry of Health, through its health plan, supports the socioeconomic plan of the country and the new economic policy of the nation. Central to the role of the Ministry is its efforts to improve the health standard of the people through health-improvement activities of either a preventive or a curative nature. Before independence in 1957, health services were virtually non-existent in the rural areas, services of a mainly curative nature being usually concentrated in the urban areas. The main thrust of the national strategy was therefore development of a rural health infrastructure, providing integrated preventive and curative services through a three-tier network of main health centres, health subcentres and midwife clinics, with referral to the more sophisticated secondary and tertiary services at district, state, regional and, eventually, national levels. While the 1960s saw emphasis placed on the development of a rural health infrastructure, the 1970s, in line with the new economic policy, saw continuing emphasis placed on the economically depressed areas, as well as on the development of maternal and child health, family planning, nutrition and sanitation programmes. At the same time the curative services, as well as training and planning capabilities, were being upgraded. In 1973, during the mid-term review of the Second Malaysia Plan, 1971-75, the three-tier system of rural health services was reorganized into a two-tier system of health centres and rural clinics, on the basis of the findings of operational research in which WHO collaborated. It was estimated that the existing rural health services covered less than half the rural population, and thus total population coverage with the two-tier system could not be achieved until 1995. Mobile teams will visit the remoter villages until a more permanent health infrastructure can be made available. However, the rising expectations of the population living in the more economically depressed underserved areas, where health standards might be expected to be correspondingly poor, 'made it clear that the felt needs for health services were more extensive than those now met by the mobile health teams. It was necessary to provide essential health services, in areas hitherto unserved or underserved by the existing rural health services, as quickly as possible, pending the establishment of more permanent integrated health services. The need to start using the primary health care approach in those areas therefore became pressing.

248 ~LAYSIA

(continued)

Survey of underserved areas A survey carried out in 1977-78 ~n 47 administrative districts of Peninsular Malaysia, where the applied food and nutrition programme was in progress, indicated that 88% of the population was covered by the existing rural health services. With only 24% of the villages, comprising 12% of the population, being considered "underserved", it is now anticipated that total coverage by the present health services can be achieved well before 1990. A further survey was carried out late in 1979 in the rest of Peninsular Malaysia as well as in Sabah and Sarawak. Preliminary data indicated that rural population coverage by health services in the rest of Peninsular Malaysia was 86% of the villages and 94% of the population. In Sabah and Sarawak, permanent health facilities were found to be accessible to about 40% of the total population, although overall health services, including mobile teams and the flying doctor services, were accessible to about 70%. With the identification of underserved areas, it is now possible to develop a strategy for health for all within the overall context of the Fourth Malaysia Plan, 1981-85. The health for all strategy Strategy To implement activities aimed at total coverage of the population, the following strategy is being adopted: (1)

priority prov~sLon of essential health care in areas still unserved or underserved by the "comprehensive" health services provided by the present network of health centres and rural clinics/midwife clinics, to ensure that they are extended quantitatively to cover the total population in the shortest possible time; eventual provision of a permanent health infrastructure suitable for the underserved areas, where villages are small and scattered, before 1990; introduction of health services research aimed at improving the quality of the existing health services, through improved management of resources and greater involvement of communities 1n improving their health status and utilizing the health services, together with a stronger intersectoral approach through the national community development programme; eventual upgrading of essential health services in the underserved areas into more comprehensive programmes.

(2) (3)

(4)

Surveys The prov1s1on of essential health care to the underserved areas is preceded by identification of those areas. Three steps are entailed: (1) identification of areas considered unserved and underserved through a mapping/utilization methodology; (2) identification of local community resources, both manpower and physical, which could be involved in providing the essential health services; and (3) consultation at village level to identify resources (for example, existing traditional birth attendants, or candidates for training in first aid) and a community organization to coordinate village-level activities. In 1977-78 Step (1) was carried out in 47 districts covered by the applied food and nutrition programme. In the rest of ~alaysia, including Sabah and Sarawak, Step (2) was started in late 1979 and 1s still going on. Community Health Renewal ~ovement Essential health care to the underserved villages is provided through a community development project known as the Community Health Renewal Movement (the Government's communicable diseases programme is called the Rene1ial Xovement), consisting of three components: the integrated mobile teams mentioned in the Introduction above; (2) organized community efforts to complement and supplement government efforts; (3) education of the community, through rural broadcasts as well as through local educational resources and the mobile teams, in all matters relating to health. (1)

Health services research With UNICEF assistance, a study to ietermine the most suitable fo~ of rural health infrastructure for the underserved areas, where the villages are small and scattered, will be completed in 19RO. The new infrastructure will be an extension of the existing rural health infrastructure in the served areas. During 1981-82, in-depth studies will be carried out in selected districts to determine the utilization pattern and as a result improve the quality of the existing health services throughout the country, that is in the underserved as well as the "overserved" areas. Since the primary health care approach need not be confined to the rural areas, studies in urban squatter and slum areas may also uncover new strategies for the improvement of their health status. The results will be incorporated in the Fourth Malaysia Plan at the mid-term review in 1983.

249

250

MALAYSIA (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management In the Fourth Malaysia Plan, health programming is emphasized as the approach for formulating the five-year national health plan, as against the past practice of identifying projects to form the basis of the plan. This approach is in line with the country health programming approach advocated by WHO. Effective measures must therefore be taken to upgrade the capability of national staff to ensure that the Ministry of Health performs its proper role in health planning. Primary health care The results of the study of underserved areas will be utilized in planning the strategy for the Community Health Renewal Movement. In 1980 a study is being made, with UNICEF assistance, of the most suitable infrastructure for underserved areas. The primary health care programme will be implemented according to the national plan, priority coverage being given to rural areas. Community education and community participation will be major elements of this strategy which will be reviewed in 1982-83. Workers' health Because of the rapid rate of industrialization and the further expansion of primary industries, it is envisaged that workers' health problems will further increase. With more women coming into the work force, it will be essential to start a nursing service. With cooperation from WHO, the extent of the problem will be assessed and an occupational health nursing service developed. This will be followed by appropriate training overseas for local nursing personnel. Appropriate technology for health (Health laboratory technology) and developing the public health laboratory services in Malaysia. Family health Maternal and child health The maternal and child health services continue to develop, priority being given to underserved areas, including estates, mines and urban slums, with extension of the services to Sabah and Sarawak where health workers are being trained in maternal and child health/family planning. Use of the risk approach, which commenced in 1979 and 1980, will be ongoing and will be reviewed in 1982-83. By that time, which coincides with the mid-term review of the Fourth Malaysia Plan, the maternal and child health services will also be reviewed in the light of national priorities. WHO will cooperate in reviewing

One of the new criteria for further expansion of the integrated family health service is that the Ministry of Health should be able to provide support services as adequate as those provided by the National Family Planning Board and the Federation of Family Planning Associations. To that end a feasibility study will be carried out with the participation of WHO. UNFPA will provide support for the strengthening of maternal and child health/family planning services and for staff development at the Ministry of Health. Nutrition The planning, organization, implementation, monitoring and evaluation of nutritional activities in the underserved areas of Sabah and Sarawak will be strengthened and a nutritional surveillance system established in the two States. Health education movement programme. The rural broadcasting service will be extended as part of the community health

Prophylactic, diagnostic and therapeutic substances Drug policies and management Activities will be further developed for the production and quality control of drugs and management of the drug programme, the objectives of which are to ensure the availability, safety, quality and effectiveness of production, distribution and use of pharmaceuticals as well as their efficacy. Pharmaceuticals and biologicals Drug control administration and capabilities in quality control, standardization and the rational use of herbal medicines, as well as the quality control of vaccines, will be strengthened. Communicable disease prevention and control Epidemiological surveillance This is the mainstay of communicable disease prevention and control activities. Data collection, collation, analysis and dissemination will be strengthened, together with capabilities in evaluating communicable disease prevention and control activities and in adapting technology for local use. Bacterial, viral and mycotic diseases The planning and implementation of national programmes for the control of sexually transmitted diseases and diarrhoeal diseases will be strengthened. Expanded programme on immunization Logistics for the supply and distribution of vaccine and the reference laboratory services supporting the expanded programme on immunization against measles and other leading childhood diseases require strengthening. ~1

252

MALAYSIA (continued) Vector biology and control Vector biology and control, including training and research at the Institute for Medical Research, will be strengthened. The vector and biology control programme will be reviewed and evaluated and the training curriculum consolidated. Cooperation will be given to the vector control units in the prevention and control of vector borne diseases, such as dengue fever/dengue haemorrhagic fever, typhus, and rodent control at seaports and airports. Noncommunicable disease prevention and control Cancer The strategies used in the cancer programme will be reviewed, together with the operation and evaluation of prevention and control activities. Cardiovascular diseases The cardiovascular diseases programme will be reviewed, including training, overall planning, implementation, the interventions used and evaluation of the effectiveness of the programme. Oral health By the end of 1980, 88 fluoridation plants will have been installed and commissioned throughout Malaysia, providing facilities to a population of about 6 million. ~ith this achieved, the fluoridation programme should be evaluated. Promotion of environmental health Environmental health planning and management With the formation of a technical unit in the Ministry of Housing and Local Government, projects for improving sanitation and other related services 1n the smaller towns will be developed and implemented. The various regulations under the Environmental Quality Act will be fully enforced. Environmental impact considerations will be incorporated in government development projects. An engineering services division has been formed, further to develop and implement maintenance programmes for the engineering equipment and plants of the Ministry of Health, with a view to ensuring the proper functioning and full implementation of health and health-related programmes and services. Food safety During the period 1980-85, food laboratories will be established at Port Klang and Penang and, if approved, a total of six regional laboratories for food analysis will be included in the Fourth Malaysia Plan. A laboratory manual for food analysis is very much needed. Food import and export control is minimal at present. It needs to be strengthened by drawing on the experience of countries with adequate food import and export control regulations.

Health manpower development Health manpower planning and management High priority is given to manpower training, in order to produce adequate numbers of the right types of health and allied personnel for the expanding health and related services. Many in-country programmes, at both basic and postbasic level, are currently being undertaken and new programmes are planned, to train new categories of staff or for postbasic training. Promotion of training WHO will cooperate in the training in management of Ministry of Health personnel at managerial and supervisory level. Educational develcrp~ent and support Establishment of a teacher training programme at the Public Health Institute is planned. This programme will train teachers of paramedical and auxiliary workers within the health system. Not only will facilities for basic training be provided but also impetus will be given to the continuing education of teachers and the improvement of educational programmes generally. To overcome the current shortage of physicians, a third Faculty of Medicine will be established at the Universiti Sains Malaysia, Penang. The teaching hospital will be located at Kubang Kerian, Kelantan. The first batch of about 64 students will commence studies in 1981. The intake is expected to increase to 128 by 1985. WHO will participate in planning the programme.

253

254

MALAYSIA Regular budget

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds Total

Increase/ (Decrease) Regular budget US$

Major programme/programme

uss 2.2 General ero&ramme develo2!!!ent and manasement 2.2.2 Country health programming (Costs of WHO Programme Coordinator's office, Kuala Lumpur, Malaysia Less: Share of costs of the WHO Programme Coordinator attributed to Singapore) develo~nt

usf

uss

247 200

353 500

(24 900) 222 300

222 300

(26 000) 327 500

327 500

105 200

3.1

Health services 3.1. l 3. 1. 2 3. l. 3 3.1. 5

Heat th services planning and management Primary health care Workers' health Appropriate technology for health (Health laboratory techno logy)

20 000 26 000 117 000

30 800 15 000 64 600

10 800 (11 000) (52 400)

10 000

3.2

Familx: health 3.2.1 3.2.2 3.2.4 Matet'nat and child health Nutt'ition Health education 52 000 78 000 6 000 559 000 FP 611 000 78 000 6 000 60 000 21 400 10 000 163 300 FP 223 300 21 400 10 000 8 000 (56 600) 4 000

MALAYSIA Regular budget US$ 3.3 3.4 Mental health Prophllactic dia&nostic and therapeutic substances 3.4.0 3.4. l 3.4. 2 4.1 Programme planning and general activities Drug policies and management Pharmaceuticals and biologicals 18 000 24 000 24 000 13 000

1980-81

1982-83 Regular budget Other Sources Total

--,-------------,..---Major programme/programme

Increase/ (Decrease) Regular budget

Other Sources Source of funds Total US$ 13 000

usr-

us$

-- ------usr- ----

us$-(13 000)

18 000 24 000 24 000 31 600 89 200 31 600 89 200

(18 000) 7 600 65 200

Communicable disease prevention and control 4. l. 1 4.1. 3 Epidemiological surveillance Bacterial, viral and mycotic diseases 20 000 30 000 10 000 32 000 20 000 30 000 10 000 32 000 36 800 23 600 6 400

36 800 23 600 6 400 39 200

16 800 (6 400) (3 600) 7 200

4.1. 5 Expanded programme on immunization 4.1.8 4.2 Vector biology and control

39 200

Noncommunicable disease prevent ion and control 4. 2.1 4.2.2 4.2.3 Cancer Cardiovascular diseases Oral health 25 000 28 000 25 000 25 000 28 000 25 000 9 400 22 200 31 000 9 400 22 200 31 000 (15 600) (5 800) 6 000

255

256

MALAYSIA Regular budget US$ 5.1 Promotion of environmental health 5. 1. 1 5.1.4 6.1 Environmental health planning and management Food safety 135 000 24 000

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

135 000 24 000

99 100 55 600

99 100

(35 900) 31 600

55 600

Health maneower develoement 6.1. 1 6.1. 2 6.1. 3 Health manpower planning and management Promotion of training Educational development and support Total ~LAYSIA

60 000 60 000

30 000 21 400 92 700 ------1 127 500 ====:a:::::::=

30 000 21 400

(30 000) (38 600) 92 700

----1 059 300

----559 000 =======-::~=

-----========= 1 618 300

---163 300

92 700 ----

=====:::===

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

========:=

l 290 800

======::==

68 200

NEW HEBRIDES NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The national health policy is to provide the necessary health services to enable all citizens to contribute their share to the country's socioeconomic development. Health is considered to be a necessary condition for the general development of New Hebrides. Emphasis will be placed on improving conditions in rural areas, including the organization and strengthening of primary health care and preventive services, at the same time maintaining the present standards of curative facilities. Strategies for the objective of health for all are as follows: (1) ( 2) (3) (4) (5) to strengthen and upgrade health services through development of the necessary manpower at all leve Is; to develop health planning, coordination and management capabilities; to develop programmes for the control of communicable diseases; to promote environmental health, including the control of environmental pollution; to develop services for the education and information of the people in the field of health, especially family health.

From being a condominium administered by two metropolitan powers, the country became a completely oclf-governing Republic in 1980. Efforts are being made to integrate all services and facilities into a unified service. Those efforts will be supported by developing the planning and management capabilities of senior staff and by upgrading the training of medical and paramedical staff. Other priority areas are the prevention and control of communicable diseases, including immunization against diseases, and primary health care with emphasis on the family health services.

257

258

NEW HEBRIDES (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH- DEVELOPMENT Health services development Health services planning and management With the achievement of independence, all health services have been transferred to the Ministry of Health. It will now be po s sible to plan for the development of a comprehensive national health services structure. A national administration will be established, to operate the integrated service efficiently and to plan future services to meet the needs of the people. Unification of services, with the general objective of health for all by the year 2000, will ·necessitate reorganization of the network of health facilities and further development of basic health services at peripheral and intermediate levels. WHO, with anticipated support from UNDP, will be closely involved in the planning and implementation of this reorganization, as well as in coordinating other cooperation in this field. Primary health care New Hebrides is typical of a country of many islands, where the health system has the difficult task of providing continuous health care, accessible to all or most of the people. Distance, isolation and high transportation costs are major factors to be considered in making health care available to the population at the periphery. The objective of the primary health care programme is to cooperate with local authorities in training health workers, based in the community and supported by a health service team, who will meet the basic health needs of the people wherever they may reside. WHO will cooperate in training those workers, and in setting up an organizational structure for the effective functioning of the programme. Family health Mate rnal and child health Health activities will continue to res-pond to the importance given to family health and family health services as the cornerstone of community development. Services will be as comprehensive as possible and will include maternal and child health, immunization against childhood diseases, nutrition promotion activities and health education of the public. WHO collaboration, with support anticipated from UNFPA, will concentrate on the training of staff, overseas and locally, and on upgrading the quality of services by setting standards and strengthening supervision.

Communicable disease prevention and control Epidemiological surveillance Although the general status of health is very satisfactory, many communicable diseases are common. Diarrhoeal diseases are still an important cause of child mortality and morbidity. With increased coverage and surveillance by trained staff more communicable and noncommunicable diseases are being diagnosed. It is planned progressively to strengthen the epidemiological surveillance services. WHO will cooperate in setting up an epidemiological unit. Malaria and other parasitic diseases Malaria will continue to be a public health problem in the 1980s and control measures will be strengthened. WHO collaboration will concentrate on training activi~le•s, on the setting up of an effective surveillance network and on the assessment of control measures. Expanded programme on immunization The Government is planning, with WHO and UNICEF cooperation, to expand and to improve its immunization programme. Although coverage by immunization is satisfactory, results are not yet as good as they could be, owing to various logistical problems. Promotion of environmental health Basic sanitary measures Improvement of environmental sanitation and of the standard of living conditions in general is a major concern of the health administration. Efforts will continue, with anticipated support from UNDP, to provide a safe water supply to the whole population, especially ~n rural areas, and to help the people to take the necessary measures to protect themselves from environmenta~ hazards. Health manpower development Health manpower planning and management The recruitment, tra~n~ng and posting of health personnel at all levels of the health delivery system will be top priority activities throughout the programming period. Manpower resources will be severely tested in achieving a smooth transition towards the establishment of a unified national health system. WHO expertise will be required to help in implementing this overall manpower development programme, a~ well as in organizing and implementing courses for special categories of personnel, for example postbasic nursing courses. Promotion of training Skilled manpower (doctors, some nurses, technicians) will still have to be sent to neighbouring countries for their education. While local training facilities will be used to provide frontline health personnel (community nurses and sanitarians), WHO fellowships will be used to strengthen long-term education programmes. 259

260

NEW HEBRIDES (continued) Health information Health statistics The collection of health statistics has to be organized and unified. At present, information is being collected by various units and is not always reliable. Plans are being made to centralize all health information in a health statistical unit, which will also be responsible for compiling and processing the information and will closely cooperate with the epidemiological unit on the one hand and with the health planning unit on the other. Health legislation WHO will continue to cooperate in reviewing existing health legislation and in advising on new legislation which may be necessary.

NEW HEBRIDES Regular budget US$ 2.2 General 2.2.2 2ro~ramme

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

develo2ment

Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

48 400

94 600

46 200

3.1

Health services development 3.1. 0 3.1.1 3.1. 2 Programme planning and general activities Health services planning and management Primary health care 39 200 184 700 120 500 DP 184 700 120 500 39 200 124 000 30 000 248 000 DP 372 000 30 000 (184 700) 124 000 (9 200)

3.2

Family health 3.2.1 Maternal and child health 257 800 FP 257 800 185 000 FP 185 000

4.1

Communicable disease prevention and control 4.1.0 4.1.1 4.1.2 Programme planning and general activities Epidemiological surveillance Malaria and other parasitic diseases 146 600 146 600 104 000 134 000 104 000 134 000 (146 600) 104 000 134 000

5.1

Promotion of environmental health 5 .1. 2 Basic sanitary measures 25 200 25 200 20 000 DP 20 000 (25 200)

261

262

NEW HEBRIDES Regular budget US$ 6.1 Health maneower develoement 6.1.1 6.1.2 7.1 Health manpower planning and management Promotion of training 104 300

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

114 000 104 300 159 000

114 000 159 000

114 000 54 700

Health information 7 .1.1 7 .1.3 Health statistics Health legislation Total - NEW HEBRIDES 20 000 15 000 20 000 15 000 20 000 15 000

===========

548 400

378 300 =====s====

=========

926 700

===·======

794 600

=========

453 000

======:===

1 247 600

=======·=

246 200

NEW ZEALAND NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The national health policy of New Zealand is expressed in several Acts relating to the promotion or conservation of human health, including in particular the Health Act of 1956, the Hospitals Act of 1957, the Mental Health Act of 1969, the Social Security Act of 1964, and all other public Acts. The Department of Health is responsible for administering those Acts. The major programmes supported include research and education, environmental health, family health, disease control, accident prevention, and delivery of medical care. Current emphasis is directed towards a downward delegation of authority. Specific goals of the Department of Health are to: (1) develop responsibility for environmental health at local authority level; (2) maintain a well-qualified career public health service, which sets standards and advises local authorities on all health matters; (3) develop, on the basis of existing hospital board structure, the concept of a unified medical care delivery service administered by a single health authority in each area; (4) equip the Department so that it can effectively discharge responsibility for the direction of policy, determination of priorities, general financial control and the evaluation and surveillance of the efficiency of management; (5) further develop primary health care services in the community. TECHNICAL COOPERATION PROGRAMME FOR HEALTH Health manpower development Promotion of training Because of the country's comparatively isolated situation and the restrictions placed on overseas travel, it is very difficult for senior staff of the health services to study areas of interest in other countries. It is intended to continue the training of selected staff AS part of the Department's overall manpower development scheme. Preference will be given to persons employed in policy formation areas associated with strategies for the development of health for all by the year 2000. DEVELOP~lliNT

263

NEW ZEALAND (continued) The Government will continue to collaborate actively with the World Health Organization and the countries or areas of the Pacific in various health development programmes, including training and medical research. Since the WHO fellowship programme is a vital aspect of the overall health services development programme for countries of the Pacific, New Zealand is most willing to share again in this collaborative activity for the 1982-83 biennium.

---------------------------NEW ZEALA"'l1 ----------------------------~----

·-------·--·----------·-------------- -------------------·--·-·-·---------,----·-----------------,-- -------·-+----------- ,----,----:------~----,----- -·-1---'('-'-D..:e.~c-"r-=e-=a-'-s-'-e"'-)-! Regular budget Other Sources Source of funds Total Regular budget Other Sources Source of funds Total Regular budget

1980-81

1982-83

Increase/

~ajor programme/progra~e

--==u=sr-$--+----Us$-------6.1 Health manpower development 6. 1.2 Promotion of training Total - NEW ZEALAND

1----us$~--~--US$---

---ugr-r--·.....::.::.=:c.:....j.------usr------Us$----

60 000 60 000

265

266

NIUE NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The five-year national development plan, 1980-85, outlines the Government's policy for the health component as providing total medical and dental care. The health component specifies the following objectives: (1) (2) (3) to achieve as effective a programme of free preventive and rehabilitative medicine as the community will accept and the Government can afford; to control the cost of the health services; to achieve a hospital service offering all reasonable care to inpatients and outpatients.

The Health Department has for some time followed a policy which emphasizes a community-based programme for the achievement of its health objectives. Through such a policy the community has accepted, to an ever increasing extent, responsibility for solving its own health problems and creating a healthful environment. During the biennium 1982-83, the Health Department will continue to nurture community involvement in health. To support this overall strategy, the following specific objectives have been established: (1) (2) (3) (4) (5) to develop medical and dental personnel to full practitioner level, each with a speciality relevant to the needs of the community; to ensure an adequate level of paramedical and nursing staff with basic training; to maintain a continuous postgraduate training programme, aimed at ensuring that all staff are up to date in knowledge, competent and efficient; to upgrade the administrative ability of the section heads and improve channels of control and communication; to regulate and improve the human environment and to promote a wide understanding of preventive health measures.

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management Achievement of the above-mentioned objectives will necessitate qualitative improvement in the existing resources making up the health system. This calls for improvements in administration, supervision and some technical skills of the health personnel. In addition, promotion of community involvement will continue to be the responsibility of all health workers. WHO will collaborate in developing and implementing health service development objectives. Appropriate technology for health (Health laboratory technology) The laboratory services still need to be improved. This will be achieved by staff training and provision of equipment and supplies. UNDP-funded project under WHO execution will be continued. Communicable disease prevention and control Expanded programme on immunization The Health Department has continued to maintain a high level of immunization coverage over the past years. It will collaborate, within the WHO expanded programme on immunization, to maintain the standard of immunization and seek improved efficiency. Vector biology and control The control of vectors and pests in the environment is a priority concern of the Health Department. Promotion of environmental health Basic sanitary measures The programme for building sanitary latrines, which is nearing completion, has clearly shown the effectiveness of community involvement in major health activities. The Health Department, in collaboration with WHO, will continue to seek ways for furthering the development of a healthy environment in each community. Health manpower development Promotion of training The overseas training programme will provide the required specialities for curative and preventive programmes. The New Zealand bilateral aid training scheme supports much of the basic training required to maintain the Health Department establishment. Postbasic training support will be required for medical officers, dental officers and nursing staff. 267

268

NIUE Regular budget US$ 3.1 Health services develoement 3.1.5 Appropriate technology for health (Health laboratory technology)

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/progrannne

•;, l

Promotion of environmental 5. 1. 2

I health

30 300

11 000

Basic sanitary measures

9 000

t...l

Health maneower develoement t;,l,

Promotion of training Total - NIUE

60 000 60 000 ==ss:~=a:a::sm

60 000 39 300 =::::~==•===·

50 000 50 000 ••:z=!ll==·=

50 000

(10 000)

====•===-=

99 300

==·======

11 000

====*====-=

61 000

==========

(10 000)

PAPUA NEW GUINEA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The national development strategy, published in October 1976, recognizes that the health of individuals and communities has an important effect on their ability to participate in, and contribute to, economic and social development. It also confirms that the strategy outlined in the national health plan, covering the period 1974 to 1978, will continue to be followed, with slight modifications in line with the primary health care approach. The redefined national health development objective is the development of primary health care for all, through village health aides, aid posts, health subcentres, health centres, and hospitals as referral centres, equitably distributed. Future expansion of the health services will concentrate on improving primary health care in rural areas. No new major hospitals are planned and there will be only limited extension of existing hospitals. Training of health personnel, to reorient them to providing an acceptable level of primary health care, is essential for the improvement of services to ru~al communtttes. Emphasis will be placed on training an increased number of personnel, such as doctors, dentists, health extension officers, nurses, aid-post orderlies, nurse aides and village health workers, when and where feasible. Close liaison between the church authorities and the Government is a vital factor tn promoting primary health care, since much of the rural health service is provided by the former. With the advent of provincial governments, decision making is being decentralized to a much greater degree to the provincial level. The provincial health officer is now regarded as head of all health services within a province. It is thus very important that the person holding that position should be well trained in the field of public health. The National Public Expenditure Plan (NPEP) forms the policy basis for the management of the national health programme and provides a framework for the development of health policies as part of the overall socioeconomic development policy. The NPEP will also provide an administrative mechanism for the regulation of government spending so that it is focused on sectors of most importance, such as the improvement of rural welfare, rural education, food production and nutrition, to build foundations for health. Country health programming has been adopted as a means of identifying programmes/projects to be financed through the NPEP. Continued country health programming, including the progressive use of provincial health planning, will be needed to ensure the orderly development and extension of primary health care, province by province, to reach the whole population by the year 2000.

269

270

PAPUA NEW GUINEA (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management The concept of primary health care has been adopted as the Primary health care means of extending the scope of comprehensive care, particularly in the rural areas, where 85% of the population lives. Included in the concept are all the health-related activities of the community having a direct bearing on the promotion and maintenance of its health, such as agricultural production, promotion of literacy for easy dissemination of health information, improvement of water supply and waste disposal facilities, improvement of roads and other measures to raise the standard of living. Through the community, the local health services can develop primary health care, with the collaboration of other national extension services in undertaking socioeconomic projects having an impact on community health. At present, organization of a mechanism for interagency cooperation to promote community improvement is at an early stage. There is a great need for research on community participation in health at the local government council level and below. The preparation of rural health personnel, government and church employees and voluntary health workers (village health workers) should include reorientation of their activities from clinical to community-based health, with special reference to the content of primary health care and the use of appropriate health technology. WHO will cooperate in developing a system of primary health care and mechanisms for provincial health planning and programming. Workers' health With the expansion of industry, steps will be taken, with WHO collaboration, to develop the necessary expertise to establish a central technical unit and organize and supervise occupational health activities. Care of the aged, disability prevention and rehabilitation The Department of Health is still very much dependent on expatriate physiotherapists. Its disability prevention and rehabilitation activities in the main base hospitals have frequently been hampered by these expatriate physiotherapists resigning or finishing their contracts, without suitable replacements being available. A definite effort is now being made to overcome this deficiency by sending suitable national officers for overseas training in physiotherapy. Appropriate technology for health (Health laboratory technology) One of the problems identified within the laboratory services is the chronic shortage of trained laboratory workers to support disease and environmental control. WHO will cooperate, through training medical laboratory assistants, to raising the standard of diagnostic techniques at health centre level.

Radiological technology With WHO participation, the Government will make efforts to become self-reliant in the repair and maintenance of biomedical and radiological equipment. Family health Maternal and child health Mothers and children, who comprise over half the total population, also comprise the largest number of sufferers from infection and malnutrition. Infant and maternal mortality rates are among the highest in the Western Pacific Region. Appropriate preventive, and timely remedial, action, using practicable and appropriate health technology can reduce the major causes of death in those vulnerable groups. Family planning can be strongly justified, not only for the protection of mothers "at risk" but for the health of the child and of the family. WHO collaboration, with support from UNFPA, will further the national programme for improving the family health services, including those for health education and nutrition. Nutrition Although good headway has been made in promoting nutrition programmes, malnutrition is still a problem. There is an urgent need for more trained nutritionists to plan, implement and direct nutrition programmes, as well as to ensure proper coverage of the rural areas, initially on a regional basis, but later extending to every province. Health education The importance of health education in the family health and nutrition delivery system cannot be over-emphasized. The systematic development of health education in schools will contribute greatly in the long run to improvement of the health status of the population. Mental health. Following a rapid change in the social-cultural situation and a considerable degree of urban drift, the need for activities to maintain mental health cannot be under-estimated. Because of limited resources, mental health services will have to be integrated into the general health services, with a referral centre operating at central level. There is a need for one or two national medical officers to specialize in mental health to meet the demand for professional services. WHO will collaborate in such training, by preparing health training curricula to include mental health and by supporting epidemiological studies on mental health problems and mental health monitoring.

271

272

PAPUA NEW GUINEA (continued) Prophylactic, diagnostic and therapeutic substances Drug policies and management A sound national drug policy already exists. updating to include current WHO recommendations. In 1982 it may need WHO will

Pharmaceuticals and biologicals ~ere are no national pharmacists in Papua New Guinea. collaborate in the provision of training for national staff in pharmacy. Communicable disease prevention and control

Epidemiological surveillance A start has been made in streamlining the system for the recognition and notification of the major communicable diseases and in developing a protocol for surveillance, to ensure that timely remedial action is taken at all levels. WHO cooperation will be directed towards the development of more effective surveillance mechanisms, to support control of the major communicable diseases, including sexually transmitted diseases, the expanded programme on immunization and the diarrhoeal diseases control programme. Malaria and other parasitic diseases Since malaria continues to be the most important single disease affecting the health status of all age groups, the Government accords high priority to the control programme. There have, however, been significant operational difficulties, especially with regard to management, supervision and logistical support, which resulted in spraying operations having little impact in reducing malaria incidence. This necessitated a redirection of spraying operations in the more densely populated areas and progressive judicial application of other antimalaria measures, based on the primary health care approach. WHO will cooperate, with the participation of UNDP, in the malaria control, training and research programme. Bacterial, viral and ~cotic diseases As well as malaria, the other communicable diseases are serious public health problems, some having considerable economic impact. Respiratory diseases are the foremost cause of mortality and morbidity. WHO will participate in the acute respiratory infections programme at the Institute of Medical Research, Goroka. Hospital records show the principal causes of death as pneumonia and respiratory illnesses generally, gastroenteritis and diarrhoeal diseases, and perinatal infections. Outbreaks of poliomyelitis and whooping cough are not infrequent in remote areas.

Because of the interest expressed by the government in the diarrhoeal diseases control programme, with a view in particular to reducing child mortality through the use of oral rehydration salts, WHO will collaborate in developing the programme to promote the use of oralyte. The community-based control of tuberculosis and leprosy, fully integrated with the basic health services, has gradually been expanded to cover major endemic areas. WHO cooperation will help to solve technical as well as operational problems. Expanded programme on immunization The Government has adopted a policy aimed at expanding the immunization programme and has commenced improvements, in which WHO will cooperate, in vaccine storage facilities at base and regional depots and in the "cold chain" for the transport and storage of vaccine at the periphery. Vector biology and control There is a great need to strengthen field activities aimed at preventing malaria and other mosquito-borne diseases, particularly in the major cities and towns. will collaborate in vector biology and control activities. Noncommunicable disease prevention and control I

WHO

Oral health There has been considerable improvement in the training of dental therapists who are the main cadre providing dental services in the field. WHO cooperation will extend to the national dental services and training institutes in updating technical proficiency. Promotion of environmental health Environmental health planning and management Poor environmental conditions, particularly lack of safe water supply and basic sanitary measures in rural areas, are contributory factors, not only to the high incidence of diarrhoeal diseases, intestinal parasitism and vector borne diseases, but also to the extensive occurrence of respiratory conditions. As a result of urban drift and the consequent development of shanty towns, sewerage and water supply facilities need to be expanded. There is a great need to increase water supply systems and basic sanitary facilities in rural areas to attain the goal of the United Nations to provide safe drinking water for all by the year 1990. In the wake of industrialization in certain developing areas, environmental control will need to be enforced by experts. WHO collaboration will further the national programme by providing pre-investment services, with UNDP support, for environmental control, particularly in water supply. It will also assume a liaison role with bilateral agencies to help mobilize additional investment.

273

274

PAPUA NEW GUINEA (continued)

Health manpower development Promotion of training Expatriate manpower will continue to be needed for a number of posts, particularly that of medical officer, and also for other highly specialized posts. The appointment of qualified national staff to fill such positions is gaining momentum but adequately trained workers are still urgently required at all levels. The education system cannot yet meet the demand, either in quality or in quantity, and this shortcoming has to be taken into account in health manpower planning. High priority is given to the training of a sufficient number of health workers with a broad range of skills, particularly in primary health care and in the ability to communicate their knowledge to members of communities as far as is feasible. Methods of education need to be geared to the local situation and improved. To meet the objectives of the national health development strategy, it is considered imperative to make a vigorous effort to improve training programmes for aid-post orderlies and village health aides. The number of medical and dental students enrolling and finally graduating is still low but is expected to rise steadily. Incentives are needed to encourage an increased number of national medical graduates to assume teaching roles in order to orientate medical education to the country's health needs. WHO will cooperate in health manpower planning and in improving the training of intermediate and auxiliary health workers, including village health aides. Such training will have to be reorientated in support of the priority accorded to primary health care and rural improvement. Methods of education for the tra1n1ng of all health services personnel will be improved. The fellowship programme will include the training of national health teachers overseas. Officers in charge of the Diploma Courses in Nursing Education, Nursing Administration and Community Health at the College of Allied Health Sciences will be trained to enrich their courses to attract students of high calibre to meet the needs for competent educators, administrators and supervising staff in community health. Educators are especially needed to implement the new general nurse programmes. With the decentralization of health services, more emphasis should be placed on developing strategies for improving the collaboration and coordination of the chief nursing officers with their provincial counterparts. Continuing education programmes are essential if health service delivery is to remain relevant and meet the current needs of the population.

PAPUA NEW GUINEA

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$ Regular budget US$ 1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

2.2

General ~rosramme and manasement 2.2.2

develo~ment

Country health programming (Costs of WHO Programme Coordinator's Office, Port Moresby, Papua New Guinea)

293 400

389 700

96 300

3.1

Health services develoement 3.1.1 3.1. 2 3.1.3 3.1.4 Health services planning and management Primary health care Workers' health Care of the aged, disability prevention and rehabilitaion Appropriate technology for health (Health laboratory technology) (Radiological technology) 428 800 8 000 19 600 428 800 8 000 19 600 27 000 27 000 179 000 179 000 (249 800) (8 000) 7 400

116 000

3.1. 5

72 400

12 000 15 000

(60 400) 15 000

3.2

Family health 3.2.1 3.2.2 3.2.4 Maternal and child health Nutrition Health education 110 600 37 400 103 800 991 500 FP 1 102 100 37 400 103 800 29 000 31 000 324 800 FP 324 800 29 000 31 000 ( 110 600) (8 400) (72 800)

275

276

PAPUA NEW GUINEA Regular budget

1980-81 Other Sources Source of funds Total US$ Regular budget US$ 24 000

1982-83 Other Sources Source of funds US$ Total US$ 24 000

Increase/ (Decrease) Regular budget US$ 24 000

Major programme/programme

3.3 3.4 Mental health P~oeh!lactic, dia&nostic and

US$

iJS$

theraeeutic substances 3.4.2 4.1 Phar111aceut icals and biologicals 96 000 96 000 96 000

Communicable disease erevention and control 4.1.1 Epidemiological surveillance \

107 600

160 500

268 100

64 000

(107 600)

4.1. 2 Malaria and other parasitic diseases 4.1. 3 Bacterial, viral and mycotic diseases

196 000 19 400 75 000 17 000 56 700 ST VL

196 000 168 100

236 000

326 000

562 000

40 000 (19 400)

VD 12 600 20 000 20 000 7 400

4.1.8 4.2

Vector biology and control

. 12 600

Noncommunicable disease erevention and control 4.2.3 Oral health 17 400 17 400 29 000 29 000 11 600

5.1

Promotion of environmental health 5.1.1 Environmental health planning and management 20 400 67 400 DP 87 800 236 000 150 000 DP 386 000 215 600

6.1

Health maneower develoement 6.1. 2 Promotion of training Total - PAPUA NEW GUINEA 246 000

---========== 1 368 100

246 000 3 061 500 :::~~:::=::=====

450 000 1 889 700 ==~======

450 000 864 800 2 754 500 :=::as:a::r:====

204 000 ----1:96 300

·=========

1 693 400

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

===-=-=::===

PHILIPPINES NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The national development policy of the Philippines is aimed primarily at rectifying the grave economic and social inequities that have accumulated over many years. Its major areas of concern are: self-reliance, social justice, rural development, effective and efficient management of resources, development of appropriate manpower, environmental development and the maintenance of harmonious international relations. Guided by such concerns, the national health plan for 1978-82 has identified the following main health objectives: (1)

to provide adequate promotive, preventive and rehabilitative services to the population; to improve the sanitation of the environment especially the supply of potable water and sanitary waste disposal facilities; to improve the nutritional status of the population, with emphasis on infants and children; to attain and maintain an acceptable level of population growth.

(2) (3) (4)

To attain those objectives, an organizational strategy and plan of action has been developed for achieving health for all Filipinos by the year 2000, in response to the country's socioeconomic environment of scarce and unequal distribution of health resources and high and persistent infectious disease prevalence together with malnutrition. The features of the strategy are: (1)

it is a multisectoral approach to the development of the community's capability to lead a healthy life; it focuses on building self-reliance within commun1t1es, by engaging individuals in identifying their health and health-related problems, optimizing the use of available resources, and effectively planning and managing solutions, in order to build a foundation for health, thus enabling them to become active partners in health development; it is a means of reallocating government resources to meet the expressed needs of the community;

(2)

(3)

277

278

PHILIPPINES (continued) (4) it requires health and health-related workers in the government service not only to make available to communities their technical expertise but actively to participate in community problems; it aims at strengthening and utilizing existing structures at different levels of government for planning and implementing programmes and projects; it aims at enhancing the relevance of health manpower development activities to the needs of the nation; it makes the primary health care concept a major policy for removing inequity in health, by proposing to develop it as an integral part of total health care delivery.

(5) (6) (7)

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management Implementation of the Re-structured Health Care Delivery System (RHCDS) demands increased capabilities from the country's limited health resources. Action will be focused on the further development of skills in country health programming and the management of health programmes through a series of training activities. In addition, continued attention will be given to important supporting activities such as the health management information system, logistics, etc. A given number of facilities (health centres, hospitals) will also be improved or developed. Such activities are expected to hasten accomplishment of the Government's objectives of more equitable distribution of health resources and attainment of a level of health for all Filipinos that will enable them to live socially and economically productive lives. The Ministry of Health will receive support from external resources such as the IBRD (World Bank) and UNICEF, and WHO will provide technical cooperation. Primary health care Utilizing experience gained within the country, the concept of primary health care has been developed and is planned for limited nationwide implementation in 1980-81, to cover some 120 municipalities with an estimated population of about three million. It is intended to accelerate implementation in 1982-83.

The programme focuses on (1) the need for each citizen to be responsible for the promotion and protection of his own health and (2) the importance of community participation in the identification and solution of its health problems. Depending on the situation and as decided by the community with the advice of operational units of the Ministry of Health, primary health care workers will be trained. The initial implementation of the programme in 12 provinces (one in each of the regions of the country) should serve to improve subsequent national implementation of the programme. WHO will participate in training health manpower for the development of skills necessary to mobilize communities for self-reliance in health and in the training and placement of primary health workers in areas where they are most needed. It will also participate in programme evaluation, research, and the development of information/education/communications support to primary health care. care. One of the components of support received from the World Bank is the development of primary health Other external agencies collaborating are UNICEF, USAID, SIDA and DANIDA.

Workers' health The following activities will be pursued in implementation of the occupational health programme: (1) training courses in occupational health and safety; (2) development of two regional centres for occupational health and safety; (3) research. Appropriate technology for health (Radiological technology) The radiation health service will be expected to satisfy future demands in cancer control. Corresponding development activities will have to be undertaken. It is expected that, by the end of 1981, substantial improvement in capability for the maintenance and repair of X-ray and other equipment will have been achieved. However, further development, with cooperation from WHO, will be needed to strengthen regional capabilities. Family health Maternal and child health The principal concern is to strengthen the management of maternal and child health as an integral part of primary health care. It is intended to reformulate the objectives of the programme in accordance with the results of an assessment which will be carried out in 1981-82; to ensure coordination and integration of all activities for maternal and child health, develop evaluation mechanisms and conduct training. It is planned, with support expected from UNFPA, to strengthen maternal and child health care and family planning in all regions, based on the experienced gained from the programme initiated in Bohol. 279

280

PHILIPPINES (continued) Nutrition Major emphasis in the nutrition programme will be placed on improved diagnosis, treatment and control of nutritional deficiencies, health education, more effective delivery of nutrition services, nutritional surveillance, research, training, and control of endemic goitre. Major external contributors of resources to these activities are the Cooperative for American Relief Everywhere (CARE) and UNICEF. Health education Health education will continue to provide support in attaining the objectives of the var~ous health programmes. Of particular significance is the educational component of primary health care. While a comprehensive information/education/communication component has been developed as part of a World Bank population project, with emphasis on primary health care, a definitive step has been taken to increase the capa~ility of the health education programme through the recruitment, training and placement of additional health educators. Communications support in terms of mobile vans with audiovisual equipment, to be deployed in each of the regions, will also be provided. Evaluative research will be a built-in component of the programme. Mental health While recent emphasis, in mental health activities, has been on institutionalized care, interest has increased in the community approach to the problem and it has been obtaining more support. In line with the national policy on primary health care, mental health care at the community level will be strengthened by increasing the capabilities of the rural health services and the community, by developing a reporting and monitoring system, by operational research and by training staff in the control of drug abuse. Prophylactic, diagnostic, therapeutic substances Pharmaceuticals and biologicals The expanded programme on immunization demands a corresponding expansion of vaccine production and improvement of quality control. Similarly, the increased demands for pharmaceutical, food and allied products of quality require added vigilance on the part of the Food and Drug Administration. I t is planned to increase the capability of the programme through continuing education and professional development.

Communicable disease prevention and control Malaria and other parasitic diseases The objective of the malaria eradication programme remains the achievement of optimal control, and eradication in areas where it is feasible. It is expected that, with the continuation of efforts to integrate control activities into the basic health services, a malaria vigilance system will be fully operational in 12 provinces by 1980. The process of integration is a continuous one and training of rural health service personnel is envisaged as a continuing activity. Spraying and drug administration remain the technology for control. The control programme for schistosomiasis is based on a multisectoral approach, carried out in cooperation with agricultural and water-related development schemes. Those schemes, implemented with the assistance of the World Bank and the Asian Development Bank, will have built-in schistosomiasis control components. Epidemiological and research act1v1t1es continue to be pursued by the Filariasis Control Service. In areas where the disease is highly endemic, the rural health units also remain active. With the development of primary health care and active community involvement and support, significant achievements are expected in the control of the three diseases. Bacterial, viral and mycotic diseases Tuberculosis is still one of the leading health problems. It is expected that, by the end of 1981, activities instituted as a result of operational research on case-finding and ambulatory chemotherapy will be implemented. Epidemiological surveillance will continue to intensify. Emphasis will be placed on sputum microscopy for case-finding. Efforts will be exerted to ensure the availability of effective anti-tuberculosis drugs at a cost the community can afford. Similarly, communities will be mobilized to participate actively in the programme. The National Institute of Tuberculosis will continue to provide technical leadership, especially in the field of training and research. The major development activities in the leprosy control programme will be continuation of efforts to integrate the service within the general health services, and improvement of contact tracing, casefinding and supervision through community involvement and research.

281

282 PHILIPPINES (continued) For the control of sexually transmitted diseases, the Ministry of Health is still concerned with the improvement of existing social hygiene facilities, especially the laboratories in large cities which are the priority areas. Insofar as rabies control is concerned, attention will be directed towards the formulation and implementation of systematic campaigns for the mass immunization of dogs, with a corresponding increase in production of vaccine. It is expected that activities in diarrhoeal disease control and research in control of acute respiratory infections will be further intensified. Expanded programme on immunization Improvement of the programme will continue through the rural health units. With mobilization of the community, using the primary health care approach, staff of rural health units expect to achieve increased coverage. Prevention of blindness Support to the Philippine Eye Research Institute is planned through training control programme staff, as will be required by the programme to be formulated during the biennium 1980-81. Vector biology and control Improvement of the programme through staff development is planned.

Noncommunicable disease prevention and control Cancer Through the National Cancer Control Center, the objective of effectively reducing cancer morbidity and mortality will be pursued, through intensified education, the full utilization of facilities for cancer detection, diagnosis, pre-treatment evaluation and treatment. Training programmes will be carried out in various specialized fields of oncology for medical and paramedical personnel involved in cancer work. It is planned that, during the biennium 1982-83, additional satellite cancer units will be attached to regional hospitals. Cardiovascular diseases Cardiovascular diseases continue to rank among the first ten leading causes of death. Should the current pilot community programmes for the control of rheumatic fever-rheumatic heart disease prove that a comprehensive cardiovascular disease community control programme is feasible, a nationwide programme will be developed jointly with the Philippine Heart Center for Asia. The Center itself will continue to develop as one of the centres for cardiovascular diseases epidemiology in Asia. Oral health In addition to the flouridation of community water supply where it is possible, it is proposed Lo implement an intensified programme of preventive dentistry. It has been observed that the onset of periodontal disease commences before adolescence and it becomes progressive in adulthood. In areas where flouridation is not possible, a programme of mouth-rinsing with flouride and oral hygiene will be undertaken.

Promotion of environmental health Environmental health planning and management The environment aspects of industrial planning and training in environmental sanitation will receive more attention. Basic sanitary measures The training of staff in solid waste management and environmental health administration is planned. Seminars will be conducted on excreta disposal and solid waste management. Recognition and control of environmental hazards It is intended to develop further and implement a comprehensive sanitation programme in support of the United Nations International Drinking-Water Supply and Sanitation Decade which will include water control and monitoring, development of regional and provincial sanitary laboratories, air pollution control, manpower development, community organization and health education. Health manpower development Promotion of training Current efforts to orient the health services effectively to the needs of the people makes it necessary for the content of training be more relevant to the changes required in the skills, knowledge and attitude of health workers; for effective training methods and approaches to be developed; for the distribution of health manpower to be rationalized; and for a continuous programme to strengthen the libraries of all regional offices to be undertaken. Development activities will be focused on the Ministry of Health and the Institute of Public Health. Educational development and support Health information Health statistics Efforts will continue for the development of a national health information sytem. The programme for teacher training will be expanded.

283

284

PHILIPPINES Regular budget US$ 2.2 General ero~ramme develoement and mana~ement 2.2.2 Country health programming (Costs of WHO Programme Coordinator's office, Manila, Philippines)

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

~ajor

programme/programme

156 800

198 900

42 100

3.1

Health services develoement 3. 1.1 3. 1. 2 Health services planning and management Primary he a 1th care 342 700 13 600

57 500

400 200 13 600 22 800

270 000 82 600 37 000

(72 700) 69 000 14 200

3. 1. 3 Workers' health 3. l. 5 Appropriate technology for health (Radiological technology)

22 800

86 200 "\

86 200

19 200

(67 000)

3.2

Famill health 3. 2. 1 Maternal and child health 3.2.2 3.2.4 Nutrition Health education 37 600 36 600 63 700 40 000 1 171 000 FP 1 208 600

19 200 25 200 39 600 61 400

1 072 800

l 092 000 25 200 39 600 61 400

(18 400) ( 11 400) (24 100) 21 400

36 600 63 700 40 000

3.3

Mental health

-----------------.PHILIPPI:-<ES

-------------------------- -----------------1980-81 Regular budget Regular budget 1982-81 Other Sources Total

Major programme/programme

--us 3.4 Prophylactic, diagnostic and therapeutic substances 3.4.1 3.4.2 Drug policies and management Pharmaceuticals and biologicals 46 200 19 200

us$

46 200 56 100 FT

(46 200) 25 400 25 400 6 200

75 300

4. l

Communicable disease prevention and control 4.1.2 4.1.3 4.1.5 4.1.7 4.1.8 Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization Prevention of blindness I

126 900 151 300 10 000 86 900 VD

126 900 238 200 10 000

138 600 183 700 28 500 6 200

138 600 183 700 28 500 6 200 9 600

11 700 32 400 18 500 6 200 (29 000)

Vector biology and control

38 600

9 600

4.2

Noncommunicable disease prevention and control 4.2. 1 4.2.2 4.2.3 Cancer Cardiovascular diseases Oral health 54 100 27 000 37 400 54 100 27 000 37 400 27 600 22 900 29 600 27 600 22 900 29 600 (26 500) (4 100) (7 800)

285

286

PHILIPPINES Regular budget US$ 5.1 Promotion of environmental health 5. 1.1 5 .1. 2 5.1. 3 5.1.4 6.1 Environmental health planning and management Basic sanitary measures Recognition and control of environmental hazards Food safety 101 900 68 700 19 900 29 000

1980-81 Other Sources Source of funds US$ Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

us$

101 900 68 700 19 900 29 000

15 600 34 900 179 200

(86 300) (33 800) 159 300 (29 000)

Health maneower develo2ment 6.1. l 6 .1. 2 6.1. 3 Health manpower planning and management Promotion of training Educational development and support 98 300 79 900 55 400 98 300 79 900 55 400 105 800 37 200 105 800 37 200 (98 300) 25 900 (18 200)

7.1

Health information 7 .1.1 Health statistics Tota1 - PHILIPPINES

----1 763 800 •~:s:a-:::aa

27 000 1 371 500 3 135 300 x:as:a:aaa:aa

27 000 1 072 800 a:a•••s•sa

27 000 (138 900)

·=-···=-···

1 624 900 •=-••:s••••

2 697 700 •=-••aa:a:aa

==-u•••*•••

REPUBLIC OF KOREA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The Republic of Korea will commence its fifth five-year development plan on 1 January 1982. As part of the planning process, the Economic Planning Board has commissioned a guidance document entitled "Long-Term Prospect for Economic and Social Development, 1977-1991". Against this background will be prepared the fifth to eighth five-year development plans ending 31 December 2001. It is the intention to improve the health of the population by providing primary health care to all, through a network of health centres and hospitals, with community participation in conjunction with the private sector, and assisted by a health insurance scheme to cover the entire population. The quality of life will also be improved by controlling environment pollution and providing water supply and waste disposal facilities for the entire country. The National Health Council serves as a coordinating and policy-making body in the broad field of health. The Chairman is the Deputy Prime Minister and Head of the Economic Planning Board and members include the Ministers of Health and Social Affairs, Home Affairs and Education as well as leading health professionals. The Korean Health Development Institute serves as the main advisory body to the Ministry of Health and conducts operational research and other activities to assist in formulating the health sector of the five-year development plan. The projected health indicators up to 1991 are as 1970 Population (per 1000 persons) Health status Average life expectancy (years) Crude death rate (per 1000 persons) Infant mortality rate (0-4 years per 1000) 65.0 8.5 45.5 67.4 6.6 38.0 69.3 5.9 27.0 70.9 5.5 22.5 72.0 5.2 15.7 follows~

1976 35 860

1981 38 807

1986 42 088

1991 45 261

287

288 REPUBLIC OF KOREA (continued) 1970 Nutrition Calorie consumption (person/day) (Percentage of recommended daily requirements) Protein, total (gram/day) of animal origin (gram/day) Medical resources and their utilization Population per physician Population per nurse Population per hospital bed Bed utilization rate (%) Delivery assistance rate (%) *Represents the 1973 figure. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management From 1982 to 1986 the fifth five-year development plan will be implemented. The expanding activity for development of a health insurance scheme and the changing emphasis from infectious to chronic non-infectious disease will require a more complex system for monitoring plan implementation. WHO will collaborate in improving planning and health administration. Primary health care Emphasis will be placed on community participation in primary health care, based on a health centre and a subcentre network. WHO will collaborate technically through activities for maternal and child health, water supply, nutrition and health services research. 2107 1742 909* 58.4 14.0 2011 572 742 64.5 22.0 1545 405 390 75.0 45.0 1317 323 250 80.0 65.0 1166 275 130 83.0 75.0 2370 (91.2) 65.1 10.6 2390 (91.9) 71.1 15.2 2590 (99.6) 77.6 19.7 2712 (104.3) 84.0 25.7 2823 (108.6) 90.0 33.3 1976 1981 1986 1991

REPUBLIC OF KOREA (continued) Care of the aged, disability prevention and rehabilitation Greater attention will be given to the health and social aspects of old age. WHO will collaborate in this field and also in the field of rehabilitation and traffic accidents. Appropriate technology for health (Radiological technology) The programme of radiation protection will be expanded. WHO will participate in tra1ning and in the proper maintenance of x~ray equipment. Health services research Through the Korean Health Development Institute, research on all aspects of the health care delivery system will be carried out, with the cooperation of WHO, in order to provide health planners with reliable data based on scientific research. The Institute will be involved in all aspects of the programme for the development of comprehensive health services, including family health. Mental health As the incidence of infectious diseases decreases the chronic non-infectious diseases are given accent. A comprehensive national programme for mental health will be developed with WHO cooperating particularly in geriatric mental health activities. Communicable disease prevention and control Bacterial, viral and mycotic diseases against tuberculosis and leprosy. WHO will continue to collaborate in the national programmes

Noncommunicable disease prevention and control Cancer With the participation of WHO, emphasis will be placed on the further development of hospital-based cancer registries and a national cytology service for cervical carcinoma. Cardiovascular diseases A national programme for the control of hypertension and stroke will be developed, with WHO cooperation in development activities and in epidemiological studies. Promotion of environmental health Recognition and control of environmental hazards Rapid and sustained industrialization has created environmental control problems, particularly as they refer to air and water pollution. An office of th~ environment was established in January 1980 and WHO collaboration, which commenced in 1976, will continue in developing the priority programme.

289

290

REPUBLIC OF KOREA (continued) Health manpower development Health manpower planning and management With the expansion of national services in the broad field of health, a detailed analysis of future manpower requirements is required. WHO will participate in the studies involved. Promotion of training This actLVLty is of top priority, particularly in fields relatively new to the country: for example environmental pollution control and the chronic noncommunicable diseases. WHO will cooperate in training and in the organization of national workshops to introduce new concepts and techniques in priority areas. Educational development and support The activities of the National Teacher Training Centre for Health Personnel, Seoul National University are expanding to encompass all the health professions. With WHO collaboration, emphasis is being placed on the further development of provincial medical and other health profession schools and on developing the Seoul National University Medical School as a graduate training centre.

--------------------..,-----------------------------REPUBLIC OF KOREA 1980-81 1982-8 'j Regular budget

r------------------'iajor progrannne/programme

------.---"---------Regular budget Other Sources Source of funds Total Total

Increase/ (Decrease) Regular budget

1----------------2.2 General programme development 2.2.2 Country health programming (Cost of WHO Programme Coordinator's office, Seoul, Republic of Korea) develop~ent

-----usr--- ~"--usr

--us-r---

195 300

293 000

298 000

102 700

3.1

Health services 3.1.1 3.!.4

Health services planning and management Care of the aged, disability prevention and rehabilitation Appropriate technology for health (Radiological technology) Health services research

249 700

15 000

(234 700)

20 000

3. 1.5

33 300

30 000 118 000

30 000 118 000 20 000

300)

3.1.6 3.3 4. l

118 000 600

'iental health Communicable disease prevention

19 400

20 000

and control 4.1.3 Bacterial, viral and mycotic diseases 14 800 VD

14 800

291

292

REPUBLIC OF KOREA Regular budget US$ 4.2 Noncommunicable disea$e 2revention and control 4.2.0 4.2.1 4.2.2 5.1 Programme planning and general activities Cancer Cardiovascular diseases 34 200 117 200

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major progranune/progrannne

34 200 117 200 59 000 20 000 59 000 20 000

(34 200) (58 200) 20 000

Promotion of environmental health 5. 1.1 5. l. 2 Environmental health planning and management Basic sanitary measures 38 700 53 700 252 800 38 700 53 700 252 800 266 000 266 000 (38 700) (53 700) 13 200

5. l. 3 Recognition and control of environmental hazards 6.1 Health maneower develoement 6. 1.1 6.1. 2 Health manpower planning and management Promotion of training

15 000 122 300 305 000 122 300 305 000 457 000 180 000

15 000 457 000 180 000

15 000 334 700 (125 000)

6. 1. 3 Educational development and support 7.1 Health information 7. 1.1 Health statistics Total - REPUBLIC OF KOREA

33 700 ---1 455 300 =~~:=~=-:=::::

33 700 14 800 1 470 100

----======-=== 1 498 000 1 498 000 ::c::::::::::==

(33 700) 42 700

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

=========

=====c::.:::

========

SAMOA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Overview Samoa, in a period of relatively rapid change and economic growth, is faced with environmental, occupational, sociocultural, demographic and nutritional problems which may profoundly affect the health of the community. The more significant causes of mortality and morbidity already reflect the influence of these factors on the Samoan way of life and it is to be expected that the trend will increase and must be counteracted by appropriate national policies and strategies for health care delivery. Among the main health concerns of the nation are diarrhoeal and respiratory diseases, nutritional and metabolic disorders, trauma, and vector-borne and other infections. The Government of Samoa endorses, and has adopted in principle, the goal of health for all by the year 2000, established at the Alma-Ata Conference in 1978. It is recognized that health is not an isolated phenomenon in human existence, but is interlinked with the political, social, spiritual and economic life of the country. Strategies for health must therefore be developed in the context of broad development plans for the community, which take account of both internal and international influences. Key factors in the Samoan health development programme are: an efficient administration; adequate and properly trained health personnel; well-developed primary health care programmes in partnership with community authorities; a vigorous programme of preventive medicine; effective public health services; facilities for the delivery of high quality health care, close to people's homes and places of work; a referral system which provides advanced diagnostic and treatment resources to patients suffering from serious conditions; and good liaison between government departments and other agencies having some part to play in prevention and treatment of illness or promotion of health. The fourth five-year development plan, which begins in 1980, sets out systematically to raise the level of health and the quality and accessibility of health care. It gives particular weight to promotion of primary health care, continuing the traditional involvement of the rural people through the Women's Committees and the Pulenu'us for rural development and health. It introduces a population policy designed to enable each family to plan and have the number of children which will meet its own aspirations and the national goal, for whom the best possible growth environment can be assured. Considerable importance will be attached to the further development of maternal and child health care a~d health education to ensure that individuals and families can act intelligently in their own and the nation's interests. 293

294

SAMOA (continued)

Specific health development These are as follows: (l)

st~ategies

Continuation of efforts to strengthen prima~y health care, particula~ly in rural a~eas. By the end of 1983, it is planned to have a trained health aide, or village health worker, in most villages. The water-seal latrine programme should have been completed and the Government expects bilateral aid sources to assist in quantitative and qualitative development of the Apia water supply system, a water carriage sewerage system for the urban a~ea and improved rural water supplies. A national working party has been established to take part in the International Drinking-Water and Sanitation Decade. Maternal and child health/family planning services will be intensified and health education tn maternal and infant health p~omoted. Health manpower development will be pursued along the planning lines already established and with increased local training content. District and regional supportive clinical and la~oratory serv1ces will be improve the quality of care close to people's homes. st~engthened

(2) (3) (4)

(5)

The National Hospital and Laboratory will be completed to provide a high quality referral service for patients identified as needing a level of care beyond that available in the districts. Health education services will be fully developed to provide programming, consultant, teaching and production services, particularly in priority preventive programmes and tn the schools. The policy planning and evaluation procedures of the Health Department will be strengthened, to improve the flexibility and responsivenesss of health care delivery. Intersectoral and community consultation and planning for health care improvement will be encouraged.

(6)

(7)

(8)

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management The Samoa country health programme, developed with WHO collaboration, identified a number of areas in which health care delivery can be improved, by reorganization, to provide for clearer definition of technical functions, closer supervision and upgrading of rural services and primary health care. The 1978 Commission of Enquiry into the Health Services Administration recommended a new administrative structure to achieve similar aims and the Government has adopted the Commission's recommendations. The country's capability for effective planning and management of health care will, with WHO collaboration, be continuously improved. Primary health care Village health workers (health aides) have been trained on a pilot scale to provide simple health care, health education and environmental advice in the villages. Provision of more health aides and other aspects of primary health care will form the main basis for the Health Department's contribution to rural development. WHO will collaborate, with support also anticipated from UNDP, in the tratntng and evaluation of the village health workers and health aides. UNICEF assistance will be required in equipping the health aides and providing them with so~e mobility. Workers' health Most workers are in the rural industries, although a growing number, including many women, are employed in small-scale manufacturing and service industries. The Health Department has been aware of the chemical and other hazards which may be significant and has embarked on a programme to improve occupational health services, beginning with a most successful national seminar in 1979. WHO will collaborate in further improving the services. Appropriate technology for health (Health laboratory technology) Upgrading the rural health services demands a corresponding improvement in the laboratory services available in the health districts. Plans for such development will be prepared during a visit to Samoa by a laboratory specialist already programmed for 1980. Contingent upon these plans, the Government has anticipated the need for considerable expenditure in this area and WHO will collaborate with certain activities in quality assurance.

295

296

SAMOA (continued) Family health Maternal and child health An intensive programme to improve the health of mothers and children through better antenatal, natal and postnatal care is planned; neonatal and child care and nutrition education will be a fundamental activity in attacking maternal and infant morbidity and mortality. More effective family planning programmes will be encouraged as part of the national population policy and staff, transport and resources for the family welfare services will continue to be provided. WHO will collaborate to further these programmes in conjunction with UNFPA and UNICEF. Health education A national programme has begun to develop a health education section. A nutrition education centre is also being established. By 1982, the health education services will be fully operational and the Health Department proposes to embark, with WHO participation, on the local training of health staff and especially of teachers in support of programmes in schools and in the community. Communicable disease prevention and control Malaria and other parasitic diseases The programme of research in epidemiology and control of filariasis, including studies on the minimum effective dosage of treatment drugs, has been in operation since 1977 with WHO collaboration. However, filariasis is a major problem in Samoa and the Health Department expects that it will be necessary to continue control programmes, including mass treatment from time to time. WHO will collaborate in the development and maintenance of national vector control and clinical programmes, supported by UNICEF's continued collaboration in the provision of essential drugs and maintenance of transport and equipment. Bacterial, viral and mycotic diseases It is anticipated that, by 1982, the tuberculosis and leprosy control programmes will have been reorganized with cooperation from WHO. Collaboration with UNICEF for provision of the necessary drugs and vaccines will be sought and training and monitoring activities continued. Expanded programme on immunization A special effort will be made, in the expanded programme on immunization, to raise the level of effective immunization against the childhood diseases and further to improve programme management and vaccine handling. In 1982, measles vaccination will be introduced into the schedule of immunization for Samoan children.

Noncommunicable disease prevention and control Cardiovascular diseases There is still an increasing trend in the incidence of cardiovascular and metabolic diseases. With bilateral support and WHO cooperation, development of control activities in these fields will be continued. Oral health Caries and periodontal disease are problems affecting a majority of the population. Special attention will be given to preventive programmes, especially among schoolchildren and pregnant women. More dental nurses will be locally trained to carry out prophylactic programmes in the schools and villages. WHO will collaborate in these activities. Other noncommunicable diseases Certain noncommunicable diseases, such as peptic ulcer, obesity and diabetes, are of growing importance. Their control is difficult and may require substantial behavioural and dietary modification. WHO will collaborate in planning and implementing countermeasures against these destructive diseases. Promotion of environmental health Environmental health planning and management Staff wastage, through resignation and retirement, and increased demands for environmental health management have led to a shortage of trained sanitarians. WHO will collaborate in the local training of assistant health inspectors, in revision of the public health legislation and in strengthening the programme as a whole. Basic sanitary measures Considerable progress has been made, with WHO and UNICEF cooperation, in the provision of water-seal latrines for rural dwellers. By 1982, the project will have been largely completed. A working party has also been established in implementation of the United Nations International Drinking-Water Supply and Sanitation Decade, to define the remaining needs for potable water and sanitation in every household. The role of WHO, with support anticipated from UNDP, will be to collaborate in expanding the programme, including training and information transfer. The programme has high priority in the delivery of primary health care and in relation to the urban situation, in view of the continuing threat to health posed by diarrhoeal diseases.

297

298 SAMOA (continued) Health manpower development Promotion of training With cooperation from WHO staff, a manpower development plan up to 1984 has been prepared. It is apparent that the shortage of trained personnel' continues to present a serious impediment to plans for health care. While bilateral aid sources provide some assistance, the mainstay of the external training programme for some years past has been the provision of overseas training by WHO, in which the Organization will continue to collaborate as well as in local training to meet many of the manpower needs defined in the Health Department's plan. Educational development and support A particular need is upgrading of the nursing school, to provide for the local training of graduate nurses in postbasic areas of public health, midwifery and physician assistant duties. WHO will continue to collaborate in the further development of these courses, with participation from UNFPA.

S~'!OA

1980-81 ,---

1982-83 Regular budget US$ Other Sourc es So urce US$

Increase/ (Decrease)

Major programme/programme

Regular budget US$

r---

Other Sources Source of funds US$ Total

Total

Regular budget

"""US$

of funds ________ _,___

~u~s=-$---r---=u~-

2.2

General l!ro~ramme development and management 2.2.2 Country health programmi ng (Share of costs of \o/HO Programme Coordinator's office, Suva, Fiji)

48 400

94 600

46 200

3.1

Health services development 3. l. 1 3. l. 2 3. 1. 3

Health services planning and management Primary health care \o/orkers' health Appropriate technology for health (Health laboratory technology)

106 400

110 000 20 000 20 000 DP

110 000 40 000 000

3 600

20 000 2 500

2 500

5 000

3. 1. 5

5 000

3.2

Family health 3.2.1 3.2.4 Maternal and child health Health education 2 000

74 800

74 800 2 000 5 000

170 000

170 000 5 000 3 000

4.1

Communicable disease prevention and control 4.1.2 4.1.3 Malaria and other parasitic diseases Bacterial, viral and mycotic diseases 4 000 86 600 VD 86 600 4 000 15 000 15 000 11 000

299

300

SAMOA Regular budget US$

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget

Major programme/programme

·4.2 Noncommunicable disease ~revention and control 4.2.2 4.2.3 5.1 Cardiovascular diseases Oral health

USl

1 000 5 800

5 000 20 000

4 000 14 200

Promotion of environmental health 5. 1.1 5.1. 2 Environmental health planning and management Basic sanitary measures man~ower develo~ment

110 000 84 900 DP 84 900 40 000 DP

110 000 40 000

110 000

6.1

Health

6. l. 1 Health manpower planning and management 6.1. 2 Promotion of training

10 000 202 300

10 000 202 300 290 000 15 000 ----694 600 ::=::-:::::=::::=rs

oo 290 000

ooo>

87 700 __ 15_000 307 200 =====:a::aa:s

6.1. 3 Educational development and support Total - SAMOA

---387 400 ==s:z::c:=::s::s.:=r

---========:== 633 700

---230 000

15 000

246 300 :"::=:::::~::=:=

::::::s::=====

===-======

924 600

SINGAPORE NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL In 1978, the population of Singapore was estimated at 2 334 400. The infant mortality rate was 12.6 per thousand live births; the natural increase of population was 1.2%, the crude birth rate 16.9 per thousand and the crude death rate 5./. per thous~nd. The demographic goal is to maintain fertility at replacement level to achieve zero population growth by the year 2030. Health education to promote a healthy life-style and prevent disease will continue to receive greater emphasis. National health campaigns are organized as part of the sustained programme to promote health consciousness. One such campaign was launched in 1979, the theme being "Combat diseases due to harmful life-styles". The five main diseases highlighted in the campaign were ischaemic heart disease, hypertension, lung cancer, mental illness and diabetes. With the increasing momentum in resettling the population in the new satellite towns and housing estates, new generation polyclinics were established between 197~-80 to provide better primary health care services. The polyclinics provide curative, preventive, psychiatric and dental services to the resident community of the new towns. This is in addition to the existing 30 outpatient clinics and maternal and child health clinics. Plans are under way to build another four polyclinics between 1980 and 1985, which will, in time, replace some of the existing older clinics. The school health services, through composite health teams of doctors and nurses, provide preventive health care to the half million school children in Singapore. Not only is the general health and nutritional status of pupils assessed but also their mental, emotional and intellectual development. The immunization programme for school ch~ldren includes smallpox revaccination and the provision of booster doses of diphtheria, tetanus, and poliomyelitis va~cines. The immunization programme against rubella, which was started in late 1976 for girls in the 11+ age group, will continue. In 197A, the total number of health personnel in the public and private sectors was 1860 physicians, 476 dentists, 7059 nurses, 857 midwives and 330 pharmacists. Plans are under way to improve the fa~ilities available in the existing government hospitals. The Singapore General Hospital, which is betng redeveloped at an estimated cost of S$270 million,l will initially provide accommodation for approximately 1350 patients with the possibility of increasing the number to 2100. Redevelopment is expected to reach completion by 1982. In addition, plans are under way to construct a new 750-bed teaching hospital, to be completed by 1985. To meet the increasing demands of the health facilities and carry on the work in preventive health care, the emphasis in cooperation with WHO will still be on training of health personnel, particularly the paramedical, ancillary and nursing members of the health team.

lus$1

= S$2.16.

301

302

SINGAPORE (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Workers' health Accidents in factories causing death and injury have been increasing since industrialization began in the 1960s. Because manpower is the only natural resource, the economic well-being of the country depends to a large extent on the continuing productivity of its workers. The importance of safe and healthy working conditions is recognized, as is the need for trained workers and safety personnel, consultant services and research. The Institute of Occupational Safety and Hygiene has been established with the aim of reducing the industrial accident rate. With cooperation from UNDP and 'JHO, the Institute hopes to: (1) (2)

train workers and health personnel to meet the needs of industry; provide consultant and expert services in occupational safety and health to industry and other esta?lishments; promote ae1d undertake research in occupational safety and health.

(3) ~ental

health

With the expected increase in demand for psychiatric care in an urban society, it is essenttal that psychiatrists and paramedical staff, such as the psychologist and the medical social worker, are competent. Coopecation will be needed in training such personnel. Communicable disease prevention and control Epidemiological surveillance The incidence of viral hepatitis, foodborne diseases and influenza emphasizes the need for epidemiological surveillance and research. The existing surveillance system and laboratory facilities will be evaluated and the most practical method for reducing the morbidity and mortality of these diseases investigated. Noncommunicable disease prevention and control Oral health ~YHO

will collaborate in the training of dental technicians.

SINGAPORE (continued) Promotion of environmental health Environmental health planning and management The Ministry of the Environment is responsible for the protection and improvement of the environment. As more industries are established, there will be an increase in air and water pollution problems. The objective is to protect Singapore's water resources and maintain a standard of public health to match the economic development. Cooperation will be needed to train staff in public health engineering, pollution and food control. An increased number of chemical and pharmaceutical industries will be established as a direct result of active promotion for investment in the future. As a result, it is likely that air and water pollution problems will arise. Cooperation will be extended in acquiring techniques for control. With rapid ind~strialization it is necessary to approach the problem of solid waste disposal in a more scientific manner. Legislation is being drafted to tighten control. Cooperation will be given in developing safe methods of disposal. Basic sanitary measures Cooperation will be extended in training for the maintenance and improvement of basic sanitary measures. Food safety The Food Section of the Ministry of the Environment is responsible for the control of all food sold in Singapore, including canned and pre-packed food. It is also responsible for licensing and periodical inspection of food factories. WHO will cooperate in developing standards to be used in the inspection of food. Health manpower development Promotion of training Greater emphasis will be placed on the training of paramedical, ancillary and nursing staff as important members of the health care delivery team. Health information Health statistics Cooperation will be given in training a statistician in the epidemiology of cancer, cardiovascular diseases and mental illness so that epidemiological analysis and research may be carried out for the purpose of evaluating and monitoring activities.

303

304

SINGAPORE

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of ful!~-Total US$

-· Major programme/programme

Increase/ (Decrease) Regular budget

US$

us$

2.2

General erogramme develoement and management 2.2.2 Country health programming (Liaison office of the WHO Programme Coordinator, Kuala Lumpur, Malaysia Add: Share of costs of WHO Programme Coordinator)

80 000 24 900 104 900 104 900

89 700 26 000 115 700 115 700 10 800

3.1

Health services develoement 3. 1.1 Health services planning and management 48 000 185 300 6 400 DP 48 000 185 300 6 400 14 000 314 400 (48 000)

3.1. 3 Workers' health 3.3 4.1 Mental health Communicable disease erevention and control 4.1. 1 4.2 Epidemiological surveillance

314 400 14 000 7 600

6 500

Noncommunicable disease erevention and control 4.2.3 Oral health 2 400 2 400 24 000 24 000 21 600

5.1

Promotion of environmental health 5.1.1 5 .1. 2 5.1.4 Environmental health planning and management Basic sanitary measures Food safety 8 800 8 800 11 000 11 000 1 500 11 000 11 000 1 500 2 200 11 000 1 500

..-------· 1-·

SINGAPORE Regular budget 1980-81 Other Sources Source Total of funds uS$- - - - - r-·--usr Regular budget US$ 1982-83 Other Sources Source of funds

---- ------Increase/ (Decrease) Regular budget

Major programme/programme

Total

-·---6.1 Health maneower develoement 6 .1. 2 7. l

us$

usr-

US$---

1--usr-79 600

Promotion of training

143 400

223 000

Health information 7. 1. l Health statistics Total - SINGAPORE 6 000

---========::= 185 300

6 000

9 000

-----314 400 s=====:=:::

9 000 ----

3 000 -----

=========

319 900

=========

505 200

======::o==

415 700

=========

730 100

=========

95 800

305

306

SOLO~ON

ISLANDS

NATIO~AL

HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL

The national development plan, 19RO-R4, proposes the following aims for the health component: (1) (2) (3) to provide a comprehensive integrated health service throughout Solomon Islands; to improve the distribution of existing and new health services on a provincial basis; to encourage the people in the villages to improve their standards of personal health through programmes of primary health care, environmental health and sanitation, health education and family health as well as other preventive techniques; to ensure that the present level of medical services is maintained throughout the country; to undertake an investigation into the use and practices of traditional medicines and to determine their contribution to the national health service.

(4) (5)

To attain the goal of health for all, priority is given to development of the basic health services, supported by village health aides and other primary health workers, together with strong community participation. Improvement of family health with a reasonable population growth, control of malaria and other major communicable diseases, and provision of safe water and sanitation facilities receive particular emphasis. At the same time, physical facilities are to be improved to ensure better coverage. Development of manpower will continue, to provide a sufficient number of well-trained local health personnel for the health services as a whole.

TECHNICAL COOPERATION

PROG~

FOR HEALTH DEVELOPMENT

Health services development Health services planning and management WHO will cooperate with the Ministry of Health and Medical Services in efforts to improve its planning and managerial capacity at all levels, with a view to providing a comprehensive integrated health service. Divisions or programmes of the Ministry are to be well-balanced and effectively coordinated. In keeping with the basic government policy of decentralization and rural development, an effective network of health services, with emphasis on

peripheral health services, will be further developed and strengthened. While a satisfactory standard of hospital services will be maintained, health centres, health clinics and health aid-posts will be substantially improved and expanded to provide a basic framework for the objective of health for all in Solomon Islands. Primary health care The Government of Solomon Islands, a country of many islands spread over a wide area, faces a difficult problem in delivering health care to all the population, particularly the population of the outer islands and remote rural areas. The high cost of transport and poor communications, as well as a shortage of health personnel, aggravate the situation further. Primary health care, based on practical, scientifically sound and socially acceptable methods and technology, will be made universally available to the population as a whole, through their full participation and at a cost the community can afford. WHO will continue to cooperate in training the village health aides and other primary health workers and in the overall development of primary health care. Consideration will be given to bringing the traditional health system and workers into the network of primary health care. Family health Maternal and child health The family health programme is integrated into the general health servtces. Efforts will continue, to improve the health of mothers and children. Nurses are now allowed to prescribe and apply a wide range of contraceptive methods, and family planning, with its aim of achieving a reasonable rate of population growth, has gathered momentum. WHO collaboration, with support anticipated from UNFPA, will concentrate on staff training and on upgrading the coverage and supply of contraceptives, both as to quality and quantity. Nutrition Attention will also be paid to the problem of nutrition in view of the socioeconomic and cultural changes taking place in the country. WHO will cooperate in monitoring the nutritional status and advise on the necessary preventive measures. Health education The Government, fully recognizing the vital role to be played by health education in public enlightenment, will, with WHO cooperation, for which support will be negotiated with UNFPA, expand its activities to cover rural areas and schools. Local customs and culture are being taken into greater consideration in the development of health education programmes. Communicable disease prevention and control Malaria and other parasitic diseases The antimalaria programme has progressed considerably in the last decade and malaria morbidity and mortality has been significantly reduced, especially among children. However, because of various technical, operational and administrative problems, the programme 307

308 SOLOMON ISLANDS (continued) has encountered serious setbacks, including flare-ups of the disease since 1978. Consideration is being given to changing the objective to malaria control in 1980, with a view to maintaining the gains already achieved and controlling the disease below the level of public health importance. Consideration will also be given to further decentralization and integration within the general health services. The Government accords a high priority to the malaria programme, in which WHO will continue to collaborate with support anticipated from UNDP. Expanded programme on immunization Through the expanded programme on immunization, WHO and UNICEF will continue to cooperate in improving the cold chain and immunization coverage. Promotion of environmental health Environmental health planning and management To meet the health manpower requirements of the expanding and improving environmental health services, the Government will continue, with WHO cooperation and UNDP funding support, to train assistant health inspectors. Basic sanitary measures Lack of a safe water supply and poor sanitation services rank high among the main contributory causes of morbidity and mortality in Solomon Islands. To combat the situation, the Government is intensifying its efforts to strengthen the decentralized health services by appointing better trained environmental health staff. The national development plan aims at improving environmental health by including provisions to improve rural water supplies, build latrines and develop waste disposal facilities within the community development programme. As a result of industrial development, more attention will be given to pollution. WHO cooperation will consist in ensuring the availability of information on relevant low-cost technology and helping to mobilize additional investment, extrabudgetary resources and collaboration with UNDP and other bilateral agencies. Health manpower development Promotion of training The shortage of trained health personnel, particularly physicians, nurses, malaria workers, pharmacy staff and health educators, is a critical and primary constraint in the development of health services. With WHO cooperation, the training and retraining of health staff will be accelerated throughout the programming period. National facilities will be used to train front-line health workers, including nurses, health inspectors and primary health care workers, but a need remains to train skilled manpower, physicians, some nurses and technicians, in neighbouring countries.

Health.information Health statistics The health information system, including vital statistics, will be strengthened in order to monitor the prevailing situation as well as the implementation of major health programmes and their impact on socioeconomic development. Health legislation To support these developments, health legislation ~s

being updated.

309

310

SOLOMON ISLANDS Regular budget US$

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total

Increase/ (Decrease) Regular budget US$

Major programme/programme

2.2 General eroaramme develoement and man asement 2.2.2 Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

Us$

48 400

94 600

46 200

3.1

Health services develoement 3.1. 1 3.1. 2

Health services planning and management Primary health care

121 200 30 000

120 000 56 000

(l 200) 26 000

3.2

health Fami~ 3.2.1 3.2.4 Maternal and child health Health education 13 400 FP 13 400

60 000 60 000

4.1

Co11111lUni cable disease ereventio!!_ and con trol 4.1. 2 4.1. 3

Malaria and other parasitic diseases Bacterial, viral and mycotic diseases

108 000 9 700

135 200

243 200 9 700

213 000

134 000

347 000

105 000 (9 700)

4. 2

Noncommunicable disease 2revent ion and control 4.2.0 Programme planning and general activities 4 800 4 800 "h'

(4 800)

SOLOMON ISLANDS Regular budget US$ 5.1 Promotion of environmental health 5 .1.1 5.1. 2 6.1 Environmental health planning and management Basic sanitary measures

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

96 000 400 000

DP DP

96 000 400 000

104 600 548 000

DP DP

104 600 548 000

Health maneower develoement 6.1.1 6.1. 2 Health manpower planning and management Promotion of training Total - SOLOMON ISLANDS 9 400 216 900 9 400 216 900 644 600 =~==z::s::a::r

(9 400) 261 000 744 600 =========:a~

261 000 906 600 s:zs:::a:=:=::=:::

44 100 196 200 ====:.t====

========·

548 400

1 193 000 =-=====:a==

=====:====

1 651 200

311

312

TOKELAU NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL In 1976 the population of Tokelau was roughly 1600, more than 50% being under the age of 16. The social, educational and economic level is that of a developing country. Social, cultural, political and economic development must keep pace, and be directly proportional to, the level of education as it advances. Although the health problems of Tokelau are much less complicated than those of a developing country, the national goal is much the same. The policy is to maintain a health service that is capable of: (1) supporting the national goal of attainment of a higher educational status by the younger generation; coping with emergencies and the common illnesses normally encountered by the general population.

(2)

The aim is continuously to modify the primary health care strategy so that it relates to prevalent public health problems and the preventive measures that should be adopted. This calls for an appreciable understanding by the health personnel of such fields as environmental health, including vector and pest control, maternal and child health, school and community health, family planning, dental health, immunization and epidemiology. Because of the situation in Tokelau and its total population, it is not intended to develop a sophisticated health service. However, there is a need for continuous review and adaptation of policies and strategies, depending on the health problems prevalent at any one time. Such problems will be dealt with on an ad hoc basis, keeping in mind the necessity to maintain the health status at a manageable level. The free medical service continues but, because of the magnitude of the sum involved in relation to the national budget, a change in this policy is foreseen for the future, whereby people will have to pay for medical care, or assistance will be sought from agencies within the United Nations system or bilateral sources. The involvement of local councils in the delivery of the health services is not encouraged, because the present health personnel are able to cope well with the task, taking into account the size of the population. However, the community is being motivated, through health education, to maintain an acceptable level of general health.

TOKELAU (continued) TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health manpower development Promotion of training The only contact Tokelau has with the outside world is when a chartered vessel visits the group, usually five times a year. Thus, efforts must be oriented to prevention, rather than to cure. A long-term training programme is needed for medical and paramedical personnel, of which there is a shortage which is expected to worsen. The extent of the public health workload reflects the type of population. Specialization is not favoured. It is preferred that the knowledge and responsibilities of the health personnel should be more general. There is therefore a need for constant familiarization and proper supervision. WHO will cooperate in the training of medical staff.

314

TOKELAU 1----

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total

Increase/ (Decrease) Regular budget

Major programme/programme 1---

uS$

us$

6.1

Health maneower development 6. l. 2 Promotion of training Total

-----===:::======

- TOKELAU

---===-:::=====

----==========

10 000 ------

---=========

10 000 ----

10 000 ------

==========

10 000

=========

10 000

::::=======

10 000

TONGA NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL National development objectives for the fourth five-year development plan, 1980-85, include a sustained increase in services, a fair distribution between people in different parts of the Kingdom, enhanced quality of life, preservation of the environment, and harmonious relations and mutual cooperation with all national and international organizations. The (1) (2) ~inistry

of Health has approved the following sectoral aims for 1981-85:

increased social and economic productivity as a result of the improved health of the population; improved quality of family life, through education and opportunities for families to be planned. The natural growth rate of the population to be brought into balance with socioeconomic development; more equity in the health service system: maximal development of the abilities of Tongan nationals within the system; greater equalization of levels of service to all island groups and rural areas; greater efficiency in the health service system; Increased protection of the population from environmental hazards.

(3)

(4) (5)

The development of primary health care has been accorded the highest priority. This will involve several strategies, the first of which is the medical assistant programme, under which the new Tonga Health Training Centre has initiated the development of manpower. These workers, to be known as health officers, will be posted to underserved areas, initially mostly rural. Other manpower development activities in the context of primary care will affect nurses, people in the community and traditional health workers. Primary health care will be the main focus for improvements in facilities, information systems and health education. It is recognized as a key aspect for the strengthening of immunization, diarrhoeal and communicable disease control, and family health services. Intensified efforts will be needed to achieve a birth rate target of 25 per 1000 by 1985. Environmental health strategies aim at the attainment of full coverage with safe water supplies by 1985 and a strengthening of the service in the existing systems in the interim. Various approaches will be tried to improve the handling of excreta disposal and other environmental hazards.

316 TONGA (continued) The strengthening of planning, programming and management is essential for the execution of other strategies for health. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management A vital aspect of the programme to extend the health services coverage and increase efficiency, is the necessity to improve the Department of Health's planning and managerial capacity. Clearly defined post descriptions and areas of responsibility for health workers at various levels must be developed. The national health information system, including vital statistics, needs strengthening in order to facilitate the planning and implementation of the health programme. WHO will cooperate 1n all aspects of health services planning and management. Primary health care In Tonga, a country comprising several islands, great difficulty is encountered in providing health care at the periphery. The high cost of transport for staff and supplies and poor communication facilities compound the problems. The national policy is to develop an efficient primary health care network as part of an integrated community development programme. Greater community involvement and responsibility for primary health care is being promoted. WHO will collaborate in the national training programme for primary health workers and in developing the network of services. Family health Maternal and child health As the health system improves, with its important primary health care component, closer integration of all family health activities is planned. There is a particular need to strengthen the maternal and child health programme, as well as family planning, in view of the increasing young population entering the reproductive age. Appropriate health education at community level is needed to promote continuing family planning practices. WHO will collaborate in developing the family health programme with the support of UNFPA.

Communicable disease prevention and control Malaria and other parasitic diseases There is no malaria in Tonga. Filariasis, however, is a particularly persistent problem. WHO will continue to cooperate in the national filariasis control programme. Bacterial, viral and mycotic diseases Typhoid fever and tuberculosis still rank as important health problems while there is hope for eradication of leprosy. WHO will continue to cooperate in national control programmes for those diseases, particularly in training and the development of systems of follow-up and contact management. Noncommunicable disease prevention and control Cardiovascular diseases Noncommunicable diseases, in particular cardiovascular disorders, cancer and metabolic diseases, are of growing importance in Tonga. WHO collaboration will support the emphasis being placed on the prevention and early effective treatment of these conditions. Oral health Cooperation from WHO will continue in the evaluation of oral health problems and methods of control, while new approaches will be explored to solve the difficult manpower problems involved. Promotion of environmental health Environmental health planning and management Tonga is very short of trained personnel at the managerial and planning levels. WHO will continue to collaborate, with support from UNDP, in the national environmental health programme and in pre-investment studies for water supply, construction of water systems and latrines, and construction of drainage and waste disposal facilities. It will also cooperate in seeking extrabudgetary support from bilateral and multilateral sources. Basic sanitary measures Many villages, especially on the outer islands, have not been provided with adequate and safe sources of potable water and safe and proper disposal facilities for refuse and sewage. Even in the main districts, a fair proportion of households do not have a supply of safe water. WHO and UNDP cooperation, including operational assistance, is expected to be required throughout 1982, in the man2gement of the Nuku'alofa waterworks and subsequently in completing the water systems for peripheral areas and in seeking effective solutions to disposal problems.

317

TONGA (continued) Health manpower development Promotion of training The training of medical assistants started in Tonga, with ~~0 cooperation, in 1979 and will be continued throughout the biennium 1982-83, as the Tonga Health Training Centre begins to extend its approach to other categories of personnel. To reorient nursing education towards current service needs, WHO will cooperate in integrating undergraduate nursing education, in-service training and the training of other levels of staff, with a curriculum flexibly adapted to serve national health objectives. Although national facilities are available for the training of frontline health workers, including nurses, medical assistants, sanitarians and volunteer health workers, there will still be a need to train skilled manpower (physicians, some nurses, and technicians) in neighbouring countries. WHO will cooperate in strengthening national courses and in providing fellowships for study abroad.

TO'qGA Regular budget

1980-81 Other Sources

--------------------------------,--------, 1982-83 Regular budget Other Sources Total Increase/ (Decrease) Regular budget

~ajor

orogramme/programme

-------- -----us r--2.2 General programme development and management 2.2.2 Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

---rrsr--

Source of funds

Total

---us$

us$

US$

usr---

47 600

47 300

(300)

3.1

Health services development 3.1. l 3.1.2 3.1.5 Health services planning and management Primary health care Appropriate technology for health (Health laboratory technology) 124 000 28 000

124 000 28 000

130 000 40 000

6 000 12 000

38 600

(38 600)

3.2

Family health 3.2.0 3.2.1 Programme planning and general activities Maternal and child health 129 400 FP 129 400 180 000 FP 180 000

4. l

Communicable disease prevention and control 4.1.2 4.1.3 Malaria and other parasitic diseases Bacterial, viral and mycotic diseases

5 000

5 .000

5 000 20 000

5 000

io ooo

20 000

319

320

TONGA Regular budget US$ 4.2 Noncommunicable disease ~revention and contro~ 4.2.0 4.2.2 5.1 Programme planning and general activities Cardiovascular diseases 9 700

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

9 700 5 000 5 000

(9 700) 5 000

Promotion of environmental health 5. l.l 5.1. 2 Environmental health planning and management Basic sanitary measures man~ower

23 600 180 700 OP

23 600 180 700

20 000 30 000

100 000 60 000

DP OP

120 000 90 000

(3 600)

30 000

6.1

Health 6.1.0

develoement 102 800 37 300 416 600 :a:as:as::ss=

Programme planning and general activities

102 800 37 300 310 100 :IS:S::SSS'!ll$=

(102 800) 250 000 547 300 s===•====340 000 =ss!=tls:ss::a:a

6.1. 2 Promotion of training Total - TONGA

2'>0 000 887 300 •*==::a••••

212 700 130 700 :::a:::aa:c•••

726 700 ::s::c::s-::s=ss•=

TRUST TERRITORY OF THE PACIFIC ISLANDS NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL With the termination of the United Nations Trusteeship Agreement in 1981, it is expected that four separate political entities will be created: Commonwealth of the Northern Mariana Islands, Marshall Islands, Republic of Palau, Federated States of Micronesia. While each entity has a different economic outlook, all have the stated goal of self-sufficiency through internal economic development so as to decrease dependence on the United States of America. A preliminary state health plan for the Trust Territory, covering the period 1979-1984, has been developed under the following guiding principles: (1)

increased self-sufficiency in the protection of health and the provision of health serv1ces; change from the current emphasis on curative health services to the promotion of healthy living practices and the prevention of avoidable and unnecessary conditions of ill health; improved equality in access to health services; improvement in quality of the direct health care serv1ces and the health supportive services provided 1n the Trust Territory.

(2) (3) (4)

A report on a medical facilities replacement study has been prepared for the Commonwealth of the Northern Mariana Islands (CNMI). The report emphasizes development of community-based outreach and preventive services, health education, maternal and child health, environmental health, and health manpower development. The priority areas for future development, as stated in the Trust Territory preliminary state health plan and the CNMI medical facilities replacement study, can be summarized as follows: (1)

provision of primary care services for medically underserved. populations, especially those located in rural or economically depressed areas; training and increased utilization of physician assistants, especially nurse clinicians (Trust Territory); promotion of activities to achieve needed improvement in the quality of health servi~es;

(2)

(3)

321

322 TRUST TERRITORY OF THE PACIFIC ISLANDS (continued) (4) development, by health service institutions, of the capacity to provide various levels of care (including intensive care, acute general care, and extended care) on a geographically integrated basis; promotion of activities for the prevention of disease, including studies of nutritional and environmental factors affecting health and the provision of preventive care services; development of effective methods for educating the general public in proper personal (including preventive) health care and methods for the effective use of the available health services.

(5) (6)

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management Major attention will be paid to changing the emphasis of health services from the curative to the preventive and to improving the administration and supervision of health services so that more effective and efficient health care services may be delivered by the health system. Improvement in the efficiency of health services will require a continuous input of managerial skills. Primary health care One of the national goals, as stated in the comprehensive health plan, is to raise the level of public awareness and understanding of health-related issues, so that more individuals involve themselves in improvement efforts for their own health and the health status of the community. The developme~t of community-based primary health care programmes will directly contribute to that goal. A national workshop on primary health care will be held in 1980. Major areas to be developed in 1982-83, with WHO cooperation, will be closer coordination between the various sectors and development of the potentials of community organizations to contribute to the primary health care programme. Primary health care workers will be further developed to meet the requirements of the programme. Appropriate technology for health (Health laboratory technology) The comprehensive health plan also calls for the establishment of public health laboratory services which are of low cost but effective for the service area. There will also be a need for trained personnel. In 1980 cooperation is being extended in strengthening laboratory techniques. WHO will continue to collaborate in improving the public health laboratory services through provision of fellowships for selected laboratory personnel.

Family health Maternal and child health The long-range goals of the family health programme are to reduce morbidity and mortality in infants, children and mothers and to regulate fertility. The primary health care approach will be emphasized in the development of the programme at the community level. It is envisaged that UNFPA will be requested to contribute funds for the family health programme, including maternal and child health and family planning. Nutrition The need to strengthen the nutrition programme will be met with cooperation from WHO.

Health education WHO will cooperate in developing the health education programme and in producing the necessary educational materials. Communicable disease prevention and control Bacterial, viral and mycotic diseases Major attention will be paid to the prevention and control of diarrhoeal diseases, sexually transmitted diseases, tuberculosis and leprosy. WHO will participate in strengthening surveillance and control activities in this broad area. Expanded programme on immunization With WHO cooperation, continuous efforts will be made to improve the immunization programme against childhood diseases. Particular emphasis wilt be placed on improving the cold chain and the coverage of eligible population groups by potent vaccines. Vector biology and control There is a need for continuation of staff training in this field and WHO will cooperate in the organization of inservice courses. Noncommunicable disease prevention and control Oral health health education. Oral health programmes will be further developed and extended, with emphasis on dental WHO will collaborate in activities for training.

Other noncommunicable diseases Metabolic diseases, especially diabetes, are of growing importance and concern. Surveys will be continued and health education programmes intensified with WHO cooperation. 323

324

TRUST TERRITORY OF THE PACIFIC ISLANDS (continued) Promotion of environmental health Basic sanitary measures The programme on the development of safe water supply and waste disposal facilities will be continued, with inservice training courses to upgrade local expertise. Food safety Improvement of food sanitation is needed in many of the islands. will be in such areas as improving food health legislation and inservice training. Health manpower development Promotion of training Shortage of health manpower is still a constraint to the development of health programmes. To meet the objectives of the comprehensive health plan and to support the primary health care programme, it is necessary to train health staff at the supervisory and teaching levels. WHO will continue to collaborate in the programme. Health information Health statistics To develop a sound health information system, the hospital records, health records and reporting system require further improvement. In conjunction with primary health care, the feasibility of developing a lay reporting system will be explored. WHO will collaborate in developing the system. WHO collaboration

PACIFIC ISLANDS Regular budget

1980-81 Regular budget

1982-83

------------- ---.---Other Sources Source of funds Total Source of funds Total

Increase/ (Decrease) Regular budget

~ajor programmelprogra~e

-----us$-2.2 General 2.2.2 progr~mme

development and

manage~~

Country health programming (Share of costs of WHO Programme Coordinator's office, Suva, Fiji)

47 300

3. 1

Health services development 3. l. 2 3. l. ') Primary health care Appropriate technology for health (Health laboratory technology) 5 000 5 000 24 000 24 000 19 000

25 000

13 000

(12 000)

3.2

.Fami !1.._he a 1 th 3. 2. 1 3.2.4 Maternal and child health Health education 20 000 4 000 10 000 20 000 4 000 10 000 42 000 20 000 90 000 FP 132 000 20 000 22 000 16 000 (lO 000)

3.3 3.4

Mental health -------Proehylactic, dia!lnostic and therapeutic substances 3.4.0 Programme planning and general activities

10 000

(lO 000)

4.1

----4.1.1 4. l. 3 4. l. 8

Communicable disease prevention and-contro-l____ Epidemiological surveillance Bacterial, viral and mycotic diseases Vector biology and control 15 000 15 000 3 000

(15 000) 3 000 6 000 3 000 6 000

6 000

325

326

TRUST TERRITORY OF THE PACIFIC ISLANDS Regular budget US$ 4.2 Noncommunicable disease 2revention and control 4.2.0 4.2.3 4.2.4 5.1 Programme planning and general activities Oral health Other noncommunicable diseases 10 000 16 000

1980-81 Other Sources Source of funds Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

usf

usr

10 000 16 000 19 000 3 000 19 000 3 000

(10 000) 3 000 3 000

Promotion of environmental health 5. l. 2 Basic sanitary measures 5. 1.4 Food safety 20 000 20 000 8 000 8 000 (20 000) 8 000

6.1

Health maneower develoement 6. l. 2 Promotion of training 72 000 72 000 456 000 456 000 384 000

7.1

Health information 7.1.1

Health statistics Total - TRUST TERRITORY OF .THE PACIFIC ISLANDS

6 000

6 000 90 000

6 000

========·=

207 000

::=======:~:=

=====:====

207 000

=========

647 300

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

===·=-·===

737 300

=========

440 300

TUVALU NATIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL The second national development plan, of which health is an integral part, 1s being formulated covering the period 1981-83. Objectives in the field of health will be: (1)

to continue to develop and maintain preventive health services on all islands; to extend and improve the quality of the basic health services; to promote and strengthen activities relating to family planning and maternal and child health.

(2) (3)

The national development plan will give priority to the following programme areas in the field of health: (l) (2) (3) (4) extension of family planning services to cover up to 40% of eligible women in the reproductive age group; continued extension of sanitary facilities and water supply to all islands; development of adequate services for the care of the mentally ill; reduction of the incidence of faP.cally transmitted diseases through health education, supply of safe drinking water and sanitation.

The network of basic health services is acces~ible to the entire population. Further improvement is required through improved supervision of the island health services, referral of cases, and training of health personnel, especially nurses in midwifery and assistant health inspectors in environmental sanitation. Improvement of inter-island transport and telecommunication would greatly facilitate improvement in the health services. TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development With ~~0 cooperation, attention will be given to the development of health Primary health care services through primary health care. Under one programme in the previous national development plan it was proposed to give the island councils wider responsibilities in determining priorities and

327

328

TUVALU (continued) implementing projects. The island councils have unanimously mentioned health as a priority area. The wo!llen's committees, through the island councils, \-lill be involved in promotion of the concept of primary health care and further development of the health services. Appropriate technology for health (Health laboratory technology) There is a need to provide simple health laboratory services on all the islands, through training nurses and medical assistants to use simple laboratory techniques and equipment. WHO will participate in the prograrmne and UNICEF will be requested to provide funds for the purchase of essential laboratory equipment. Family health Maternal and child health The family health programme will be further developed. UNFPA will be requested to extend the family health project to 1984 and WHO will provide support to the programme. Development of antenatal, natal and postnatal services and child health care will continue, and family planning services will be extended to provide greater coverage of eligible women. Communicable disease prevention and control Malaria and other parasitic diseases ~ajor attention will be paid to the control of diarrhoeal and Bacterial, viral and mycotic diseases intestinal parasitic diseases, filariasis and tuberculosis. WHO will continue to cooperate in strengthening disease surveillance and control activities. In particular, it will be necessary to follow-up on the filaria mass treatment campaign carried out with WHO cooperation in 1972 and to determine the prevalence of helminthic parasitism with a view to instituting appropriate control measures. Expanded programme on immunization Further efforts will be made to extend the immunization programme against childhood diseases. Cold chain facilities, extending to all the islands, will be improved, in particular the repair and maintenance of refrigeration equipment. P~omotion

of environmental health

Basic sanitary measures The programme for the development of safe water supply 'and waste disposa::. facilities has progressed satisfactorily on Funafuti, the main island. Environmental health programmes on the outer islands will require a continued effort. A request will be made to extend the services of the United Nations volunteer, who will also assist in the inservice training of health inspectors.

Health.manpower development Promotion of training There is still a shortage of health manpower, especially nurses and medical assistants. WHO will cooperate in the postgraduate training of nurses in midwifery, public health/maternal and child health/family planning, psychiatry and theatre work, as well as in the local training of sanitation aides, assistant health inspectors, nurses and medical assistants. Health information Health statistics There is a need to develop a sound health information system, including a system for the lay reporting of health information. ~iHO will cooperate in the development of the health information system.

329

330

TUVALU Regular budget US$ 3.2 Familx health 3.2.1 3.2.4 5.1 Maternal and child health Health education 9 600

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

13 300

12 000

12 000 (9 600)

9 600

Promotion of environmental health 5.1. 2 Basic sanitary measures 12 300 DP 12 300 14 500 DP 14 500

6.1

Health man2ower development 6.1. 2 Promotion of training Total - TUVALU 42 400 42 400 75 000 75 000 32 600

---

=========

52 000

=========

25 600

==========

77 600

==========

75 000

=========

26 500

=========

101 500

=========

23 000

VIET NAM NA'IIONAL HEALTH DEVELOPMENT STRATEGY FOR HEALTH FOR ALL Based on the success of the health services development programme under the 1976-80 five-year plan, activities during the 1980s will continue to focus on the long-term objective for the year 2000, that is, protection of the health of all people, one of the most essential aspects being management of the health of the entire population. Other problems will have to be solved simultaneously such as those related to the after-effects of war, natural disasters and the environment. The basic objectives of the health services in Viet Nam under the five-year plan (1981-85) are the following: (1) Strengthening and developing the basic health services network, especially at district and commune levels

to reinforce the organization of basic health stations (commune, agency, company, construction site, forestry service, school, etc.); to improve the quality of basic commune and district health services in line with standards set by the Government and by the Ministry of Health regarding the construction of septic tanks, wells and bathrooms; to strengthen the management of the health of the population; to develop family planning in order to reduce the population growth rate; to develop self-sufficiency in the field of drugs by promoting the use of medicines made with locally available materials for a number of common diseases; to reinforce the basic health services network, the objective being to multiply by five or six compared with 1980 the number of communes and districts complying with the above-mentioned standards. (2) Improving the environment

Improving the environment is one of the main tasks of the health services. Problems of excreta disposal, water supply and garbage collection are still to be solved, especially in rural areas and populated districts. The objective of the plan is to provide one septic tank per family, and a well and a bathroom for every three families. 331

332 VIET NAM (continued) ()) Preventing and controlling infectious diseases

to reinforce the prevention and control of epidemics in order to eradicate cholera, plague, poliomyelitis and typhoid fever, to reduce the incidence of diphtheria, pertussis, measles and rabies, and to prevent the occurrence of widespread epidemics of such diseases as dengue haemorrhagic fever, Japanese B encephalitis and dysentery; to continue to control the following social diseases: malaria antimalaria activities will be pursued, to reduce the parasite rate to an average of 50/1000 throughout the country, with emphasis on target areas and the southern provinces in particular; tuberculosis the rate of M. tuberculosis positive cases will be reduced and the management of tuberculosis strengthened; 70% of M. tuberculosis positive cases will be cured; venereal diseases syphilis and gonorrhoea will be treated;

trachoma special attention will be devoted to the prevention and control of trachoma; the active morbidity rate will be reduced to 5% of the population living in 30% of all provinces and cities; goitre prophylaxis, based on iodized salt, will cover 6 to 7 million inhabitants throughout the country and 80 000 patients affected with third degree goitre will be treated; mental disorders

30% of all mental patients will be treated.

(4)

Reducing the natural increase rate from 2.3% in 1980 to about 1.5% 1n 1985.

(5) Strengthening the training of different categories of health supervisory personnel especially senior medical officers (duration of training, 4 years). It is aimed to increase the number of physicians and senior medical officers from 14 000 in 1980 to 22 000 in 1985. (6) Increasing production capacity for medicines, vaccines, chemical reagents and health equipment by using local materials, in order to double drug production from local raw materials by 1985.

TECHNICAL COOPERATION PROGRAMME FOR HEALTH DEVELOPMENT Health services development Health services planning and management Cooperation will continue in strengthening hospitals, Primary health care the five faculties of medicine and pharmacy, and the six schools for the training of middle-level health personnel. To meet the quantity and quality standards established for the construction and strengthening of the basic health network, the above-mentioned objectives will be included in the State Plan and in the plans of all provinces and regions, to ensure supervisory staff training, construction and maintenance of houses, definition of organizational and technical requirements, and establishment and operation of a basic health network throughout the country. WHO will cooperate in the following areas: exchange of experience in the organization of a basic health network; provision of resources for health management and efforts to increase the number of communes and districts having adequate facilities for protection of the health of the population; further organization of intercommunal laboratories and district hospital laboratories. Other international organizations will be requested to provide technical equipment for a number of commune health stations, district health and epidemics control teams (UNICEF) and for regional and district polyclinic and district hospital outpatient departments. Workers' health WHO will cooperate in training in occupational health and in developing an occupational health and hygiene laboratory. Care of the aged, disability prevention and rehabilitation the communities methods for rehabilitation of the handicapped. WHO will collaborate in introducing to WHO will cooperate in efforts

Appropriate technology for health (Health laboratory technology) towards standardization of laboratory techniques. Family health

Maternal and child health In the past, Viet Nam has received assistance in the field of family planning from a number of international organizations such as the International Planned Parenthood Federation and UNFPA. A request will be submitted for cooperation in 1982-83. 333

334

VIET NAM (continued) WHO will cooperate in the exchange of experience in family planning and in the scientific and technical supervision and management of family planning activities. Nutrition WHO will participate in continuing efforts to control endemic goitre through the provision of iodized salt and to treat disease caused by the third degree of goitre. Health education Cooperation established, will continue. Mental health Attention will be given to mental disorders. WHO will cooperate in the organization of control activities, in training supervisory staff, and in the treatment of mental patients. Cooperation will also be extended in establishing a centre for the treatment of drug abuse. Prophylactic, diagnostic and therapeutic substances Drug policies and management Improved self-sufficiency in drug and laboratory reagents supply Pharmaceuticals and biologicals is an essential aspect of disease prevention and treatment in Viet Nam. A pilot plant is to be developed at the National Institute for the Control of Medicines for the production of a number of standard laboratory chemicals to be distributed to the regions in order to standardize the quality of reagents. The Pharmacy Department at the Institute of Traditional Medicine will carry out similar activities. UNICEF, as well as WHO, is expected to collaborate in these activities. Communicable disease prevention and control Malaria and other parasitic diseases The five-year plan for malaria control will be continued. In view of the importance attached to malaria eradication, cooperation will be requested from a number of other international organizations as well as from WHO. Bacterial, viral and mycotic diseases In close cooperation with WHO, information on communicable diseases will be exchanged with other countries. ~n

health education activities including training, already well

Expanded programme on immunization An expanded immunization programme will be organized, based on national experience and on the programme developed by WHO. Vaccine production centres will be improved with UNICEF assistance in line with the three-year plan (1980-82). UNICEF and WHO cooperation will be provided in efforts to improve the cold chain. Prevention of blindness WHO will cooperate in the control and treatment of trachoma and other eye infections, including the exchange of experience in the organization of control activities and the techniques used throughout the world. Promotion of environmental health Basic sanitary measures The Government will endeavour to rely on local resources to carry out sanitation works, to train supervisory staff, to promote a wide and continuous sanitation mass movement and to review implementation problems. WHO will cooperate, with UNICEF assistance, in the field of water supply for some provinces. Recognition and control of environmental hazards WHO will cooperate in the exchange of experience in environmental improvement and in strengthening the national capability to assess and to solve environmental pollution problems, especially industrial pollution. Food safety Measures to control the quality of food products will be developed with the cooperation of WHO. Health manpower development Promotion of training To achieve the objectives in training physicians and senior medical officers, priority will be given, with WHO cooperation, to the establishment and operation of the six schools for the training of middle level health personnel and to the completion of the five faculties of medicine and pharmacy. Information will be exchanged on training and organization in these schools as well as on the training of supervisory personnel. Health information Health statistics Problems in connexion with development of a health information system will be dealt with in future years. WHO will cooperate in the organization of the system and with techniques relevant to the national situation during the first years of the five-year plan (1981-85). 335

336

VIET NAM Regular budget US$ 2.2 General ero~ramme develoEment and mana~ement 2.2.2 Country health programming (Costs of WHO Programme Coordinator's office, Hanoi, Viet Nam)

1980-81 Other Sources Source of funds US$ Total Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

us$

168 800

333 600

164 800

3.1

Health services develoEment 3.1.1 Health services planning and management 550 000 13 700 VK

563 700

200 000 425 000

(350 000) 425 000

3.1. 2 Primary health care 3. 1. 3 Workers' health 3.1.4 Care of the aged, disability prevention and rehabilitation

so so

000

so so

000

so so

000

3 .1. s Appropriate technology for health (Health laboratory technology) 3.2 Family health 3.2.1 3.2.2 3.2.4 3.3 Maternal and child health Nutrition Health education

2SO 000

19 100

vv FP

269 100

000

(200 000)

311

soo

311

soo 17S 000 2S 000 100 000 17S 000 25 000 100 000 17S 000 25 000 100 000

Mental health

VIET NAM Regular budget US$ 3.4 Proph)::lactic, diagnostic and therapeutic substances 3. 4.1 3.4.2 4.1 Drug policies and management Pharmaceuticals and biologicals 800 000 300 000

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

800 000 74 500

100 000 125 000

(700 000) (175 000)

374 500

Communicable disease prevention and control 4.1. 2 4.1. 3 4 .1. 5 4.1. 7 Malaria and other parasitic diseases Bacterial, viral and mycotic diseases Expanded programme on immunization Prevention of blindness 150 000 150 000 150 000 9 200 133 200 VD

150 000

30 000 50 000 200 000 70 000

(120 000) 50 000 200 000 (80 000)

142 400

4.2

Noncommunicable disease prevention and control 4.2.3 4.2.4 Oral health Other noncommunicable diseases 100 000 150 000 100 000 150 000 (100 000) (150 000)

5.1

Promotion of environmental health -5. 1. 2 5 .1. 3 5. 1.4 Basic sanitary measures Recognition and control of environmental hazards Food safety 200 000 200 000 70 000 100 000 30 000 70 000 100 000 30 000 70 000 (100 000) 30 000

337

338

VIET NAM Regular budget US$ 6.1 Health manEower develoEment 6.1.2 Promotion of training 550 000 300 000

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

550 000 300 000

1 100 000

550 000 (300 000)

6.1. 3 Educational development and support 7.1 Health information 7. 1.1 Health statistics Total - VIET NAM

50 000 3 668 800

50 000

============

===========

561 200

4 230 000

==========

3 333 600

==========

=========

3 333 600

=========

(335 200)

ANNEX III

INTERCOUNTRY

PROGRfu~E

INTERCOUNTRY PROGRAMMES General programme development and management General programme development The objectives, approaches and review for the regional general programme development programme appear on pages 21 to 23. The intercountry programme provides for technical officers in management training and support and operational research to cooperate in activities for implementing national strategies for health/2000, formulating national health programmes, developing health practice research, and designing and conducting training programmes in management and planning, as well as activities for technical cooperation among developing countries. Information systems programme The objectives, approaches and review for the regional information systems programme appear on pages 29 and 30. The intercountry programme provides for a regional adviser ~n health information and a statistician, to be responsible for formulating, implementing and evaluating the programme at national and regional level. Research promotion and development The objectives, approaches and review for the regional research promotion and development programme appear on pages 34 and 35. The intercountry programme provides for a programme manager to implement the programme recommended by the Western Pacific Advisory Committee on Medical Research and endorsed by the Regional Committee, which will include training in research, grants to individuals and to institutes to carry out specific research activities and a working group for directors of medical research councils. The Regional Centre for Research and Training in Tropical Diseases at the Institute for Medical Research, Kuala Lumpur, through an epidemiologist, a biostatistician, a clinical nutritionist and an entomologist, will continue its biomedical research and training activities for improving the diagnosis, prevention and treatment of the major communicable diseases, especially those of parasitic origin. Regional directors's development programme As in previous years the funds provided under this heading will be used for financing collaborative programmes with governments which could not be foreseen when the programme budget proposals were being developed. ~1

342 INTERCOUNTRY PROGRAMMES (continued) Health services development Programme planning and general activities The objectives, approaches and review for the regional health services development programme appear under the specific programme headings from page 41 to page 62. Four regional advisers in different aspects of the development of health services will carry out intercountry programme planning and general activities. Other intercountry activities are included under the following programme headings: Health services planning and management The objectives, approaches and review for the regional health services planning and management programme appear on pages 41 and 42. The intercountry programme provides for consultants and a public health advisory services team which will continue to collaborate in the development of national health services in the South Pacific, using the primary health care approach. The need for training in hospital management, design and maintenance will be met through a course at the Central Institute of Technology, New Zealand and in hospital administration through courses at the Institute of Public Health, University of the Philippines and the University of the South Pacific, the latter with support from UNDP. Provision is also made for a working group to make recommendations on strategies for enhancing and strengthening the contributions of nursing and midwifery. Primary health care The objectives, approaches and review for the regional primary health care programme appear on pages 44 to 46. The intercountry programme provides for a team to continue to cooperate in developing primary health care activities. Such activities will include training, to strengthen the existing health services so that the necessary infrastructure is developed for primary health care and to exchange experience in the spirit of technical cooperation among developing countries. To provide support to Member States in implementing, through primary health care, their strategies for health/2000, provision is made for a medical officer.

Workers' health The objectives, approaches and review for the regional workers' health programme appear on pages 48 and 49. The intercountry programme provides for consultants to respond to requests for cooperation in implementation of resolution WPR/RC29.R14 adopted by the Regional Committee at its twenty-ninth session in 1978.1 Care of the aged, disability prevention and rehabilitation The objectives, approaches and review for the regional care of the aged, disability prevention and rehabilitation programme appear on pages 51 and 52. The intercountry programme provides for training in activities for the prevention of road traffic accidents, such as development of a coordinated multisectoral and multidisciplinary approach to the problem, of a feasible information system, and of research into the human factors involved. Appropriate technology for health The objectives, approaches and review for the regional appropriate technology for health programme appear on pages 54 to 57. The intercountry programme provides for a regional adviser in health laboratory services. Cooperation from consultants in radiation health 1n connexion with the development of basic radiation services are also provided for. Health services research The objectives, approaches and rev1ew for the regional health services research programme appear on pages 60 and 61. The intercountry programme provides for consultants in health services research methodology, information and health economics to support national workshops; training of research workers in operational research and economics for institution strengthening; development of a network of collaborating centres; and development of a regional information system. Family health Maternal .and child health The objectives, approaches and review for the regional maternal and child health programme appear on pages 63 to 65.

lHandbook of Resolutions and Decisions of the Regional Committee for the Western Pacific, Vol. II, 2nd ed., 1980, pages 26-27. 343

344

INTERCOUNTRY PROGRAMMES (continued) The intercountry programme provides for a regional adviser in maternal and child health. The intercountry family health advisory services project funded by UNFPA, which is expected to include a regional adviser in maternal and child health/family planning, two medical officers and a health education specialist, will continue to cooperate in countries or areas where its services are needed and to support research in human reproduction and fertility regulation. Nutrition pages 67 to 69. The objectives, approaches and review for the regional nutrition programme appear on

The intercountry programme provides for a regional adviser in nutr~t~on, together with a team consisting of two medical nutritionists and consultants. Provision for support to national workshops and promotional activities for action-orientated research development and training are included, in order to cooperate in developing the health components of multisectoral food and nutrition policies and programmes, promoting the control of specific nutritional deficiencies and carrying out the necessary operational or basic research. Health education The objectives, approaches and review for the regional health education programme appear on pages 71 to 73. The intercountry programme provides for a regional adviser in health education. In addition, cooperation will be provided under three separate components of the programme (1) health education in schools - development of curricula, teaching aids and textual material, training teachers in health education and production of teaching-learning materials; (2) the strengthening of training programmes in health education; and (3) the strengthening of national capabilities to establish facilities for the use of audiovisual aids and modern media in support of health programmes. Mental health The objectives, approaches and review for the regional mental health programme appear on pages 75 and 76. The intercountry programme provides for a regional adviser in mental health and drug dependence. A regional coordinating group on the mental health programme was established by the Regional Committee in 1978.1 Provision is made for a meeting in 1983. At its first meeting, in 1979, the Coordinating Group lsee resolution WPR/RC29.Rl2, Handbook of Resolutions and Decisions of the Regional Committee for the Western Pacific, Vol. It, 2nd ed., 1980, pages 32-33.

emphasized the need to strengthen mental health research. Collaborative studies are planned to compare the determinants of health, disease and disability in different cultures, including the psychosocial factors involved; on methods of providing mental health care; and on psychosocial problems such as those pertaining to psychosocial development and the mental health of children. A working group will review the progress achieved in management and control of drug dependence and make recommendations for the future programme of cooperation in the Region. Prophylactic, diagnostic and therapeutic substances Drug policies and management The objectives, approaches and rev1ew for the regional drug policies and management programme appear on pages 80 and 81. The intercountry programme provides for a scientist to further the objectives of the programme, including establishment of the South Pacific Pharmaceutical Service and training in drug quality control and the utilization and distribution of drugs. Support to the South Pacific Pharmaceutical Service will also be provided by the United Nations Development Programme. Pharmaceuticals and biologicals The objectives, approaches and review for the regional pharmaceuticals and biologicals programme appear on pages 83 to 85. The intercountry programme provides for consultants to cooperate 1n improving national vaccine production and quality control facilities. Communicable disease prevention and control Programme planning and general activities The objectives, approaches and review for the regional communicable disease prevention and control programme appear under the specific programme headings and diseases from page 87 to page 115. Two regional advisers in communicable disease and one in chronic diseases will carry out intercountry programme planning and general activities. Other intercountry activities are included under the following programme headings. Epidemiological surveillance The objectives, approaches and review for the regional epidemiological surveillance programme appear on pages 89 and 90. 345

346 INTERCOUNTRY PROGRAMMES (continued) The intercountry programme provides for an intercountry team, stationed in the South Pacific, to continue cooperation in strengthening national epidemiological and surveillance services and in studying specific problems, particularly in relation to the expanded programme on immunization and the control of diarrhoeal diseases but also in relation to the control of filariasis and dengue fever. Support in these activities is also provided from extrabudgetary resources. Cooperation will be extended to national courses for the training of non-medical personnel in epidemiology. Malaria and other parasitic diseases The objectives, approaches and review for the regional malaria and other parasitic diseases programme appear on pages 92 to 95. Malaria The intercountry programme provides for a regional adviser in malaria, for the continuation of the regional antimalaria team which will cooperate technically with governments on the prevention and control of malaria and for training in malaria control. Other parasitic diseases Provision is also made for a parasitologist to cooperate in parasitic diseases control and research activities; for support to research on the control of schistosomiasis and filariasis; and for training research workers with a view to strengthening institutes to the point where they can be recognized as national centres for research in tropical diseases or designated WHO collaborating centres. Bacterial, viral and mycotic diseases The objectives, approaches and review for the regional bacterial, viral and mycotic diseases programme appear on pages 97 to 106. Tuberculosis The intercountry programme for tuberculosis provides for the continuation of a regional tuberculosis control team, the regional tuberculosis training course in Tokyo, and a consultant to cooperate in the production of freeze-dried BCG vaccine. Leprosy The intercountry programme for leprosy provides for a medical officer, partially supported from extrabudgetary resources, to cooperate in assessing the leprosy problem throughout the Region but mainly in the South Pacific, in strengthening leprosy services and in training personnel. Diarrhoeal diseases control The intercountry programme for diarrhoeal diseases control provides for a medical officer to cooperate, through health services development projects, in accelerating the development and implementation of the programme (see pages 97 and 98) in pursuance of resolution WPR/RC30.R22 adopted by the Regional Committee at its thirtieth session.l

lHandbook of Resolutions and Decisions of the Regional Committee for the Western Pacific, Vol. II, 2nd ed., 1980, page 38.

Acute respiratory infections The intercountry programme for the control of acute respiratory infections provides for a medical officer to be stationed at the Institute of Medical Research, Goroka, Papua New Guinea, where the first acute respiratory infections unit has been established, with a view to developing a regional network of such units. Consultants will cooperate in the regional programme, and research and training activities will be supported. Sexually transmitted diseases The intercountry programme provides for consultants to cooperate developing control programmes, training and research. Expanded programme on immunization The objectives, approaches and review for the regional expanded programme on immunization programme appear on pages 108 and 109. The intercountry programme provides for continuation of the team which will give support to the staff of health services development projects in delivering the expanded programme on immunization, cooperate in training activities, promote research into special operational and technical problems, provide resources and expertise for development of cold chain systems and prepare a regional plan for vaccine supply and distribution. Vector biology and control The objectives, approaches and control programme appear on page 114. rev~ew

for the regional vector biology and

The intercountry programme provides for a regional adviser in vector biology and control. Provision is also made for consultants to cooperate in vector surveillance, control and training activities, including a course on vector and rodent control in 1982. Noncommunicable disease prevention and control Programme planning and general activities The objectives, approaches and review for the regional noncommunicable disease prevention and control programme appear under the specific programme headings and diseases from page 118 to page 129. A regional adviser in cardiovascular and metabolic diseases will carry out intercountry programme planning and general activities. Other intercountry activities are included under the following programme headings.

347

348 INTERCOUNTRY PROGRMAMES (continued) Cancer and 119. The objectives, approaches and review for the regional cancer programme appear on pages 118

The intercountry programme provides for consultants to cooperate in the comprehensive cancer control programme through activities for prevention and diagnosis by case-finding; in establishing or strengthening cancer registries; and in research on the etiology of cancer. A working group on the organization of comprehensive cancer control programmes is planned for 1983. Cardiovascular diseases The objectives, approaches and diseases programme appear on pages 121 and 122. rev~ew

for the regional cardiovascular

The intercountry programme provides for a training course on the prevention and control of cardiovascular diseases, to be held in 1982. Oral health The objectives, approaches and review for the regional oral health programme appear on pages 124 and 125. The intercountry programme provides for a regional adviser in oral health. Consultants will cooperate in reducing the incidence of dental caries and periodontal disease. Support will also be given to tra~n~ng and to national seminars in oral health. A meeting of heads of dental schools and directors of schools for operating dental auxiliaries is planned for 1982. Other noncommunicable diseases Metabolic diseases The objectives, approaches and review for the regional metabolic diseases programme appear on pages 127 and 128. The intercountry programme provides for a seminar on metabolic diseases (diabetes and gout) in 1982. Promotion of environmental health Programme planning and general activities The objectives, approaches and review for the regional promotion of environmental health programme appear under the specific programme headings from page 132 to page 140. Two regional advisers will carry out intercountry programme planning and general activities. Other intercountry activities are included under the following programme headings.

Environmental health planning and management The objectives, approaches and review for the regional environmental health planning and management programme appear on pages 132 and 133. The intercountry programme provides for the Western Pacific Regional Centre for Promotion of Environmental Planning and Applied Studies (PEPAS) to cooperate in activities for: (1) developing competent national policies in environmental health and related resource protection; (2) strengthening the capacity of national environmental institutions; (3) developing and implementing education and training programmes for personnel in environmental planning, pollution control, water supply and wastes disposal management; (4) facilitating the monitoring, collection and processing of information for environmental planning purposes; (5) solving problems related to the improvement of environmental conditions and the protection of natural resources against pollution; (6) identifying low-cost and appropriate technology. Included in the activities will be a working group in 1983 to make recommendations on priorities for health-related environmental problems and a seminar on industrial and hazardous waste control. Basic sanitary measures The objectives, approaches and review for the regional basic sanitary measures programme appear on page 135. The intercountry programme in support of the International Drinking-Water Supply and Sanitation Development Decade provides for continuation of environmental health advisory services in the South Pacific, to cooperate in basic programmes for adequate water supply and sanitation facilities and also in activities related to industrial waste, marine outfall and urbanization, which cause special problems. Training of water supply, sewerage and sanitation personnel will be undertaken with support from UNDP. Food safety The objectives, approaches and review for the regional basic sanitary measures programme appear on page 139. The intercountry activities provide for consultants 1n the control of ichthyosarcotoxism (fish poisoning). Health manpower development Programme planning and general activities The objectives, approaches and review for the regional health manpower development programme appear under the specific programme headings from page 143 to page 151. Two regional advisers will carry out intercountry programme planning and general activities including implementation of the fellowships programme.

350

INTERCOUNTRY PROGRAMMES (continued) Other intercountry activities are included under the following programme headings. Health manpower planning and management The objectives, approaches and review for the regional health manpower planning and management programme appear on pages 143 and 144. The intercountry programme provides for consultants to cooperate in (1) field testing draft guidelines for incorporating the health manpower development process within country health programmes and national health plans; (2) developing intersectoral coordination between those responsible for health services and those responsible for manpower development; (3) developing national systems and facilities for the continuing education of health personnel. Promotion of training The objectives, approaches and review for the regional promotion of training programme appear on pages 146 and 147. The intercountry programme provides for the development of faculty to be responsible for training health personnel, the establishment of a regional module bank for nursing/midwifery education, and cooperation in training and utilizing auxiliary and primary health care workers. Educational development and support The objectives, approaches and review for the regional educational development and support programme appear on pages 149 and 150. The intercountry programme provides for support to the training carried out by faculty of the Regional Teacher Training Centre for Health Personnel, Sydney and to the development of national teacher training centres for health personnel. Consultants will cooperate in developing educational technology for nursing and midwifery in the South Pacific, and training will be supported. Provision is made for participation from the Region in the 1983 interregional meeting of directors or representatives of schools of public health, to which the Regional Office will act as host. A meeting of directors of nursing schools and colleges in the Region is planned for 1982 and a meeting of deans of medical schools for 1983. Health information Health statistics The objectives, approaches and review for the regional health statistics programme appear on pages 152 to 154. Cooperation in developing national health information systems is delivered through this programme. falls under the responsibility of the Regional Adviser in Health Information who is supported by the information systems programme (see page 341). It

The intercountry programme provides for an information systems analyst and consultants, a computer systems analyst and a statistician, who will cooperate in strengthening national capacities for the planning and management of health information systems. A working group on health indicators for monitoring the evaluation of strategies for health/2000 is planned for 1982, followed by national workshops on the subject. In 1983 it is proposed to prepare the regional contribution to Revision 10 of the International Classification of Diseases, scheduled for 1984, by convening a working group to obtain consensus on the modifications Member States might wish to introduce. The need to train primary health care workers in methodology for reporting health information is becoming of crucial importance. Consultants in public health administration and statistics will cooperate in national workshops for such lay reporting in 1982. Further development of health statistics activities in the Region will be carried out by statisticians assigned to country and other intercountry programmes. Health literature services The objectives, approaches and review for the regional health literature services programme appear on page 158. The intercountry programme provides for the supply of books, documents and other teaching-learning materials. Health information of the public The objectives, approaches and review for the regional health information of the public programme appear on pages 163 and 164. The intercountry programme provides for a workshop on information, education and communication 1n health, planned for 1983. The workshop will review and elaborate upon the activities undertaken at a similar workshop in 1981 to enable national public health information officers to keep up with trends in communication and media reporting during the 1980s. In an attempt to increase awareness in journalists of the principles of public health and the concept of primary health care and thus educate the public through the mass media, provision is made to invite them to attend selected WHO meetings or activities. General services and support programmes Staff development and training The objectives and approaches of the regional staff development and training programme appear on page 168. The intercountry programme provides for a programme manager. The training and development of WHO staff will continue. Increased attention will be paid to career development, the expansion of staff development activities in the Region, and the re-training of staff members so that their capabilities may be utilized more effectively in new roles created by changing demands on the Organization. 351

352

r--

INTERCOUNTRY PROGRAMMES Regular budget

1980-81 Other Sources

1982-83 Regular budget Other Sources

Increase/ (Decrease) Total Regular budget US$

Major programme/programme

-----Source of funds

Total US$

---------------2.2 General erosramme develoement and manasement 2.2.1 2.2.3 2-4 General programme development Information systems programme and

us$

US$

us$

--1---

us$

Source of funds

us$

569 800 344 100 1 249 900 38 200 26 000 VD ST

569 800 344 100 1 314 100

525 800 501 800 885 600

(44 000) 157 700 (364 300)

Research~motion

deve lo(!ment 2.5 3.1 Resional Director's develoement erosramme Health services develoement 3. LO 3. 1. l Programme planning and general activities Health services planning and management

643 600

775 300

131 700

461 200 348 800 31 100 83 700 52 900 VD ST DP

461 200 516 500

519 200 772 200 176 000 DP

519 200 948 200

58 000 423 400

3.1. 2 3.L3 3.1.4

Primary health care Workers' health Care of the aged, disability prevention and rehabilitation Appropriate technology for health (Health laboratory technology) (Radiological technology)

457 900

371 800 10 000

(86 100) 10 000

27 000

32 000

5 000

3. l. 5

208 000 20 000 13 200 VK

208 000 33 200

129 800 15 000

(78 200) (5 000)

INTERCOUNTRY PROGRAMMES Regular budget US$ 3.1. 6 3.2 Health services resea.rch

1980-81 Other Sources Regular budget US$ 160 800

Total US$ ST 68 300

1982-83 Other Sources Source of funds US$ Total US$ 160 800

Increase/ {Decrease) Regular budget US$ 160 800

Major programme/programme

Source of funds US$ 68 300

Famill health 3.2.1 3.2.2 3.2.4 Maternal and child health Nutrition Health education 144 000 383 900 305 400 275 800 35 000 21 600 ST VP 579 600 FP 723 600 383 900 305 400 332 400 129 800 403 800 271 800 221 300 587 800 FP 717 600 403 800 271 800 221 300 (14 200) 19 900 (33 600) (54 500)

3.3 3.4

Mental health Proehllactic, diasnostic and theraeeutic substances 3.4.1 Drug policies and management

112 400

406 97 14 141

800 600 700 600

DP ST VD VK

773 100

140 800

523 700

664 500

28 400

3.4.2 4.1

Pharmaceuticals and biologicals

53 400

15 000

(38 400)

Communicable disease erevention and control 4.1.0 4.1. l Programme planning and general activities Epidemiological surveillance 352 200 405 900 913 200 157 300 331 000 62 000 24 200 VI DP ST VD

352 200 563 200 1 330 400

389 400 500 600 1 059 400 73 000 VI

389 400 573 600 l 059 400

37 200 94 700 146 200

4.1. 2 Malaria and other parasitic diseases

353

354

INTERCOUNTRY PROGRAMMES 1-·

1980-81 Regular budget US$ Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

4.1. 3 Bacterial, viral and mycotic diseases

591 800

618 500 133 700 240 000 275 900 17 700

ST VD

1 584 000

1 090 100

64 000

1 154 100

498 300

VL VI VB

4.1. 5 Expanded programme on immunization 4.1. 7 4.1.8 4.2 Prevention of blindness Vector biology and control

l 018 600

1 294 500 77 700 281 200

363 800

(654 800)

159 300

14 600 107 300

ST DP

196 800

37 500

Noncommunicable disease Erevention and control 4.2.0 4,, 2.1 4.2.2 4.2.3 4.2.4 Programme planning and general activities Cancer Cardiovascular diseases Oral health Other noncommunicable diseases 115 300 27 000 34 100 194 300 9 000 115 300 27 000 34 100 194 300 9 000 129 800 46 000 50 200 254 600 35 000 129 800 46 000 50 200 254 600 35 000 14 500 19 000 16 100 60 300 26 000

5.1

Promotion of environmental health 5.1.0 Programme planning and general activities 230 600 772 000 257 500 9 700 224 400 DP 230 600 772 000 481 900 9 700 259 600 963 000 257 000 25 000 44 500 DP 259 600 963 000 301 500 25 000 29 000 191 000 (500) 15 300

5.1. 1 Environmental health planning and management 5.1. 2 5.1.4 Basic sanitary measures Food safety

-·

·-----

INTERCOUNTRY PROGRAMMES Regular budget US$ 6.1 Health manpower develo2ment 6.1.0 6.1.1 6.1. 2 6.1.3 Programme planning and general activities Health manpower planning and management Promotion of training Educational development and support 318 800 94 000 331 200 296 600

1980-81 Other Sources Source of funds US$ Total US$ Regular budget US$

1982-83 Other Sources Source of funds US$ Total US$

Increase/ (Decrease) Regular budget US$

Major programme/programme

318 800 94 000 331 200 72 000 83 000 VD

375 100 60 000 161 000 458 300

56 300 (34 000) (170 200) 161 700

451 600

7.1

Health information 7 .1.1 7 .1.4 7 .1. 5 Health statistics Health literature services Health information of the public 20 000 17 500 20 000 17 500 252 600 10 000 60 800 252 600 10 000 60 800 252 600 (10 000) 43 300

8.1

General services and support 2rogramme 8.1.1 Staff development and training Total - INTERCOUNTRY PROGRAMMES 24 000 11 797 800

24 000 4 031 900 15 829 700

288 800

264 800

==========

=========

==========

13 168 700

=========

1 469 000

==========

14 637 700

=========

1 370 900

355

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1980

Source Organisation mondiale de la santé